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 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.

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

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

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.

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
🚀 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

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	235 files
Source Files	160 files
Header LOC	~71,500 lines
Source LOC	~95,300 lines
Example LOC	~35,600 lines
Test LOC	~66,700 lines
Total LOC	~269,100 lines
Test Files	140 files
Test Cases	1977+ tests
Example Programs	32 apps
Documentation	59 markdown files
CI/CD Workflows	10 workflows
Version	0.1.0
Last Updated	2026-02-22

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 344 Commits
.github/workflows		.github/workflows
benchmarks		benchmarks
docs		docs
examples		examples
include/pacs		include/pacs
samples		samples
scripts		scripts
src		src
tests		tests
web		web
.gitignore		.gitignore
CMakeLists.txt		CMakeLists.txt
CMakePresets.json		CMakePresets.json
Doxyfile		Doxyfile
LICENSE		LICENSE
README.kr.md		README.kr.md
README.md		README.md
_config.yml		_config.yml
build.sh		build.sh
compile_commands.json		compile_commands.json

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PACS System

Overview

Table of Contents

Project Status

Architecture

DICOM Conformance

Supported SOP Classes

Transfer Syntax Support

Getting Started

Prerequisites

Build

Linux/macOS

Windows

Build Options

Windows Development Notes

CLI Tools & Examples

Tool Summary

Quick Examples

Ecosystem Dependencies

Project Structure

Documentation

Performance

Key Performance Metrics

Running Benchmarks

Code Statistics

Contributing

License

Contact

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