For a small dental clinic, Orthanc is the easier starting point: one lightweight server that installs with a Windows installer or one Docker image. dcm4chee Archive is the better pick when you need hospital-style features such as HL7 feeds, tiered storage and central configuration for several sites, and you have someone to run WildFly, LDAP and a database. Both are free and open source, and both can receive CBCT and X-ray studies over DICOM.
This comparison uses our verified program pages and the official dcm4chee-arc-light wiki and release notes, checked on 15 October 2026. Status: Not tested yet — we have not run either server on a clinic network, so there are no benchmark, install-time or load claims below. Editorial team.
Orthanc and dcm4chee side by side
| Item | Orthanc | dcm4chee Archive 5 |
|---|---|---|
| Licence | Free; GPLv3 or later for the server, AGPLv3 or later for some plugins | Free; Mozilla Public License 1.1 |
| Current version on our page | Server 1.13.0 (Aug 2026); Windows and Docker bundles numbered separately (26.9.1) | 5.35.1 (24 Aug 2026) |
| Platforms | Windows, macOS, Linux, FreeBSD, Docker | Docker (usual route); manual install on Linux or Windows |
| Stack to run | One service; SQLite built in, PostgreSQL or MySQL/MariaDB optional | WildFly, an LDAP server and a SQL database; Java 17 or later |
| Default ports | 8042 web/REST, 4242 DICOM | 8080 web UI, 11112 DICOM, 9990 WildFly console |
| Web interface | Orthanc Explorer 2, viewer plugins | Archive UI at /dcm4chee-arc/ui2 |
| Browser viewing | Stone Web Viewer, OHIF, VolView plugins | Pair with OHIF or Weasis |
| Worklist, HL7 | Modality Worklist plugin; no HL7 interface listed on our page | Modality Worklist, UPS and HL7 v2 interface |
| Best for | One clinic or a few sites | Multi-site groups, hospital-grade workflows |
Installing and running it
Orthanc runs as a single service. On Windows the official installer sets it up as a service that starts with the computer, and all settings sit in JSON files in one folder. In Docker, the orthancteam/orthanc image takes settings as environment variables. We have not timed an install ourselves, so we make no claim about how long it takes.
dcm4chee Archive is built differently. The official Docker guide lists at least three images that must be released together: an LDAP server (dcm4che/slapd-dcm4chee), a PostgreSQL database (dcm4che/postgres-dcm4chee) and the archive itself (dcm4che/dcm4chee-arc-psql). Manual installs need Java 17 or later, WildFly and an LDAP server; the wiki marks the embedded H2 database as not for production use. Every component is something to patch, monitor and back up.
Receiving studies from CBCT and X-ray units
Both accept studies over standard DICOM, so the imaging software on the CBCT unit just needs a DICOM destination: server address, port and AE title. For Orthanc that is port 4242 and AE title ORTHANC by default; dcm4chee listens on 11112 and uses AE titles you configure. If the imaging software cannot send DICOM at all (some export only their own format), neither server helps.
Viewing images
Orthanc ships viewer plugins, so a workstation can open a study in the browser straight away. dcm4chee has an administration and study-management UI but no diagnostic viewer of its own; its wiki points to OHIF Viewer over DICOMweb and to Weasis on the desktop. OHIF also works with Orthanc, so the viewer is not a deciding factor. Neither project makes a medical-device claim on the pages we checked; OHIF states that its viewer is not FDA-cleared or CE-marked.
Security and updates
Both need hardening before real patient data arrives. For Orthanc, the official security page assumes a secured local environment and lists the settings to change; our Orthanc setup guide walks through them. For dcm4chee, the plain images have an unsecured UI; the project publishes -secure variants with Keycloak login. Version 5.35.1 fixes a remote-code-execution advisory (GHSA-hxq8-xgh3-4f76 in the release notes), so any older install should be updated. Keeping an archive current is routine work with dcm4chee; budget time for it.
Backup
Orthanc with default SQLite storage is backed up as three things together: the configuration, the DICOM files and the index database, with the service stopped. With PostgreSQL, hot backups use the database’s own tools. dcm4chee spreads state across the archive storage, the database and the LDAP configuration, so a restore plan must cover all three. We have not tested a restore with either. See the free dental imaging software hub for related tools.
Which one should you use
- One practice, one IT person or an outside IT contractor: Orthanc. Fewer parts, fewer things to patch.
- Several clinics sending to one archive, with scheduled imaging driven by HL7: dcm4chee, if you can staff it.
- Unsure: start with Orthanc. Studies are standard DICOM, so they can be sent to another archive later.
Limitations
- Not tested yet: facts come from our verified program cards and the official project pages, not from our own installs.
- Neither tool has dental charting, scheduling, billing or implant planning.
- The official Orthanc Book was unreachable from our checking server on the day of writing, so Orthanc statements rely on our program card and the guide checked on 12 October 2026.
- Nothing here is legal or compliance advice.
FAQ
Is Orthanc or dcm4chee better for a small dental clinic?
For one clinic, Orthanc is simpler to install and maintain. dcm4chee suits multi-site groups that need worklists, HL7 and tiered storage.
Are Orthanc and dcm4chee really free?
Yes. Orthanc’s server is GPLv3 or later; dcm4chee Archive is under the Mozilla Public License 1.1. Running either still costs hardware, backup and IT time.
What is the best open source PACS for a dental office?
There is no single answer. Orthanc fits a lightweight clinic archive; dcm4chee fits larger, standards-heavy setups. Both need a separate plan for security and backup.
Can I use OHIF Viewer with both?
Yes. OHIF connects to DICOMweb archives, and Orthanc and dcm4chee both offer DICOMweb.
Do I need a database for Orthanc?
No. It uses SQLite by default; PostgreSQL or MySQL/MariaDB are optional for hot backups and larger archives.
Is dcm4chee the same as dcm4che?
No. dcm4che is the Java DICOM library and toolkit; dcm4chee Archive is the PACS application built on it.
Last updated: 15 October 2026 · DentIIT editorial team. Licence, version and platform details are checked against each developer's official documentation; none of the tools listed here should be treated as a certified medical device unless its vendor says so.
