Radiology & Diagnostic Imaging (PACS)

This section describes the complete imaging and radiological reporting workflows in the Radiology Dashboard, including modality worklists, DICOM PACS image integration, structured report authoring, critical urgency flagging, and diagnostic sign-off.

1. System Architecture & 2-Step Verification

The Radiology module connects three integrated components:

Moana EHR Core: Manages CPOE imaging orders, worklists, and report display.
Orthanc PACS Server: Stores DICOM images received directly via DICOM C-STORE from hospital imaging modalities (X-Ray, CT, Ultrasound, MRI).
OHIF Viewer: Browser-based diagnostic DICOM viewer accessed directly from within Moana.

graph LR
    A[Doctor: Order in EHR] --> B[Modality: DICOM C-STORE to PACS]
    B --> C[Radiologist: OHIF Review]
    C --> D[Radiologist: 3-Part Report Written]
    D --> E[Radiologist: Release Report]
    E --> F[Doctor: Acknowledge Report]

⚡

IMPORTANT:

Two-Step Verification Model The Radiologist's report release and the Doctor's acknowledgment are two separate, independently timestamped actions. This two-step model is intentional and represents the strongest verification pattern in the system.

2. Radiologist Workflow — Step by Step

Access Radiology Worklist: Open Radiology → Radiology Worklist. Locate the imaging order.
Identity Verification: Confirm patient identity: verify the Moana Patient ID on the order against the DICOM study metadata.
Mark as Performed: When the study is completed (imaging equipment sends images to Orthanc via DICOM C-STORE; automatic sync takes ~60 seconds), open the order and click Mark as Performed.
Link Study & Launch Viewer: Link the Orthanc PACS study to the order and open the OHIF Viewer to inspect the images.

OHIF Integrated Browser-Based DICOM PACS Image Viewer🔍 Click to enlarge

Historical Comparison: Review previous imaging studies for the same patient when available — side-by-side historical comparison is built directly into the OHIF viewer.
Author 3-Part Structured Report: The system enforces that all three sections are mandatory before a report can be released:
- (1) Findings: Detailed, objective anatomical description of visible features.
- (2) Impression: Concise clinical interpretation and primary diagnosis.
- (3) Recommendations: Suggested further management or follow-up imaging.
Critical Finding Protocol: If you identify a life-threatening or acute urgent finding, call the ordering clinician directly BEFORE releasing the report. Document this call within the report text ("Critical finding communicated verbally to Dr. [Name] at [Time]").
Release Report: Click Release Report. The ordering doctor receives an immediate notification.
Doctor Acknowledgment: The ordering doctor reviews and acknowledges the report in their EHR view. Both timestamps are permanently recorded in the audit trail.

Structured Radiology Report Editor with Findings and Impression🔍 Click to enlarge

3. Common Issues & Troubleshooting in Radiology

Issue / Symptom	Probable Cause	Mandatory Corrective Action
Study not visible in OHIF viewer	~60-second sync delay after DICOM C-STORE transmission	Wait 60–90 seconds; refresh the Radiology Worklist.
Study appears unlabelled / unmatched	DICOM sent directly from scanner without accession number	Manually link the orphan study to the order in the worklist.
Report cannot be released	One or more of Findings / Impression / Recommendations is empty	Complete all three required sections before attempting release.
Doctor has not acknowledged critical report	Notification missed or clinician in surgery/ward round	Contact the ordering clinician directly; escalate to department head if unreachable.

1. System Architecture & 2-Step Verification​

2. Radiologist Workflow — Step by Step​

3. Common Issues & Troubleshooting in Radiology​

1. System Architecture & 2-Step Verification

2. Radiologist Workflow — Step by Step

3. Common Issues & Troubleshooting in Radiology