Migrating a PACS involves much more than installing a new platform and moving images from one server to another. It requires preserving patients’ diagnostic histories, maintaining the relationship between studies and reports, rebuilding integrations, and ensuring that the radiology service can continue operating throughout the transition.
A poorly planned migration can result in incomplete studies, duplicate patients, hard-to-locate prior exams, performance issues, or workflow interruptions. By contrast, when the process is organized in stages, the institution can modernize its infrastructure without compromising access to clinical information.
A PACS migration is a technological, clinical, and operational project. Its success is measured not only by the number of files transferred, but also by the ability of professionals to correctly find, open, compare, and use studies in the new environment.
A PACS migration is the process of transferring medical images, studies, metadata, and other content from one picture archiving and communication system to a new platform.
It may be carried out when an institution replaces an obsolete PACS, changes providers, modernizes its infrastructure, adopts cloud storage, or needs to unify operations across multiple sites.
Depending on the existing architecture, the project may involve:
The objective is to ensure that the transferred information retains its clinical usefulness. Confirming that a file reached its destination is not enough: the study must be complete, linked to the correct patient, and available within the workflow.
To understand the role this platform plays in a healthcare institution, also read What Is a PACS in Radiology and How Does It Transform Your Institution’s Operations?.
The volume and complexity of medical images continue to grow. Infrastructure that worked properly several years ago may no longer meet the current needs of the service.
The need to migrate often arises when the PACS shows one or more of the following signs:
In some organizations, the problem is not concentrated in a single failure. The PACS continues to operate, but the workflow depends on increasingly complex processes: manual searches, multiple access points, additional servers, or constant intervention by the technology team.
In this context, continuing to expand the existing infrastructure may solve isolated difficulties, but it does not necessarily address the underlying cause of the problem.
Migration makes it possible to review the entire environment and determine which technology the institution truly needs for the coming years.
>> Is your current PACS limiting the growth of your service? Talk to a Pixeon specialist and assess the needs of your radiology operation.
A medical image is not an isolated file. It is part of a structure that identifies the patient, organizes the exam, and maintains the relationship among all the elements that make up a study.
In simplified terms, the information can be organized into different levels:
A computed tomography study, for example, may contain different series and hundreds or thousands of instances. If part of this structure is lost or linked to incorrect data, the study may reach the new system but still be clinically unusable.
In addition, some content associated with interpretation is not always stored in the same repository. Reports may be stored on another platform, measurements may depend on the viewer, and certain documents may be retained outside the DICOM format.
For this reason, a migration must answer at least four questions:
The project should not begin by moving files. It should begin by understanding the ecosystem to be migrated.
The scope depends on each institution. However, the assessment should consider much more than the primary diagnostic images.
These include objects generated by modalities such as radiography, computed tomography, magnetic resonance imaging, ultrasound, mammography, nuclear medicine, and other diagnostic areas.
These are the data used to identify, search, and classify information, such as:
Consistency across these fields is essential to prevent a person from appearing more than once or a study from being linked to the wrong patient.
Reports may be:
Before migration, the institution must define the official source of the report and how its link to the images will be preserved.
The archive may also contain:
Not all of these objects are transferred, interpreted, or displayed in the same way. Their compatibility must be verified before assuming that they will be available in the new PACS.
The following should also be reviewed:
Depending on the existing architecture, these connections may involve an RIS, an HIS, an electronic health record, or proprietary or third-party platforms. Mentioning them as part of the institutional ecosystem does not mean that they are included in Pixeon’s portfolio available in Latin America.
Not necessarily.
Moving the entire archive may appear to be the simplest option from a clinical perspective because it consolidates prior exams in a single environment. However, it can also increase the duration, cost, and complexity of the project.
Before making a decision, the institution should analyze:
For example, recent exams are generally accessed more frequently than exams performed many years ago. An institution could prioritize their initial transfer and temporarily retain the remainder of the history in an accessible archive.
However, a selective decision requires an answer to one fundamental question:
Prior exams that have not been migrated should not become hidden, depend on informal searches, or require excessively slow processes.
There is no universal strategy. The decision must be adapted to the volume of information, the infrastructure, the timeline, and the required level of continuity.
| Strategy | How does it work? | Main advantage | Main challenge |
| Full migration | The entire historical archive is moved to the new environment. | Consolidates the information on a single platform. | May require more time, capacity, and validation. |
| Selective migration | Specific time periods, sites, modalities, or study types are moved. | Reduces the initial volume of the project. | Requires the non-migrated information to remain accessible. |
| On-demand migration | Prior exams are transferred when they are accessed again. | Prioritizes the studies that are actually used. | May cause delays during the first retrieval. |
| Hybrid migration | Combines an initial load with gradual or on-demand transfer. | Balances access, time, and resources. | Requires coordination of multiple retrieval routes. |
It may be suitable when the archive is manageable, the institution needs to fully retire the previous system, or prior exams are accessed frequently.
Its main challenge is that the larger the volume, the more rigorous the inventory, transfer, and validation processes must be.
It allows rules to be defined, such as:
The criteria should be clinical and operational, not solely technical.
In this approach, historical studies initially remain in their repository and are transferred when they are requested again.
It can reduce the volume of the first stage, but it requires a reliable connection between the previous archive and the new environment.
It usually combines:
This option allows the project to move forward without waiting for the entire archive to be transferred, provided that clear controls identify which information is located in each environment.
Each project requires its own methodology, but ten stages can help reduce risks.
The migration should not be left exclusively to the technology department.
The team may include representatives from:
Each area identifies different risks. Technology may confirm that the images arrived, while a radiologist may detect missing series or determine that comparison with prior studies is not working as expected.
The institution must also define who makes decisions when an exception arises.
Before starting, the institution must agree on:
The objectives must be verifiable.
“Moving the archive” is too general. A more useful success criterion might be:
Authorized users can find, open, compare, and use the migrated studies in the new PACS, together with their related data and reports, within the defined operational timeframes.
The institution needs to know what it has before deciding how to move it.
The inventory should include:
Measuring only terabytes is not enough.
Two archives of the same size may require very different processes. One may consist of a few large studies, while the other may contain millions of small objects distributed across numerous series and patients.
Systems used for many years often accumulate inconsistencies.
These may include:
These situations must be identified before or during the process. Migrating disorganized information without reconciliation rules may simply move the problem to the new platform.
DICOM makes it possible to produce, store, query, send, retrieve, and display medical images and other related objects. However, the fact that two systems claim DICOM compatibility does not mean that all their functions are automatically interoperable.
Each implementation may support different:
For this reason, the DICOM Conformance Statements of both the source and destination systems must be reviewed.
These statements help explain which capabilities each platform supports, but they do not replace real-world testing.
With the inventory and quality assessment complete, the institution can decide:
The strategy must also account for new studies generated while the historical migration is still in progress.
The transfer must be sized according to:
A migration that consumes the full capacity of the network may affect other institutional operations. For this reason, it may be necessary to establish limits, transfer windows, or specific routes.
Before moving the entire archive, it is advisable to select a representative sample.
The pilot should include:
The test makes it possible to identify compatibility, performance, and quality issues while they can still be corrected without affecting the entire project.
During execution, each item should be classified as:
There should not be a generic “error” category without additional information.
Reconciliation compares the source with the destination, identifies differences, and makes it possible to determine how each case should be handled.
Once the transfer meets the agreed criteria, the operational transition stage begins.
This phase may include:
The migration does not end on the go-live date. The institution must observe how the new environment performs during the first few weeks and correct any points of friction.
>> A secure migration begins before the first study is transferred. Request an assessment to learn how to prepare the evolution of your radiology environment.
A complete inventory helps size the project and prevents new information sources from being discovered after the migration is already underway.
In addition to the space used, it is advisable to measure:
These levels allow more precise comparisons after the transfer.
All sources that generate or send images must be identified:
Equipment that is used infrequently should also be included.
Knowing the current size is not enough. The institution must estimate how quickly the archive is growing and how much capacity it will need in the future.
This information helps distinguish between:
It is necessary to document:
A simple workflow diagram may reveal dependencies that were not visible when analyzing only the PACS.
The quality of the archive largely determines the complexity of the migration.
The same person may appear under different identifiers because of system changes, registration errors, or differences between sites.
Without a reconciliation rule, prior exams may be split across different records.
Names may vary, but identifiers are the elements systems use to maintain relationships.
The institution should pay particular attention to:
Unique identifiers should not be modified without a controlled strategy because other objects may reference them.
A study may appear in the inventory even when series or images are missing. For this reason, the study count must be supplemented by a review of its structure.
Some objects may exist in the database but no longer be available in physical storage. Others may have become corrupted over time.
These cases must be documented transparently. A migration cannot automatically recover information that was already damaged at the source.
Some manufacturers use private fields to store specific information. The new system may not interpret these fields in the same way.
Before removing or transforming them, the institution must assess whether they contain data required for visualization or the clinical workflow.
If the report is stored outside the PACS, the institution must define how to identify its corresponding study.
The date or patient name may not be sufficient. The link must be based on consistent identifiers and a clearly defined official source.
DICOM is the international standard for medical images and related information. Its scope includes production, storage, query, retrieval, processing, and visualization.
During a migration, certain concepts are especially relevant.
This is the logical identifier of a DICOM application within the network.
The modalities, source PACS, routers, and new system must be configured to recognize and communicate with one another correctly.
This service makes it possible to query what information exists in another DICOM application.
It can be used to search for patients, studies, series, or instances, depending on the supported model.
This service makes it possible to request that an application send specific objects to another DICOM destination.
The application receiving the request initiates the operations required to transfer the identified objects.
This is the service used to send and store DICOM objects in another system.
During a migration, it may be used to transfer objects from the previous PACS to the new environment.
This document describes the capabilities an implementation declares that it supports.
Reviewing it makes it possible to compare:
However, a statement alone does not guarantee that two systems will work correctly in every situation. It must be complemented by interoperability testing and real-world cases.
When identifiers change or duplicate records exist, the institution must define how to update the information without losing relationships.
This task requires coordination with the systems that manage demographic data and with institutional policies.
The transfer method depends on the archive size, connectivity, available time, and system capacity.
Studies are sent electronically from the source to the destination.
It may be suitable when:
It must be monitored to prevent it from competing with daily operations.
For higher-volume projects, reserved network capacity may be used to reduce interference and improve predictability.
For very large archives, the institution may consider a controlled export to storage devices followed by upload at the destination.
This method requires strict security, chain-of-custody, encryption, and validation protocols.
It may combine different mechanisms:
The decision should not be based solely on theoretical speed. Retries, failures, processing capacity, and validation must also be considered.
An institution cannot stop providing care for weeks while it waits for the historical transfer to be completed.
Continuity must be designed from the outset.
The cutover date establishes when the new PACS begins receiving production studies.
This does not mean that the previous system must be shut down immediately.
For a controlled period, the previous system may remain available for consultation of prior exams that have not yet been migrated.
Its use should be monitored to identify which information is still needed.
During the transition, both systems may coexist:
The period should be long enough to reduce risks, but not so long that it creates an indefinite dual operation.
It should establish:
Users need to know:
A lack of communication can cause errors even when the infrastructure is functioning correctly.
Validation must be quantitative, technical, clinical, and operational.
It compares the source and destination based on:
A different count does not necessarily mean that the entire project failed. It may result from duplicates, agreed exclusions, or invalid records. The difference must be explainable.
It confirms that:
The team that will use the system must participate.
Professionals should verify:
It must be confirmed that the following work correctly:
It is not always possible to review every image manually. Therefore, the sample must be representative and risk-based.
It may include:
Documented conditions must be in place before the previous system is deactivated.
For example:
The decision should not depend solely on the statement that “the migration is complete.”
If the institution does not agree on what must be migrated, it will be impossible to determine whether the project was successful.
Size does not reflect the number of studies, objects, or relationships that must be processed.
Historical issues often emerge during the transfer. Quality must be assessed beforehand.
The images may be complete and still lose part of their clinical context if the report is not available.
Videos, PDFs, documents, captures, measurements, or other objects may require different handling.
Two systems may show the same number of studies even when some series or images are incomplete.
The initial test makes it possible to correct issues before they affect the entire archive.
The source system should remain available until validation is complete and the agreed exceptions have been resolved.
The new PACS may store information correctly, but the workflow will remain interrupted if modalities or external platforms cannot communicate with it.
Speed, latency, and everyday network usage affect the actual transfer time.
A technically correct migration may fail operationally if professionals cannot find the information or do not understand the new workflow.
Damaged, incompatible, or excluded studies must be recorded and assigned a defined treatment.
Moving unnecessary or duplicate information can increase complexity without improving care.
A migration is an opportunity to correct problems, not merely move them to a new platform.
DICOM cloud storage may be part of a modernization strategy, but it should not be confused with the complete migration process.
It can help to:
However, several concepts must be distinguished.
This refers to where images and other objects are retained.
It manages functions such as the reception, organization, visualization, query, and distribution of medical images.
It maintains copies intended to recover information after specific incidents.
It defines how systems, information, and operations will be restored after a serious disruption.
Using cloud storage does not automatically mean that a complete backup or recovery plan is in place. Each strategy requires its own objectives and controls.
Aurora Drive is Pixeon’s solution for complementing the radiology ecosystem through DICOM image storage in the cloud. It supports the growth of the historical archive and the application of storage policies without requiring constant expansion of local infrastructure.
To explore this topic in greater depth, read:
Replacing the PACS should not mean reproducing exactly the same workflow on a new platform.
The institution can use the project as an opportunity to review how the following stages are connected:
When these stages are fragmented, delays, duplicate tasks, loss of traceability, and difficulty accessing the patient’s complete context may arise.
A connected operation allows the image, history, and report to move through the same workflow.
Pixeon Aurora PACS makes it possible to manage the capture, visualization, interpretation, and distribution of medical images.
Its features include:
Pixeon’s Reporting Center is a cloud-based platform integrated with the PACS for creating, managing, and delivering radiology reports.
It offers features such as:
Aurora Drive complements the environment with scalable DICOM image storage in the cloud.
The combination of these solutions connects:
image visualization and management → report production → historical archive storage
The appropriate architecture will depend on the volume, modalities, sites, connectivity, and workflows of each institution.
The migration must begin with an assessment of these needs rather than an isolated technology decision.
To understand how these stages are connected, read How to Connect PACS, Reporting, and Storage to Improve the Radiology Workflow.
>> Discover how Pixeon Aurora PACS, the Reporting Center, and Aurora Drive can help your institution evolve toward a more integrated, scalable radiology operation that is prepared for growth. Request a demonstration with our specialists.
Before starting, verify whether your institution can answer the following questions:
If several of these answers are still unclear, the institution needs to deepen its planning before beginning the transfer.
Migrating a PACS means moving much more than images.
The process must preserve the diagnostic history, maintain relationships among the data, rebuild integrations, and ensure that professionals can continue working throughout the change.
When migration is approached solely as a transfer task, essential aspects may be overlooked, including archive quality, access to prior exams, reports, interoperability, and the user experience.
By contrast, a planned strategy makes it possible to:
The final objective should not be simply to install another PACS.
It should be to build an environment in which images, reports, and the historical archive are better connected, available, and prepared to support the institution’s evolution.
It is the process of moving medical images, studies, metadata, reports, and other content from one PACS to a new platform. The objective is to preserve the radiology history and keep clinical information available during and after the change.
An institution may consider a change when the current PACS has performance problems, integration difficulties, storage limitations, dependence on obsolete infrastructure, or insufficient capacity to support growth in studies, users, and sites.
No. In addition to the images, the relationships among patients, studies, series, instances, identifiers, and reports must be preserved. Integrations, permissions, and workflows must also be rebuilt.
Not necessarily. The institution may choose a full, selective, on-demand, or hybrid migration. The decision depends on volume, access frequency, clinical needs, archive quality, and retention policies.
Yes. A phased strategy may include preloading prior exams, incremental transfer, parallel operation, and a planned cutover date. A contingency plan must also be in place to resolve incidents.
It depends on the number of studies, total volume, data quality, connectivity, modalities, integrations, and the selected strategy. Each project requires a specific assessment.
Validation must compare patients, studies, series, instances, reports, and documents between the source and destination. Clinical and functional tests must also be performed across different modalities, sites, and time periods.
The institution must determine where they are stored, their format, and how they are linked to the images. It must also define the official source of the report and whether it will be transferred or remain available through an integration.
No. DICOM facilitates information exchange, but the capabilities of each implementation may vary. The Conformance Statements must be compared, and real-world interoperability tests must be performed.
They must be identified, documented, and handled according to previously defined rules. The migration can also be used to reconcile duplicates and improve archive quality, although it cannot recover information that was already damaged at the source.
No. It can be carried out to another local environment, a hybrid architecture, or a cloud-based solution. The appropriate option depends on the infrastructure, connectivity, institutional policies, and project objectives.
Not necessarily. The PACS manages the reception, organization, visualization, and distribution of images, while a DICOM cloud storage solution can complement the environment with scalable capacity for retaining the historical archive.
After validating the transferred information, confirming the integrations, resolving critical pending items, and verifying that users can access the necessary prior exams. There must also be a strategy for any content that was not migrated.
Representatives from radiology, technology, management, information security, and clinical users should participate, together with the providers responsible for the source, destination, and integrations.
To explore PACS operation, report production, DICOM storage, and radiology workflow integration in greater depth, read the following content:
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