We describe a cloud-based medical image reconstruction service designed to meet a real-time and daily demand to reconstruct thousands of images from proton cancer treatment facilities worldwide. Rapid reconstruction of a three-dimensional Proton Computed Tomography (pCT) image can require the transfer of 100 GB of data and use of approximately 120 GPU-enabled compute nodes. The nature of proton therapy means that demand for such a service is sporadic and comes from potentially hundreds of clients worldwide. We thus explore the use of a commercial cloud as a scalable and cost-efficient platform for pCT reconstruction. To address the high performance requirements of this application we leverage Amazon Web Services' GPU-enabled cluster resources that are provisioned with high performance networks between nodes. To support episodic demand, we develop an on-demand multi-user provisioning service that can dynamically provision and resize clusters based on image reconstruction requirements, priorities, and wait times. We compare the performance of our pCT reconstruction service running on commercial cloud resources with that of the same application on dedicated local high performance computing resources. We show that we can achieve scalable and on-demand reconstruction of large scale pCT images for simultaneous multi-client requests, processing images in less than 10 minutes for less than $10 per image.
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