Configuring DICOM TLS

Starting with release 1.9.0, Orthanc supports the encryption of the DICOM protocol using DICOM TLS. This allows the secure exchange of medical images between different sites, even if using the DICOM protocol.


To enable DICOM TLS, each DICOM modality must have been assigned with a X.509 certificate. Obtaining such a certificate from a recognized certification authority is obviously out of the scope of the Orthanc project. Here is a simple command-line to generate a self-signed certificate using the OpenSSL command-line tools:

$ openssl req -x509 -nodes -days 365 -newkey rsa:2048 \
          -keyout orthanc.key -out orthanc.crt -subj "/C=BE/CN=localhost"

Obviously, you have adapt the arguments to your setup (notably the subj argument that generates a certificate for Belgium for the server whose DNS address is localhost). This command line will generate two files using the PEM file format: orthanc.crt is the newly-generated certificate, and orthanc.key contains the private key that protects the certificate. The orthanc.crt can be openly distributed, but orthanc.key must be kept secret (it should only be placed on the modality using the corresponding certificate).

Once orthanc.crt and orthanc.key have been generated, all the modalities that will be in touch with Orthanc (either as SCP or as SCU) through DICOM TLS must be identified, and their public certificates must be collected. All those certificates must be concatenated into a single file in order to tell Orthanc which modalities can be trusted.

Concretely, if one has collected a.crt, b.crt and c.crt as the certificates (in the PEM format) for trusted remote DICOM modalities, a trusted.crt file can be generated as follows:

$ cat a.crt b.crt c.crt > trusted.crt

Once the three files orthanc.crt, orthanc.key and trusted.crt are available, setting the following configuration options will enable DICOM TLS in Orthanc SCP:

  • DicomTlsEnabled must be set to true.
  • DicomTlsCertificate must be set to orthanc.crt.
  • DicomTlsPrivateKey must be set to orthanc.key (note that this private key must not be password-protected).
  • DicomTlsTrustedCertificates must be set to trusted.crt.

If Orthanc acts as a DICOM SCU against one remote DICOM modality, and if this remote modality is protected by DICOM TLS, the UseDicomTls field must be set to true in the definition of the modality in the configuration file of Orthanc (cf. the DicomModalities option). The file indicated by DicomTlsCertificate will be used to authentify Orthanc by the remote modality: This modality must thus include orthanc.crt in its list of trusted certificates.

Remark 1: Pay attention not to confuse the configuration options related to HTTPS encryption, with the options related to DICOM TLS. In Orthanc, HTTPS and DICOM TLS are not obliged to use the same encryption certificates.

Remark 2: Orthanc SCU and Orthanc SCP share the same set of trusted certificates.

Example using DCMTK

Let us generate one certificate for Orthanc, and one certificate for DCMTK:

$ openssl req -x509 -nodes -days 365 -newkey rsa:2048 \
          -keyout orthanc.key -out orthanc.crt -subj "/C=BE/CN=localhost"
$ openssl req -x509 -nodes -days 365 -newkey rsa:2048 \
          -keyout dcmtk.key -out dcmtk.crt -subj "/C=BE/CN=localhost"

Let us start Orthanc using the following minimal configuration file:

  "DicomTlsEnabled" : true,
  "DicomTlsCertificate" : "orthanc.crt",
  "DicomTlsPrivateKey" : "orthanc.key",
  "DicomTlsTrustedCertificates" : "dcmtk.crt",
  "DicomModalities" : {
    "dmctk" : {
      "Host" : "localhost",
      "Port" : 4242,
      "AET" : "DCMTK",
      "UseDicomTls" : true

It is then possible to trigger a secure C-GET SCU request from DCMTK to Orthanc as follows:

$ echoscu -v -aet DCMTK localhost 4242 +tls dcmtk.key dcmtk.crt +cf orthanc.crt
I: Requesting Association
I: Association Accepted (Max Send PDV: 16372)
I: Sending Echo Request (MsgID 1)
I: Received Echo Response (Success)
I: Releasing Association