Summary
A DICOM modality worklist sends patient and study details from the practice management software (PIMS) to the imaging equipment the moment an order is placed, so nobody types them at the modality. Keystone PACS has built integrations with Shepherd, NaVetor, Instinct, DaySmart Vet and a number of other practice management systems, and routes completed studies back to the patient record without duplication or double entry.
What goes wrong without a worklist
Without a worklist integration, a technician finishing triage walks to the X-ray room, sits at the modality console, and types the patient's name, species, breed, body weight, patient ID and study type by hand. Every time. That takes time and introduces transcription errors. A misspelled name, a transposed digit in the patient ID or the wrong breed code from a dropdown means the study lands in the wrong patient record, or nowhere at all until someone hunts it down and files it.
In a practice running ten to twenty imaging studies a day this is a recurring workflow problem, not a theoretical risk. A misfiled radiograph can delay a diagnosis. A study attached to the wrong patient ID does not appear when the veterinarian opens the chart expecting it. Someone has to reconcile the mismatch, which usually means a practice manager in the PACS after the fact, matching orphaned studies to records by cross-referencing timestamps and modality logs.
The modality worklist removes that failure mode at the source.
What a DICOM modality worklist does
When an order is placed in the PIMS, the practice management software sends DICOM-formatted patient and study data to the imaging equipment. The modality shows a worklist: a queue of scheduled studies with patient name, ID, species, breed, weight and study description already filled in. The technician selects the right entry with one tap and starts imaging.
No manual entry. No guessing at spelling. The study is captured with the correct identifiers attached from the first frame.
Understanding what DICOM is explains why this works. DICOM (Digital Imaging and Communications in Medicine) is the standard for how medical imaging systems talk to each other. When the PIMS and the imaging equipment both speak DICOM, they pass structured data in a format each can read and act on without manual translation.
The modality worklist is one DICOM service class, called MWL for Modality Worklist, and it handles the upstream half of the exchange. A separate service class, DICOM Store (C-STORE), handles the downstream half: moving the completed images from the modality to the PACS after acquisition. A complete integration uses both. The worklist populates before the scan; Store delivers the images after it.
If the worklist has not synced, for example because the PIMS order was not placed before the patient reached the imaging room, the modality still accepts a manual entry as a fallback. The integration adds automation on top of a system that keeps working without it. That fallback exists in Keystone's workflow because no integration removes every edge case. The aim is to make the manual fallback rare, not to pretend it never happens.
How the PIMS integrations connect to Keystone
Keystone PACS ships pre-built integrations with a range of practice management platforms. Each follows the same pattern: an order placed in the PIMS sends worklist data to the modality, and the completed study returns to the patient record. The depth of integration varies with what each PIMS supports.
- Shepherd. The Shepherd integration carries worklist data to the modality and the completed study back to the Shepherd patient record.
- NaVetor. NaVetor's cloud-based practice management sends orders to the modality worklist without an on-premises middleware layer between the PIMS and the PACS.
- Instinct. Instinct supports automated worklist population. It is used heavily in emergency and specialty settings, where imaging volume per patient encounter is high and the time saved by not re-entering demographic data matters most.
- DaySmart Vet. The DaySmart Vet integration completes the appointment-to-archive workflow for practices on that cloud platform.
- Others. Covetrus Ascend, VetlinkPRO, OpenVPMS, VisionVPM, PetBooqz and Tracks are also connected. The integrations page lists every current partner, including the teleradiology services Keystone routes studies to.
For practices whose PIMS is not on the list, Keystone runs as a standalone PACS using manual patient entry at the modality or a DICOM-native worklist configuration independent of the PIMS. Practices weighing a PIMS change can ask Asteris whether a connection to the platform they are considering exists or is in development.
What changes in the practice day
The effect of a connected worklist shows up in three places.
At the modality. Technician time spent entering patient data before a scan drops to the time it takes to tap a name on a list. In a practice with several imaging rooms or back-to-back appointments, that saving repeats on every study in the schedule, and the technician's attention stays on positioning and image quality.
In the patient record. Studies arrive in the chart with the right metadata attached: patient ID, study description, acquisition time. A veterinarian opening the record after rounds sees the radiographs already there and correctly labelled. Nothing sits in an unfiled queue.
In practice management oversight. When orders flow through the PIMS into the worklist and completed studies return through the integration, the whole imaging pipeline becomes traceable. A practice manager can see what was ordered, what was acquired and when, without reconciling PACS logs against PIMS records by hand. That trail also matters for record accuracy and, where it applies, for billing tied to imaging charges.
The studies that cause the most trouble downstream are the ones where something went wrong at the front: a patient ID typed wrongly, a blank study description, an image filed by hand under the wrong record. The worklist removes the conditions that create those errors.
Cloud reading through NewLumen
For practices that send studies to off-site radiologists or specialists, NewLumen extends the same connected workflow into cloud reading. A study acquired through the PIMS-to-modality worklist and stored in Keystone can be forwarded to NewLumen for remote interpretation. The patient data that travelled correctly through the worklist and into the PACS travels with the study, so the radiologist receives a complete, correctly labelled case with no re-entry anywhere in the chain.
That matters in referral and specialty work, where the practice sending the study and the radiologist reading it may be on different systems entirely. A study labelled correctly at acquisition is a study that arrives at the reading station ready to interpret.
Implementation and setup
Keystone's PIMS integrations are pre-built and supported by Asteris. Once the PIMS is connected, the worklist runs without ongoing configuration on the practice side. There is no middleware to maintain and no custom development to switch on a supported integration.
If you are evaluating Keystone or considering a move from another PACS, talk to the team about your PIMS and workflow. We will walk through how the worklist behaves in your setting, what the study-to-record return path looks like in your PIMS, and what your imaging team will see from day one.
Frequently Asked Questions
What is a DICOM modality worklist in veterinary practice?
A DICOM modality worklist passes patient and study information from the practice management software to the imaging modality when an order is placed. The modality reads it automatically, so the technician selects the patient from a list instead of typing demographic data. That removes manual entry errors and means every acquired image is labelled with the correct identifiers before it reaches the PACS.
Which practice management systems does Keystone PACS connect to?
Keystone PACS has built integrations with Shepherd, NaVetor, Instinct, DaySmart Vet, Covetrus Ascend, VetlinkPRO, OpenVPMS, VisionVPM, PetBooqz and Tracks. Each covers at least the modality worklist and the study-to-record return path. The current list is on the integrations page.
What is the difference between a DICOM worklist and DICOM Store?
They work at different points in the workflow. The modality worklist (MWL) sends patient and order data from the PIMS to the modality before acquisition, so images are labelled correctly at capture. DICOM Store (C-STORE) moves the completed images from the modality to the PACS afterwards. A full integration uses both: worklist on the way in, Store on the way out.
If my PIMS is not on Keystone's integration list, can I still use Keystone PACS?
Yes. Keystone runs as a standalone PACS without a PIMS integration, using manual patient entry at the modality or a DICOM-native worklist configuration. The PIMS integrations add automation on top of a system that works on its own. Practices considering a PIMS change can ask Asteris whether a connection to the new platform is available.