Solo-build case study · Radiology imaging
A complete radiology imaging chain, built solo in 33 commits: an offline-first edge gateway that scanners push into, a multi-tenant cloud archive speaking pure DICOMweb, a GPU-adaptive browser viewer with MPR and 3D volume rendering, and an AI agent that reads scans by driving that viewer itself. This page explains the system in plain language, then quotes the code.
Nine steps from a modality in a clinic to a signed report in the archive. These are the real protocols, files and endpoints from the code.
A modality pushes the study to the clinic's LAN Orthanc over classic DIMSE. Scanning never depends on the internet.
C-STORE :4242The gateway holds the study until it is stable: fully received from the scanner and no longer changing.
gateway/orthancA standard-library-only Python sidecar pushes stable studies to the cloud over STOW-RS, retries forever offline, and deletes locally only after the cloud confirms.
gateway/forwarder.pyEach gateway authenticates with its own per-center credential; every accepted study is attributed to its center and audited.
/api/gateway/studiesPixels live in the DICOM archive keyed by SOP Instance UID. Identity, tenancy, reports and audit live in Postgres.
orthanc + studies_indexRadiologists see only their center's studies, filtered by patient, modality and date. Unindexed studies are denied by default.
PostgresWorklistIndexThe viewer streams slices through a credential-injecting proxy that allowlists the path shape. The archive is never exposed to the browser.
/api/dicomweb/[...path]Optionally, an AI reader drives the same viewer: montages of slices, Hounsfield measurements over a drawn ROI, then a structured draft report.
view_slices · measure_huOnly radiologists and admins sign. A signed report can never be edited again, and every signature lands in the append-only audit log.
reports/[studyUid]/signBrowser upload joins the chain at the archive: drag DICOM files or a whole zip onto the home page; files are detected by the DICM magic bytes at offset 128, never by extension. Studies open from the worklist or straight from the device.
Four excerpts quoted from the repository, with paths, so the claims on this page stay checkable rather than atmospheric.
"""Store-and-forward relay for the edge gateway.
Watches the gateway Orthanc for *stable* studies (fully
received from the scanner) and pushes each one to the
cloud archive via STOW-RS ...
- internet down -> studies accumulate on the gateway
disk and retry forever
Standard library only - the sidecar container is a bare
python:alpine."""/* Portability discipline: this class speaks ONLY * standard DICOMweb - STOW-RS to store, QIDO-RS to * search, WADO-RS to retrieve - never a vendor's * proprietary REST API. Swapping Orthanc for AWS * HealthImaging / Google or Azure DICOM services * should be a config + auth change, not a code * change. */
/* abridged: tools carry deliberately NO execute handlers - the loop stops after each model turn and the presentation layer executes the calls against the in-browser viewer, where the pixel data lives */ view_slices up to 9 slices, labeled montage, CT presets measure_hu mean HU over a circular ROI, drawn back submit_report structured draft, called exactly once
export const DEFAULT_AGENTIC_MODEL_ID = 'claude-opus-4-8'; // On a head-CT ground-truth case, Flash still // confabulated a mass. Opus 4.8 gave the most // calibrated, clinically sound report - so it // is the default.
Technical depth
Exact architecture, the reliability mechanisms, and the decision record with tradeoffs stated, closing with the boundary of what this page does and does not claim.
Route files are razor-thin shells; real UI lives in presentation components, hooks and the Cornerstone lib layer. The Zustand store mirrors transient viewport state only: no business logic, no DICOM data.
presentation/components · hooks · lib/cornerstone18 use-cases orchestrate upload, retrieval, reporting and identity. Route handlers act as composition roots, wiring concrete implementations through factories.
application/usecases · factories as composition rootsStudy assembly grouped by series and instance UIDs, modality window presets, agent tool names, and the repository and AI ports all live framework-free. The AI is typed in the domain before any provider exists.
domain/services · repositories (interfaces)The DICOMweb repository, four Postgres stores (identity, reports, worklist, audit), a scrypt password hasher, Anthropic and Google adapters, and the Python edge gateway implement the ports.
infrastructure/repositories · services · identityStore-and-forward with stable-study detection: the gateway pushes only fully received studies, retries forever through connectivity loss, deduplicates by SOP Instance UID, and deletes its local copy only after the cloud archive confirms.
STOW-RS · retry foreverThe browser reaches the archive only through a read-only proxy that injects server-held credentials, validates every path segment against an allowlist regex, checks tenancy per request, and caches privately.
Credential-injecting proxyCenter users see only their center's studies, deny-by-default for anything unindexed. Every sensitive action lands in an append-only audit log. Signing is restricted to radiologists and admins, and a signed report can never be edited again.
audit_log · signed reportsRaw Postgres with no ORM. The schema self-migrates on first use under a Postgres advisory lock, so a fresh deploy needs no migration step and concurrent instances cannot race. Passwords use memory-hard scrypt; session tokens are stored only as hashes.
Advisory-lock migrate · scryptA one-time WebGL2 probe reads each device's true texture ceiling and measures the largest float32 3D texture it can actually sample, fixing black volume renders on older iPhones. Pixel ratio is capped on 3x phones, a decode worker is reserved so scrolling never starves, and slices decimate to a GPU memory budget.
Device profile · WebGL2A 16-step ceiling with wrap-up forced at step 13, image history pruned to the last two tool steps, over-call traps written into the protocol prompt, a mandatory verification pass, and a required first impression line: AI-proposed draft, radiologist verification required.
Bounded loop · protocol promptThirty-three commits, June 8 to July 9, 2026. The viewer came first; the platform arrived in a five-phase finale.
Clean-architecture scaffold, Cornerstone3D v4 stack viewer, upload with DICM magic-byte detection, and the first four AI report features.
Structured ICRI reporting, a mobile-first PWA, synchronized multi-screen scrolling, and the 3D workspace: MPR crosshairs, volume rendering, slab projections.
The AI stops captioning and starts driving: view_slices and measure_hu executed by the viewer, live HU under the cursor, quad layouts, 2D MPR.
Black 3D renders on iPhones: an on-device GPU diagnostics overlay, measuring the real float32 texture ceiling, demoting LINEAR to NEAREST filtering, and a mobile chrome redesign.
Orthanc archive over pure DICOMweb, the edge gateway for scanner connectivity, the archive worklist, and platform auth: centers, roles, signed reports, audit.