Radiology Management System
Secure multi-clinic radiology platform with DICOM image management, patient assignment, and role-based workflows.
Technology Stack
Overview
Dental radiology centres receive X-ray requests from multiple clinics and dentists. The traditional workflow: a clinic calls the radiology centre, the patient comes in, images are taken on DICOM equipment, and the dentist receives images via WhatsApp or a USB drive. There is no record-keeping, no access control, and no audit trail.
This client operates a radiology centre serving 12 dental clinics and 30+ dentists. They needed a system where dentists could log in and view only their patients' images, clinics could manage their patient assignments, and the radiology centre could track activity across all clients.
The result is a multi-tenant platform where every stakeholder has a precisely scoped role — and DICOM images are served through a secure Orthanc integration rather than shared as unencrypted files.
The Problem
No access control on medical images: X-ray images shared via WhatsApp could be forwarded to anyone. Patient data was not protected. HIPAA-equivalent (Indian medical data protection) compliance was impossible.
Manual patient assignment: When a patient arrived for imaging, the radiology staff had to call the referring dentist to confirm patient details. There was no digital record linking the patient to the requesting dentist.
No centralised reporting: The radiology centre had no visibility into volume by clinic, revenue by dentist, or equipment utilisation. Billing was handled verbally.
DICOM handling: Medical-grade dental X-rays are in DICOM format. Without a DICOM viewer integration, dentists couldn't view images in the browser — they needed proprietary viewer software.
The Solution
Role-Based Multi-Tenant Architecture:
Four distinct roles — Radiology Admin, Clinic Manager, Dentist, and Radiographer. Each role has precisely defined permissions. A dentist can only see patients assigned to them. A clinic manager sees all patients at their clinic. The radiology admin has full visibility.
Orthanc DICOM Integration:
Orthanc is an open-source DICOM server. I integrated the Laravel backend with Orthanc's REST API to store, retrieve, and stream DICOM files. The Filament interface shows DICOM images inline using a browser-based viewer (cornerstone.js embedded in a Filament custom page). Dentists view images in the browser without any software installation.
Patient Workflow:
The radiology staff creates a patient record and assigns it to the requesting dentist and clinic. When imaging is complete, DICOM files are uploaded to Orthanc through the admin panel. The dentist receives a notification and can immediately view images in their browser.
Activity Audit Trail:
Every access to patient records and images is logged with user, timestamp, and action. This satisfies audit requirements and gives the radiology centre full visibility.
Architecture
Laravel 11 + Filament 3:
Standard Laravel application with Spatie Laravel Permission for role management. Filament resources for Patient, Clinic, Dentist, and Imaging Study. Custom Filament page for the DICOM viewer embedding cornerstone.js.
Orthanc Integration:
The Laravel backend communicates with Orthanc via its REST API. DICOM files are streamed through the Laravel application (not served directly from Orthanc) so that authentication and access control are enforced for every image request.
Cornerstone.js DICOM Viewer:
Browser-based DICOM viewing without plugin requirements. Embedded within a Filament modal, supporting pan, zoom, window/level adjustment, and annotation.
Security:
All image requests pass through Laravel's authentication middleware. Signed URLs with expiry for image retrieval. No direct access to Orthanc from the browser.
Key Implementation Details
- Designed multi-tenant role system: Radiology Admin, Clinic Manager, Dentist, Radiographer
- Integrated Orthanc DICOM server via REST API for medical image storage and retrieval
- Built browser-based DICOM viewer using cornerstone.js embedded in Filament custom page
- Implemented secure image streaming through Laravel auth middleware (no direct Orthanc access)
- Built patient assignment workflow with clinic and dentist association
- Created comprehensive audit log for all patient record and image access events
- Implemented PWA for mobile access by radiology staff on tablets
- Built activity dashboard with volume by clinic, dentist, and imaging type
Screenshots
Business Impact
- Patient data now protected with role-based access — zero unauthorised sharing incidents since deployment
- Dentists access images in browser within 5 minutes of imaging completion, vs. next-day USB delivery previously
- Radiology centre gained monthly volume reports by clinic for the first time
- Clinic managers can track patient referrals and imaging history without calling the radiology centre
Key Engineering Challenge
DICOM is a complex medical imaging standard with multiple transfer syntaxes. Getting cornerstone.js to reliably render images from our Orthanc instance required understanding DICOM transfer syntax negotiation — particularly converting older JPEG 2000 encoded DICOMs that cornerstone.js couldn't natively decode. The solution was a server-side transcoding step via Orthanc's built-in transcoding API before serving images to the browser.