diff --git a/app/Services/AuditTrail/Activity.php b/app/Services/AuditTrail/Activity.php
index a256fb3..8ce05ad 100644
--- a/app/Services/AuditTrail/Activity.php
+++ b/app/Services/AuditTrail/Activity.php
@@ -15,6 +15,14 @@ final class Activity
 
     public const int Study_History_Update = 105;
 
+    public const int Study_Create = 106;
+
+    public const int Study_Update = 107;
+
+    public const int Study_Archived = 108;
+
+    public const int Study_Delete = 109;
+
     // report
 
     public const int Report_Save = 201;
diff --git a/app/Services/AuditTrail/ActivityLogger.php b/app/Services/AuditTrail/ActivityLogger.php
index a4d697a..31a8063 100644
--- a/app/Services/AuditTrail/ActivityLogger.php
+++ b/app/Services/AuditTrail/ActivityLogger.php
@@ -24,19 +24,22 @@ class ActivityLogger
 
     private ?string $ipAddr = null;
 
-    /**
-     * @var true
-     */
     private bool $anonymous = false;
 
+    private ?string $orthancId = null;
+
     public function __construct()
     {
         $this->category = Category::GENERAL;
     }
 
-    public function on(Study $study): static
+    public function on(Study|int $study): static
     {
-        $this->studyId = $study->id;
+        if ($study instanceof Study) {
+            $this->studyId = $study->id;
+        } else {
+            $this->studyId = (int) $study;
+        }
 
         return $this;
     }
@@ -77,6 +80,13 @@ public function url(?string $url = null): static
         return $this;
     }
 
+    public function orthanc(string $uuid): static
+    {
+        $this->orthancId = $uuid;
+
+        return $this;
+    }
+
     public function notes(string $notes): static
     {
         $this->notes = $notes;
@@ -122,12 +132,12 @@ public function log(bool $initDefaults = true): bool
             'user_id' => $this->userId,
             'category' => $this->category,
             'activity' => $this->activity,
+            'orthanc_uuid' => $this->orthancId,
             'ip_addr' => $this->ipAddr,
             'user_agent' => $this->userAgent,
             'url' => $this->url,
             'notes' => $this->notes,
             'created_at' => now(),
-            'updated_at' => now(),
         ]);
     }
 }
diff --git a/app/Services/Pacs/Sync/Pipes/ArchiveStudies.php b/app/Services/Pacs/Sync/Pipes/ArchiveStudies.php
new file mode 100644
index 0000000..ade509e
--- /dev/null
+++ b/app/Services/Pacs/Sync/Pipes/ArchiveStudies.php
@@ -0,0 +1,38 @@
+<?php
+
+namespace App\Services\Pacs\Sync\Pipes;
+
+use App\Services\AuditTrail\Activity;
+use App\Services\AuditTrail\Category;
+use App\Services\Pacs\Sync\StudiesSync;
+use Closure;
+use Illuminate\Support\Facades\DB;
+
+final readonly class ArchiveStudies
+{
+    public function __invoke(StudiesSync $sync, Closure $next): StudiesSync
+    {
+        foreach ($sync->getArchiveQueue() as $orthanc_uuid) {
+            $row_id = DB::table('studies')->where(compact('orthanc_uuid'))->value('id');
+            if ($row_id === null) {
+                continue;
+            }
+
+            $payload = [
+                'is_archived' => true,
+                'updated_at' => now(),
+            ];
+            DB::table('studies')->find($row_id)->update($payload);
+
+            audit()
+                ->anon()
+                ->category(Category::SYSTEM)
+                ->on($row_id)
+                ->orthanc($orthanc_uuid)
+                ->did(Activity::Study_Archived)
+                ->log(false);
+        }
+
+        return $next($sync);
+    }
+}
diff --git a/app/Services/Pacs/Sync/Pipes/FetchStudyDetails.php b/app/Services/Pacs/Sync/Pipes/FetchStudyDetails.php
new file mode 100644
index 0000000..00ebd64
--- /dev/null
+++ b/app/Services/Pacs/Sync/Pipes/FetchStudyDetails.php
@@ -0,0 +1,5 @@
+<?php
+
+namespace App\Services\Pacs\Sync\Pipes;
+
+final readonly class FetchStudyDetails {}
diff --git a/app/Services/Pacs/Sync/Pipes/FilterStudies.php b/app/Services/Pacs/Sync/Pipes/FilterStudies.php
new file mode 100644
index 0000000..d4c79ed
--- /dev/null
+++ b/app/Services/Pacs/Sync/Pipes/FilterStudies.php
@@ -0,0 +1,48 @@
+<?php
+
+namespace App\Services\Pacs\Sync\Pipes;
+
+use App\Models\Enums\StudyLevelStatus;
+use App\Services\Pacs\Sync\StudiesSync;
+use Closure;
+use Illuminate\Support\Collection;
+use Illuminate\Support\Facades\DB;
+
+final readonly class FilterStudies
+{
+    public function __invoke(StudiesSync $sync, Closure $next): StudiesSync
+    {
+        $sync->resetQueues();
+
+        $studies = DB::table('studies')
+            ->where('is_archived', false)
+            ->get(['orthanc_uuid', 'study_status'])
+            ->pluck('study_status', 'orthanc_uuid');
+
+        $study_ids = $sync->getStudyIds();
+        foreach ($study_ids as $study_id) {
+            $this->checkUpdate($study_id, $sync, $studies);
+        }
+
+        $missing_orthanc_uuids = $studies->keys()->diff($study_ids);
+        foreach ($missing_orthanc_uuids as $orthanc_uuid) {
+            $sync->getArchiveQueue()->add($orthanc_uuid);
+        }
+
+        return $next($sync);
+    }
+
+    private function checkUpdate(string $orthanc_uuid, StudiesSync $sync, Collection $studies): void
+    {
+        $study_status = $studies->get($orthanc_uuid);
+        if ($study_status === null) {
+            $sync->getInsertQueue()->add($orthanc_uuid);
+
+            return;
+        }
+
+        if ($study_status < StudyLevelStatus::StudyArrived->value) {
+            $sync->getUpdateQueue()->add($orthanc_uuid);
+        }
+    }
+}
diff --git a/app/Services/Pacs/Sync/Pipes/InsertStudies.php b/app/Services/Pacs/Sync/Pipes/InsertStudies.php
new file mode 100644
index 0000000..b537ad4
--- /dev/null
+++ b/app/Services/Pacs/Sync/Pipes/InsertStudies.php
@@ -0,0 +1,39 @@
+<?php
+
+namespace App\Services\Pacs\Sync\Pipes;
+
+use App\Models\Study;
+use App\Models\StudyDetails;
+use App\Services\AuditTrail\Activity;
+use App\Services\AuditTrail\Category;
+use App\Services\Pacs\Sync\StudiesSync;
+use Closure;
+
+final readonly class InsertStudies
+{
+    public function __invoke(StudiesSync $sync, Closure $next): StudiesSync
+    {
+        foreach ($sync->getInsertQueue() as $orthanc_uuid) {
+            $study = $sync->fetchStudyDetails($orthanc_uuid);
+            if ($study == null) {
+                continue;
+            }
+
+            $payload = $sync->transformData($study);
+            $row = Study::create($payload['study']);
+            $payload['details']['study_id'] = $row->id;
+            $payload['details']['orthanc_uuid'] = $orthanc_uuid;
+            StudyDetails::create($payload['details']);
+
+            audit()
+                ->anon()
+                ->category(Category::SYSTEM)
+                ->on($row->id)
+                ->orthanc($orthanc_uuid)
+                ->did(Activity::Study_Create)
+                ->log(false);
+        }
+
+        return $next($sync);
+    }
+}
diff --git a/app/Services/Pacs/Sync/Pipes/ScanStudies.php b/app/Services/Pacs/Sync/Pipes/ScanStudies.php
new file mode 100644
index 0000000..59c77d4
--- /dev/null
+++ b/app/Services/Pacs/Sync/Pipes/ScanStudies.php
@@ -0,0 +1,17 @@
+<?php
+
+namespace App\Services\Pacs\Sync\Pipes;
+
+use App\Services\Pacs\Sync\StudiesSync;
+use Closure;
+
+final readonly class ScanStudies
+{
+    public function __invoke(StudiesSync $sync, Closure $next): StudiesSync
+    {
+        $study_ids = $sync->getClient()->getStudiesIds();
+        $sync->setStudyIds($study_ids);
+
+        return $next($sync);
+    }
+}
diff --git a/app/Services/Pacs/Sync/Pipes/UpdateStudies.php b/app/Services/Pacs/Sync/Pipes/UpdateStudies.php
new file mode 100644
index 0000000..317d7da
--- /dev/null
+++ b/app/Services/Pacs/Sync/Pipes/UpdateStudies.php
@@ -0,0 +1,46 @@
+<?php
+
+namespace App\Services\Pacs\Sync\Pipes;
+
+use App\Services\AuditTrail\Activity;
+use App\Services\AuditTrail\Category;
+use App\Services\Pacs\Sync\StudiesSync;
+use Closure;
+use Illuminate\Support\Facades\DB;
+
+final readonly class UpdateStudies
+{
+    public function __invoke(StudiesSync $sync, Closure $next): StudiesSync
+    {
+        foreach ($sync->getUpdateQueue() as $orthanc_uuid) {
+            $study = $sync->fetchStudyDetails($orthanc_uuid);
+            if ($study == null) {
+                continue;
+            }
+            $study_id = DB::table('studies')->where(compact('orthanc_uuid'))->value('id');
+            if ($study_id === null) {
+                continue;
+            }
+
+            $payload = $sync->transformData($study);
+            unset($payload['study']['orthanc_uuid']);
+            $payload['study']['updated_at'] = now();
+            DB::table('studies')->find($study_id)->update($payload['study']);
+
+            if (! empty($payload['details'])) {
+                $payload['details']['updated_at'] = now();
+                DB::table('study_details')->where(compact('study_id'))->update($payload['details']);
+            }
+
+            audit()
+                ->anon()
+                ->category(Category::SYSTEM)
+                ->on($study_id)
+                ->orthanc($orthanc_uuid)
+                ->did(Activity::Study_Update)
+                ->log(false);
+        }
+
+        return $next($sync);
+    }
+}
diff --git a/app/Services/Pacs/Sync/StudiesSync.php b/app/Services/Pacs/Sync/StudiesSync.php
new file mode 100644
index 0000000..1790423
--- /dev/null
+++ b/app/Services/Pacs/Sync/StudiesSync.php
@@ -0,0 +1,225 @@
+<?php
+
+namespace App\Services\Pacs\Sync;
+
+use App\Models\Enums\StudyLevelStatus;
+use App\Services\Pacs\DicomUtils;
+use App\Services\Pacs\InstituteMapper;
+use App\Services\Pacs\OrthancRestClient;
+use Carbon\Carbon;
+use Illuminate\Pipeline\Pipeline;
+use Illuminate\Support\Collection;
+use Illuminate\Support\Facades\Log;
+
+class StudiesSync
+{
+    private Collection $study_ids;
+
+    private Collection $insert_queue;
+
+    private Collection $update_queue;
+
+    private Collection $archive_queue;
+
+    private OrthancRestClient $client;
+
+    public function execute(): void
+    {
+        app(Pipeline::class)
+            ->send($this)
+            ->through([
+                Pipes\ScanStudies::class,
+                Pipes\FilterStudies::class,
+                Pipes\InsertStudies::class,
+                Pipes\UpdateStudies::class,
+                Pipes\ArchiveStudies::class,
+            ])
+            ->thenReturn();
+    }
+
+    public function __construct(?OrthancRestClient $client = null)
+    {
+        $this->study_ids = collect();
+        $this->client = $client ?? new OrthancRestClient;
+        $this->resetQueues();
+    }
+
+    public function getClient(): OrthancRestClient
+    {
+        return $this->client;
+    }
+
+    public function getStudyIds(): Collection
+    {
+        return $this->study_ids;
+    }
+
+    public function setStudyIds(array $study_ids): void
+    {
+        $this->study_ids = collect($study_ids);
+    }
+
+    public function resetQueues()
+    {
+        $this->insert_queue = collect();
+        $this->update_queue = collect();
+        $this->archive_queue = collect();
+    }
+
+    public function getInsertQueue(): Collection
+    {
+        return $this->insert_queue;
+    }
+
+    public function getUpdateQueue(): Collection
+    {
+        return $this->update_queue;
+    }
+
+    public function getArchiveQueue(): Collection
+    {
+        return $this->archive_queue;
+    }
+
+    public function fetchStudyDetails(string $orthanc_uuid): ?array
+    {
+        $study = $this->client->getStudyDetails($orthanc_uuid);
+        if ($study == null) {
+            return null;
+        }
+
+        $stats = $this->client->getStudyStatistics($orthanc_uuid);
+        $study['Statistics'] = $stats;
+
+        $series = $this->client->getStudySeries($orthanc_uuid);
+        $study['Series'] = $series;
+
+        return $study;
+    }
+
+    public function transformData(mixed $orthanc_src): array
+    {
+        $inst_name = data_get($orthanc_src, 'MainDicomTags.InstitutionName');
+        $inst_id = InstituteMapper::map($inst_name);
+
+        $study = [
+            'orthanc_uuid' => strtolower($orthanc_src['ID']),
+            'is_locked' => false,
+            'is_active' => true,
+
+            'institution_name' => $inst_name,
+            'institute_id' => $inst_id,
+
+            'patient_uuid' => strtolower($orthanc_src['ParentPatient']),
+            'patient_id' => data_get($orthanc_src, 'PatientMainDicomTags.PatientID'),
+            'patient_name' => data_get($orthanc_src, 'PatientMainDicomTags.PatientName'),
+            'patient_sex' => data_get($orthanc_src, 'PatientMainDicomTags.PatientSex'),
+
+            'accession_number' => data_get($orthanc_src, 'MainDicomTags.AccessionNumber'),
+            'referring_physician_name' => data_get($orthanc_src, 'MainDicomTags.ReferringPhysicianName'),
+            'study_id' => data_get($orthanc_src, 'MainDicomTags.StudyID'),
+            'study_instance_uid' => data_get($orthanc_src, 'MainDicomTags.StudyInstanceUID'),
+            'study_modality' => data_get($orthanc_src, 'RequestedTags.Modality'),
+            'body_part_examined' => data_get($orthanc_src, 'RequestedTags.BodyPartExamined'),
+
+            'study_date' => DicomUtils::dateTimeToCarbon($orthanc_src['MainDicomTags']['StudyDate'], $orthanc_src['MainDicomTags']['StudyTime']),
+            'received_at' => Carbon::parse($orthanc_src['LastUpdate'], 'UTC'),
+
+            'image_count' => data_get($orthanc_src, 'Statistics.CountInstances'),
+            'series_count' => data_get($orthanc_src, 'Statistics.CountSeries'),
+            'disk_size' => data_get($orthanc_src, 'Statistics.DiskSize'),
+        ];
+
+        if ((bool) data_get($orthanc_src, 'IsStable', false)) {
+            $study['study_status'] = StudyLevelStatus::StudyArrived->value;
+        } else {
+            $study['study_status'] = StudyLevelStatus::Pending->value;
+        }
+
+        $dob = data_get($orthanc_src, 'PatientMainDicomTags.PatientBirthDate');
+        if (filled($dob)) {
+            try {
+                $study['patient_birthdate'] = Carbon::parse($dob);
+            } catch (\Exception) {
+                Log::error('Failed to parse PatientMainDicomTags.PatientBirthDate: {dob}', ['dob' => $dob]);
+            }
+        }
+
+        $descr = data_get($orthanc_src, 'MainDicomTags.StudyDescription');
+        if (blank($descr)) {
+            $descr = data_get($orthanc_src, 'RequestedTags.AcquisitionDeviceProcessingDescription');
+        }
+        if (blank($descr)) {
+            $descr = data_get($orthanc_src, 'MainDicomTags.AcquisitionDeviceProcessingDescription');
+        }
+        $this->setValue($study, 'study_description', trim($descr));
+
+        $properties = [
+            'other_patient_names' => data_get($orthanc_src, 'RequestedTags.OtherPatientNames'),
+            'other_patient_ids' => data_get($orthanc_src, 'RequestedTags.OtherPatientIDs'),
+            'software_versions' => data_get($orthanc_src, 'RequestedTags.SoftwareVersions'),
+            'station_name' => data_get($orthanc_src, 'RequestedTags.StationName'),
+            'operators_name' => data_get($orthanc_src, 'RequestedTags.OperatorsName'),
+            'manufacturer' => data_get($orthanc_src, 'RequestedTags.Manufacturer'),
+            'manufacturer_model_name' => data_get($orthanc_src, 'RequestedTags.ManufacturerModelName'),
+            'acquisition_date' => DicomUtils::dateTimeToCarbon(data_get($orthanc_src, 'RequestedTags.AcquisitionDate'), data_get($orthanc_src, 'RequestedTags.AcquisitionTime')),
+        ];
+        $properties = array_purge($properties);
+        if (empty($properties)) {
+            $properties = [
+                'other_patient_names' => data_get($orthanc_src, 'MainDicomTags.OtherPatientNames'),
+                'other_patient_ids' => data_get($orthanc_src, 'MainDicomTags.OtherPatientIDs'),
+                'software_versions' => data_get($orthanc_src, 'MainDicomTags.SoftwareVersions'),
+                'station_name' => data_get($orthanc_src, 'MainDicomTags.StationName'),
+                'operators_name' => data_get($orthanc_src, 'MainDicomTags.OperatorsName'),
+                'manufacturer' => data_get($orthanc_src, 'MainDicomTags.Manufacturer'),
+                'manufacturer_model_name' => data_get($orthanc_src, 'MainDicomTags.ManufacturerModelName'),
+                'acquisition_date' => DicomUtils::dateTimeToCarbon(data_get($orthanc_src, 'MainDicomTags.AcquisitionDate'), data_get($orthanc_src, 'MainDicomTags.AcquisitionTime')),
+            ];
+            $properties = array_purge($properties);
+        }
+
+        $series = [];
+        foreach (data_get($orthanc_src, 'Series', []) as $ser) {
+            $params = [
+                'orthanc_uuid' => strtolower($ser['ID']),
+                'series_instance_uid' => data_get($ser, 'MainDicomTags.SeriesInstanceUID'),
+                'series_date' => DicomUtils::dateTimeToCarbon(data_get($ser, 'MainDicomTags.SeriesDate'), data_get($ser, 'MainDicomTags.SeriesTime')),
+                'series_number' => data_get($ser, 'MainDicomTags.SeriesNumber'),
+                'series_description' => data_get($ser, 'MainDicomTags.SeriesDescription'),
+                'protocol_name' => data_get($ser, 'MainDicomTags.ProtocolName'),
+                'modality' => data_get($ser, 'MainDicomTags.Modality'),
+                'body_part_examined' => data_get($ser, 'MainDicomTags.BodyPartExamined'),
+                'performed_procedure_step_description' => data_get($ser, 'MainDicomTags.PerformedProcedureStepDescription'),
+                'sequence_name' => data_get($ser, 'MainDicomTags.SequenceName'),
+            ];
+            $params['num_instances'] = count(data_get($ser, 'Instances', []));
+            $params = array_purge($params);
+            if (! empty($params)) {
+                $series[] = $params;
+            }
+        }
+
+        if (empty($series)) {
+            $series = null;
+        } else {
+            // $series = array_multisort(array_column($series, 'series_number'), SORT_ASC, $series);
+            usort($series, fn ($a, $b): int => (int) $a['series_number'] <=> (int) $b['series_number']);
+        }
+        if (empty($properties)) {
+            $properties = null;
+        }
+        $details = compact('properties', 'series');
+        $details = array_purge($details);
+        $study = array_purge($study);
+
+        return compact('study', 'details');
+    }
+
+    private function setValue(array &$array, string $key, mixed $value): void
+    {
+        if (filled($value)) {
+            $array[$key] = $value;
+        }
+    }
+}
diff --git a/database/migrations/2024_12_28_144858_create_study_details_table.php b/database/migrations/2024_12_28_144858_create_study_details_table.php
index d74d2b2..941a687 100644
--- a/database/migrations/2024_12_28_144858_create_study_details_table.php
+++ b/database/migrations/2024_12_28_144858_create_study_details_table.php
@@ -11,6 +11,7 @@ public function up(): void
         Schema::create('study_details', function (Blueprint $table) {
             $table->id();
             $table->foreignId('study_id')->unique()->constrained('studies')->cascadeOnDelete();
+            $table->string('orthanc_uuid')->unique();
             // $table->foreignId('user_id')->constrained('users');
             $table->text('clinical_history')->nullable();
             $table->text('surgical_history')->nullable();
diff --git a/database/migrations/2024_12_30_152300_create_audit_logs_table.php b/database/migrations/2024_12_30_152300_create_audit_logs_table.php
index 30ffca1..2a72485 100644
--- a/database/migrations/2024_12_30_152300_create_audit_logs_table.php
+++ b/database/migrations/2024_12_30_152300_create_audit_logs_table.php
@@ -16,6 +16,7 @@ public function up(): void
             $table->unsignedSmallInteger('activity');
             $table->ipAddress('ip_addr')->nullable();
             $table->string('user_agent')->nullable();
+            $table->string('orthanc_uuid')->nullable();
             $table->text('url')->nullable();
             $table->text('notes')->nullable();