On June 19th, BMD Software participated in the 12th IEEE International Conference on Healthcare Informatics (IEEE ICHI 2025) held at the University of Calabria in Italy. The paper, titled “Incremental Open Source Architecture Supporting a High Availability National PACS,” demonstrated how scalable open-source systems can support national-level medical imaging archives with high performance and availability.
The article by Rui Jesus, co-authored with Tibério Batista, Eduardo Pinho, Luís Bastião Silva, and Carlos Costa, introduces an incremental, open-source architecture designed to meet the demands of a nationwide PACS deployment. By tackling the technical and operational challenges of large-scale imaging systems, the proposed solution shows its ability to reliably support over 2,000 active users daily across 150 connected clinics, managing one million DICOM files each day.
The final architecture of the developed multi-node PACS system (fig. 1) includes two computing nodes that share incoming traffic, boosting the overall system throughput. Each node provides high processing power, with distributed indexing via Elasticsearch and load balancing through HAProxy. The storage is shared, ensuring consistent and scalable performance. Notably, the system can seamlessly expand by adding more nodes as data volumes and user demands increase, maintaining continuous robustness and performance.
The chart in Figure 2 illustrates the number of DICOM studies (red line) and files (blue line) stored monthly in the deployed PACS system. It highlights the system’s scalability and its ability to manage high-volume clinical imaging data across an expanding network of healthcare facilities.
Main Achievements
- Scalable nationwide deployment: Supports 150 clinics and 2000 daily users and one million images uploaded daily.
- Achieve to build a system based on Open-Source technology stack: Built on Dicoogle, Elasticsearch, MySQL, and HAProxy, setting a strong foundation for future growth and innovation in digital health infrastructure.
This nationwide PACS deployment showcases our commitment to building future-proof healthcare infrastructure that meets the real-world demands of clinical workflow. Always considering performance, reliability, and accessibility on a big scale.