The exploitation of multiple imaging modalities is central to the radiotherapy routine. As a consequence, the flows of biomedical images inside the RT departments are at the same time numerous and complex. This has motivated the development of the Orthanc open-source software that is designed to improve such workflows. Orthanc is a free, Web-based DICOM store. Orthanc features rich scripting capabilities that makes it scalable and flexible: Thanks to its RESTful API, Orthanc can be driven from any computer language to automate the imaging workflows that are very specific to each hospital. Orthanc is deployed in our Institution to optimize several real-world clinical processes by improving the interconnection between various DICOM modalities and by simplifying the data management of medical images.