Risk assessment of cyber-attacks on telemetry-enabled cardiac implantable electronic devices (CIED)

Abstract

Cardiac implantable electronic devices (CIED) are vulnerable to radio frequency (RF) cyber-attacks. Besides, CIED communicate with medical equipment whose telemetry capabilities and IP connectivity are creating new entry points that may be used by attackers. Therefore, it remains crucial to perform a cybersecurity risk assessment of CIED and the systems they rely on to determine the gravity of threats, address the riskiest ones on a priority basis, and develop effective risk management plans. In this study, we carry out such risk assessment according to the ISO/IEC 27005 standard and the NIST SP 800-30 guide. We employed a threat-oriented analytical approach and divided the analysis into three parts, an actor-based analysis to determine the impact of the attacks, a scenario-based analysis to measure the probability of occurrence of threats, and a combined analysis to identify the riskiest attack outcomes. The results show that vulnerabilities on the RF interface of CIED represent an acceptable risk, whereas the network and Internet connectivity of the systems they rely on represent an important potential risk. Further analysis reveals that the damages of these cyber-attacks could spread further to affect manufacturers through intellectual property theft or physicians by affecting their reputation.

A Survey: To Govern, Protect, and Detect Security Principles on Internet of Medical Things (IoMT)

“…In risk assessment, the threat, risk, and vulnerability analysis (TVRA) technique are implemented. The risk assessment was carried out in accordance with the ISO/IEC 27005 standard for handling information security risks [30]. TVRA is based on the probability of a specified attack, as well as the impact of the attack on system assets and associated threats.…”

“…The study in [41] proposed a systemtheoretic process analysis (STPA) on an insulin pump device to detect accidents caused by security threats that are not protected by functional safety. In [30] used a threat-oriented analytical technique to assess the impacts of the attacks, a scenario-based analysis to determine the probability of threats occurring, and a composite analysis to select the most serious attack.…”

Risk Assessment Methodologies for the Internet of Medical Things: A Survey and Comparative Appraisal

“…The authors make use of attack-tree structure analysis as part of their threat analysis model. In [59] The authors use a threat-oriented analytical approach to split the analysis into three parts, an actor-based analysis to assess the effects of the attacks, a scenario-based analysis to calculate the possibility of threats happening, and a composite analysis to classify the most dangerous attack findings. Table 5 presents a comparison of the various IoMT threat models found in the scientific literature.…”

“…In [71] four major groups of impact are proposed: a) Patient safety (Imposing the impact on the health of a patient due to medical device failures such as minor/severe injury or even death), b) Service personnel or environment safety (Imposing the impact on medical personnel or the surrounding ecosystem due to to failures), c) Maintenance (Measuring the average time needed for restoring or maintenance the system after a software failure) and d) Cost (Measuring the total economic cost for maintenance and the time for holding up medical operation). A four-scale impact assessment is presented in [59]. The authors identify four scales: health, economy, quality of life, and privacy.…”

Cybersecurity Model Based on Hardening for Secure Internet of Things Implementation

“…In the same line, M. Ngamboé et al [36] assess the risks in implantable cardiac electronic devices (CIED) using the ISO/IEC 27,005 standard and the National Institute of Standards and Technology (NIST) Special Publication (SP) 800-30 guide. Using a methodical approach, they perform the analysis in three parts that are actor-based, scenario-based and combined.…”