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A recent investigation by ProPublica, the German public broadcaster Bayerischer Rundfunk, and vulnerability and analysis firm, Greenbone Networks has revealed 24.3 million medical images contained in image storage systems are freely accessible online and require no authentication to view or download the images.
Those images, which include X-rays, MRI, and CT scans, are stored in picture archiving and communications systems (PACS) connected to the Internet.
Greenbone Networks audited 2,300 Internet-connected PACS between July and September 2019 and set up a RadiAnt DICOM Viewer to access the images stored on open PACS servers.
Those servers were found to contain approximately 733 million medical images of which 399.5 million could be viewed and downloaded. The researchers found 590 servers required no authentication whatsoever to view medical images.
PACS use the digital imaging and communications in medicine (DICOM) standard to view, process, store, and transmit the images. In most cases, a DICOM viewer would be required to access the images, but in some cases, all that is required is a web browser or a few lines of code. Anyone with rudimentary computer expertise would be able to view and download the images.
The exposed PACS were located in 52 countries and the highest concentration of unprotected PACS were found in the United States. 187 unsecured servers were found in the United States. The exposed U.S. PACS contained 13.7 million data sets and 303.1 million medical images of around 5 million U.S. patients.
The researchers found more than 10,000 security issues on the audited systems, 20% of which were high-severity and 500 were critical and had a CVSS v3 score of 10 out of 10.
The images included personal and medical information such as patients’ names, dates of birth, scan date, scope of the investigation, type of imaging procedure performed, institute name, attending physicians’ names, and the number of generated images. Some of the images also contained Social Security numbers.
The types of patient information included on the images could be used for identity theft, medical identity theft, and insurance fraud. The data could also be used to extort money from patients or create highly convincing spear phishing emails.
While the investigation uncovered no evidence to suggest any of the exposed information had been copied and published online, the possibility of data theft could not be discounted.
PACS are designed to allow images to be accessed easily by healthcare professionals, but the systems often lack security controls to restrict access. It is the responsibility of healthcare delivery organizations (HDOs) to ensure safeguards are implemented to secure their PACS, but HDOs can face major challenges addressing vulnerabilities and securing their systems without negatively impacting workflows.
To help address the problem, the National Cybersecurity Center of Excellence (NCCoE) recently released new guidance for HDOs to help them improve security controls on PACS and mitigate risks without negatively impacting user productivity and system performance.