Securing Picture Archiving and Communication System (PACS): Cybersecurity for the Healthcare Sector

Medical imaging plays an important role in diagnosing and treating patients. The system that manages medical images is known as the picture archiving communication system (PACS) and is nearly ubiquitous in healthcare environments. PACS is defined by the Food and Drug Administration (FDA) as a Class II device that “provides one or more capabilities relating to the acceptance, transfer, display, storage, and digital processing of medical images.” PACS centralizes functions surrounding medical imaging workflows and serves as an authoritative repository of medical image information.

PACS fits within a highly complex healthcare delivery organization (HDO) environment that involves interfacing with a range of interconnected systems. PACS may connect with clinical information systems and medical devices and engage with HDO-internal and affiliated health professionals. Complexity may introduce or expose opportunities that allow malicious actors to compromise the confidentiality, integrity, and availability of a PACS ecosystem.

The NCCoE at NIST analyzed risk factors regarding a PACS ecosystem by using a risk assessment based on the NIST Risk Management Framework. The NCCoE also leveraged the NIST Cybersecurity Framework and other relevant standards to identify measures to safeguard the ecosystem. The NCCoE developed an example implementation that demonstrates how HDOs can use standards-based, commercially available cybersecurity technologies to better protect a PACS ecosystem. This practice guide helps HDOs implement current cybersecurity standards and best practices to reduce their cybersecurity risk and protect patient privacy while maintaining the performance and usability of PACS.