Load balancing Siemens Healthineers Syngo Imaging

Updated on November 19, 2025
Published on March 6, 2023

Benefits of load balancing Syngo Syngo

Load balancing Siemens Healthineers Syngo Imaging provides High Availability, enhanced performance, and scalability:

  • High Availability (HA): In a 24/7 patient care environment, uninterrupted access to critical diagnostic images is essential. Load balancing is crucial for achieving this high availability. The load balancer distributes traffic across multiple image servers (e.g., PACS or VNA servers). It continuously monitors the health of all servers. If a server fails or needs maintenance, the load balancer automatically and seamlessly redirects all new and existing traffic (DICOM studies, retrieval requests) to the remaining healthy servers. This prevents any single server failure from causing an outage, ensuring continuous workflow for clinicians and radiologists, which is vital for timely diagnosis and patient care.
  • Enhanced performance: Medical imaging files (from CT, MRI, 3D mammography, etc.) are often very large and can overwhelm a single server, creating bottlenecks. Load balancing resolves this to provide enhanced performance. The load balancer intelligently routes incoming requests to the server that is least busy or has the most available resources. This distribution prevents any single server from becoming a bottleneck, ensuring that the processing load is balanced. It ensures rapid processing and retrieval of large imaging studies, leading to faster response times for clinicians, improving workflow efficiency, and reducing turnaround times for reports.
  • Scalability: Healthcare organizations face a constantly increasing volume of medical data and growing user demands, especially with the introduction of new imaging modalities. Load balancing provides the architectural flexibility needed for scalability. When capacity needs to increase (due to more studies or users), new servers can be added to the system without service interruption. The load balancer automatically incorporates these new servers into the distribution pool. This allows the Syngo Imaging system to scale capacity quickly and cost-effectively, handling increased workload and future growth while maintaining consistent, optimal performance.

About Siemens Syngo

Siemens Syngo is a suite of intelligent imaging software applications for multi-modality reading (Syngo.via), Radiology workflow and information systems (Syngo Workflow RIS), PACS and VNA storage archives (Syngo.plaza, Syngo.share).

Loadbalancer.org facilitates the deployment of Siemens Healthineers Syngo Imaging servers in a cluster, ensuring zero downtime and greatest resource efficiency. This provides a cost-effective, highly available, and scalable Siemens Healthineers Syngo Imaging solution for environments where study volume is ever increasing. By clustering servers behind a load balancer product managers can guarantee zero downtime and greatest resource efficiency. This provides a cost-effective, highly available, and scalable Siemens Healthineers Syngo Imaging solution.

Why Loadbalancer.org for Siemens Syngo?

Loadbalancer’s intuitive Enterprise Application Delivery Controller (ADC) is designed to save time and money with a clever, not complex, WebUI. 

Easily configure, deploy, manage, and maintain our Enterprise load balancer, reducing complexity and the risk of human error. For a difference you can see in just minutes.

And with WAF and GSLB included straight out-of-the-box, there’s no hidden costs, so the prices you see on our website are fully transparent.

More on what’s possible with Loadbalancer.org.

How to load balance Siemens Syngo

The load balancer can be deployed in 4 fundamental ways: Layer 4 DR mode, Layer 4 NAT mode, Layer 4 SNAT mode, and Layer 7 Reverse Proxy (Layer 7 SNAT mode).

For Siemens Syngo, Layer 4 DR mode is recommended. This is a high-performance solution that requires little change to your existing infrastructure.

It is also possible to load balance a Siemens Healthineers Syngo Imaging server deployment using Layer 7 Reverse Proxy. This mode might be preferable if making changes to the real servers is not possible. Due to the increased amount of information at Layer 7, performance is not as fast as at Layer 4.

DC Siemens, Network Diagram, Loadbalancer.org

About Layer 4 DR mode load balancing

One-arm direct routing (DR) mode is a very high performance solution that requires little change to your existing infrastructure. 

Layer 4 DR Mode Network Diagram Loadbalancer

DR mode works by changing the destination MAC address of the incoming packet to match the selected Real Server on the fly which is very fast. 

When the packet reaches the Real Server it expects the Real Server to own the Virtual Services IP address (VIP). This means that you need to ensure that the Real Server (and the load balanced application) respond to both the Real Server’s own IP address and the VIP.  

The Real Servers should not respond to ARP requests for the VIP. Only the load balancer should do this. Configuring the Real Servers in this way is referred to as Solving the ARP problem. 

On average, DR mode is 8 times quicker than NAT for HTTP, 50 times quicker for Terminal Services and much, much faster for streaming media or FTP.  

The load balancer must have an Interface in the same subnet as the Real Servers to ensure Layer 2 connectivity required for DR mode to work.  

The VIP can be brought up on the same subnet as the Real Servers, or on a different subnet provided that the load balancer has an interface in that subnet.  

Port translation is not possible with DR mode, e.g. VIP:80 → RIP:8080 is not supported. DR mode is transparent, i.e. the Real Server will see the source IP address of the client.