In 2018, clinics and hospitals were hit with numerous attacks leading to significant data breaches and interruptions in medical services. An attacker with access to medical records can do much more than hold the data for ransom or sell it on the black market. In this paper, we show how an attacker can use deep-learning to add or remove evidence of medical conditions from volumetric (3D) medical scans. An attacker may perform this act in order to stop a political candidate, sabotage research, commit insurance fraud, perform an act of terrorism, or even commit murder. We implement the attack using a 3D conditional GAN and show how the framework (CT-GAN) can be automated. Although the body is complex and 3D medical scans are very large, CT-GAN achieves realistic results which can be executed in milliseconds. To evaluate the attack, we focused on injecting and removing lung cancer from CT scans. We show how three expert radiologists and a state-of-the-art deep learning AI are highly susceptible to the attack. We also explore the attack surface of a modern radiology network and demonstrate one attack vector: we intercepted and manipulated CT scans in an active hospital network with a covert penetration test. Demo video: this https URL Source code: this https URL
Copy-move attacks can be used to remove cancer or duplicate an existing cancer. However, duplicating an existing cancer will raise suspicion because radiologists closely analyze each sample. Image-splicing can be used to inject cancer into healthy lungs. However, CT scanners have distinct local noise patterns which are visually noticeable @cite_30 @cite_29 . The copied patterns would not fit the local pattern and thus raise suspicion.
@cite_30 @cite_29
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High radiation dose in computed tomography (CT) scans increases the lifetime risk of cancer and has become a major clinical concern. Recently, iterative reconstruction algorithms with total variation (TV) regularization have been developed to reconstruct CT images from highly undersampled data acquired at low mAs levels in order to reduce the imaging dose. Nonetheless, the low-contrast structures tend to be smoothed out by the TV regularization, posing a great challenge for the TV method. To solve this problem, in this work we develop an iterative CT reconstruction algorithm with edge-preserving TV (EPTV) regularization to reconstruct CT images from highly undersampled data obtained at low mAs levels. The CT image is reconstructed by minimizing energy consisting of an EPTV norm and a data fidelity term posed by the x-ray projections. The EPTV term is proposed to preferentially perform smoothing only on the non-edge part of the image in order to better preserve the edges, which is realized by introducing a penalty weight to the original TV norm. During the reconstruction process, the pixels at the edges would be gradually identified and given low penalty weight. Our iterative algorithm is implemented on graphics processing unit to improve its speed. We test our reconstruction algorithm on a digital NURBS-based cardiac-troso phantom, a physical chest phantom and a Catphan phantom. Reconstruction results from a conventional filtered backprojection (FBP) algorithm and a TV regularization method without edge-preserving penalty are also presented for comparison purposes. The experimental results illustrate that both the TV-based algorithm and our EPTV algorithm outperform the conventional FBP algorithm in suppressing the streaking artifacts and image noise under a low-dose context. Our edge-preserving algorithm is superior to the TV-based algorithm in that it can preserve more information of low-contrast structures and therefore maintain acceptable spatial resolution. Purpose Due to the potential risk of inducing cancer, radiation exposure by X-ray CT devices should be reduced for routine patient scanning. However, in low-dose X-ray CT, severe artifacts typically occur due to photon starvation, beam hardening, and other causes, all of which decrease the reliability of the diagnosis. Thus, a high-quality reconstruction method from low-dose X-ray CT data has become a major research topic in the CT community. Conventional model-based de-noising approaches are, however, computationally very expensive, and image-domain de-noising approaches cannot readily remove CT-specific noise patterns. To tackle these problems, we want to develop a new low-dose X-ray CT algorithm based on a deep-learning approach. Method We propose an algorithm which uses a deep convolutional neural network (CNN) which is applied to the wavelet transform coefficients of low-dose CT images. More specifically, using a directional wavelet transform to extract the directional component of artifacts and exploit the intra- and inter- band correlations, our deep network can effectively suppress CT-specific noise. In addition, our CNN is designed with a residual learning architecture for faster network training and better performance. Results Experimental results confirm that the proposed algorithm effectively removes complex noise patterns from CT images derived from a reduced X-ray dose. In addition, we show that the wavelet-domain CNN is efficient when used to remove noise from low-dose CT compared to existing approaches. Our results were rigorously evaluated by several radiologists at the Mayo Clinic and won second place at the 2016 “Low-Dose CT Grand Challenge.” Conclusions To the best of our knowledge, this work is the first deep-learning architecture for low-dose CT reconstruction which has been rigorously evaluated and proven to be effective. In addition, the proposed algorithm, in contrast to existing model-based iterative reconstruction (MBIR) methods, has considerable potential to benefit from large data sets. Therefore, we believe that the proposed algorithm opens a new direction in the area of low-dose CT research. Copy-move forgery is one of the most common type of tampering in digital images. Copy-moves are parts of the image that are copied and pasted onto another part of the same image. Detection methods in general use block-matching methods, which first divide the image into overlapping blocks and then extract features from each block, assuming similar blocks will yield similar features. In this paper we present a block-based approach which exploits texture as feature to be extracted from blocks. Our goal is to study if texture is well suited for the specific application, and to compare performance of several texture descriptors. Tests have been made on both uncompressed and JPEG compressed images. We present an adversarial domain adaptation based deep learning approach for automatic tumor segmentation from T2-weighted MRI. Our approach is composed of two steps: (i) a tumor-aware unsupervised cross-domain adaptation (CT to MRI), followed by (ii) semi-supervised tumor segmentation using Unet trained with synthesized and limited number of original MRIs. We introduced a novel target specific loss, called tumor-aware loss, for unsupervised cross-domain adaptation that helps to preserve tumors on synthesized MRIs produced from CT images. In comparison, state-of-the art adversarial networks trained without our tumor-aware loss produced MRIs with ill-preserved or missing tumors. All networks were trained using labeled CT images from 377 patients with non-small cell lung cancer obtained from the Cancer Imaging Archive and unlabeled T2w MRIs from a completely unrelated cohort of 6 patients with pre-treatment and 36 on-treatment scans. Next, we combined 6 labeled pre-treatment MRI scans with the synthesized MRIs to boost tumor segmentation accuracy through semi-supervised learning. Semi-supervised training of cycle-GAN produced a segmentation accuracy of 0.66 computed using Dice Score Coefficient (DSC). Our method trained with only synthesized MRIs produced an accuracy of 0.74 while the same method trained in semi-supervised setting produced the best accuracy of 0.80 on test. Our results show that tumor-aware adversarial domain adaptation helps to achieve reasonably accurate cancer segmentation from limited MRI data by leveraging large CT datasets.