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Sheppyb 10-15-2012 01:21 PM

Future NAS and Medical / Radiology PACS system
First time poster. If the post needs to be redirected to another forum or to a different site, please make suggestions. Since I am looking for hardware and software recommendations, I am only posting in General. Also, I am unsure on what distro of Linux or BSD.

At this time I have used the following sites for reference:

  • Network Attached Storage (NAS) / Server
    • Video and audio streaming (Transcoding would be a plus [I do understand this would significantly increase the required CPU])
    • Photo Server with the ability to do light editing
    • Document server
    • P2P
  • PACS Workstation. My wife is a Radiologist (physician/M.D). She would like to do teleradiology from home for additional income. This would require a PACS medical workstation. Typically a DICOM server (database + web server) supported in both Windows and various Linux and BSD distros, with Windows most likely being the OS used. Nothing too powerful, just viewing images with an integrated voice dictation system. I would like to setup the system so that she could access the PACS in her 'Reading Room' via a thin client (TBD) hooked up to a radiology-quality screen for viewing.
  • Remove computer noise from the work areas. Put the setup in a ventilated A/C'ed closet in an unused bedroom.
  • Access NAS via various smart phones, computers, Smart TVs (w/Plex).
  • Access PACS via thin client.
  • Ability to set up several VMs for testing / educational purposes.
  • Cost - I would like to keep server costs under $3000 USD.

Potential Solutions
  • One consolidated server running a distribution of Linux or BSD with several VMs running FreeNAS (or an equivalent) and Windows 7 home/pro/ult for the PACS.
  • Separate DIY servers for each task. One running a version of Linux or BSD for the NAS and the other running Windows of some type either via a VM or natively.
  • A pre-built NAS (e.g. Synology, QNAP) and a Windows/Linux/BSD DIY server or workstation for the PACS.
  • A DIY NAS and a pre-built PACS.
  • Both pre-built servers and/or workstation for the PACS.

  1. What would you recommend for a solution for H/W and S/W.
    Notional H/W for a single, consolidated server:
    1 x Rosewill RSV-L4411 Black Metal 4U Rackmount Server Chassis, 12 SATA Hot-swap Drives $249.99 1 x SUPERMICRO MBD-X9SCM-F-O LGA 1155 Intel C204 Micro ATX Intel Xeon E3 Server Motherboard $204.99
    1 x SeaSonic X series SS-400FL Active PFC F3 400W ATX12V Fanless 80 PLUS GOLD Certified Modular $159.99
    1 x Intel Xeon E3-1265L V2 Ivy Bridge 2.5GHz (3.5GHz Turbo) LGA 1155 45W Quad-Core Server Processor $329.99
    1 x Kingston 16GB (4 x 4GB) 240-Pin DDR3 SDRAM DDR3 1333 ECC Registered Server Memory DR x8 1.35V Intel Model KVR13LR9D8K4/16I $124.99
    6 x Western Digital Red WD30EFRX 3TB IntelliPower SATA 6.0Gb/s 3.5" Internal Hard Drive $209.99 x 6 $1,259.94
    Subtotal: $2,264.89
  2. If doing the consolidated server, would you recommend using server-grade components or consumer? I was trying to go with as powerful a processor as I could with the lowest TDP, in addition to using lower voltage ram (though at this point I am not even sure if the mobo I have listed can go below 1.65v). That ended up being the Xenon E3 with 45W TDP. Pretty amazing processor, even has hyper threading so 4 cores / 8 threads. I have read reviews that describe the WD Red HDDs as consumer drives with enterprise firmware. These are not recommended, it seems, for larger than 6+ HDD arrays.
  3. I just realized the server mobo does not have integrated audio for the PACS voice dictation system. How are Linux / BSD distributions now on drivers for PCI-E audio cards? Audio via VM?
  4. If using a pre-build NAS, I am looking at the Synology DS1512+. I have read favorable reviews of DSM 4.1+ with DS Video. However, the DIY server isn’t that much more than a fully populated pre-built server. You can also get a substantially more powerful processor that also happened to be energy efficient. The DS 1512+ runs on an Intel Atom 2700 (2c/4T) at 2.13GHz. (
    Also, according to a Plex forums document ( ), anything not an I3+ may only transcode some low-bit 720p media. The pre-builts that happen to have a I3 or better are also near $4K+.
  5. What distribution of Linux or BSD?
    I have taken the Linux quiz at
    and it recommends OpenSuSE 100% Mandriva 100% Ubuntu 100% Kubuntu 95% Linux Mint 95% Fedora 90% Debian 90%. As far as BSD, at first I was leaning towards FreeNAS 8 and installing any additional packages necessary to get VMware ESXi to work for the PACS.
  6. What would I lose from not installing FreeBSD vice FreeNAS? Problems with the FreeNAS split? (i.e. NAS4Free) FreeNAS seems to be well supported right now, and the new version re-introduced plug-ins.
  7. Any recommendations for storage on a consolidated server running VMs for the NAS and PACS? Use ZFS? Separate ZFS pools for each, if applicable? Use a H/W raid controller if not using ZFS? I am leaning towards ZFS if it is available in the distro I use. I would probably choose raidz2. I have read that for storage greater than 6 TB using ZFS, it is recommended to use 1GB ram per TB storage. That adds u quickly! The notional build initially has 16GB ram.

I have been out of the UNIX/Linux world (never used any BSD distros) since undergraduate / engineering school in the early 1990s doing thermodynamic, fluid dynamic and finite element modeling. Please be gentle!



jefro 10-15-2012 03:32 PM

I'd be scared to death to recommend any advice for medical use. If this data is needed to save a life you really run into some legal and ethical issues. The minute you said stuff like roswell I got scared.

Just pay the big companies price for medical products.

Sheppyb 10-16-2012 08:27 AM

Thanks for the reply jefro.

The server would be a home NAS first. I think you are misunderstanding the medical part. The PACS workstation portion is pretty simple in concept. Flavors would depend on the host facility, maybe a VPN into a service so you can view images and have an integrated voice dictation system. Looking at typical horsepower requirements on these, they are small. The important part is the display, these usually run $3-6K new and that is already taken care of.

With regards to the server chasis, this can easily be swapped out for a Supermicro, Ark, iStar, or Chenbro case.

Any thoughts on the concept? Rec's on H/W or S/W builds?


joebpa 10-16-2012 10:47 AM

After reading your post I simply put got scared. I think it was mentioned earlier by a previous GURU about the security aspects, but it cannot be stated harsher than that. HIPPA regulations are very strict. I would become a GURU at HIPPA, not to mention all the other forms of documentation relating to computer technology SARBANES Ox... etc.. These should help you stay legal. Now for you info: The assumption is that this will be a home office, I say again assumption. If so you will need some form of security at the local BLDG. Medical records must be kept under lock and key. Refer to the regulations. Now onward to the technical side; I have found a FREE virtual server option that provides the same capabilities as ESXI servers.. It is called proxmox. I have used that at home and at the college I teach at. It provides a very sound system with a lot of similarities to ESXI. FreeNAS is the option for storage which has I-SCSI as well as many other forms of technologies built in. With all your computer needs being housed on one physical box I have to ask where/what is your backup solution? Off-site storage? Is your web presence for LAN or internet activity? If you are out on the internet you have just opened another ball of wax. I would find the nearest hospital near you and talk directly to the tech department and ask questions. They will have the most current info on rules and options for technology. I am not a medical field person, but a techie. Marine Corps career and been teaching for years. I hope I have given you some food for thought. Always remember Security is everyone’s responsibility...

To Quote "Fox Mulder" "Trust no one"
MSM/IT, MIS/IT, (MBA still working on it)

Sheppyb 10-16-2012 02:44 PM

Thanks Joebpa for the post.

With regards to your post about security. Both my wife and I are well trained in the aspects of HIPAA. Also, no physical medical records will ever be produced. In regards to the IT aspects of HIPAA, I use the following for reference:

For general IT / Cybersecurity and Communications, I would maintain a security level at or above general DISA, FIPS, NIST standards, as required. As the DISA gold disk is phased out, I will have access to capable folks that will be able to perform Host Based Security System and red team pen testing on the system.

Backup - for personal files we currently use Mozy pro. That is more than enough at this time for everything personal that is not video. I do not intend to backup any video with online services and will rely on the original physical media.
Backup for PACS. Since there are well over 100+ variations of PACS being used, it would really depend on the institution being supported remotely. Yes, the PACS would require access to the internet. Best case scenario is their PACS connection would use an SSL VPN or secure Web access. Use of muli-layer authentication /tokens/CAC/PKI/etc would be specific to their service. If their security policies and implementation of security is lacking, we would not pursue a working relationship with them.

We do have access to several PACS administrators at major academic medical institutions and have been in contact with one. As stated before, there are many hundreds of versions of PACS in the wild. Their knowledge while helpful, is limited to their service. Best case scenario for the PACS is simply a secure web portal that requires some form of two-layer authentication. Real nice as nothing would ever be stored locally and I could concentrate on the primary reason why I started the thread in the first place - setting up a nice NAS for the house.

Thanks for the recommendation on proxmox. I'll take a look at it later using Ubuntu.



jefro 10-16-2012 03:40 PM

You got me on that suggestion. Not sure how proxmox or esxi could possibly help you.

Freenas is a very good solution for software based NAS. It has almost every option one could want. Since it is based on BSD is tends to have options and settings for stability. If you want you can use the advanced features like Iscsi and ZFS. Saying that though doesn't negate the consideration of a real enterprise level NAS. They are sold and backed up by warranty and service.

As for the medial part my statement still stands. Does this use have any connection with life or living or heath of patients? If so then pay the $10K for a professional system.

Sheppyb 10-16-2012 05:51 PM

Thanks again for the input jefro and joebpa.

The proxmox or esxi would allow for the PACS software to run as a VM on our server. The 5 systems I just looked up run on Windows xp/vista/7 64-bit and all have relatively low system requirements and use a single, double, or triple medical diagnostic display setup. From initial research, PACS are pretty much the same service that have their own GUI skin on top. The backend PAC servers at the hospitals seem to use either MySQL or PostgreSQL. The clients typically use Windows with their respective image viewer. The only thing real special about a radiologists' technology setup is their displays. The desktops are your run on the mill Dells and HPs.

Radiology technicians do nearly all the imaging. A diagnostic radiologist (the doctor) sits in a dark room all day looking at x-rays, CTs, MRIs, ultrasounds etc. and talking into a microphone that either has voice recognition or is recorded for a transcriptionist to later type down. If they are lucky, it is all done digitally (i.e. no films) and with voice recognition so they can see on the screen what they say as they speak. Going fully digital has enabled literally thousands of these diagnostic radiologists to work from home or at satellite offices in the United States. Some US board certified radiologists read from outside of the country (e.g. Australia where during their daytime they can read US films during our night).

jefro, you are correct and I could pay $10K for someone to set up 2-3 screens attached to a sub-$1000 desktop that will most likely only use SSL VPN or Web. I am only looking into integrating the PACS capability into the NAS / home server project I am about to start. Technically, this should be rather easy to do. As joebpa has stated, HIPAA compliance and information assurance would be very important. I totally agree and this would be taken care with the personal resources at my disposal; to include several ISSO, ISSM and testers that used to work for me in addition to the PACS administrators we know on the east and west coasts of the US.

Any other recommendations on S/W or H/W. I will probably end up using Ubuntu or FreeBSD. FreeNAS may pose a problem if I do integrate the PACS capability into the proposed server. There is a lot of information on running FreeNAS within a VM, but not with running VMs from within FreeNAS. I'll look at proxmox, maybe virtualbox too. I also need to do some research on multi-display thin clients that would work with this type of setup.



jefro 10-16-2012 08:02 PM

OK, I get the proxmox deal.

Don't get too caught up in vm versus a real computer. For most situations treat them as if they were real computers.

The only oddity is how each type of VM uses nic's or usb or virtual routers and such.

Freenas is more of a complete solution for NAS replacement. Almost any mainstream distro could do most of it's tasks. Minus the zfs unless you went with Debian and the bsd kernel.

onebuck 10-17-2012 09:46 AM

Member Response

60 OS Replacements for Storage Software

Datamation: Find top open source backup, NAS, RAID, and other storage-related software. Read more
Look at:


NAS 43. FreeNAS
Replaces EMC Isilon products, IPDATA appliances, Netgear ReadyNAS
Based on FreeBSD, FreeNAS allows users to create a network-attached storage (NAS) device that will allow them to share files with other systems on the network, regardless of what operating system those systems use. It includes ZFS and incorporates both file and volume management capabilities. Operating System: FreeBSD.
44. NAS4Free
Replaces EMC Isilon products, IPDATA appliances, Netgear ReadyNAS
A fork of FreeNAS, this project also creates a BSD-based NAS system. Key features include ZFS, Software RAID (0, 1, 5), disk encryption and reporting. Operating System: FreeBSD.
45. Openfiler
Replaces EMC Isilon products, IPDATA appliances, Netgear ReadyNAS
This storage management solution combines some of the characteristics of NAS with some of the characteristics of SAN devices. Use it with any industry-standard server to create your own storage device. Commercial support and plug-ins are available. Operating System: Linux.

46. OpenSMT

Replaces EMC Isilon products, IPDATA appliances, Netgear ReadyNAS

Like Openfiler, OpenSMT also allows users to turn standard system hardware into a dedicated storage device with some NAS features and some SAN features. It uses the ZFS filesystem and includes a convenient Web GUI. Operating System: OpenSolaris.

47. Turnkey Linux File Server

Replaces EMC Isilon products, IPDATA appliances, Netgear ReadyNAS

Turnkey offers a wide variety of Linux-based software that you can use to create your own appliance. The File Server version creates a simple NAS device. Operating System: Linux.
Plus look at the '51. OwnCloud' or other online storage below from;

Online Data Storage


Replaces Box, DropBox, ADrive, Amazon Cloud Drive, Google Drive

This open source collaboration suite allows users to share, organize, search and collaboratively work on files. In addition to the open source download, it's also available as a paid enterprise appliance or on an SaaS basis. Operating System: Server requires Linux; client versions are OS independent.

49. FTPbox

Replaces Box, DropBox, ADrive, Amazon Cloud Drive, Google Drive

FTPbox makes it easy to sync your files across multiple devices or share your files with others. It can use SFTP or FTPS protocol for secure file transmission. Operating System: Windows.

50. iFolder

Replaces Box, DropBox, ADrive, Amazon Cloud Drive, Google Drive

Built with syncing, backup and file sharing in mind, iFolder works much like DropBox. Simple save your files locally as usually, and iFolder will update them on your server and the other workstations you use. It was originally founded by Novell and is now managed by Kablink. Operating System: Linux, OS X.

51. OwnCloud

Replaces Box, DropBox, ADrive, Amazon Cloud Drive, Google Drive

As the name suggests, OwnCloud makes it possible to create your own cloud for storing music, photos and all other kinds of files. Supported business and enterprise versions are available. Operating System: Windows, Linux, OS X.

52. SparkleShare

Replaces Box, DropBox, ADrive, Amazon Cloud Drive, Google Drive

Because it was built for developers, this online storage solution includes version control software (Git, to be specific). It automatically syncs all files with the hosts, and it allows you to set up multiple projects with different hosts. Operating System: Windows, Linux, OS X.

53. Syncany

Replaces Box, DropBox, ADrive, Amazon Cloud Drive, Google Drive

Syncany works with commercial online storage solutions like Amazon S3 or Google Storage, adding better synchronization functionality (akin to DropBox) and improved security. It encrypts files locally, making it more feasible to use an online service to store sensitive data. Operating System: Linux (Windows and OS X versions planned.)
Open source software for Linux,Windows or OSX.


joebpa 10-17-2012 11:21 AM

Don't forget your backup UPS. The system is sounding better as we go. I think FreeNAS seems to be the option for you. Also, the Proxmox should provide all available options to support your PACS. If you do run VM's is there a finite number of VM's or will this adjust as time. The hardware seems appropriate for what I understand about your plan.
I did look over something - if you are just using VM's to access the PACS there is a very small Linux version with minimal options, but has full access to the internet. It is called Dam Small Linux (DSL). I am not sure if this would fit any solution you have, but figured I would mention it for its very small footprint. Also I have never planned the security side of DSL. Its quick fast and easy. You may want a quick poke around to see. Depending on the amount of workload the system has to do there is a more capable Ubuntu version called Ubuntu Ultimate Edition 3.2 it has many many bells and whistles. Avoid version 3.4 for and 3.5 for now because I have found a few issues. You surely don't need issues in this scenario. After reading over your posting again I noticed that something comes to mind. Since you are building a robust server to handle all your functions and providing a solid powerful system with RAID and additional features the speed should be more than enough because the data that is accessed through the web will be completely at the mercy of your ISP connection. I doubt you will see a lag in performance on the system.

I actually prefer Debian as my Linux choice

JaseP 10-17-2012 03:14 PM

Radiology/PACS,... have a look at;

It's a Windows thing. I don't know about the transcription end, and whether something like Dragon Naturally Speaking would meet compliance regs.

Keep this system as separate for the rest as possible. You don't want a malpractice suit against the Mrs. to pull the whole family's property in because of something you did.

For router/DHCP,... You need something that can handle throughput. You also may want something that you can replace/upgrade the firmware,... Look at projects like DD-WRT, OpenWRT, etc. for compatible products.

NAS,... I'd go with some of the others' recommendations and say Debian. Debian is for people getting back into the *nix world as the best compromise between power, flexibility and ease of use.

Sheppyb 10-18-2012 08:49 AM

OneBuck - great article link, definitely bookmarked! Best part is, the article was just published so all the info is relevant. I did all right in my own haphazard research. Several I had not hear of and will check out -- OpenSMT, Turnkey for NAS, and OwnCloud with respect to online storage. Also the command line and tutorial links will come in handy.

joepba - good call on the UPS. The h/w I had previously listed were placeholders just so I could get a rough order magnitude on cost. CPU and mobo seem solid. I'll have to make sure the ram is compatible with the mobo. That sku isn't listed at Microserver, so I'll look at other forums for its compatibility or other good 16GB modules. Same with the psu on chassis and ATX psu compatibility. I wanted to go modular to keep cable management and air flow under control. The chassis is still the biggest unknown for h/w. I wanted 6 or more hot swap bays, a user installed modular psu (so I can select one that does't sound like a leaf blower), and user replaceable fans (primarily for sound reduction, maybe install a fan controller, larger fans would be a plus too so I could run at lower rpms). If I could get away with a 2u option that would be great. I have access to a 12u rack on casters that I will probably snag up. I would love to avoid loud 40mm/60mm fans. The h/w wouldn't be going into a standard server room with multiple racks where ping, pipe, power and cooling can be a balancing act. Also, h/w raid it still TBD - may just use ZFS if the distro I use is compatible.

I'll also see if I can get some LiveCDs going on DSL and UUE.

JaseP - thanks for the info on freepacs. I'll need something free to play around with to get a multi-display thin client with voice recognition working on a vm. Wife currently uses Talk and Powerscribe. Each PACS she works with integrates the voice recognition into their service a little differently. Dragon does have their medical version too. In the end, the PACS software used will already be selected by the group/hospital/etc. I'll just need to make sure that it will work on our hardware and OS either be a vm or natively.

For the router, I am a former user of openWRT. I had upgraded to wireless N and have been using a product not compatible with WRT but still has a good QoS setup for the LAN. I will probably upgrade at some point to a router with a more powerful cpu and to ac, or at least dual band N600. The PACS system would be landline and could be optimized to have some sort of QoS priority.

Consolidated or separate systems is something I broached in the first post. Several options. The easiest of course if to have two separate systems (either DIY or pre-built). If it could be done legally, responsibly, securely, etc - I may be game for a consolidated system. The PACS side of things could be easily be separated into a low cpu power 1u enclosure with a simple storage setup for mirroring. This is brainstorming at this time.



onebuck 10-18-2012 09:44 AM

Member Response

Glad link was helpful.

Personally, I have done a lot of consulting, research while at the University. Bonding was sufficient for me at the time. Some work in the medical field that was covered by association with the College program and overall coverage by the University Insurance kept things from burdening me. I no longer contract consult because insurance, bonding are expensive individually. Plus, I am comfortable doing tasks when and if I want too. :)

You need to be very careful when doing work as a subcontractor or direct contract. Please consider contacting your provider or looking at forming a 'LLC'. Of course this will depend on the contract work, whether it is direct from your wife's office/employer rather than single element contracts or unilateral contracts for multiple parties.

Lawyers are necessary, protect your wife and yourself.

Sheppyb 10-18-2012 10:06 AM

onebuck - good info.

Already an S-corp with enough CPAs and Lawyers to create another Law and Order spin-off!

EDIT: I also have experience in contracts as a technical adviser and source selection authority ranging from $500K to $1B+.

onebuck 10-18-2012 10:48 AM

Member Response


Originally Posted by Sheppyb (Post 4809160)
onebuck - good info.

Already an S-corp with enough CPAs and Lawyers to create another Law and Order spin-off!

EDIT: I also have experience in contracts as a technical adviser and source selection authority ranging from $500K to $1B+.

Good, I hate to have someone fall into problems that could be prevented. Now, you might consider a 'screenplay'. :)

I thought 'S-corp' is for taxation to allow the corp to pass corp income, plus losses, deductions and credit through to the shareholders(which have several qualifying restrictions). Primarily to prevent double taxation on the 'S-corp by the federal government for the corp & shareholders.

I am not sure but insurance & bonding must be handled individually for each participant. Been awhile, just trying to remember all of this. Good reason to have the CPA & Lawyers.

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