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aws · devops · pacs · security

Orthanc PACS Deployment

Overview​

I deployed a production DICOM PACS backend on AWS for a healthcare startup that needed secure DXA scan storage, fast delivery, and predictable operating cost.

Problem​

  • The client needed a production rollout in 3 weeks.
  • Medical data access had to stay VPN-only with no public exposure.
  • The system needed backups, observability, and secure REST integration.
  • Commercial PACS options were too expensive for the target scale.

Solution​

  • I deployed Orthanc in Docker with PostgreSQL metadata indexing and S3-backed DICOM storage.
  • I implemented layered security: VPN access, restricted Security Groups, HTTPS, and encrypted S3 storage.
  • I configured CloudWatch alarms and SNS notifications for disk, CPU, and database failures.
  • I automated daily PostgreSQL backups to S3 with retention policy.
  • I kept infrastructure simple and reproducible with Docker Compose for fast operations.

Results​

  • Production system delivered in 3 weeks.
  • 1500+ studies supported in production workflow.
  • Study listing performance under 2 seconds.
  • Monthly operating cost around $70-80.

Stack​

Orthanc, AWS EC2, AWS S3, PostgreSQL, Docker Compose, CloudWatch, SNS

Architecture​

Orthanc PACS Architecture

Interface​

Orthanc PACS UI