Congratulations! You've managed to setup your PACS. However, after a day or two, you realize that the ride is not as smooth as you had imagined. For instance, the modality successfully sends a study belonging to "Ndaziona Munthune" to storage archive but the doctor can't retrieve it on the viewing station. The study can't be traced on the archive.

Before we tackle the above problem, here's a quick reminder: PACS is just one of the many systems found in a hospital. In an ideal paperless hospital environment, you'd have an EHR/EMR, LIMS, HRMS, RIS (sometimes embedded in EHR), PACS, etc. Together, these systems form an integrated Hospital Information System (HIS). The EHR is usually the entry-point and is responsible for assigning unique patient IDs. All the other patient systems get the IDs from this system. In a hybrid hospital environment, however, it is not uncommon for patients to be assigned IDs randomly. In certain instances, patients get IDs which were previously assigned to other patients.

Back to our scenario where the doctor can't find patient named "Ndaziona Munthune" in the system despite the radiographer testifying that the transfer was successful, it is possible that the patient was assigned someone else's ID. If the storage archive already has another patient with that ID, then Ndaziona's images will be filed under the previous patient. The DICOM standard prioritizes patient ID than names. Try to edit the patient on the modality then resend the study to archive.

Second scenario. There was prolonged power outage and modalities can't send images to the archive after power recovery. Check if the storage server is powered on. If not, check UPS (battery backup). Some UPS units do not recover properly after prolonged power loss. REMEDY: Press and hold UPS power button for at least 10 seconds until it shuts down completely. Power on the UPS again by momentarily pressing the power button. The server should turn on automatically (storage servers are configured to automatically power on after power loss). Check network activity on network switches (blinking green or amber lights). Check at the back of modality console computer, is there network activity where the cable is attached?  Try to restart all the workstations in radiology (modality consoles, storage server). These issues may also occur in the absence of power loss. Nothing seems to work? This is where the ICT/Networking/PACS_Admin guy comes in.