Cybersecurity Challenges for PACS and Medical Imaging

Area of Science:

• Medical Informatics
• Cybersecurity
• Health IT

Background:

• Healthcare cybersecurity threats are escalating, with a notable increase in attacks targeting medical networks and data formats.
• Digital Imaging and Communications in Medicine (DICOM) and Picture Archiving and Communications Systems (PACS) are increasingly vulnerable.
• Existing security measures are often underutilized by healthcare providers and vendors.

Purpose of the Study:

• To identify and describe prevalent cybersecurity attack scenarios targeting PACS and medical imaging networks.
• To highlight the gaps in current security practices and the need for specialized guidelines.
• To propose solutions for enhancing the security of medical imaging systems.

Main Methods:

• Analysis of five distinct attack vectors on PACS and medical imaging networks.
• Categorization of attacks including malware on storage media, network compromise, embedded malware in DICOM images/reports, image manipulation, and Health Level Seven (HL7) message infiltration.
• Review of existing prevention and mitigation strategies.

Main Results:

• Five key attack scenarios were detailed: malware import, hospital network compromise, DICOM malware, medical image manipulation, and malicious HL7 messages.
• Prevention and mitigation measures are available but not consistently implemented by users or vendors.
• A lack of practical PACS network security guidelines for practitioners was identified.

Conclusions:

• There is an urgent need for comprehensive PACS network security guidelines tailored for healthcare practitioners.
• Enhanced collaboration between users and vendors is crucial for implementing robust security measures.
• Integration of healthcare enterprise integration profiles and testing tools is recommended for secure deployment of technologies like public key infrastructure and digital signatures in PACS environments.