DICOMHawk: A Cyber Deception Framework for Medical Imaging Infrastructure

Karina Elzer; Alberto Mongardini; Ricardo Yaben; Georgios Theodoridis; Alexandra Babanuta; Nawras Mouala; Emmanouil Vasilomanolakis

arXiv · 2607.15754

DICOMHawk: A Cyber Deception Framework for Medical Imaging Infrastructure

Karina Elzer·Alberto Mongardini·Ricardo Yaben·Georgios Theodoridis·Alexandra Babanuta·Nawras Mouala·Emmanouil Vasilomanolakis

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Abstract

Cyber-attacks against exposed healthcare infrastructure threaten sensitive patient data and clinical operations, yet existing defensive tools for DICOM-based medical imaging systems provide limited interaction and are easily fingerprinted. We introduce DICOMHawk, a cyber-deception framework that emulates DICOM and PACS services using realistic interactions, dynamically populated medical records, and embedded honeytokens. In an 86-day comparison and a 424-day deployment across multiple networks, DICOMHawk attracted more valid sessions than Dicompot, avoided honeypot detection, and captured 67 medical-related attacks from 15 unique IPs. The results show that realistic, long-term, multi-location deception improves visibility into threats targeting medical imaging systems.

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Karina Elzer, Alberto Mongardini, Ricardo Yaben, Georgios Theodoridis, Alexandra Babanuta, Nawras Mouala, Emmanouil Vasilomanolakis. 2026-07-17. DICOMHawk: A Cyber Deception Framework for Medical Imaging Infrastructure. https://arxiv.org/abs/2607.15754

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