Open Access

Introduction: The recent publication of several critical cyber security issues in cardiac implantable devices and the resulting press coverage upsets affected users and their trust in medical device producers. Reviewing the published security vulnerabilities regarding networked medical devices, it raises the question, if the reporting media, the responsible security researchers, and the producers handle security vulnerabilities appropriately. Are the media reports of security vulnerabilities in medical devices meaningful in a way that patients can assess their respective risk for an attack via the security vulnerability? The collaboration between IT-security experts and clinicians aims at reviewing published security vulnerabilities of rhythm devices, and evaluate overall patients risks. Methodology: We performed a literature review on security vulnerabilities in implantable medical devices with a focus on cardiac devices. We analyzed (Fig. 1) the (1) requirements for an attacker and the (2) technical feasibility and clustered them in three different scenarios: The first scenario requires that the attacker physically approaches a victim with a programming device. The second scenario requires proximity to the victim, e.g., within a few meters. The third and strongest attacker scenario is a remote attack that doesn’t require any physical proximity to the victim. We then compare the attacker scenarios and (3) the overall patients’ risks with the press coverage (overhyped, adequate, underhyped). (4) The resulting overall patients’ risk was rated by clinicians (security vulnerability of patients’ data, dangerous programming possible). Results: Out of the three analyzed incidents, we found one to be underhyped, one to be overhyped, and one was appropriate compared to the medial coverage (Fig. 2). The most occurring technical issues were based on the absence of basic security primitives. The patient damage for all of the analyzed incidents was fatal in the worst-case scenario. Further, the patient damage and the overall patient risks are disjunct due to the missing capability of performing large scale attacks. Conclusion: The resulting overall patients’ risks may not adequately reflect the patient damage in the considered cases. Often, the overall patient risk is not as severe as the necessary attacker capabilities are high and it would require strongly motivated attackers to perform the attack. Therefore, most of the reviewed cases are considered with a smaller overall patient risk than implied by press reports. Reviewing the ongoing IT-Security trends regarding implantable medical devices shows an increasing focus on researching in the field of medical device security. Therefore, further findings in the near future are to be expected. To deal with this fact in a responsible way, proper proactive knowledge management is mandatory. We recommend medical staff to critically reflect reports in mass media due to possible sensationalism. Therefore, we propose a joint approach in combining the technical expertise of cyber security experts with clinical aspects of medical experts, to ensure a solid understanding of a newly published vulnerability. The combination of both communities promises to result in better predictions for patients’ risks from security vulnerabilities in implanted cardiac devices.

OpenPGP and S/MIME are the two major standards for email end-to-end encryption. We show practical attacks against both encryption schemes in the context of email. First, we present a design flaw in the key update mechanism, allowing a third party to deploy a new key to the communication partners. Second, we show how email clients can be tricked into acting as an oracle for decryption or signing by exploiting their functionality to auto-save drafts. Third, we demonstrate how to exfiltrate the private key, based on proprietary mailto parameters implemented by various email clients. An evaluation shows that 8 out of 20 tested email clients are vulnerable to at least one attack. While our attacks do not target the underlying cryptographic primitives, they raise concerns about the practical security of OpenPGP and S/MIME email applications. Finally, we propose countermeasures and discuss their advantages and disadvantages.

Background: Modern healthcare devices can be connected to computer networks and many western healthcareinstitutions run those devices in networks. At the same time, cyber attacks are on the rise and there is evidence thatcybercriminals do not spare critical infrastructure such as major hospitals, even if they endanger patients. Intuitively,the more and closer connected healthcare devices are to public networks, the higher the risk of getting attacked. Methods: To asses the current connectivity status of healthcare devices, we surveyed the field of German hospitalsand especially University Medical Center UMCs. Results: The results show a strong correlation between the networking degree and the number of medical devices.The average number of medical devices is 25.150, with a median of networked medical devices of 3.600. Actual keyusers of networked medical devices are the departments Radiology, Intensive Care, Radio-Oncology RO, NuclearMedicine NUC, and Anaesthesiology in the group of UMCs. In the next five years, the usage of networked medicaldevices will increase significantly in the departments of Surgery, Intensive Care, and Radiology. We detected a strongcorrelation between the degree of connectivity and the likelihood of being attacked.The survey answers regarding the cyber security status reveal a lack of security basics in some of the inquiredhospitals. We did discover successful attacks in hospitals with separated or subsidiary departments. A fusion ofcompetencies on an organizational level facilitates the right behavior here. Most hospitals rated themselvespredominantly positively in the self-assessment but also stated the usefulness of IT security insurance.Conclusions:Concluding our results, hospitals are already facing the consequences of omitted measures within theirgrowing pool of medical devices. Continuously relying on historically grown structures without adaption and trustingmanufactures to solve vectors is a critical behavior that could seriously endanger patients.

Due to the increasing connectivity of modern vehicles, collected data is no longer only stored in the vehicle itself but also transmitted to car manufacturers and vehicle assistant apps. This development opens up new possibilities for digital forensics in criminal investigations involving modern vehicles. This paper deals with the digital forensic analysis of vehicle assistant apps of eight car manufacturers. We reconstruct the driver’s activities based on the data stored on the smartphones and in the manufacturer’s backend. For this purpose, data of the Android and iOS apps of the car manufacturers Audi, BMW, Ford, Mercedes, Opel, Seat, Tesla, and Volkswagen were extracted from the smartphone and examined using digital forensic methods following forensics guidelines. Additionally, manufacturer data was retrieved using Subject Access Requests. Using the extensive data gathered, we reconstruct trips and refueling processes, determine parking positions and duration, and track the locking and unlocking of the vehicle. Our findings show that the digital forensic investigation of smartphone applications is a useful addition to vehicle forensics and should therefore be taken into account in the strategic preparation of future digital forensic investigations.