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Install OsiriX as a PACS server

What is PACS server?

A PACS (Picture Archiving and Communication System) server is a computer for the short- and long-term storage, retrieval, management, distribution and presentation of medical images. Medical equipment can automatically store the medical images on the PACS server. Other computers, equipped with OsiriX, can store and retrieve images directly from the PACS server.
You can use OsiriX as a PACS server with these benefits:

• Based on OsiriX DICOM engine and Database (SQLite) engine
• Unlimited number of simultaneous clients
• Manage your PACS through OsiriX GUI
• Fully compatible with Mac hardware and software
• Fully compatible with DICOM protocol (C-Move, C-Store, C-Find, C-Get, WADO)
• Seamless integration with any DICOM viewers, through the DICOM protocol
• Web access through built-in web server, built-in HTML5 viewer compatible with any OS
• Expansion: write your own plugins to extend the integration with any protocols/systems, including EMR, RIS or HIS.

Introduction

Typically a PACS network consists of a central PACS server which stores a database containing the images, and of multiple clients that can retrieve and display these images on medical imaging software. The images are stored in DICOM format. The modalities (MRI, CT, PET, Ultrasounds, …) send the images to the PACS Server by using a DICOM “push” (DICOM C-Store). The server and the clients communicates by using the DICOM protocol (DICOM C-Store, WADO or Query & Retrieve). The clients display the images by using a medical imaging software: a DICOM viewer.

Each computer in a DICOM network are identified by their network address (IP address), a communication port (TCP/IP port) and a name (AETitle): each computer is a DICOM Node in the DICOM network. IP address, TCP/IP port number and AETitle is the information required to connect each DICOM Node to the DICOM network. These informations can be found in the Preferences > Listener window in OsiriX.

Hence, to build a PACS, you need:

1. A PACS Server: a computer with a lot of hard disk space and a PACS Server software. The PACS Server software needs to be robust, working flawlessly 24/7, with a powerful database engine, capable of storing millions of DICOM images.
2. PACS Clients: computers with a DICOM viewer software, like OsiriX. These PACS Clients can query and retrieve the DICOM images from the PACS server, by using the DICOM network protocol (DICOM C-Move, C-Store, C-Get, C-Find, WADO, …).

The important qualities of a DICOM viewer are:

• Fast transferring time (only limited by the network bandwidth)
• Fast loading time to be able to load and browse 1’000 images in less than few seconds
• Complete DICOM protocol supports to handle all different types of DICOM images
• Powerfull 2D imaging functions to analyze the images (ROIs, window levels, zooming, ….)
• 3D post-processing functions to view the datasets in volume rendering, MPR or MIP
• Image fusion support to multi-modal modalities like PET-CT, PET-MR, SPECT-CT studies

PACS Network architecture (Q&R = DICOM Query & Retrieve protocol):
Multiple Modalities, a PACS Server, and multiple PACS Clients (PACS Workstations / DICOM Viewers)

To build our PACS network, we will use OsiriX (always use the last available version!), as the DICOM viewer, and as the PACS server.

Set-up

Hardware

1. For the PACS Server: choose a MacPro with 4TB of storage to store up to 25 millions of CT images. We highly recommend a RAID system: for example, you can install 4 identical hard disks in the MacPro, and format them as a RAID 5 system. You’ll have faster performances, and a more secure system (no data are lost if a drive fails). You can also use an external RAID system, connected through FireWire or Thunderbolt for best performances (Promise VTrak, Promise Pegasus, LaCie RAID towers).
2. For the PACS Clients: choose iMac or MacPro, depending if you need to do 3D post-processing or only 2D viewing. If needed, connect a Medical monitors (Totoku, Eizo, …). A SSD is highly recommended for best performances when loading the images. Select at least 8GB of RAM.
3. Build your network on a 1GB or faster Ethernet hardware. Select high performances active routers.

Software

1. For the PACS Server: we will use OsiriX MD with specific settings.
2. For the PACS Clients: we use OsiriX MD.

Set-up of OsiriX as a PACS server

Use OsiriX MD for best performances, and unlimited performances.
We want to be sure that your PACS server will be also running:

• In OS X preferences, activate automatic restart after a power failure (Energy Server, Power tab, “Start up automatically after a power failure”)
• In OS X preferences, select automatic log-in (Users & Groups, Login Options, Automatic login)
• We want to be sure OsiriX is always running (after a computer restart or crash). We will create a LaunchAgent file. You can uses Lingon to easily create an always-up setting (select At Login and Keep running).
• We want to be sure OsiriX is always responsive (Spinning Beach Ball of Death). We will install a small software running as a different process: it will test if OsiriX is alive and responsive. It uses the built-in Web server and the XML-RPC interfaces of OsiriX to send tests to the database: hence be sure to activate them in OsiriX preferences. If OsiriX doesn’t answer to the requests, this software will kill OsiriX, allowing it to restart (thanks to the LaunchAgent settings). For the Web server address, use “http(s)://localhost:XXXX/testdbalive”, and for the XML-RPC interface, use “http(s):localhost:XXXX”. This software is available here. (Be sure that this software is always running by creating a LaunchAgent for it – see previous paragraph).
  
• Activate the “Server mode” in OsiriX. This mode will hide the GUI, and OsiriX will never present a blocking window to the user (nobody will look at the server monitor to click the “OK” button…). Go to OsiriX Preferences > Listener, Server mode.

Set-up OsiriX as a PACS Client (DICOM Viewer)

To be able to Send or Retrieve an exam from/to your new PACS Server, you need to declare it on each PACS Clients:
Run OsiriX, select Preferences > Locations and add your DICOM PACS Server informations (upper table):

There are several protocols for a DICOM viewer to retrieve images from a PACS server (OsiriX is compatible with all these protocols):

• C-MOVE. This protocol REQUIRES to declare each DICOM viewer on the PACS server (see below). Most DICOM viewers are compatible with this protocol.
• C-GET. This protocol doesn’t require to declare the DICOM viewer on the PACS server. Only few DICOM viewers support this protocol.
• WADO. This protocol doesn’t require to declare the DICOM viewer on the PACS server. Only few DICOM viewers support this protocol. This protocol is extremely fast when using OsiriX as a DICOM viewer or a PACS server. We highly recommend to use it, if possible.

Add PACS Clients (DICOM Nodes) on your PACS Server, if needed (C-MOVE protocol): You can find the DICOM Node informations of your OsiriX workstation in the Preferences > Listener window.

Exchange images between OsiriX PACS server and OsiriX clients

If you want to retrieve specific studies from your PACS server, you can now open the Query & Retrieve window in OsiriX:
Select the source, enter a patient’s name and click Query.

You can also send new studies from OsiriX to the PACS Server by using the DICOM Send function of OsiriX.

Conclusion

You just created and installed a complete PACS Network: PACS Server and PACS Workstations. To go further, you can now deploy the OsiriX built-in Web server or the PACS On-Demand features:

Problems? Support?

Are you looking for a 24/7 experts support to manage your PACS network and your OsiriX workstations?
Check our partners area.

OsiriX

Yes, OsiriX is fully compatible and enhanced for such screens. All the available pixels will be used to display the images at a very high resolution. We highly recommend these screens.

Latest version of OsiriX is compatible with any Mac computers, running from OS X 10.11 to macOS 11.0. We recommend a minimum of 6GB of RAM. Any graphic boards are compatible. Intel and Apple Silicon processors are supported. We recommend a SSD hard disk for best performances.

Yes, OsiriX is compiled and optimised for Apple Silicon processors, including the M1 processor. These new processors are recommended for OsiriX best performances.

See this document for more information.

No, OsiriX runs only on a Mac with macOS / OS X.

DICOM Conformance Statement (apply to all versions of OsiriX)

OsiriX Lite

OsiriX Lite is limited and can only open about 800 images series at the same time (images matrix of 512×512).
OsiriX MD is not limited and can open any number of images. OsiriX MD is available to purchase on our store.

OsiriX Lite is the demo version of OsiriX MD. Features are limited.
OsiriX MD is the complete edition with all features.
A comparison table is available here

OsiriX MD

The license for OsiriX MD is available here.

Yes, only if an appropriate approved medical monitor (explicitly certified for mammography) is connected to your Mac computer.

As a certified medical device, we have to notify the user when OsiriX runs in an untested and unvalidated environment. Each version of OsiriX MD is validated for macOS versions (list of supported macOS versions is available in OsiriX software license). It is highly discouraged to use OsiriX in an unsupported environment. It can crash, produce errors or corrupt the database.

Purchase

It depends on your license purchase.
– If you purchased OsiriX MD standard license, it’s a one time purchase. The licence is perpetual. After the first year, you can optionally renew your license at a discounted price to continue to receive free updates during one new year. (You can also continue to use your current version, without updates).
– If you purchased OsiriX MD Subscription, the installation and use of OsiriX MD requires a valid subscription. If the subscription is invalid/cancelled or stopped, the use of OsiriX MD will be limited.

Instead of buying a perpetual license, you can subscribe a monthly subscription to use OsiriX MD. You are charged each month. You can stop the subscription at any time without extra charges. The minimal duration is 1 month.

If you buy 4 or more “OsiriX MD” new licenses at the same time, you have a 15% discount.
If you buy 8 or more “OsiriX MD” new licenses at the same time, you have a 20% discount.

The most effective way to buy OsiriX is to use our e-commerce store. If needed, we can provide a quote / invoice.

No.

Osirix Lite Viewer

No, OsiriX MD (single computer license) can only be installed on 1 computer. For each extra computer, you need to buy an extra license.
If you want to install OsiriX MD on 10 computers or more, site licenses are also available.

Yes, if you want to install it on more than 8 workstations, we can provide a site license with 10, 15 or 20 seats. This site license has a single registration key, easier to deploy on several workstations. Prices and options are available on this page.

Yes, contact us. We will prepare a quote/invoice document, with our bank account information. We need your complete address to prepare this document.

It depends on your license purchase.
– If you purchased OsiriX MD standard license, you need to be online (connected to Internet) during the installation. You can then use it without an active connection.
– If you purchased OsiriX MD monthly Subscription, you need to be always online when you use OsiriX MD.

Your OsiriX account is created when you purchase one of our products or a subscription. You can access your account through our web site, and you can also connect OsiriX to your OsiriX account to have access to your subscriptions (Preferences window → General panel).

Registration Key

Log in your account.
The username is the email address used during the purchase process. If you don’t already have a password, you can request one from this page.
In your purchase list, you will find the registration key.

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You can request a new password by email on this page.

Buying a registration key gives you access to all updates of OsiriX for free for 1 year. You need to buy a registration upgrade (at a discounted price) to continue to receive free updates during one new year, in your account.

Log in your account, in your purchase list, you will find the download link.

Yes:
1) Delete the application from your old computer (Applications folder).
2) Use the installer (available in your account), to install the application on your new computer.

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The username and password are the macOS username and password. The user or the administrator of the computer have created them. They are required to install OsiriX application.

Reseller

Osirix Viewer Free Download

Yes, for 20+ licenses per year. Contact us to become a reseller.

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Yes, if you send us the final user email with the transaction ID, when you transfer the purchase to the end user. This is mandatory for OsiriX MD, certified as a medical device : we need to be able to contact the end user, if we discover a major problem in OsiriX MD.