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Cardiac Implantable Electronic Devices (CIED) are fast becoming a fundamentaltool of advanced medical technology and a key instrument in saving lives.Despite their importance, previous studies have shown that CIED are notcompletely secure against cyber attacks and especially those who are exploitingtheir Radio Frequency (RF) communication interfaces. Furthermore, the telemetrycapabilities and IP connectivity of the external devices interacting with theCIED are creating other entry points that may be used by attackers. In thispaper, we carry out a realistic risk analysis of such attacks. This analysis iscomposed of three parts. First, an actor-based analysis to determine the impactof the attacks. Second, a scenario-based analysis to determine the probabilityof occurrence of each threat. Finally, a combined analysis to determine whichattack outcomes (i.e. attack goals) are riskiest and to identify thevulnerabilities that constitute the highest overall risk exposure. Theconducted study showed that the vulnerabilities associated with the RFinterface of CIED represent an acceptable risk. In contrast, the network andinternet connectivity of external devices represent an important potentialrisk. The previously described findings suggest that the highest risk isassociated with external systems and not the CIED itself.

Risk Assessment of Cyber Attacks on Telemetry Enabled Cardiac Implantable Electronic Devices (CIED)