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

---

Table of Contents

• Project Status
• Architecture
• DICOM Conformance
• vcpkg Features
• Getting Started
• CLI Tools & Examples
• Ecosystem Dependencies
• Project Structure
• Documentation
• Performance
• Code Statistics
• Contributing
• License
• Contact

---

Project Status

Current Phase: ✅ Phase 4 Complete - Advanced Services & Production Hardening

Phase	Scope	Status
Phase 1: Foundation	DICOM Core, Tag Dictionary, File I/O (Part 10), Transfer Syntax	✅ Complete
Phase 2: Network Protocol	Upper Layer Protocol (PDU), Association State Machine, DIMSE-C, Compression Codecs	✅ Complete
Phase 3: Core Services	Storage SCP/SCU, File Storage, Index Database, Query/Retrieve, Logging, Monitoring	✅ Complete
Phase 4: Advanced Services	REST API, DICOMweb, AI Integration, Client Module, Cloud Storage, Print Management, Security, Workflow, Annotation/Viewer	✅ Complete

Test Coverage: 1,980+ tests passing across 141+ test files |

For detailed feature lists per phase, see Features.

---

Architecture

┌──────────────────────────────────────────────────────────────────────┐
│                            PACS System                               │
├──────────────────────────────────────────────────────────────────────┤
│  ┌──────────┐ ┌──────────┐ ┌─────────┐ ┌──────────┐ ┌───────────┐  │
│  │ REST API │ │ DICOMweb │ │ Web UI  │ │ AI Svc   │ │ Workflow  │  │
│  │ (Crow)   │ │ WADO/STOW│ │ (React) │ │Connector │ │ Scheduler │  │
│  └────┬─────┘ └────┬─────┘ └────┬────┘ └────┬─────┘ └─────┬─────┘  │
│       └─────────────┼───────────┼───────────┼──────────────┘        │
│  ┌──────────────────▼───────────▼───────────▼────────────────────┐  │
│  │  Services (Storage/Query/Retrieve/Worklist/MPPS/Commit/Print) │  │
│  └──────────────────────────────┬────────────────────────────────┘  │
│  ┌──────────────────────────────▼────────────────────────────────┐  │
│  │  Network (PDU/Association/DIMSE) + Security (RBAC/TLS/Anon)   │  │
│  └──────────────────────────────┬────────────────────────────────┘  │
│  ┌──────────────────────────────▼────────────────────────────────┐  │
│  │  Core (Tag/Element/Dataset/File) + Encoding (VR/Codecs/SIMD)  │  │
│  └──────────────────────────────┬────────────────────────────────┘  │
│  ┌─────────────┐  ┌─────────────┴──────────┐  ┌─────────────────┐  │
│  │  Storage    │  │  Client Module         │  │  Monitoring     │  │
│  │  (DB/File/  │  │  (Job/Route/Sync/      │  │  (Health/       │  │
│  │   S3/Azure) │  │   Prefetch/RemoteNode) │  │   Metrics)      │  │
│  └──────┬──────┘  └────────────────────────┘  └─────────────────┘  │
├─────────┼────────────────────────────────────────────────────────────┤
│         │             Integration Adapters                           │
│  container │ network │ thread │ logger │ monitoring                  │
├─────────┼────────────────────────────────────────────────────────────┤
│         │              kcenon Ecosystem                               │
│  common_system │ container_system │ thread_system │ network_system   │
│  logger_system │ monitoring_system │ database_system (opt)           │
└──────────────────────────────────────────────────────────────────────┘

---

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
Storage Commitment	1.2.840.10008.1.20.1	✅ Complete
NM Storage	1.2.840.10008.5.1.4.1.1.20	✅ Complete
PET Storage	1.2.840.10008.5.1.4.1.1.128	✅ Complete
RT Storage	1.2.840.10008.5.1.4.1.1.481.x	✅ Complete
SR Storage	1.2.840.10008.5.1.4.1.1.88.x	✅ Complete
SEG Storage	1.2.840.10008.5.1.4.1.1.66.4	✅ Complete
MG Storage	1.2.840.10008.5.1.4.1.1.1.2.x	✅ Complete
CR Storage	1.2.840.10008.5.1.4.1.1.1	✅ Complete
SC Storage	1.2.840.10008.5.1.4.1.1.7	✅ Complete
Basic Grayscale Print	1.2.840.10008.5.1.1.9	✅ Complete
Basic Color Print	1.2.840.10008.5.1.1.18	✅ Complete
Printer	1.2.840.10008.5.1.1.16	✅ Complete

Transfer Syntax Support

Transfer Syntax	UID	Status
Implicit VR Little Endian	1.2.840.10008.1.2	✅ Complete
Explicit VR Little Endian	1.2.840.10008.1.2.1	✅ Complete
Explicit VR Big Endian	1.2.840.10008.1.2.2	✅ Complete
JPEG Baseline (Process 1)	1.2.840.10008.1.2.4.50	✅ Complete
JPEG Lossless (Process 14)	1.2.840.10008.1.2.4.70	✅ Complete
JPEG 2000 Lossless	1.2.840.10008.1.2.4.90	✅ Complete
JPEG 2000 Lossy	1.2.840.10008.1.2.4.91	✅ Complete
JPEG-LS Lossless	1.2.840.10008.1.2.4.80	✅ Complete
JPEG-LS Near-Lossless	1.2.840.10008.1.2.4.81	✅ Complete
RLE Lossless	1.2.840.10008.1.2.5	✅ Complete

For the full DICOM Conformance Statement, see DICOM Conformance Statement.

---

vcpkg Features

vcpkg install kcenon-pacs-system[feature1,feature2,...]

Feature	Default	Description	Pulls In	Prerequisites
aws	off	AWS S3 integration for cloud-based PACS storage	aws-sdk-cpp (S3)	--
azure	off	Azure Blob storage integration for cloud-based PACS storage	azure-storage-blobs-cpp	--
codecs	off	Image compression codecs (JPEG, JPEG 2000, HTJ2K, JPEG-LS, PNG)	libjpeg-turbo, openjpeg, charls, openjph, libpng	--
rest-api	off	DICOMweb REST API via Crow HTTP framework	crow	--
ssl	off	TLS/SSL support for secure DICOM associations	openssl	--
storage	off	SQLite3-based PACS storage and indexing	sqlite3	--
testing	off	Unit tests and benchmarks	gtest, benchmark	--

Feature Selection Guidance

• Minimal install: vcpkg install kcenon-pacs-system
• Production with TLS: vcpkg install kcenon-pacs-system[storage,ssl]
• Full imaging pipeline: vcpkg install kcenon-pacs-system[storage,codecs,ssl,rest-api]
• Cloud deployment (AWS): vcpkg install kcenon-pacs-system[storage,codecs,ssl,aws,rest-api]

---

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: 1,980+ tests passing across 141+ test files (Core, Encoding, Network, Services, Storage, Security, Web, Workflow, Client, AI, Monitoring, Integration)

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

Installation via vcpkg

vcpkg install kcenon-pacs-system

In your CMakeLists.txt:

find_package(pacs_system CONFIG REQUIRED)
target_link_libraries(your_target PRIVATE kcenon::pacs_system)

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);

---

CLI Tools & Examples

The project includes 32 example applications. Build them with:

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

Tool Summary

Category	Tool	Description
File Utilities	dcm_dump	Inspect DICOM file metadata
	dcm_info	Display DICOM file summary
	dcm_modify	Modify DICOM tags (dcmtk-compatible)
	dcm_conv	Convert Transfer Syntax
	dcm_anonymize	De-identify DICOM files (PS3.15)
	dcm_dir	Create/manage DICOMDIR (PS3.10)
	dcm_to_json	Convert DICOM to JSON (PS3.18)
	json_to_dcm	Convert JSON to DICOM (PS3.18)
	dcm_to_xml	Convert DICOM to XML (PS3.19)
	xml_to_dcm	Convert XML to DICOM (PS3.19)
	img_to_dcm	Convert JPEG images to DICOM
	dcm_extract	Extract pixel data to image formats
	db_browser	Browse PACS index database
Network	echo_scu / echo_scp	DICOM connectivity verification
	secure_dicom	TLS-secured DICOM Echo SCU/SCP
	store_scu / store_scp	DICOM Storage (C-STORE)
	query_scu	Query client (C-FIND)
	find_scu	dcmtk-compatible C-FIND SCU
	retrieve_scu	Retrieve client (C-MOVE/C-GET)
	move_scu	dcmtk-compatible C-MOVE SCU
	get_scu	dcmtk-compatible C-GET SCU
	print_scu	Print Management client (PS3.4 Annex H)
Servers	qr_scp	Query/Retrieve SCP (C-FIND/C-MOVE/C-GET)
	worklist_scu / worklist_scp	Modality Worklist (MWL)
	mpps_scu / mpps_scp	Modality Performed Procedure Step
	pacs_server	Full PACS server with configuration
Testing	integration_tests	End-to-end workflow tests

Quick Examples

Verify DICOM connectivity:

./build/bin/echo_scu localhost 11112

Send a DICOM file:

./build/bin/store_scu localhost 11112 image.dcm

Query studies by patient name:

./build/bin/query_scu localhost 11112 PACS_SCP --level STUDY --patient-name "DOE^*"

Inspect a DICOM file:

./build/bin/dcm_dump image.dcm --format json

For complete CLI documentation with all options, see CLI Reference.

---

Ecosystem Dependencies

Ecosystem Dependency Map

graph TD
    A[common_system] --> B[thread_system]
    A --> C[container_system]
    B --> D[logger_system]
    B --> E[monitoring_system]
    D --> F[database_system]
    E --> F
    F --> G[network_system]
    G --> H[pacs_system]

    style H fill:#f9f,stroke:#333,stroke-width:3px

Loading

Ecosystem reference: common_system — Tier 0: Result<T>, IExecutor, event bus container_system — Tier 1: DICOM data serialization thread_system — Tier 1: Thread pool (via network_system) logger_system — Tier 2: Logging infrastructure (via network_system) monitoring_system — Tier 3: Metrics and observability (optional) network_system — Tier 4: TCP/TLS transport for DICOM database_system — Tier 3: Database abstraction (optional)

For the complete IEC 62304 SOUP register with versions, licenses, and safety classifications, see docs/SOUP.md.

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

Module	Location	Description
Core	include/pacs/core/	DICOM tags, elements, datasets, Part 10 file I/O, tag dictionary
Encoding	include/pacs/encoding/	VR types, transfer syntaxes, compression codecs (JPEG, JP2K, JPLS, RLE)
Network	include/pacs/network/	PDU encoding/decoding, association state machine, DIMSE protocol
Services	include/pacs/services/	SCP/SCU implementations, SOP class registry, IOD validators
Storage	include/pacs/storage/	File storage, SQLite indexing, cloud storage (S3/Azure), HSM
Security	include/pacs/security/	RBAC, anonymization (PS3.15), digital signatures, TLS
Monitoring	include/pacs/monitoring/	Health checks, Prometheus metrics
Web	include/pacs/web/	REST API (Crow), DICOMweb (WADO/STOW/QIDO)
Client	include/pacs/client/	Job, routing, sync, prefetch, remote node management
Workflow	include/pacs/workflow/	Auto prefetch, task scheduler, study lock manager
AI	include/pacs/ai/	AI service connector, result handler (SR/SEG)
Integration	include/pacs/integration/	Ecosystem adapters (container, network, thread, logger, monitoring)

pacs_system/
├── include/pacs/         # Public headers (222 files)
├── src/                  # Source implementations (148 files)
├── tests/                # Test suites (141+ files, 1,980+ tests)
├── examples/             # Example applications (32 apps)
├── docs/                 # Documentation (57 files)
└── CMakeLists.txt        # Build configuration (v0.2.0)

For the full file-level directory tree, see Project Structure.

---

C++20 Module Support

PACS System provides C++20 module support as an alternative to the header-based interface.

Requirements for Modules

• CMake 3.28+
• Clang 16+, GCC 14+, or MSVC 2022 17.4+
• common_system, container_system, network_system with module support

Building with Modules

cmake -B build -DPACS_BUILD_MODULES=ON
cmake --build build

Using Modules

import kcenon.pacs;

int main() {
    // Use PACS components directly
    auto server = kcenon::pacs::create_scp_server();
    server->start();
}

Module Structure

Module	Contents
kcenon.pacs	Primary module (imports all partitions)
kcenon.pacs:core	Core DICOM data structures and utilities
kcenon.pacs:network	DICOM network protocol (DIMSE)
kcenon.pacs:storage	DICOM file storage and retrieval
kcenon.pacs:encoding	Transfer syntax and codec support
kcenon.pacs:services	DICOM service implementations (C-STORE, C-FIND, etc.)
kcenon.pacs:security	TLS and authentication
kcenon.pacs:web	DICOMweb REST API
kcenon.pacs:workflow	Workflow management

Note: C++20 modules are experimental. The header-based interface remains the primary API.

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
• 🖥️ CLI Reference - CLI tools documentation
• 📄 DICOM Conformance Statement - DICOM conformance
• 🏥 IHE Integration Statement - IHE profile conformance (XDS-I.b, AIRA, PIR)
• 🚀 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
• 🏛️ ADR-002 - PACS storage boundary and repository-set contract
• ⚡ Performance Guide - Database optimization tips
• 📦 Dependency Manifest - Canonical native, fetched, internal, and frontend provenance
• ⚖️ Third-Party Licenses - Product distribution license inventory

---

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	282 files
Source Files	204 files
Header LOC	~76800 lines
Source LOC	~110100 lines
Example LOC	~35700 lines
Test LOC	~85300 lines
Total LOC	~307800 lines
Test Files	180 files
Test Cases	2584+ tests
Example Programs	32 apps
Documentation	83 markdown files
CI/CD Workflows	14 workflows
Version	0.1.0
Last Updated	2026-04-09

---

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 🍀☀🌕🌥 🌊