MRI images get mixed up

[sirmartin]

Hello everyone,

At our institution we have weird things happen since the PACSONE upgrade to version 6.5.1
We are a radiotherapy institution, we get many images from CT, PET-CT, MRI, US offered to us by many different hospitals in the country from patients who are referred to us.
Those images we get offered on DVD which we upload thru a Citrix session from DVD stations on a few of our PC’s. We had problems with uploading large transversal fused PET-CT movies after trying to tackle this problem we came up with the idea to upgrade from a 32 to a 64 bit version. This solved our initial problem.

But now we have a new problem or challenge, the MRI images we get from other hospitals are mixed up in the PACSONE. One of our doctors noticed it in her meddream viewer. E.g. in a series of transversal images the 14th image in this case is a sagittal image. Sometimes it is image 17, 11 or 33. So it seems random. But it is not random.
After digging into the DICOM header of the images it seem to be always a localizer image that is the wrong image (0008,0008 Image Type says LOCALIZER. It comes before the right image which has the same instance number in the PACSONE. The difference I can find is in the 0020,0018 Acquisition Number in the DICOM header. So the localizer file gets merged in next to the image file with the same instance number
Our PACSONE runs on a server far away which we access thru a Citrix session. The images are stored in a image directory on a server I noticed that the localizer file is in a different subdirectory then the image file.
We also have a stand alone Etiam PACS/Viewer if we use this to push the MRI images to the PACSONE they are in the right order.

Does anybody has any idea how these localizer files get mixed up with the rest of the images? Or what I can do about it or where to look to tackle this?
If needed I can add attachments with pics.

Thanks,
Martin
Netherlands

[pacsone]

PacsOne Server uses the SOP Instance UID as the key to the IMAGE table, so you can have multiple images with the same Instance Number stored in the same series as long as their SOP Instance UIDs are different. But how the viewers choose to present those multiple instances with the same Instance Number may differ from viewer to viewer (MedDream and Etiam viewers in your case below).

When the same MRI Images are in the right order if pushed from the Etiam Viewer, can you check that specific localizer image and see if the SOP Instance UID and Instance Number are the same vs the ones when it's NOT in the right order? Also, what's the definition of "right order" when you have multiple instances sharing the same Instance Number within the same series?