Digitalization of X-Ray
The Problem: Digital Images, Analog Workflow
Prior to digitalization, KKBM’s X-ray workflow relied on conventional processes, where images were processed and printed onto film for clinical review. Doctors interpreted studies manually using physical films, with no proper system for archiving or retrieving DICOM data.
As part of the Ministry of Health’s broader push for digitalization through CCMS, KKBM undertook efforts to modernize its radiology services. Spearheaded by Dr. Fuad with strong support from the clinic’s administrative leadership, the initiative focused on establishing a centralized system for DICOM storage and web-based image access—enabling a more efficient, accessible, and fully digital radiology workflow.
A doctor in Room 1 ordering a chest X-ray would send the patient to Room 7, wait for the film to be printed, then receive the physical film for review. Compare that to today: the image appears on their browser before the patient walks back.
Why Orthanc?
Commercial PACS solutions were expensive and required dedicated IT engineers. KKBM had neither. The team looked for something that could be learned, managed & maintained in-house.
Orthanc fit because it was:
- Free and open-source — no licensing cost
- Lightweight — ran on a repurposed clinic desktop
- Browser-based — doctors needed no software installation
- Stable — proven in hospitals and research centres worldwide
The Timeline: Digitalization of X-Ray
October 2023 — Selecting the Solution
The team evaluated several PACS options against clinic constraints
- No dedicated server engineer
- No large IT budget
- Open source and readily available to be learned
- No additional software needed to be use and browser-based
Orthanc met all criteria — open-source, lightweight, DICOM-compliant, and browser-accessible.
Full Support from MOIC & Xray Unit
- The project was led by Dr. Fuad and presented to the MOIC of KK Maharani, Dr. Zurina, along with the Head of the Radiology Unit, JXR Nooraini.
- Full support was granted for the implementation of digitalization through PACS.
Late October 2023 — Building the Infrastructure
A suitable clinic PC was identified and upgraded with an NVME SSD and additional RAM. The team mapped the clinic's network layout to ensure all consultation rooms could reach the server, and reviewed Orthanc documentation to plan the configuration.
21 November 2023 — Installation
- Orthanc was installed in the Radiology Unit, near the X-ray machine.
- It was configured on a dedicated PC and connected to the main Fujifilm workstation to access processed DICOM files.
- Images generated by the Fujifilm system were then sent to the Orthanc server, making them accessible to clinic staff.
- Initial testing confirmed that images were successfully received, stored & viewable via the web interface.
Early December 2023 — Trial Phase
For two weeks, the team ran a hybrid workflow: printing films for safety while also uploading to Orthanc. All clinical units tested image access from their rooms. The team monitored loading speed, viewer stability & gathered feedback from doctors and radiographers.
3 January 2024 — Going Film-Free
After confirming reliability, the unit stopped printing films for internal cases. External referrals continued to receive printed films — their clinics had no access to KKBM's PACS — but internal operations became fully digital.
February 2024 Onwards — Sustained Operation
- Orthanc became the default imaging archive.
- Doctors retrieved prior studies in seconds. Radiographers shifted from "print and hand over" to "verify and transfer." The system has run continuously since with minimal downtime.
June 2024 — Protecting the Data
- The team implemented regular manual backups and began archiving DICOM data and configuration files to external storage.
- This addressed the risk of relying on a single server with no backup routine.
- The process is done manually every month.
November 2025 — Building Resilience (Planned)
A dedicated backup server is planned to mirror the primary Orthanc instance automatically. This forms part of a broader 3-2-1 backup strategy to eliminate the single point of failure.
December 2025 — Orthanc Replication Ecosystem Developed
- A robust Python-based script has been developed to automate daily DICOM file replication and backups, supporting a 3-2-1 backup strategy.
- The system is fully configured to run automatically, provide clear status updates & self-recover from common errors, ensuring reliable and seamless DICOM data replication.
What Changed Day-to-Day
| Before | After |
|---|---|
| Film printed for every case | Film printed only for external referrals |
| Doctor walks to Room 7 or receives physical film | Doctor reviews image in their browser instantly |
| Old studies retrieved manually from storage | Prior images searchable by IC number in seconds |
| Lost film = repeat X-ray | Image always available on the server |
| One workstation holds all images | Any clinic room can view any study |
| No backup of imaging data | Regular backups + replication in progress |
Current Status
Orthanc has been the unit's primary imaging archive since January 2024. The system runs continuously during clinic hours and is monitored by the radiography team.
For detailed technical architecture, performance metrics, and security configuration, see the full Orthanc PACS Implementation →↴ page.