Proof of commercial off-the-shelf hardware scalability in an on-line clinical PACS.

A frequently cited reason for not using commercial off-the-shelf (COTS) hardware in picture archiving and communications systems (PACS) is lack of capacity, reliability, and scalability. This report describes the evaluation the scalability of COTS hardware in a clinical PACS by migrating from an active server-passive backup server environment to an active-active cluster server arrangement.