title: How Secure Is Your Radiology Department? Mapping Digital Radiology Adoption and Security Worldwide.
abstract: 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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: 1 Graduate Division, Harvard Medical School, Harvard Extension School, Boston, MA.
authors.forename: Mark
authors.initials: M
authors.lastname: Stites
authors.affiliation: 2 Department of Radiology, Harvard Medical School, Massachusetts General Hospital, 25 New Chardon St, Office 470, Boston, MA 02114.|3 School of Data Analysis and Artificial Intelligence, National Research University-Higher School of Economics, Moscow, Russia.
authors.forename: Oleg S
authors.initials: OS
authors.lastname: Pianykh
mesh_terms: D000465:Algorithms; D016494:Computer Security / Q000592:standards*; D020407:Internet; D011872:Radiology Department, Hospital / Q000458:organization & administration*; D011873:Radiology Information Systems / Q000592:standards*; D012637:Security Measures
keywords: DICOM; PACS; firewall; networking; security