Synology NAS PACS Setup (Orthanc) – Local & Remote Access Guide

This guide provides a concise, step-by-step overview for setting up a fully functional PACS system using Orthanc on a Synology NAS, with both local (LAN) and secure remote (VPN) access. It is designed as a practical reference for rapid deployment and troubleshooting, covering Docker installation, VPN configuration, and integration with DICOM viewers such as RadiAnt and Horos. The aim is to ensure a stable, reproducible, and secure workflow for storing, accessing, and retrieving imaging studies across devices and locations.

1. Install Orthanc PACS on Synology NAS (Docker)

a. Create container

• Open Container Manager → Create Container
• Use an Orthanc image (e.g. jodogne/orthanc or orthancteam/orthanc or equivalent)

b. Configure ports

• 4242 → DICOM
• 8042 → Web interface

c. Configure volumes (IMPORTANT)

Map persistent storage (Synology folder → Container path) :

/volume1/docker/orthanc/config   → /etc/orthanc
/volume1/docker/orthanc/db       → /var/lib/orthanc/db
/volume1/docker/orthanc/import   → /var/lib/orthanc/import   (optional)

👉 Without this, data will be lost on container restart. – Enable Auto-restart

2. Configure Orthanc

Edit orthanc.json inside the config folder (edit username / password to use).

Basic required settings:

• AE Title: ORTHANC
• DICOM Port: 4242
• Enable remote access if needed
• Define DICOM peers (optional but recommended)

👉 See full template at the end.

3. Verify Orthanc is running

Open in browser:

http://<NAS-IP>:8042

Example:

http://192.168.1.13:8042

✔ If this does not open → container/network issue

4. Configure VPN (Remote Access)

a. Enable VPN Server on Synology

• Install VPN Server package
• Enable OpenVPN

b. Key settings

• Virtual IP range (e.g. 10.8.0.0)
• ✔ Enable: “Allow clients to access server LAN”

👉 This is critical for accessing PACS remotely

c. Export configuration

• Export .ovpn file

d. Router configuration

• Port forward: UDP 1194 → NAS local IP

e. Synology Firewall

Allow:

• UDP 1194 (VPN)
• TCP 4242 (DICOM)
• TCP 8042 (Web)

5. Configure PACS Viewer (RadiAnt / Horos)

a. Local Network (LAN)

Configure DICOM node:

• AE Title: ORTHANC
• IP Address: 192.168.1.13 (NAS)
• Port: 4242
• Retrieve Protocol: C-GET (simpler setup)

Optional:

• Calling AE Title:
  • RADIANT (PC)
  • HOROS (Mac)

b. Remote Access (via VPN)

Step 1 – Install OpenVPN client

• PC: OpenVPN GUI
• Mac: Tunnelblick / OpenVPN

Step 2 – Import config

• Load exported .ovpn

Step 3 – Edit config file

Replace:

remote YOUR_IP 1194

With:

• Public IP OR
• DDNS (recommended), e.g.:

remote mynas.synology.me 1194

Step 4 – Connect to VPN

After connection:

Test:

ping 192.168.1.13

✔ If reachable → OK

Step 5 – Use SAME PACS settings as local

⚠️ Important:
Use internal NAS IP, NOT public IP

• IP: 192.168.1.13
• Port: 4242
• AE Title: ORTHANC

6. (Optional but Recommended) DDNS Setup

Synology:

• Control Panel → External Access → DDNS

Example:

mynas.synology.me

👉 Avoids changing IP manually

7. DICOM Modalities (Optional but Recommended)

In orthanc.json, define known clients:

• RadiAnt (PC)
• Horos (Mac)

This improves:

• C-MOVE functionality
• Communication stability

8. Quick Troubleshooting Checklist

✔ Web UI opens (:8042)
✔ VPN connects successfully
✔ Can ping NAS (192.168.1.13)
✔ DICOM send works
✔ Query/Retrieve works

⚙️ Orthanc orthanc.json Template (Clean & Practical)

You can adapt this to your setup:

{
  "Name": "Orthanc",
  "StorageDirectory": "/var/lib/orthanc/db",

  "DicomAet": "ORTHANC",
  "DicomPort": 4242,

  "RemoteAccessAllowed": true,

  "AuthenticationEnabled": true,
  "RegisteredUsers": {
    "admin": "your_password"
  },

  "DicomModalities": {
    "RADIANT": [ "RADIANT", "192.168.1.100", 104 ],
    "HOROS": [ "HOROS", "192.168.1.101", 11112 ]
  },

  "HttpServerEnabled": true,
  "HttpPort": 8042,

  "OrthancExplorerEnabled": true,

  "DefaultEncoding": "Latin1",

  "DicomScpTimeout": 30,
  "DicomScuTimeout": 10,

  "MaximumStorageSize": 0,
  "MaximumPatientCount": 0
}

🧠 Final Notes (from experience)

• C-GET works easier than C-MOVE (no routing issues)
• VPN is the safest way → avoid exposing DICOM port publicly
• Always test:
  • Local first
  • Then VPN
• Keep a backup of orthanc.json

Get a printable PDF (1-page cheat sheet)

More details at NAS Storage for Horos