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What This Guide Helps With
Troubleshooting PACS send failures, missing worklist updates, network issues, wireless connection problems, and image transfer delays on a DRX-Revolution.
Step-by-Step Troubleshooting
1. Ensure Patient Safety First
Do not troubleshoot image transfer or worklist issues during an active patient exam unless the clinical workflow is already complete.
Action:
- Confirm the exposure is complete and the patient is no longer dependent on the mobile X-ray unit.
- If another urgent portable exam is needed, use a known-working mobile X-ray system.
- Do not delete images, repeat exposures, or reboot the system until image status is understood.
Expected outcome: Patient care continues safely, and completed images are protected from accidental loss.
Why it matters: PACS and worklist issues are usually workflow or connectivity problems, but mishandling stored images can cause repeat imaging or documentation problems.
2. Verify the Reported Problem
Confirm whether the issue is with image sending, worklist updates, or both.
Action:
Ask the technologist what specifically failed:
- Images not sending to PACS
- Images stuck in queue
- Worklist not refreshing
- Patient not appearing on worklist
- Images sent but not visible in PACS
- Error only occurs in one location
- Error only occurs with one accession or patient
Check the DRX-Revolution display for network, DICOM, PACS, worklist, or send queue messages.
Expected outcome: The failure type is clearly identified before troubleshooting.
If the issue is only one patient or accession, focus on order/worklist data first. If all exams fail, focus on network or DICOM connectivity.
3. Confirm the Exam Was Completed Correctly
Make sure the image is available and ready to send.
Action:
- Check that the exam is closed, completed, or in the proper status for transmission.
- Verify the image is not still pending review, rejected, held, or unsent.
- Check whether the image appears in the local study list or image queue.
Expected outcome: The image should be present locally and available for DICOM transfer.
If the image was never completed or is still held locally, complete the exam workflow and attempt to resend. If successful, stop.
4. Check the Send Queue
Look for images stuck in the transmission queue.
Action:
Open the local send queue, network queue, or image transmission status area.
Look for:
- Pending images
- Failed images
- Repeated retry attempts
- Destination errors
- Association errors
- Timeout messages
- Storage commitment issues, if used
Attempt a manual resend if the image is safely stored and the system allows it.
Expected outcome: Images should either send successfully or produce a clear error that helps identify the cause.
If manual resend works, document the temporary transfer delay and stop.
5. Verify Wireless Network Connection
Mobile X-ray systems commonly fail to send images when wireless coverage is weak or disconnected.
Action:
- Check the wireless connection icon or network status on the DRX-Revolution.
- Confirm the unit is connected to the correct hospital wireless network.
- Move the unit to an area with known good wireless coverage, such as near the department, a main corridor, or another location where mobile imaging normally sends successfully.
- Avoid testing in elevators, shielded rooms, basements, stairwells, or dead zones.
Expected outcome: The unit should show a stable network connection.
If the unit reconnects and images send successfully, the likely cause was wireless coverage or roaming. Stop and document the location.
6. Check Whether the Issue Is Location-Specific
Determine if the problem follows the unit or the wireless area.
Action:
- Ask whether other mobile X-ray systems can send from the same location.
- If possible, compare behavior with another known-working portable unit.
- Test the affected DRX-Revolution from a location where wireless image transfer normally works.
Expected outcome: The issue should be narrowed to the unit, network area, or hospital wireless infrastructure.
If multiple units fail in the same location, escalate to IT/network support rather than replacing imaging hardware.
7. Confirm Network Login or Authentication Status
Some systems may appear powered on but not fully authenticated to the hospital network.
Action:
- Check whether the unit requires user login, network authentication, domain access, or wireless certificate validation.
- Confirm the operator is logged in correctly.
- Look for warnings related to expired credentials, failed authentication, locked account, or disconnected network services.
Expected outcome: The unit should be fully logged into the system and connected to hospital network resources.
If login or authentication restores PACS/worklist function, stop and document the access issue.
8. Verify Worklist Search Criteria
A worklist may fail to update because the search filters do not match the expected order.
Action:
Check the worklist query fields, including:
- Date
- Modality
- Location
- Patient name
- Accession number
- Scheduled station
- Department
- Exam status
Clear unnecessary filters and refresh the worklist.
Search by accession number if available.
Expected outcome: The correct order should appear if the worklist server is reachable and the query matches the order.
If the order appears after changing filters, the device is likely functioning normally. Stop and document the filter/search issue.
9. Confirm the Order Exists in RIS/EMR
Do not assume the DRX-Revolution is failing if the order was not placed or released correctly.
Action:
- Ask imaging staff or the modality lead to confirm the order exists in the RIS/EMR.
- Verify the order is active, released, scheduled, and assigned correctly.
- Confirm that the patient identifiers and accession number match what the technologist expects.
Expected outcome: A valid order should exist before the worklist can retrieve it.
If the order is missing or incorrect in the RIS/EMR, the issue is not a device failure. Stop and document that the order/worklist source requires correction.
10. Check PACS and Worklist Destination Availability
The device may be working, but the receiving system may be down or unavailable.
Action:
- Ask whether other imaging systems are sending to PACS normally.
- Check with radiology IT, PACS support, or the imaging supervisor for known outages.
- Determine whether PACS, RIS, worklist broker, DICOM router, or network services are experiencing downtime.
Expected outcome: Hospital imaging systems should confirm whether this is isolated to the DRX-Revolution or part of a larger outage.
If there is a known PACS/worklist outage, stop device troubleshooting and document the external system issue.
11. Verify Correct PACS Destination Selection
Some systems may have multiple send destinations.
Action:
- Confirm the technologist selected the correct PACS, archive, router, or department destination.
- Check whether the image was accidentally sent to a test destination, alternate archive, local storage, or incorrect facility.
- Review recent send history if available.
Expected outcome: Images should be sent to the intended production PACS destination.
If the wrong destination was selected, resend to the correct destination and stop if successful.
12. Confirm Date and Time Accuracy
Incorrect system date or time can affect worklist queries, image timestamps, and DICOM routing.
Action:
- Check the DRX-Revolution date and time.
- Compare it with hospital network time.
- Look for incorrect time zone, wrong date, or large time drift.
Expected outcome: The unit should match hospital time closely.
If the date/time is incorrect and correcting it restores worklist or PACS behavior, stop and document the finding.
13. Reboot the System Only After Image Status Is Known
A reboot may restore network services, but it should not be the first action if unsent images are present.
Action:
- Confirm any unsent images are safely stored locally.
- Notify the technologist before rebooting.
- Perform a normal shutdown and restart of the DRX-Revolution.
- After restart, verify network connection, refresh the worklist, and attempt resend.
Expected outcome: Temporary software or network service issues may clear after reboot.
If reboot restores PACS or worklist function, document the fault as intermittent communication/software state issue and stop.
14. Check for Physical Network Options if Available
If the unit supports wired network connection or docking, use it to separate wireless issues from DICOM configuration problems.
Action:
- Connect the unit to an approved hospital network port or docking area if available.
- Confirm network link lights or connection status.
- Attempt worklist refresh and image resend.
Expected outcome: If wired network works but wireless does not, the issue is likely wireless connectivity, configuration, antenna, or network coverage related.
If wired transfer works, document the wireless-specific failure and escalate to the appropriate support group.
15. Review Error Messages Before Escalation
Capture exact communication errors before sending the device for repair.
Action:
Record any displayed messages related to:
- DICOM association failure
- PACS connection timeout
- Worklist query failure
- Network unavailable
- Destination unreachable
- Authentication failure
- Storage failed
- Queue retry failure
Take a photo of the error screen if allowed by facility policy and no patient information is exposed.
Expected outcome: The repair team, PACS team, or vendor has useful information for diagnosis.
If the Problem Persists
If patient/order issues, worklist filters, wireless coverage, PACS availability, destination selection, login status, and basic network recovery have been ruled out, the issue may involve internal network configuration, wireless hardware, software services, DICOM settings, or system-level failure.
The DRX-Revolution should be:
- Removed from service if images cannot be reliably sent or retrieved
- Labeled Out of Service
- Sent for Clinical Engineering bench evaluation, PACS/IT review, or vendor service as appropriate
Knowing when to stop is proper troubleshooting. Repeated rebooting, deleting studies, changing DICOM settings without authorization, or performing unnecessary repeat exposures can create patient safety and documentation risks.
Clinical Use Tip
Do not troubleshoot PACS transfer problems on an active patient or during an urgent portable exam. Complete patient care first, protect locally stored images, and move to another mobile X-ray system if imaging workflow is affected. Never repeat an exposure just because an image has not appeared in PACS until local image status and transfer status have been verified.
Work Order Documentation (CCR Method)
CCR = Complaint, Cause, Resolution
Complaint
What was reported by the clinical staff.
Example:
"Technologist reported that the Carestream DRX-Revolution completed portable chest images but the study would not send to PACS and the worklist would not refresh."
Cause
What was observed during troubleshooting.
Example:
"Found the unit connected to weak wireless coverage in a patient care area, with images pending in the send queue and worklist query timing out."
Resolution
What action was taken.
Example:
"Moved unit to known-good wireless area, confirmed network reconnection, manually resent pending images successfully, refreshed worklist, and returned unit to service."
Helpful Details to Include (If Known)
- Whether images were stored locally
- Whether images were stuck in the send queue
- Exact PACS or worklist error message
- Whether the issue affected one patient or all studies
- Wireless signal status
- Location where the problem occurred
- Whether other mobile units had the same issue
- Whether PACS/RIS downtime was reported
- Destination selected for image send
- Whether manual resend was successful
- Whether reboot was performed
- Whether wired network testing was available
- Final device status
Final Thought
PACS and worklist failures on a mobile X-ray system should be approached logically. Start with patient safety, protect completed images, verify the order and workflow, then check wireless connectivity, destination selection, and external PACS/RIS availability. Escalation is appropriate once external causes are ruled out, especially when images cannot be transmitted reliably. Clear CCR documentation helps separate device failure from network, workflow, and PACS issues.
That is successful troubleshooting.