Stites and Pianykh, 2016

OBJECTIVE. Despite the long history of digital radiology, one of its most critical aspects—
information security—still remains extremely underdeveloped and poorly standardized.
To study the current state of radiology security, we explored the worldwide security of
medical image archives.
MATERIALS AND METHODS. Using the DICOM data-transmitting standard, we
implemented a highly parallel application to scan the entire World Wide Web of networked
computers and devices, locating open and unprotected radiology servers. We used only legal
and radiology-compliant tools. Our security-probing application initiated a standard DICOM
handshake to remote computer or device addresses, and then assessed their security posture
on the basis of handshake replies.
RESULTS. The scan discovered a total of 2774 unprotected radiology or DICOM servers
worldwide. Of those, 719 were fully open to patient data communications. Geolocation
was used to analyze and rank our findings according to country utilization. As a result, we
built maps and world ranking of clinical security, suggesting that even the most radiology-advanced
countries have hospitals with serious security gaps.
CONCLUSION. Despite more than two decades of active development and implementation,
our radiology data still remains insecure. The results provided should be applied to raise
awareness and begin an earnest dialogue toward elimination of the problem. The application
we designed and the novel scanning approach we developed can be used to identify security
breaches and to eliminate them before they are compromised.