PACS Is Down: What Should You Check First?
PACS is down? Start here: confirm scope, rule out your workstation, check network, login, services, storage, and interfaces, then escalate the right way.
By Trisha Seal — September 24, 2026. Trisha documents first-response troubleshooting and escalation within RAD365's vendor-agnostic PACS support practice. RAD365 does not read or interpret studies.
PACS Is Down. Start Here.
When PACS is down, the first few minutes decide how long the outage lasts. The most useful first question is not “what broke?” but “who is affected?” The answer tells you whether you are dealing with one workstation or a system-wide outage, and it points everyone to the right next step.
Use this as a quick-reference card. For the full incident process, see our PACS outage runbook and checklist.
Step 1: Is It Just You?
| What you see | Likely scope | Next move |
|---|---|---|
| Only your workstation fails; colleagues are fine | Local | Check your connection, credentials, and viewer |
| Your whole department or site fails | Site or network | Call support; suspect network or site link |
| Everyone, everywhere, fails | System-wide | Escalate immediately as a critical outage |
| One modality cannot send; others can | Single device or interface | Check that modality's connection and settings |
Step 2: If It Is Just You
- Confirm your network: is the cable plugged in, is Wi-Fi or VPN connected, can you open other hospital systems?
- Close and reopen the viewer, then restart the workstation if needed.
- Try the web viewer or another workstation to rule out local software.
- Check your login: expired password or locked account are common culprits.
Step 3: If Everyone Is Affected
Stop troubleshooting locally and escalate. Then support engineers work through the layers in order:
- Network and firewalls: Are the PACS servers reachable from the clinical network?
- Authentication: Is the directory or single sign-on service up? Has a certificate or service account expired?
- Application services: Are the PACS services running on every server?
- Database: Is it online, with space for its logs?
- Storage: Are volumes mounted and not full?
- Recent changes: Was there a patch, upgrade, or network change in the last day?
Step 4: Symptom-to-Cause Quick Guide
| Symptom | Often points to |
|---|---|
| Cannot reach the login screen | Network, firewall, web service, or certificate |
| “Invalid password” for many users at once | Directory or single sign-on problem |
| Log in works, images never load | Image service, storage, or archive |
| New studies missing, priors fine | Modality sending, DICOM interface, or intake queue |
| Worklist empty or out of date | HL7 or RIS interface |
Step 5: Report It Well
A good report cuts diagnosis time. Include who is affected, when it started, the exact error, what does and does not work, and anything that changed recently. RAD365 clients can report through email, phone, secure remote desktop, or the ticketing portal, all feeding one tracked incident under the severity-based PACS support framework.
Step 6: Keep Patient Care Moving
Switch to your downtime procedures while engineers work: know where modalities hold studies, how to view images safely in the meantime, and how urgent cases are communicated. When service returns, confirm queued studies arrived and users can open priors before closing the ticket.
Why Outages Drag On
Long outages rarely come from hard problems. They come from not knowing who to call, missing vendor contract details, expired access, and one administrator who is off shift. That is why many hospitals rely on managed PACS support with staffed coverage across shifts and a two-tier team: L1 for application, access, and user issues, and L2 for infrastructure, DICOM and HL7, backup, and disaster recovery. If PACS feels sluggish rather than fully down, read what to check when PACS is slow.
RAD365 is an operations and workflow partner providing PACS Support and the Radiology Workflow Manager only. It does not read or interpret studies and provides no preliminary-read services.
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Explore Managed PACS Support →Frequently Asked Questions
First Checks
PACS is down. What should I check first?
Check scope first: is it just you, your department, one site, or everyone? Ask a colleague on another workstation to log in. If only you are affected, focus on your workstation and network connection. If everyone is affected, escalate immediately as a system-wide outage.
How can I tell if it is my workstation or the whole PACS?
Try a second workstation, and try the web viewer if your PACS has one. If other machines work, the problem is local: your network cable, Wi-Fi, VPN, cached credentials, or the viewer software. If nothing works anywhere, the problem is on the server or network side.
Should I restart my workstation when PACS will not load?
Restarting the viewer application, and then the workstation, is a reasonable step for a single-user issue after you have checked that others can connect. It should not be the response to a system-wide outage, where it only wastes time.
What does it mean if I can log in but images will not display?
That usually points past login to the image layer: storage, the archive, the image-serving service, or a stalled interface. Note which studies fail, new or prior, and report that detail, because it helps engineers find the failing component quickly.
Why does PACS say my password is wrong when it was working yesterday?
Common causes are an expired password, a locked account after repeated attempts, or a problem with the directory or single sign-on service. If several users see the same error at once, report it as a possible authentication outage rather than a personal login issue.
Server and Network Causes
What are the most common causes of a full PACS outage?
Frequent causes include network or firewall failures, expired certificates or service accounts, stopped application services, database problems, full storage volumes, failed patches or upgrades, and hardware faults. A layered check from network to storage narrows it down quickly.
Can a full disk really take PACS down?
Yes. When a storage volume or database log disk fills up, PACS may stop accepting new studies or stop responding entirely. Monitoring free space with alerts well before it runs out is one of the simplest ways to prevent this kind of outage.
How do expired certificates cause PACS outages?
Many PACS connections use security certificates for web viewers, single sign-on, and interfaces. When a certificate expires, browsers and systems refuse to connect, which looks like a sudden outage. Tracking certificate expiry dates in advance prevents these surprises.
Modalities cannot send to PACS. What should be checked?
Confirm the modality can reach PACS on the network, verify the DICOM connection details have not changed, and check whether PACS is accepting studies from other modalities. If only one modality fails, the issue is likely that device or its configuration.
Who to Call and What to Say
Who should I call when PACS is down?
Follow your department's escalation path, which usually starts with the PACS support desk or on-call PACS administrator. RAD365 clients can reach support by email, phone, secure remote desktop, or the ticketing portal, all feeding one incident record.
What information should I give support when reporting PACS down?
Share who is affected, when it started, the exact error message, whether you can log in, whether new or prior studies fail, which workstation or site you are using, and anything that changed recently. A screenshot of the error is very helpful.
How fast should a PACS outage get a response?
That depends on the severity definitions in your support agreement. Under RAD365's model, a system-down outage with clinical impact is Severity 1, with a 15-minute response and continuous work until resolved; degraded service is Severity 2 with a 1-hour response.
How do we keep working while PACS is down?
Follow your downtime procedures. These typically cover where modalities hold studies, how to view images at the modality or an approved backup viewer, and how urgent findings are communicated. If your department has no written downtime plan, that is a priority to fix.
What should we check once PACS comes back up?
Make sure queued studies have arrived from every modality, the worklist is current, and users can open both new studies and priors. Reconcile anything handled during downtime before the incident is closed.
Does RAD365 read studies during PACS downtime?
No. RAD365 supports PACS operations and the Radiology Workflow Manager only. It restores and supports the systems; it does not read or interpret studies or provide preliminary reads.
