VIENNA, Sept. 3 — The shift is unmistakable: radiology has become one of healthcare’s most targeted digital front lines, and the attackers are getting smarter. At ECR 2026 here, cybersecurity experts presented real-world cases of new vulnerabilities in AI-driven radiology systems — including a hidden prompt buried inside an abdominal CT image. The demonstration underscored a broader warning from the field: as imaging goes fully digital and AI-assisted, the attack surface grows with every connected link in the chain.
That surface is large, spanning EHR order entry, radiology information systems (RIS), modality imaging acquisition, PACS, archival storage, VNA, workstations, report preparation, and other radiology software. AI systems add risk by impacting image reconstruction and potentially adding artefacts, said Reza Forghani, MD, PhD, neuroradiologist and chief medical information officer for imaging at AdventHealth, a non-profit system with 57 hospital campuses in nine US states.
The scale of the threat is documented. In 2024, at least 289 cybersecurity incidents affected EU healthcare providers — more than any other essential sector, according to the European Commission’s Annual Report on NIS Directive Incidents. Ransomware accounted for an estimated 71% of incidents that disrupted patient care.
In the US, the FBI reported that in 2025, healthcare organisations experienced 182 data breaches and 460 ransomware attacks, the highest among all critical infrastructure sectors. While no published data exists on successful attacks specifically against hospital radiology departments, they have increased exponentially since 2000, said Po-Hao Chen, MD, security committee chair of the Society for Imaging Informatics in Medicine (SIIM) — a year correlating with the widespread conversion of US radiology to all-digital functionality.
In response, the American College of Radiology (ACR) and SIIM published comprehensive guidelines in 2025 for radiology staff and IT/PACS administrators. Overlooked vulnerabilities include offsite stolen credentials via phishing, and mobile data sources like USB drives and DICOM CD/DVDs, which should never be directly inputted without rigorous safeguards. Prof. Benoît Desjardins, MD, PhD, professor of radiology and Chief Medical Cybersecurity Officer at the Centre Hospitalier de l’Université de Montréal and the University of Pennsylvania, said people are the weakest components.
Key safeguards — physical, technical, and administrative — are like legs on a stool; if one weakens, the infrastructure becomes unstable. Physical safeguards include locked doors, key cards, biometric scans, cameras, disabled USB ports, firewalls, and intrusion detection. Technical protection requires frequent password changes, access adjustments with personnel changes, and rigorous audit log monitoring.
Regular staff training covers incident recognition, reporting, password management, workstation security, and social engineering protection. In January 2025, the European Commission developed an Action Plan on the Cybersecurity of Hospitals and Healthcare Providers.
Desjardins stressed continuous risk assessment and governance, as threats evolve constantly. Watch this space: with AI-driven imaging expanding and attackers embedding prompts inside scans, the next battleground may be the image itself.
