Radiology’s rapid digitisation has delivered faster workflows and broader access to specialist expertise, yet it has also expanded the attack surface across imaging networks, data stores and remote workstations. Health care delivery has faced sharp growth in ransomware, data exfiltration and operational disruption, with high direct and downstream costs. Imaging teams now operate amid escalating regulatory expectations, accelerating adoption of artificial intelligence, increased reliance on cloud platforms and widespread remote reading. Against this backdrop, radiology departments are being urged to align operations with recognised frameworks, strengthen safeguards across people, processes and technology and prepare for recovery as diligently as prevention to maintain confidentiality, integrity and availability of imaging data.
Converging Trends Elevate Cyber Risk
Multiple industry trends are reshaping imaging workflows and risk profiles. The integration of AI into image analysis, diagnosis and decision support increases dependence on data pipelines and introduces new vulnerabilities tied to algorithm integrity and the streams of data they process. Advancements in AI also raise the sophistication of image tampering, heightening risks to data integrity. In parallel, growing use of cloud-based storage, including PACS, brings scalability and flexibility while extending exposure through third-party software clients, shared infrastructure and data transfer across onshore and offshore centres.
The pandemic accelerated telemedicine and virtual radiologist workflows, expanding access to imaging services while increasing the number of entry points into organisations. Many remote workstations were deployed quickly and did not always follow best practices, necessitating secure communication channels and protection of patient data in transit. End-to-end encryption and strong authentication for home and other less controlled environments are highlighted to mitigate these risks. As these trends converge, proactive security governance and technical controls become essential to preserve safe, reliable imaging operations.
Regulation, Standards and Expanding Obligations
Radiology teams must navigate a complex and evolving regulatory landscape. For organisations handling data of EU citizens, the GDPR imposes stricter provisions on consent, data subject rights, breach notification and penalties, with extraterritorial reach.
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Recent and planned changes further raise expectations. Legislative proposals would tie access to certain payment programmes to meeting minimum cybersecurity standards. Internationally, amendments emphasise state-of-the-art security, and Canada is moving toward GDPR-like standards for data transfers. Collectively, the developments signal growing accountability for payers, providers and manufacturers, balanced against the realities of legacy infrastructure.
Frameworks and Safeguards for Resilient Imaging Operations
Security strategy in radiology is anchored in the CIA triad: confidentiality, integrity and availability. Confidentiality focuses on preventing unauthorised access and disclosure through robust encryption, access permissions and physical controls for systems and workstations. Integrity ensures data remain accurate, complete and unaltered across storage, transmission and use, risks include undetected manipulation of imaging data or headers, making detection and prevention of unauthorised modification a priority. Availability ensures authorised users can access systems and information when needed, with ransomware and denial-of-service attacks posing significant threats that demand redundancy, backups and tested incident response plans.
Implementing safeguards requires a coordinated approach across administrative, physical and technical domains. Administrative safeguards govern system access through training, unique credentials, least-privilege policies, multifactor authentication where feasible and routine log review with scheduled security audits. Findings should be shared with institutional stakeholders and vendors to drive continuous improvement. Physical safeguards include secure facilities with restricted zones, device inventories and storage media controls across the lifecycle. Encryption is recognised as best practice to protect lost or stolen devices, and well-documented disposal procedures support compliant decommissioning. Backup strategies, such as maintaining multiple copies across different media with at least one offline or air-gapped, can expedite restoration after failures or attacks.
Technical safeguards span network firewalls, encryption for communications and segmentation or microsegmentation to reduce blast radius and protect legacy modalities. Workstations employ password protection, privacy screens and automatic sign-off, balanced with physical controls to maintain clinical usability in different environments. These layers combine to implement defence in depth, ensuring that if one control is bypassed others remain to protect critical systems and data.
Beyond baseline controls, several best practices strengthen preparedness. Continuous risk management helps identify assets, threats, likelihood and impact to prioritise mitigation for the most critical components of the imaging infrastructure. Governance is emphasised within updated cybersecurity frameworks to align risk management with organisational objectives and ensure accountability. Documented incident response plans define roles, responsibilities and procedures to isolate affected systems, recover data and manage communications after a breach, reflecting the operational realities of imaging service lines. Training and awareness address human error, a frequent entry point for attacks and are reinforced through updated standard operating procedures so staff can recognise early indicators and act quickly.
Digital radiology now operates at the intersection of pervasive cyber threats, rapidly evolving regulation and accelerating technological change. AI integration, cloud dependence and remote reading expand capability and access while widening exposure, making governance and layered controls essential. Applying the CIA triad through administrative, physical and technical safeguards, supported by risk management, defence in depth, incident response and ongoing training, offers an actionable path to protect confidentiality, preserve integrity and ensure availability of imaging data. Organisations embedding these practices into daily operations will be better positioned to maintain patient trust, meet regulatory expectations and sustain clinical continuity when disruptions arise.
Source: Journal of the American College of Radiology
Image Credit: Freepik
