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SymmetricareRoutes

What is Routes?

Symmetricare Routes is a DICOM and HL7 router for imaging departments. It receives images from modalities and other systems, decides where each one goes, changes what needs changing on the way, and delivers it, reliably, to every destination that should have it.

It is free: no licence fees, no per-study pricing, and no limits on how many nodes, sources or destinations you use.

Who uses it

Section titled “Who uses it”
  • PACS administrators who need images to reach the PACS, the archive and the reading radiologists’ systems, without configuring every modality for every destination.
  • Imaging IT teams connecting several sites, a cloud archive, or an outside reading group.
  • Integration engineers who need HL7 orders to become a modality worklist, and HL7 messages to reach the systems around the PACS.
  • AI and research teams who need studies sent to an AI service, de-identified, and the results brought back.

What it does

Section titled “What it does”
Area In short
Routing Route by sender, by header values or by script; send to several destinations, with failover, load balancing, priorities, schedules and bandwidth limits.
Changing studies Edit tags on the way in and out, map patient IDs between domains, and de-identify for destinations that must not see identities.
Getting studies back Query and retrieve from archives through the router, and fetch a patient’s relevant prior studies when a new one arrives.
Worklist and HL7 Build a modality worklist from HL7 orders, take MPPS from modalities, send order status back to the RIS, and route and transform HL7 messages.
DICOMweb and cloud Send to cloud services over STOW-RS (Azure, Google Cloud and others), and accept uploads and searches from web viewers.
AI workflows Track studies sent to AI services, restore the identity of their results, and route results on.
Patient reconciliation Hold studies whose patient does not match their order until someone fixes, splits, merges or releases them.
Reliability Queues on disk, retries, dead letters, storage commitment, several nodes and several central servers.
Oversight A live monitoring grid, a searchable history of every instance and message, alerts, an audit log, usage reports and Prometheus metrics.

How it is built

Section titled “How it is built”

Routes has two parts: one central service, which holds the configuration, serves the web console and keeps the history, and any number of nodes, which do the routing. Nodes need nothing configured locally except the central service’s address and an enrollment key; everything else is set once in the console and reaches every node within seconds. How it works explains the pieces.

Where it runs

Section titled “Where it runs”
  • Windows Server, with MSI installers that need no .NET runtime.
  • Linux, as systemd services.
  • Docker, with images for the central service and the node and a compose file to run them with PostgreSQL.

The central service stores its data in SQL Server or PostgreSQL. PostgreSQL is free and has no database size limit, so a complete Routes installation needs no paid software at all.

Next steps

Section titled “Next steps”