Highly scalable medical imaging repository based on Kubernetes

The use of medical imaging in clinical practice has increased dramatically in recent decades. The adoption and migration to the Cloud of medical imaging systems and services is an excellent opportunity for telemedicine, telework and collaborative work environments. However, the adoption of this paradigm has been slow in this scenario. While the migration has many advantages, it also introduces new challenges mainly related with data storage and management. One of most important open problems is with the efficient handling and transmission of large volumes of data. This issue is particularly critical if the service requests data regional redundancy and high scalability. In this context, this article proposes and describes a new architecture compliant with medical imaging requirements and following standard Cloud and medical imaging interfaces. The solution is based on Kubernetes, an open-source system to deploy, scale and manage containerized applications anywhere. The proposal includes an intelligent component for distributed management of the medical studies based on service policies. The result was a scalable Cloud-based medical imaging repository that can be deployed in a standard way in multiple providers that can achieve a better performance than single node.