Hi
When index files become corrupted, stored studies cannot be retrieved in a search (although they are still stored in PACS). The index files are not as big as you think, in my case I have almost 14TB of data and my index files are 24GB in size, a file of that size will be backed up in a few minutes on an external drive.
My Orthanc server works on Windows so I prepare a .BAT file that runs every night at a certain time (configured in the Windows task scheduler) and saves the index file on a NAS that is located on the network. Believe me that the process is simple but effective.
Important, in my case I do not save the studies, I only save the SQLITE index files, the studies are stored in an external NAS that is prepared with RAID 10 and all the duplicated hardware for greater security. Anyway, if you wanted to backup ALL THE ORTHANC DATA, you can use a copy software like COBIAN and only save the files modified since the last copy (the first copy if it will take several hours) and that would not be as long as you would. think.
Good luck
William