AI-DRIVEN PACS SECURITY FRAMEWORK: THREAT MODEL, ATTACK VECTORS, AND DEFENSE STRATEGY

THREAT MODEL & SUPPLY-CHAIN COMPROMISE

WSUS Server
(Compromised)

PACS Environment

Radiology Workstations
(Infected)

PACS Server

Malicious Updates (CVE-2025-58287)

COORDINATED INTEGRITY ATTACKS

COORDINATED INTEGRITY ATTACKS

IMAGE INTEGRITY ATTACK (DISPLAY-TIME)

Rendering Engine
(Display-Time)

Image Manipulation (During Idle Screen)

In-Memory Display
(Altered Representation)

No DICOM File Modification

Workflow Timing Inference

REPORT INTEGRITY ATTACK (CREATION-TIME)

Report Assembly & Editing

(Subtle Alterations)

Digital Signing
(Pre-Signing)

RIS/EHR Systems
(Propagated Incorrect Output)

AI-DRIVEN DETECTION, DEFENSE & MITIGATION FRAMEWORK

Image Integrity Verification
- Self-Supervised Vision Transformers (e.g., ResNet, EfficientNet)
- Temporal Consistency Analysis
- Diffusion-Based Reconstruction Models

AI
INTEGRATED AI DEFENSE

Semantic Validation of Report Content
- Large Language Models (LLMs) (e.g., ClinicalBERT, BioBERT)
- Cross-Modal Vision-Language Networks

MITIGATION & REVIEW
- Halt Image Display & Report Signing
- Regenerate Trusted Content
- Flag for Secondary Clinical Review

Verified Clinical Decision Points

flow diagram