PACS System

Language: English | 한국어

Overview

A modern C++20 PACS (Picture Archiving and Communication System) implementation built entirely on the kcenon ecosystem without external DICOM libraries. This project implements the DICOM standard from scratch, leveraging the existing high-performance infrastructure.

Key Characteristics:

Zero External DICOM Libraries: Pure implementation using kcenon ecosystem
High Performance: Leveraging SIMD acceleration, lock-free queues, and async I/O
Production Grade: Comprehensive CI/CD, sanitizers, and quality metrics
Modular Architecture: Clean separation of concerns with interface-driven design
Cross-Platform: Linux, macOS, Windows support

Project Status

Current Phase: ✅ Phase 2 Complete - Network & Services (100%)

Milestone	Status	Target
Analysis & Documentation	✅ Complete	Week 1
Core DICOM Structures	✅ Complete	Week 2-5
Encoding Module	✅ Complete	Week 2-5
Storage Backend	✅ Complete	Week 6-9
Integration Adapters	✅ Complete	Week 6-9
Network Protocol (PDU)	✅ Complete	Week 6-9
DIMSE Services	✅ Complete	Week 10-13
Query/Retrieve	✅ Complete	Week 14-17
Worklist/MPPS	✅ Complete	Week 18-20
Advanced Compression	🔜 Planned	Phase 3

Test Coverage: 120+ tests passing across 39 test files

Phase 1 Achievements (Complete)

Core Module (57 tests):

dicom_tag - DICOM Tag representation (Group, Element pairs)
dicom_element - Data Element with tag, VR, and value
dicom_dataset - Ordered collection of Data Elements
dicom_file - DICOM Part 10 file read/write
dicom_dictionary - Standard tag metadata lookup (5,000+ tags)

Encoding Module (41 tests):

vr_type - All 27 DICOM Value Representation types
vr_info - VR metadata and validation utilities
transfer_syntax - Transfer Syntax management
implicit_vr_codec - Implicit VR Little Endian codec
explicit_vr_codec - Explicit VR Little Endian codec

Storage Module:

storage_interface - Abstract storage backend interface
file_storage - Filesystem-based hierarchical storage
index_database - SQLite3 database indexing (~2,900 lines)
migration_runner - Database schema migrations
Patient/Study/Series/Instance/Worklist/MPPS record management

Integration Adapters:

container_adapter - Serialization via container_system
network_adapter - TCP/TLS via network_system
thread_adapter - Concurrency via thread_system
logger_adapter - Audit logging via logger_system
monitoring_adapter - Metrics/tracing via monitoring_system
dicom_session - High-level session management

Phase 2 Achievements (Complete)

Network Module (15 tests):

pdu_types - PDU type definitions (A-ASSOCIATE, P-DATA, etc.)
pdu_encoder/decoder - Binary PDU encoding/decoding (~1,500 lines)
association - Association state machine (~1,300 lines)
dicom_server - TCP server for DICOM connections
dimse_message - DIMSE message handling (~600 lines)

Services Module (7 test files):

verification_scp - C-ECHO service (ping/pong)
storage_scp/scu - C-STORE service (store/send)
query_scp - C-FIND service (search)
retrieve_scp - C-MOVE/C-GET service (retrieve)
worklist_scp - Modality Worklist service (MWL)
mpps_scp - Modality Performed Procedure Step
parallel_query_executor - Parallel batch query execution with timeout

Architecture

┌─────────────────────────────────────────────────────────────┐
│                       PACS System                            │
├─────────────────────────────────────────────────────────────┤
│  ┌─────────────┐  ┌─────────────┐  ┌─────────────────────┐  │
│  │ Storage SCP │  │ Q/R SCP     │  │ Worklist/MPPS SCP   │  │
│  └──────┬──────┘  └──────┬──────┘  └──────────┬──────────┘  │
│         └────────────────┼────────────────────┘             │
│  ┌───────────────────────▼───────────────────────────────┐  │
│  │                  DIMSE Message Handler                 │  │
│  └───────────────────────┬───────────────────────────────┘  │
│  ┌───────────────────────▼───────────────────────────────┐  │
│  │              PDU / Association Manager                 │  │
│  └───────────────────────┬───────────────────────────────┘  │
└──────────────────────────┼──────────────────────────────────┘
                           │
         ┌─────────────────┼─────────────────┐
         │                 │                 │
┌────────▼────────┐ ┌──────▼──────┐ ┌────────▼────────┐
│ network_system  │ │thread_system│ │container_system │
│    (TCP/TLS)    │ │(Thread Pool)│ │ (Serialization) │
└─────────────────┘ └─────────────┘ └─────────────────┘
         │                 │                 │
         └─────────────────┼─────────────────┘
                           │
                  ┌────────▼────────┐
                  │  common_system  │
                  │  (Foundation)   │
                  └─────────────────┘

Ecosystem Dependencies

This project leverages the following kcenon ecosystem components:

System	Purpose	Key Features
common_system	Foundation interfaces	IExecutor, Result, Event Bus
container_system	Data serialization	Type-safe values, SIMD acceleration
thread_system	Concurrency	Thread pools, lock-free queues
logger_system	Logging	Async logging, 4.34M msg/s
monitoring_system	Observability	Metrics, distributed tracing
network_system	Network I/O	TCP/TLS, async operations
database_system	Database abstraction	SQL injection prevention, multi-DB support (Optional)

Project Structure

pacs_system/
├── include/pacs/
│   ├── core/                    # Core DICOM implementation (✅ Complete)
│   │   ├── dicom_tag.hpp        # Tag representation (Group, Element)
│   │   ├── dicom_tag_constants.hpp # Standard tag constants
│   │   ├── dicom_element.hpp    # Data Element
│   │   ├── dicom_dataset.hpp    # Data Set
│   │   ├── dicom_file.hpp       # DICOM File (Part 10)
│   │   ├── dicom_dictionary.hpp # Tag Dictionary
│   │   ├── tag_info.hpp         # Tag metadata
│   │   └── events.hpp           # Event Bus integration events
│   │
│   ├── encoding/                # Encoding/Decoding (✅ Complete)
│   │   ├── vr_type.hpp          # Value Representation enum
│   │   ├── vr_info.hpp          # VR metadata and utilities
│   │   ├── transfer_syntax.hpp  # Transfer Syntax
│   │   ├── byte_order.hpp       # Byte order handling
│   │   ├── implicit_vr_codec.hpp # Implicit VR codec
│   │   └── explicit_vr_codec.hpp # Explicit VR codec
│   │
│   ├── network/                 # Network Protocol (✅ Complete)
│   │   ├── pdu_types.hpp        # PDU type definitions
│   │   ├── pdu_encoder.hpp      # PDU encoder
│   │   ├── pdu_decoder.hpp      # PDU decoder
│   │   ├── association.hpp      # Association management
│   │   ├── dicom_server.hpp     # TCP server
│   │   └── dimse/               # DIMSE protocol
│   │       ├── dimse_message.hpp
│   │       ├── command_field.hpp
│   │       └── status_codes.hpp
│   │
│   ├── services/                # DICOM Services (✅ Complete)
│   │   ├── scp_service.hpp      # Base SCP interface
│   │   ├── verification_scp.hpp # C-ECHO SCP
│   │   ├── storage_scp.hpp      # C-STORE SCP
│   │   ├── storage_scu.hpp      # C-STORE SCU
│   │   ├── query_scp.hpp        # C-FIND SCP
│   │   ├── retrieve_scp.hpp     # C-MOVE/GET SCP
│   │   ├── worklist_scp.hpp     # MWL SCP
│   │   ├── mpps_scp.hpp         # MPPS SCP
│   │   ├── sop_class_registry.hpp # SOP Class registry
│   │   ├── cache/               # Query caching and parallel execution
│   │   │   ├── query_cache.hpp  # LRU query result cache
│   │   │   ├── query_result_stream.hpp # Paginated query streaming
│   │   │   └── parallel_query_executor.hpp # Parallel batch queries
│   │   ├── sop_classes/         # Modality-specific SOP classes
│   │   │   ├── us_storage.hpp   # Ultrasound Storage
│   │   │   └── xa_storage.hpp   # X-Ray Angiographic Storage
│   │   └── validation/          # IOD Validators
│   │       ├── us_iod_validator.hpp # US IOD validation
│   │       └── xa_iod_validator.hpp # XA IOD validation
│   │
│   ├── storage/                 # Storage Backend (✅ Complete)
│   │   ├── storage_interface.hpp # Abstract interface
│   │   ├── file_storage.hpp     # Filesystem storage
│   │   ├── index_database.hpp   # SQLite3 indexing
│   │   ├── patient_record.hpp   # Patient data model
│   │   ├── study_record.hpp     # Study data model
│   │   ├── series_record.hpp    # Series data model
│   │   ├── instance_record.hpp  # Instance data model
│   │   ├── worklist_record.hpp  # Worklist data model
│   │   └── mpps_record.hpp      # MPPS data model
│   │
│   ├── monitoring/              # Health Monitoring (✅ Complete)
│   │   ├── health_status.hpp    # Health status structures
│   │   ├── health_checker.hpp   # Health check service
│   │   └── health_json.hpp      # JSON serialization
│   │
│   ├── security/                # Security Features (✅ Complete)
│   │   ├── access_control_manager.hpp # RBAC access control
│   │   ├── role.hpp             # User roles (Viewer, Admin, etc.)
│   │   ├── permission.hpp       # Resource permissions
│   │   ├── signature_types.hpp  # Digital signature types
│   │   ├── certificate.hpp      # X.509 certificate handling
│   │   ├── digital_signature.hpp # DICOM digital signatures
│   │   ├── anonymization_profile.hpp # De-identification profiles (PS3.15)
│   │   ├── tag_action.hpp       # Tag action definitions
│   │   ├── uid_mapping.hpp      # UID mapping for de-identification
│   │   └── anonymizer.hpp       # DICOM anonymization engine
│   │
│   └── integration/             # Ecosystem Adapters (✅ Complete)
│       ├── container_adapter.hpp # container_system integration
│       ├── network_adapter.hpp  # network_system integration
│       ├── thread_adapter.hpp   # thread_system integration
│       ├── logger_adapter.hpp   # logger_system integration
│       ├── monitoring_adapter.hpp # monitoring_system integration
│       └── dicom_session.hpp    # High-level session
│
├── src/                         # Source files (~48,500 lines)
│   ├── core/                    # Core implementations (7 files)
│   ├── encoding/                # Encoding implementations (4 files)
│   ├── network/                 # Network implementations (8 files)
│   ├── services/                # Service implementations (7 files)
│   ├── storage/                 # Storage implementations (4 files)
│   ├── security/                # Security implementations (6 files)
│   ├── monitoring/              # Health check implementations (1 file)
│   └── integration/             # Adapter implementations (6 files)
│
├── tests/                       # Test suites (102 files, 170+ tests)
│   ├── core/                    # Core module tests (6 files)
│   ├── encoding/                # Encoding module tests (5 files)
│   ├── network/                 # Network module tests (5 files)
│   ├── services/                # Service tests (7 files)
│   ├── storage/                 # Storage tests (6 files)
│   ├── security/                # Security tests (5 files, 44 tests)
│   ├── monitoring/              # Health check tests (3 files, 50 tests)
│   └── integration/             # Adapter tests (5 files)
│
├── examples/                    # Example Applications (30 apps, ~35,600 lines)
│   ├── dcm_dump/                # DICOM file inspection utility
│   ├── dcm_info/                # DICOM file summary utility
│   ├── dcm_conv/                # Transfer Syntax conversion utility
│   ├── dcm_modify/              # DICOM tag modification utility
│   ├── dcm_anonymize/           # DICOM de-identification utility (PS3.15)
│   ├── dcm_dir/                 # DICOMDIR creation/management utility (PS3.10)
│   ├── dcm_to_json/             # DICOM to JSON conversion utility (PS3.18)
│   ├── json_to_dcm/             # JSON to DICOM conversion utility (PS3.18)
│   ├── dcm_to_xml/              # DICOM to XML conversion utility (PS3.19)
│   ├── xml_to_dcm/              # XML to DICOM conversion utility (PS3.19)
│   ├── img_to_dcm/              # Image to DICOM conversion utility
│   ├── dcm_extract/             # DICOM pixel data extraction utility
│   ├── db_browser/              # PACS index database browser
│   ├── echo_scp/                # DICOM Echo SCP server
│   ├── echo_scu/                # DICOM Echo SCU client
│   ├── secure_dicom/            # TLS-secured DICOM Echo SCU/SCP
│   ├── store_scp/               # DICOM Storage SCP server
│   ├── store_scu/               # DICOM Storage SCU client
│   ├── qr_scp/                  # Query/Retrieve SCP (C-FIND/C-MOVE/C-GET server)
│   ├── query_scu/               # DICOM Query SCU client (C-FIND)
│   ├── find_scu/                # dcmtk-compatible C-FIND SCU utility
│   ├── retrieve_scu/            # DICOM Retrieve SCU client (C-MOVE/C-GET)
│   ├── move_scu/                # dcmtk-compatible C-MOVE SCU utility
│   ├── get_scu/                 # dcmtk-compatible C-GET SCU utility
│   ├── worklist_scu/            # Modality Worklist Query client (MWL C-FIND)
│   ├── worklist_scp/            # Modality Worklist SCP server (MWL C-FIND)
│   ├── mpps_scu/                # MPPS client (N-CREATE/N-SET)
│   ├── mpps_scp/                # MPPS server (N-CREATE/N-SET)
│   ├── pacs_server/             # Full PACS server example
│   └── integration_tests/       # End-to-end integration test suite
│
├── docs/                        # Documentation (37 files)
└── CMakeLists.txt               # Build configuration (v0.2.0)

Documentation

📋 Implementation Analysis - Detailed implementation strategy
📋 Product Requirements - Product Requirements Document
🏗️ Architecture Guide - System architecture
⚡ Features - Feature specifications
📁 Project Structure - Directory structure
🔧 API Reference - API documentation
🚀 Migration Complete - Thread system migration summary

Database Integration:

🗄️ Migration Guide - database_system integration guide
📚 API Reference (Database) - Query Builder API documentation
🏛️ ADR-001 - Architecture Decision Record
⚡ Performance Guide - Database optimization tips

DICOM Conformance

Supported SOP Classes

Service	SOP Class	Status
Verification	1.2.840.10008.1.1	✅ Complete
CT Storage	1.2.840.10008.5.1.4.1.1.2	✅ Complete
MR Storage	1.2.840.10008.5.1.4.1.1.4	✅ Complete
US Storage	1.2.840.10008.5.1.4.1.1.6.x	✅ Complete
XA Storage	1.2.840.10008.5.1.4.1.1.12.x	✅ Complete
XRF Storage	1.2.840.10008.5.1.4.1.1.12.2	✅ Complete
X-Ray Storage	1.2.840.10008.5.1.4.1.1.1.1	✅ Complete
Patient Root Q/R	1.2.840.10008.5.1.4.1.2.1.x	✅ Complete
Study Root Q/R	1.2.840.10008.5.1.4.1.2.2.x	✅ Complete
Modality Worklist	1.2.840.10008.5.1.4.31	✅ Complete
MPPS	1.2.840.10008.3.1.2.3.3	✅ Complete

Transfer Syntax Support

Transfer Syntax	UID	Priority
Implicit VR Little Endian	1.2.840.10008.1.2	Required
Explicit VR Little Endian	1.2.840.10008.1.2.1	MVP
Explicit VR Big Endian	1.2.840.10008.1.2.2	Optional
JPEG Baseline	1.2.840.10008.1.2.4.50	Future
JPEG 2000	1.2.840.10008.1.2.4.90	Future

Getting Started

Prerequisites

All Platforms:

C++20 compatible compiler with Concepts support:
- GCC 10+ (GCC 13+ recommended for full std::format support)
- Clang 10+ (Clang 14+ recommended)
- MSVC 2022 (19.30+)
CMake 3.20+
Ninja (recommended build system)
kcenon ecosystem libraries (auto-downloaded by CMake)

Linux (Ubuntu 24.04+):

sudo apt install cmake ninja-build libsqlite3-dev libssl-dev libfmt-dev

macOS:

brew install cmake ninja sqlite3 openssl@3 fmt

Windows:

Visual Studio 2022 with C++ workload
vcpkg for package management
Dependencies: sqlite3, openssl, fmt, gtest

Build

Linux/macOS

# Clone repository
git clone https://github.com/kcenon/pacs_system.git
cd pacs_system

# Configure and build
cmake -S . -B build
cmake --build build

# Run tests
cd build && ctest --output-on-failure

Windows

# Prerequisites: Visual Studio 2022, vcpkg, CMake 3.20+

# Install dependencies via vcpkg
vcpkg install sqlite3:x64-windows openssl:x64-windows fmt:x64-windows gtest:x64-windows

# Clone repository
git clone https://github.com/kcenon/pacs_system.git
cd pacs_system

# Configure with vcpkg toolchain
cmake -S . -B build -G Ninja `
  -DCMAKE_TOOLCHAIN_FILE="$env:VCPKG_ROOT/scripts/buildsystems/vcpkg.cmake"

# Build
cmake --build build

# Run tests
cd build
ctest --output-on-failure

Test Results: 170+ tests passing (Core: 57, Encoding: 41, Network: 15, Services: 7+, Storage/Integration: 20+, Monitoring: 50)

Build Options

PACS_BUILD_TESTS (ON)              # Enable unit tests
PACS_BUILD_EXAMPLES (OFF)          # Enable example builds
PACS_BUILD_BENCHMARKS (OFF)        # Enable benchmarks
PACS_BUILD_STORAGE (ON)            # Build storage module

Windows Development Notes

When writing code for Windows compatibility, wrap std::min and std::max calls in parentheses to prevent conflicts with Windows.h macros:

// Correct: Works on all platforms
size_t result = (std::min)(a, b);
auto value = (std::max)(x, y);

// Incorrect: Fails on Windows MSVC (error C2589)
size_t result = std::min(a, b);
auto value = std::max(x, y);

Examples

Build Examples

cmake -S . -B build -DPACS_BUILD_EXAMPLES=ON
cmake --build build

DCM Dump (File Inspection Utility)

# Dump DICOM file metadata
./build/bin/dcm_dump image.dcm

# Filter specific tags
./build/bin/dcm_dump image.dcm --tags PatientName,PatientID,Modality

# Show pixel data information
./build/bin/dcm_dump image.dcm --pixel-info

# JSON output for integration
./build/bin/dcm_dump image.dcm --format json

# Scan directory recursively with summary
./build/bin/dcm_dump ./dicom_folder/ --recursive --summary

DCM Info (File Summary Utility)

# Display DICOM file summary
./build/bin/dcm_info image.dcm

# Verbose mode with all available fields
./build/bin/dcm_info image.dcm --verbose

# JSON output for scripting
./build/bin/dcm_info image.dcm --format json

# Quick view of multiple files
./build/bin/dcm_info ./dicom_folder/ -r -q

DCM Modify (Tag Modification Utility)

dcmtk-compatible DICOM tag modification utility supporting numeric tag format (GGGG,EEEE) and keyword format.

# Insert tag (creates if not exists) - supports both tag formats
./build/bin/dcm_modify -i "(0010,0010)=Anonymous" patient.dcm
./build/bin/dcm_modify -i PatientName=Anonymous -o modified.dcm patient.dcm

# Modify existing tag (error if not exists)
./build/bin/dcm_modify -m "(0010,0020)=NEW_ID" patient.dcm

# Delete tag
./build/bin/dcm_modify -e "(0010,1000)" patient.dcm
./build/bin/dcm_modify -e OtherPatientIDs patient.dcm

# Delete all matching tags (including in sequences)
./build/bin/dcm_modify -ea "(0010,1001)" patient.dcm

# Delete all private tags
./build/bin/dcm_modify -ep patient.dcm

# Regenerate UIDs
./build/bin/dcm_modify -gst -gse -gin -o anonymized.dcm patient.dcm

# Use script file for batch modifications
./build/bin/dcm_modify --script modify.txt *.dcm

# In-place modification (creates .bak backup)
./build/bin/dcm_modify -i PatientID=NEW_ID patient.dcm

# In-place without backup (DANGEROUS!)
./build/bin/dcm_modify -i PatientID=NEW_ID -nb patient.dcm

# Process directory recursively
./build/bin/dcm_modify -i PatientName=Anonymous -r ./dicom_folder/ -o ./output/

Script file format (modify.txt):

# Comments start with #
i (0010,0010)=Anonymous     # Insert/modify tag
m (0008,0050)=ACC001        # Modify existing tag
e (0010,1000)               # Erase tag
ea (0010,1001)              # Erase all matching tags

DCM Conv (Transfer Syntax Converter)

# Convert to Explicit VR Little Endian (default)
./build/bin/dcm_conv image.dcm converted.dcm --explicit

# Convert to Implicit VR Little Endian
./build/bin/dcm_conv image.dcm output.dcm --implicit

# Convert to JPEG Baseline with quality setting
./build/bin/dcm_conv image.dcm compressed.dcm --jpeg-baseline -q 85

# Convert directory recursively with verification
./build/bin/dcm_conv ./input_dir/ ./output_dir/ --recursive --verify

# List all supported Transfer Syntaxes
./build/bin/dcm_conv --list-syntaxes

# Convert with explicit Transfer Syntax UID
./build/bin/dcm_conv image.dcm output.dcm -t 1.2.840.10008.1.2.4.50

DCM Anonymize (De-identification Utility)

DICOM de-identification utility compliant with DICOM PS3.15 Security Profiles.

# Basic anonymization (removes direct identifiers)
./build/bin/dcm_anonymize patient.dcm anonymous.dcm

# HIPAA Safe Harbor compliance (18-identifier removal)
./build/bin/dcm_anonymize --profile hipaa_safe_harbor patient.dcm output.dcm

# GDPR-compliant pseudonymization
./build/bin/dcm_anonymize --profile gdpr_compliant patient.dcm output.dcm

# Keep specific tags unchanged
./build/bin/dcm_anonymize -k PatientSex -k PatientAge patient.dcm output.dcm

# Replace tags with custom values
./build/bin/dcm_anonymize -r "InstitutionName=Research Hospital" patient.dcm output.dcm

# Set new patient identifiers
./build/bin/dcm_anonymize --patient-id "STUDY001_001" --patient-name "Anonymous" patient.dcm

# Use UID mapping for consistent anonymization across study files
./build/bin/dcm_anonymize -m mapping.json patient.dcm output.dcm

# Shift dates for longitudinal studies
./build/bin/dcm_anonymize --profile retain_longitudinal --date-offset -30 patient.dcm

# Batch processing with directory recursion
./build/bin/dcm_anonymize --recursive -o anonymized/ ./originals/

# Dry-run mode to preview changes
./build/bin/dcm_anonymize --dry-run --verbose patient.dcm

# Verify anonymization completeness
./build/bin/dcm_anonymize --verify patient.dcm anonymous.dcm

Available anonymization profiles:

basic - Remove direct patient identifiers (default)
clean_pixel - Remove burned-in annotations from pixel data
clean_descriptions - Clean free-text fields that may contain PHI
retain_longitudinal - Preserve temporal relationships with date shifting
retain_patient_characteristics - Keep demographics (sex, age, size, weight)
hipaa_safe_harbor - Full HIPAA 18-identifier removal
gdpr_compliant - GDPR pseudonymization requirements

DCM Dir (DICOMDIR Creation/Management Utility)

Create and manage DICOMDIR files for DICOM media storage following DICOM PS3.10 standard.

# Create DICOMDIR from directory
./build/bin/dcm_dir create ./patient_data/

# Create with custom output path and file-set ID
./build/bin/dcm_dir create -o DICOMDIR --file-set-id "STUDY001" ./patient_data/

# Create with verbose output
./build/bin/dcm_dir create -v ./patient_data/

# List DICOMDIR contents in tree format
./build/bin/dcm_dir list DICOMDIR

# List with detailed information
./build/bin/dcm_dir list -l DICOMDIR

# List as flat file list
./build/bin/dcm_dir list --flat DICOMDIR

# Verify DICOMDIR structure
./build/bin/dcm_dir verify DICOMDIR

# Verify with file existence check
./build/bin/dcm_dir verify --check-files DICOMDIR

# Verify with consistency check (duplicate SOP Instance UID detection)
./build/bin/dcm_dir verify --check-consistency DICOMDIR

# Update DICOMDIR by adding new files
./build/bin/dcm_dir update -a ./new_study/ DICOMDIR

DICOMDIR structure follows DICOM hierarchy:

PATIENT → STUDY → SERIES → IMAGE (hierarchical record structure)
Referenced File IDs use backslash separator for ISO 9660 compatibility
Supports standard record types: PATIENT, STUDY, SERIES, IMAGE

DCM to JSON (DICOM PS3.18 JSON Converter)

Convert DICOM files to JSON format following the DICOM PS3.18 JSON representation standard.

# Convert DICOM to JSON (stdout)
./build/bin/dcm_to_json image.dcm

# Convert to file with pretty formatting
./build/bin/dcm_to_json image.dcm output.json --pretty

# Compact output (no formatting)
./build/bin/dcm_to_json image.dcm output.json --compact

# Include binary data as Base64
./build/bin/dcm_to_json image.dcm output.json --bulk-data inline

# Save binary data to separate files with URI references
./build/bin/dcm_to_json image.dcm output.json --bulk-data uri --bulk-data-dir ./bulk/

# Exclude pixel data
./build/bin/dcm_to_json image.dcm output.json --no-pixel

# Filter specific tags
./build/bin/dcm_to_json image.dcm -t 0010,0010 -t 0010,0020

# Process directory recursively
./build/bin/dcm_to_json ./dicom_folder/ --recursive --no-pixel

Output format (DICOM PS3.18):

{
  "00100010": {
    "vr": "PN",
    "Value": [{"Alphabetic": "DOE^JOHN"}]
  },
  "00100020": {
    "vr": "LO",
    "Value": ["12345678"]
  }
}

JSON to DCM (JSON to DICOM Converter)

Convert JSON files (DICOM PS3.18 format) back to DICOM format.

# Convert JSON to DICOM
./build/bin/json_to_dcm metadata.json output.dcm

# Use template DICOM for pixel data and missing tags
./build/bin/json_to_dcm metadata.json output.dcm --template original.dcm

# Specify transfer syntax
./build/bin/json_to_dcm metadata.json output.dcm -t 1.2.840.10008.1.2.1

# Resolve BulkDataURI from specific directory
./build/bin/json_to_dcm metadata.json output.dcm --bulk-data-dir ./bulk/

DCM to XML (DICOM to XML Conversion)

Convert DICOM files to DICOM Native XML format (PS3.19).

# Convert DICOM to XML (stdout)
./build/bin/dcm_to_xml image.dcm

# Convert to file with pretty formatting
./build/bin/dcm_to_xml image.dcm output.xml --pretty

# Include binary data as Base64
./build/bin/dcm_to_xml image.dcm output.xml --bulk-data inline

# Save binary data to separate files with URI references
./build/bin/dcm_to_xml image.dcm output.xml --bulk-data uri --bulk-data-dir ./bulk/

# Exclude pixel data
./build/bin/dcm_to_xml image.dcm output.xml --no-pixel

# Filter specific tags
./build/bin/dcm_to_xml image.dcm -t 0010,0010 -t 0010,0020

# Process directory recursively
./build/bin/dcm_to_xml ./dicom_folder/ --recursive --no-pixel

Output format (DICOM Native XML PS3.19):

<?xml version="1.0" encoding="UTF-8"?>
<NativeDicomModel xmlns="http://dicom.nema.org/PS3.19/models/NativeDICOM">
  <DicomAttribute tag="00100010" vr="PN" keyword="PatientName">
    <PersonName number="1">
      <Alphabetic>
        <FamilyName>DOE</FamilyName>
        <GivenName>JOHN</GivenName>
      </Alphabetic>
    </PersonName>
  </DicomAttribute>
</NativeDicomModel>

XML to DCM (XML to DICOM Conversion)

Convert XML files (DICOM Native XML PS3.19 format) back to DICOM format.

# Convert XML to DICOM
./build/bin/xml_to_dcm metadata.xml output.dcm

# Use template DICOM for pixel data and missing tags
./build/bin/xml_to_dcm metadata.xml output.dcm --template original.dcm

# Specify transfer syntax
./build/bin/xml_to_dcm metadata.xml output.dcm -t 1.2.840.10008.1.2.1

# Resolve BulkData URI from specific directory
./build/bin/xml_to_dcm metadata.xml output.dcm --bulk-data-dir ./bulk/

Img to DCM (Image to DICOM Conversion)

Convert standard image files (JPEG) to DICOM format using Secondary Capture SOP Class.

# Basic conversion
./build/bin/img_to_dcm photo.jpg output.dcm

# With patient metadata
./build/bin/img_to_dcm photo.jpg output.dcm \
  --patient-name "DOE^JOHN" \
  --patient-id "12345" \
  --study-description "Photograph"

# Convert directory of images
./build/bin/img_to_dcm ./photos/ ./dicom/ --recursive

# With verbose output
./build/bin/img_to_dcm photo.jpg output.dcm -v

# Overwrite existing files
./build/bin/img_to_dcm ./photos/ ./dicom/ --recursive --overwrite

Features:

Converts JPEG images to DICOM Secondary Capture format
Automatic UID generation for Study, Series, and Instance
Customizable patient and study metadata
Batch processing with recursive directory support
Requires libjpeg-turbo for JPEG support

DCM Extract (Pixel Data Extraction)

Extract pixel data from DICOM files to standard image formats.

# Show pixel data information
./build/bin/dcm_extract image.dcm --info

# Extract to raw binary format
./build/bin/dcm_extract image.dcm output.raw --raw

# Extract to JPEG (requires libjpeg)
./build/bin/dcm_extract image.dcm output.jpg --jpeg -q 90

# Extract to PNG (requires libpng)
./build/bin/dcm_extract image.dcm output.png --png

# Extract to PPM/PGM format
./build/bin/dcm_extract image.dcm output.ppm --ppm

# Apply window level transformation
./build/bin/dcm_extract image.dcm output.jpg --jpeg --window 40 400

# Batch extraction from directory
./build/bin/dcm_extract ./dicom/ ./images/ --recursive --jpeg

Features:

Supports RAW, JPEG, PNG, and PPM/PGM output formats
Window level (center/width) transformation
Automatic 16-bit to 8-bit conversion
MONOCHROME1/MONOCHROME2 handling
Batch processing with recursive directory support

DB Browser (Database Viewer)

# List all patients
./build/bin/db_browser pacs.db patients

# List studies for a specific patient
./build/bin/db_browser pacs.db studies --patient-id "12345"

# Filter studies by date range
./build/bin/db_browser pacs.db studies --from 20240101 --to 20241231

# List series for a study
./build/bin/db_browser pacs.db series --study-uid "1.2.3.4.5"

# Show database statistics
./build/bin/db_browser pacs.db stats

# Database maintenance
./build/bin/db_browser pacs.db vacuum
./build/bin/db_browser pacs.db verify

Echo SCP (Verification Server)

# Run Echo SCP
./build/bin/echo_scp --port 11112 --ae-title MY_ECHO

Echo SCU (Verification Client)

dcmtk-compatible DICOM connectivity verification tool.

# Basic connectivity test
./build/bin/echo_scu localhost 11112

# With custom AE Titles
./build/bin/echo_scu -aet MY_SCU -aec PACS_SCP localhost 11112

# Verbose output with custom timeout
./build/bin/echo_scu -v -to 60 localhost 11112

# Repeat test for connectivity monitoring
./build/bin/echo_scu -r 10 --repeat-delay 1000 localhost 11112

# Quiet mode (exit code only)
./build/bin/echo_scu -q localhost 11112

# Show all options
./build/bin/echo_scu --help

Secure Echo SCU/SCP (TLS-Secured DICOM)

TLS-secured DICOM connectivity testing with support for TLS 1.2/1.3 and mutual TLS.

# Generate test certificates first
cd examples/secure_dicom
./generate_certs.sh

# Start secure server (TLS)
./build/bin/secure_echo_scp 2762 MY_PACS \
    --cert certs/server.crt \
    --key certs/server.key \
    --ca certs/ca.crt

# Test secure connectivity (server verification only)
./build/bin/secure_echo_scu localhost 2762 MY_PACS \
    --ca certs/ca.crt

# Test with mutual TLS (client certificate)
./build/bin/secure_echo_scu localhost 2762 MY_PACS \
    --cert certs/client.crt \
    --key certs/client.key \
    --ca certs/ca.crt

# Use TLS 1.3
./build/bin/secure_echo_scu localhost 2762 MY_PACS \
    --ca certs/ca.crt \
    --tls-version 1.3

Storage SCU (Image Sender)

# Send single DICOM file
./build/bin/store_scu localhost 11112 image.dcm

# Send with custom AE Titles
./build/bin/store_scu -aet MYSCU -aec PACS localhost 11112 image.dcm

# Send all files in directory (recursive) with progress
./build/bin/store_scu -r --progress localhost 11112 ./dicom_folder/

# Specify transfer syntax preference
./build/bin/store_scu --prefer-lossless localhost 11112 *.dcm

# Verbose output with timeout
./build/bin/store_scu -v -to 60 localhost 11112 image.dcm

# Generate transfer report
./build/bin/store_scu --report-file transfer.log localhost 11112 ./data/

# Quiet mode (minimal output)
./build/bin/store_scu -q localhost 11112 image.dcm

# Show help
./build/bin/store_scu --help

Query SCU (C-FIND Client)

# Query studies by patient name (wildcards supported)
./build/bin/query_scu localhost 11112 PACS_SCP --level STUDY --patient-name "DOE^*"

# Query by date range
./build/bin/query_scu localhost 11112 PACS_SCP --level STUDY --study-date "20240101-20241231"

# Query series for a specific study
./build/bin/query_scu localhost 11112 PACS_SCP --level SERIES --study-uid "1.2.3.4.5"

# Output as JSON for integration
./build/bin/query_scu localhost 11112 PACS_SCP --patient-id "12345" --format json

# Export to CSV
./build/bin/query_scu localhost 11112 PACS_SCP --modality CT --format csv > results.csv

Retrieve SCU (C-MOVE/C-GET Client)

# C-GET: Retrieve study directly to local machine
./build/bin/retrieve_scu localhost 11112 PACS_SCP --mode get --study-uid "1.2.3.4.5" -o ./downloads

# C-MOVE: Transfer study to another PACS/workstation
./build/bin/retrieve_scu localhost 11112 PACS_SCP --mode move --dest-ae LOCAL_SCP --study-uid "1.2.3.4.5"

# Retrieve specific series
./build/bin/retrieve_scu localhost 11112 PACS_SCP --level SERIES --series-uid "1.2.3.4.5.6"

# Retrieve all studies for a patient
./build/bin/retrieve_scu localhost 11112 PACS_SCP --level PATIENT --patient-id "12345"

# Flat storage structure (all files in one directory)
./build/bin/retrieve_scu localhost 11112 PACS_SCP --study-uid "1.2.3.4.5" --structure flat

DCMTK-Compatible SCU Utilities

The following utilities provide dcmtk-compatible command-line interfaces for interoperability with existing DICOM toolchains:

find_scu (dcmtk-compatible C-FIND)

# Patient Root Query - find all studies for a patient
./build/bin/find_scu -P -L STUDY -k "0010,0010=Smith*" localhost 11112

# Study Root Query - find CT studies in date range
./build/bin/find_scu -S -L STUDY \
  -aec PACS_SCP \
  -k "0008,0060=CT" \
  -k "0008,0020=20240101-20241231" \
  localhost 11112

# Output as JSON
./build/bin/find_scu -S -L SERIES -k "0020,000D=1.2.840..." -o json localhost 11112

# Read query keys from file
./build/bin/find_scu -f query_keys.txt localhost 11112

move_scu (dcmtk-compatible C-MOVE)

# Move study to third-party workstation
./build/bin/move_scu -aem WORKSTATION \
  -L STUDY \
  -k "0020,000D=1.2.840..." \
  pacs.example.com 104

# Move series with progress display
./build/bin/move_scu -aem ARCHIVE \
  --progress \
  -L SERIES \
  -k "0020,000E=1.2.840..." \
  localhost 11112

get_scu (dcmtk-compatible C-GET)

# Get entire study directly (no separate storage SCP needed)
./build/bin/get_scu -L STUDY \
  -k "0020,000D=1.2.840..." \
  --progress \
  -od ./study_data/ \
  pacs.example.com 104

# Get single instance with lossless preference
./build/bin/get_scu --prefer-lossless \
  -L IMAGE \
  -k "0008,0018=1.2.840..." \
  -od ./retrieved/ \
  localhost 11112

Worklist SCU (Modality Worklist Query Client)

# Query worklist for CT modality
./build/bin/worklist_scu localhost 11112 RIS_SCP --modality CT

# Query worklist for today's scheduled procedures
./build/bin/worklist_scu localhost 11112 RIS_SCP --modality MR --date today

# Query by station AE title
./build/bin/worklist_scu localhost 11112 RIS_SCP --station "CT_SCANNER_01" --date 20241215

# Query with patient filter
./build/bin/worklist_scu localhost 11112 RIS_SCP --patient-name "DOE^*" --modality CT

# Output as JSON for integration
./build/bin/worklist_scu localhost 11112 RIS_SCP --modality CT --format json > worklist.json

# Export to CSV
./build/bin/worklist_scu localhost 11112 RIS_SCP --modality CT --format csv > worklist.csv

MPPS SCU (Modality Performed Procedure Step Client)

# Create new MPPS instance (start procedure)
./build/bin/mpps_scu localhost 11112 RIS_SCP create \
  --patient-id "12345" \
  --patient-name "Doe^John" \
  --modality CT

# Complete the procedure
./build/bin/mpps_scu localhost 11112 RIS_SCP set \
  --mpps-uid "1.2.3.4.5.6.7.8" \
  --status COMPLETED \
  --series-uid "1.2.3.4.5.6.7.8.9"

# Discontinue (cancel) a procedure
./build/bin/mpps_scu localhost 11112 RIS_SCP set \
  --mpps-uid "1.2.3.4.5.6.7.8" \
  --status DISCONTINUED \
  --reason "Patient refused"

# Verbose output for debugging
./build/bin/mpps_scu localhost 11112 RIS_SCP create \
  --patient-id "12345" \
  --modality MR \
  --verbose

MPPS SCP (Modality Performed Procedure Step Server)

A standalone MPPS server for receiving procedure status updates from modality devices.

# Basic usage - listen for MPPS messages
./build/bin/mpps_scp 11112 MY_MPPS

# Store MPPS records to individual JSON files
./build/bin/mpps_scp 11112 MY_MPPS --output-dir ./mpps_records

# Append MPPS records to a single JSON file
./build/bin/mpps_scp 11112 MY_MPPS --output-file ./mpps.json

# With custom association limits
./build/bin/mpps_scp 11112 MY_MPPS --max-assoc 20 --timeout 600

# Show help
./build/bin/mpps_scp --help

Features:

N-CREATE: Receive procedure start notifications (status = IN PROGRESS)
N-SET: Receive procedure completion (COMPLETED) or cancellation (DISCONTINUED)
JSON Storage: Store MPPS records to JSON files for integration
Statistics: Display session statistics on shutdown
Graceful Shutdown: Signal handling (SIGINT, SIGTERM)

Query/Retrieve SCP (C-FIND/C-MOVE/C-GET Server)

Lightweight Query/Retrieve SCP server for serving DICOM files from a storage directory.

# Basic usage - serve files from a directory
./build/bin/qr_scp 11112 MY_PACS --storage-dir ./dicom

# With persistent index database (faster restart)
./build/bin/qr_scp 11112 MY_PACS --storage-dir ./dicom --index-db ./pacs.db

# With known peers for C-MOVE destinations
./build/bin/qr_scp 11112 MY_PACS --storage-dir ./dicom --peer VIEWER:192.168.1.10:11113

# Multiple peers for multi-destination C-MOVE
./build/bin/qr_scp 11112 MY_PACS --storage-dir ./dicom \
  --peer WS1:10.0.0.1:104 --peer WS2:10.0.0.2:104

# Scan and index storage without starting server
./build/bin/qr_scp 11112 MY_PACS --storage-dir ./dicom --scan-only

# Customize association limits
./build/bin/qr_scp 11112 MY_PACS --storage-dir ./dicom --max-assoc 20 --timeout 600

Features:

C-FIND: Query at Patient, Study, Series, and Image levels
C-MOVE: Send images to configured destination AE titles
C-GET: Direct image retrieval over the same association
Automatic Indexing: SQLite-based fast query responses
Graceful Shutdown: Signal handling (SIGINT, SIGTERM)

Modality Worklist SCP

A standalone Modality Worklist (MWL) server for providing scheduled procedure information to modalities.

# Basic usage with JSON worklist file
./build/bin/worklist_scp 11112 MY_WORKLIST --worklist-file ./worklist.json

# Load worklist from directory
./build/bin/worklist_scp 11112 MY_WORKLIST --worklist-dir ./worklist_data

# With result limit
./build/bin/worklist_scp 11112 MY_WORKLIST --worklist-file ./worklist.json --max-results 100

Sample Worklist JSON (worklist.json):

[
  {
    "patientId": "12345",
    "patientName": "DOE^JOHN",
    "patientBirthDate": "19800101",
    "patientSex": "M",
    "studyInstanceUid": "1.2.3.4.5.6.7.8.9",
    "accessionNumber": "ACC001",
    "scheduledStationAeTitle": "CT_01",
    "scheduledProcedureStepStartDate": "20241220",
    "scheduledProcedureStepStartTime": "100000",
    "modality": "CT",
    "scheduledProcedureStepId": "SPS001",
    "scheduledProcedureStepDescription": "CT Abdomen"
  }
]

Features:

MWL C-FIND: Responds to Modality Worklist queries
JSON Data Source: Load worklist items from JSON files
Filtering: Patient ID, name, modality, station AE, scheduled date
Graceful Shutdown: Signal handling (SIGINT, SIGTERM)

Full PACS Server

# Run with configuration
./build/examples/pacs_server/pacs_server --config pacs_server.yaml

Sample Configuration (pacs_server.yaml):

server:
  ae_title: MY_PACS
  port: 11112
  max_associations: 50

storage:
  directory: ./archive
  naming: hierarchical

database:
  path: ./pacs.db
  wal_mode: true

Integration Tests (End-to-End Workflow Tests)

# Run all integration tests
./build/bin/pacs_integration_e2e

# Run specific test category
./build/bin/pacs_integration_e2e "[connectivity]"    # Basic C-ECHO tests
./build/bin/pacs_integration_e2e "[store_query]"     # Store and query workflow
./build/bin/pacs_integration_e2e "[worklist]"        # Worklist and MPPS workflow
./build/bin/pacs_integration_e2e "[workflow][multimodal]"  # Multi-modal clinical workflows
./build/bin/pacs_integration_e2e "[xa]"              # XA Storage tests
./build/bin/pacs_integration_e2e "[tls]"             # TLS integration tests
./build/bin/pacs_integration_e2e "[stability][smoke]"  # Quick stability smoke test
./build/bin/pacs_integration_e2e "[stress]"          # Multi-association stress tests

# List available tests
./build/bin/pacs_integration_e2e --list-tests

# Run with verbose output
./build/bin/pacs_integration_e2e --success

# Generate JUnit XML report for CI/CD
./build/bin/pacs_integration_e2e --reporter junit --out results.xml

Test Scenarios:

Connectivity: C-ECHO, multiple associations, timeout handling
Store & Query: Store files, query by patient/study/series, wildcard matching
XA Storage: X-Ray Angiographic image storage and retrieval
Multi-Modal Workflow: Complete patient journey with CT, MR, XA modalities
Worklist/MPPS: Scheduled procedures, MPPS IN PROGRESS/COMPLETED workflow
TLS Security: Certificate validation, mutual TLS, secure communication
Stability: Memory leak detection, connection pool exhaustion, long-running operations
Stress: Concurrent SCUs, rapid connections, large datasets
Error Recovery: Invalid SOP class, server restart, abort handling

Event Bus Integration

The PACS system integrates with common_system Event Bus for inter-module communication and event-driven workflows.

#include "pacs/core/events.hpp"
#include <kcenon/common/patterns/event_bus.h>

// Subscribe to image storage events
auto& bus = kcenon::common::get_event_bus();
auto sub_id = bus.subscribe<pacs::events::image_received_event>(
    [](const pacs::events::image_received_event& evt) {
        std::cout << "Received image: " << evt.sop_instance_uid
                  << " from " << evt.calling_ae << std::endl;
        // Trigger workflow, update cache, send notification, etc.
    }
);

// Subscribe to association events
bus.subscribe<pacs::events::association_established_event>(
    [](const pacs::events::association_established_event& evt) {
        std::cout << "New association: " << evt.calling_ae
                  << " -> " << evt.called_ae << std::endl;
    }
);

// Cleanup when done
bus.unsubscribe(sub_id);

Available Event Types:

association_established_event / association_released_event / association_aborted_event
image_received_event / storage_failed_event
query_executed_event / query_failed_event
retrieve_started_event / retrieve_completed_event

Performance

The PACS system leverages the thread_system library for high-performance concurrent operations. The thread system migration (Epic #153) has been successfully completed, replacing all direct std::thread usage with modern C++20 abstractions including jthread support and cancellation tokens. See PERFORMANCE_RESULTS.md for detailed benchmark results and MIGRATION_COMPLETE.md for the migration summary.

Key Performance Metrics

Metric	Result
Association Latency	< 1 ms
C-ECHO Throughput	89,964 msg/s
C-STORE Throughput	31,759 store/s
Concurrent Operations	124 ops/s (10 workers)
Graceful Shutdown	110 ms (with active connections)
Data Rate (512x512)	9,247 MB/s

Running Benchmarks

# Build with benchmarks
cmake -B build -DPACS_BUILD_BENCHMARKS=ON
cmake --build build

# Run all benchmarks
cmake --build build --target run_full_benchmarks

# Run specific benchmark category
./build/bin/thread_performance_benchmarks "[benchmark][association]"
./build/bin/thread_performance_benchmarks "[benchmark][throughput]"
./build/bin/thread_performance_benchmarks "[benchmark][concurrent]"
./build/bin/thread_performance_benchmarks "[benchmark][shutdown]"

Code Statistics

Metric	Value
Header Files	171 files
Source Files	108 files
Header LOC	~48,800 lines
Source LOC	~56,400 lines
Example LOC	~35,000 lines
Test LOC	~53,500 lines
Total LOC	~193,600 lines
Test Files	107 files
Test Cases	1587+ tests
Example Programs	31 apps
Documentation	56 markdown files
CI/CD Workflows	10 workflows
Version	0.1.0
Last Updated	2026-01-08

Contributing

Contributions are welcome! Please read our contributing guidelines before submitting pull requests.

License

This project is licensed under the BSD 3-Clause License - see the LICENSE file for details.

Contact

Project Owner: kcenon (kcenon@naver.com)
Repository: https://github.com/kcenon/pacs_system
Issues: https://github.com/kcenon/pacs_system/issues

Made with ❤️ by 🍀☀🌕🌥 🌊

Name		Name	Last commit message	Last commit date
Latest commit History 230 Commits
.github/workflows		.github/workflows
benchmarks		benchmarks
docs		docs
examples		examples
include/pacs		include/pacs
scripts		scripts
src		src
tests		tests
web		web
.gitignore		.gitignore
CMakeLists.txt		CMakeLists.txt
CMakePresets.json		CMakePresets.json
LICENSE		LICENSE
README.md		README.md
README_KO.md		README_KO.md
_config.yml		_config.yml

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PACS System

Overview

Project Status

Phase 1 Achievements (Complete)

Phase 2 Achievements (Complete)

Architecture

Ecosystem Dependencies

Project Structure

Documentation

DICOM Conformance

Supported SOP Classes

Transfer Syntax Support

Getting Started

Prerequisites

Build

Linux/macOS

Windows

Build Options

Windows Development Notes

Examples

Build Examples

DCM Dump (File Inspection Utility)

DCM Info (File Summary Utility)

DCM Modify (Tag Modification Utility)

DCM Conv (Transfer Syntax Converter)

DCM Anonymize (De-identification Utility)

DCM Dir (DICOMDIR Creation/Management Utility)

DCM to JSON (DICOM PS3.18 JSON Converter)

JSON to DCM (JSON to DICOM Converter)

DCM to XML (DICOM to XML Conversion)

XML to DCM (XML to DICOM Conversion)

Img to DCM (Image to DICOM Conversion)

DCM Extract (Pixel Data Extraction)

DB Browser (Database Viewer)

Echo SCP (Verification Server)

Echo SCU (Verification Client)

Secure Echo SCU/SCP (TLS-Secured DICOM)

Storage SCU (Image Sender)

Query SCU (C-FIND Client)

Retrieve SCU (C-MOVE/C-GET Client)

DCMTK-Compatible SCU Utilities

find_scu (dcmtk-compatible C-FIND)

move_scu (dcmtk-compatible C-MOVE)

get_scu (dcmtk-compatible C-GET)

Worklist SCU (Modality Worklist Query Client)

MPPS SCU (Modality Performed Procedure Step Client)

MPPS SCP (Modality Performed Procedure Step Server)

Query/Retrieve SCP (C-FIND/C-MOVE/C-GET Server)

Modality Worklist SCP

Full PACS Server

Integration Tests (End-to-End Workflow Tests)

Event Bus Integration

Performance

Key Performance Metrics

Running Benchmarks

Code Statistics

Contributing

License

Contact

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