PACS migration to Amazon AWS Cloud

The project aimed to migrate the "PACS" (Picture archiving and communication system) application to the AWS cloud. PACS is a market application developed by Sectra Medical and is used for the centralization of reports and diagnostic images produced by the various electro-medical equipment located in the 25 USI diagnostic centers, an application used daily by all medical staff. It is therefore one of the company's "core" systems with the need for high service continuity.

On the network level, the solution involved the use of a Meraki vMX instance to securely interface the VPC in AWS to the private offices of the various diagnostic centers that were already using Cisco Meraki technology. Since the PACS application runs on the Microsoft Windows operating system, the Windows domain on AWS (AWS Managed Microsoft AD) has been placed in trust with the on-premise domain.

Dedicated EC2 instances host the PACS service and the MS SQL Server database required by the application.

Given the large amount of image files managed by PACS (around 1TB per month with a growing trend), the solution saw the use of an AWS Storage File Gateway so that all files were reported to S3 Standard Tier, with an automated process for automatic movement to S3 Deep Archive for exams beyond a certain period.

The activity of moving the historical data (about 40 TB) was particularly complex and above all the configuration of the storage gateway for the permissions on the generated files and for the type of access that the PACS application performs on the archived files.