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New Malicious Medical DICOM Image Files Cause HIPAA Headache


Image credits: Nucleus Medical Media

Malicious DICOM files can be crafted to contain both CT and MRI scan imaging data and potentially dangerous PE executables, a process which can be used by threat actors to hide malware inside seemingly harmless files.

Cylera's Markel Picado Ortizachieved this by taking advantage of a DICOM format design flaw which allows for the "128-byte section at the beginning of the file, called the Preamble," to be modified to addcompatibility with non-DICOM image viewers.

The files resulting from embedding a malicious component within a DICOM imaging document "which intertwine executable malware with patient information" are called by CyleraPEDICOM files.

Hiding multiple streams of data within the same file is definitely not something new (see HERE,HERE, and HERE) but using .dcm files to spread malicious binaries is definitely a novel approach.These types of files are known as "polyglot files" which can contain two streams of data containing...(continued)

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