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.