Orthanc deployment with S3 compatibility using AWS CDK

This project aims to help you provision a ready-to-use Orthanc cluster on Amazon ECS Fargate, with support for the official S3 plugin. The infrastructure code is using the AWS Cloud Development Kit(AWS CDK).

Orthanc is an open-source DICOM server, which is designed to improve the DICOM flows in hospitals and to support research about the automated analysis of medical images. Orthanc lets its users focus on the content of the DICOM files, hiding the complexity of the DICOM format and of the DICOM protocol.

Solution Overview

Features

• "One-click" serverless deployment
• Infrastructure is split into 3 interdependent stacks (Networking, Storage, ECS Fargate Cluster)
• Configurable DICOM image storage (EFS or S3)
• DICOM indexes are stored in RDS Postgres11
• Configurable S3 Object Lifecycle policies to support archival scenarios
• Secure HTTPS connection using Cloudfront
• Automatic build of the official S3 plugin using a multi-stage Docker image file

Changelog

• 05.09.2024
  • Upgraded CDK to latest available version
  • Switched to the official Orthanc docker image (that includes the precompiled S3 plugin)
  • Upgraded PostgreSQL version to v15
• 06.12.2022
  • Upgraded to CDK v2
  • Applied a patch to the s3 object storage plugin in the dockerfile to fix the broken build

Project structure

├── infrastructure                      # Infrastructure code via CDK(Typescript).
│   ├── bin                             # CDK App - Deploys the stacks  
│   ├── lib                             #
|   |   ├── local-image-official-s3     # Orthanc Multi-stage Dockerfile 
|   |   ├── network-stack.ts            # Basic VPC config & network stack
|   |   ├── orthanc-stack.ts            # ECS Fargate Service & CDN stack
|   |   ├── storage-stack.ts            # Storage (EFS/S3) & DB stack
└── ...

The cdk.json file inside infrastructure directory tells the CDK Toolkit how to execute your app.

Prerequisites

• Make sure you have AWS CLI installed and configured with the aws account you want to use.
• Make sure you have AWS CDK installed and configured with the aws account you want to use.
• Ensure you have docker installed and is up and running locally.

Getting started

Configuration

The CDK project comes with a set of feature flags to enable/disable certain features. You can find them in /infrastructure/bin/cdk.ts.

const ENABLE_DICOM_S3_STORAGE = true;     // If true, use an S3 bucket as the DICOM image store, otherwise use EFS
const ACCESS_LOGS_BUCKET_ARN = "";        // If provided, enables ALB access logs using the specified bucket ARN
const ENABLE_MULTI_AZ = false;            // If true, uses multi-AZ deployment for RDS and ECS
const ENABLE_RDS_BACKUP = false;          // If true, enables automatic backup for RDS
const ENABLE_VPC_FLOW_LOGS = false;       // If true, enables VPC flow logs to CloudWatch

Deployment

• Change directory to where infrastructure code lives.

    cd infrastructure

• Restore NPM packages for the project

    npm install

• Bootstrap your AWS account as it's required for the automated Docker image build and deployment

    cdk bootstrap aws://{ACCOUNT_ID}/{REGION}

• Synthesize the cdk stack to emits the synthesized CloudFormation template. Set up will make sure to build and package the lambda functions residing in software directory.

    cdk synth

• Deploy the CDK application

    cdk deploy --all

Logging into Orthanc

The CDK project automatically generates a password for the admin user on deployment.

You can run the following command to retrieve the Orthanc credentials:

# Retieve Secret name from Cloudformation
aws cloudformation describe-stacks --stack-name "Orthanc-ECSStack" | jq -r '.Stacks | .[] | .Outputs[] | select(.OutputKey | test(".*OrthancCredentialsName.*")) | .OutputValue'

# Retrieve Secret from Secrets Manager
# (replace {ORTHANC_SECRET_NAME} with the name of your secret)
aws secretsmanager get-secret-value --secret-id {ORTHANC_SECRET_NAME} | jq -r ".SecretString"

You can run the following command to get the login page URL:

aws cloudformation describe-stacks --stack-name  "Orthanc-ECSStack" | jq -r '.Stacks | .[] | .Outputs[] | select(.OutputKey | test(".*OrthancURL.*")) | .OutputValue'  

Useful commands

• cdk ls list all stacks in the app
• cdk synth emits the synthesized CloudFormation template
• cdk deploy deploy this stack to your default AWS account/region
• cdk diff compare deployed stack with current state
• cdk docs open CDK documentation

Enjoy!

Security considerations

TLS termination

The solution supports TLS termination at the CloudFront distribution. However, the Application Load Balancer is listening on HTTP - which should be changed to an HTTPS listener (with a signed certificate) for production workloads. Please refer to the documentation for guidance.

Database Secret rotation

By default this solution does NOT rotate the database credentials. The credentials can be rotated manually, followed by a restart of the Fargate tasks.

Found an issue? Anything to add?

See CONTRIBUTING for more information.

License

This library is licensed under the MIT-0 License. See the LICENSE file.