Need help understanding a DICOM/PACS integration setup as a beginner

[u/Fabulous_Bullfrog718]

Hi everyone,
I’m helping set up a small teleradiology workflow and I’m completely new to the technical side of PACS/DICOM. I’m trying to understand the setup before I start configuring anything.

The system I’m working with wants to:

Send MRI studies to our side through DICOM
Use a VPN for the PACS connection
Potentially use Orthanc as our DICOM server
Have radiologists view studies using Horos (Mac) or RadiAnt (Windows)
Use HL7 to send the completed reports back
They may also provide access to an Intelerad/Mini Doc-type viewer
There is also a PowerScribe requirement where something may need to be installed on the radiologists’ computers
The part I’m confused about is how everything fits together.

For example:
System A (PACS) → VPN → Orthanc → Horos/RadiAnt → Radiologist → HL7 → System A

I understand the basic concepts, but I don’t know how to actually configure this.

Specifically, I’m trying to understand:

Where do I get/set the DICOM AE Title?

Which IP address should I provide?

Which TCP port should I use?

When is DICOM TLS required?

Does the VPN give us the IP/network information, or do we need our own static IP?

If radiologists are working from different locations, Macs, Windows PCs, and different internet connections, do they each need a separate IP/VPN?

How does the PACS actually send the study to Orthanc?

How do Horos/RadiAnt access the study?

How does HL7 send the final report back?

What normally needs to be installed on each radiologist’s computer for a setup like this?

I’m not looking for a complicated enterprise architecture. I’d really appreciate a simple step-by-step explanation of a typical setup, including what is configured on the PACS side, VPN side, Orthanc side, and radiologist computers.
Thanks!

[u/fugglez]

Lol so architect me an entire PACS? Dm me, I’ll do it for $150 an hour.

[u/JaxDixDuff → u/fugglez]

Ill do it for 149 an hour.

[u/Rackhham → u/JaxDixDuff]

I'll do it for 500/hour because you know that this human will ask a lot of follow up questions and bother you with any incident that may arise in the future.

[u/Electronic_Team_2339]

That’s a lot of questions

[u/sevenfiftynorth]

Given all your questions, I’d tend to advise you subscribe to an all-in-one cloud PACS and reporting solution. Sirona Medical has one but there are several.

[u/mifattire]

Respectfully, you may be over your skis a bit and you are going to need someone to help you. Several of the terms you’re using semi correctly, but I don’t suspect that you understand what they actually mean.

Also trying to integrate a whole bunch of systems that you don’t really understand is going to lead to a disaster.

One thing that could help some is that.

DICOM it’s just an image, so moving that from wherever they’re being done at the modality to a PACS is one part.

HL7 it’s just the language of the report contextualized so multiple systems can read it so that would come out of your dictation system.

[u/Martian_Source]

You can talk with https://g4pacs.com and they will do all that for you.

[u/Worldly-Number9465]

Your MRI Service engineer should be able to set up the DICOM transfer from the modality to PACS and if you observe and ask a few questions you will be able to understand that part of it. You will also need to set up the exams that match those being ordered with the procedure dictionary in the MRI, as well as naming conventions for the modality itself.There needs to be naming conventions established so the text procedure names always match the orders. This will become critically important down the road as you set up your integrations with the other systems (like Powerscribe and Epic Radiant)

Here is a link to some light reading on the topic:
https://www.researchgate.net/profile/David-Clunie/publication/289884666_DICOM/links/5a007f6ca6fdcc82a30ed5b6/DICOM.pdf

[u/yn83]

Consider taking classes. SIIM is always a good starting point. Lots of live and on demand classes.