Self-hosted PACS portal replacing $150–$2,000/mo cloud imaging solutions for independent clinics. Full DICOM workflow — receive from MRI/CT/X-ray equipment, view in OHIF web viewer, share with patients via QR/PIN-protected portal, transfer between facilities via C-STORE. HIPAA-ready with audit logging, JWT auth, session management. FastAPI + React/TypeScript + Orthanc + Docker.