@article{WeberSteinPilgermannetal.2023, author = {Weber, Simon B. and Stein, Stefan and Pilgermann, Michael and Schrader, Thomas}, title = {Attack Detection for Medical Cyber-Physical Systems - A Systematic Literature Review}, series = {IEEE Access}, journal = {IEEE Access}, number = {11}, publisher = {IEEE}, doi = {10.1109/ACCESS.2023.3270225}, pages = {41796 -- 41815}, year = {2023}, abstract = {The threat situation due to cyber attacks in hospitals is emerging and patient life is at risk. One significant source of potential vulnerabilities is medical cyber-physical systems (MCPS). Detecting intrusions in this environment faces challenges different from other domains, mainly due to the heterogeneity of devices, the diversity of connectivity types, and the variety of terminology. To summarize existing results, we conducted a structured literature review (SLR) following the guidelines of Kitchenham et al. for SLRs in software engineering. We developed six research questions regarding detection approach, detection location, included features, adversarial focus, utilized datasets, and intrusion prevention. We identified that most researchers focused on an anomaly-based detection approach at the network layer. The primary focus was on the detection of malicious insiders. While several researchers used publicly available datasets for training and testing their algorithms, the lack of suitable datasets resulted in the development of testbeds consisting of various medical devices. Based on the results, we formulated five future research topics. First, the special conditions of hospital networks, the MCPS deployed within them, and the contrasts to other IT and OT environments should be examined. Thereupon, MCPS-specific datasets should be created that allow researchers to address the health domain's unique requirements and possibilities. At the same time, endeavors aimed at standardization in this area should be supported and expanded. Moreover, the use of medical context for attack detection should be further explored. Last but not least, efforts for MCPS-tailored intrusion prevention should be intensified. This way, the emerging threat landscape can be addressed, IT security in hospitals can be improved, and patient health can be protected.}, language = {en} } @article{SteinPilgermannSedlmayr2025, author = {Stein, Stefan and Pilgermann, Michael and Sedlmayr, Martin}, title = {Systematic Evaluation of Manufacturer Disclosure Statements for Medical Device Security (MDS2) to Strengthen Hospital OT Security Measures - Lessons Learned}, series = {Studies in health technology and informatics}, volume = {331}, journal = {Studies in health technology and informatics}, doi = {10.3233/SHTI251404}, pages = {256 -- 264}, year = {2025}, abstract = {The growing number of connected medical devices in hospitals poses serious operational technology (OT) security challenges. Effective countermeasures require a structured analysis of the communication interfaces and security configurations of individual devices. State of the art: Although Manufacturer Disclosure Statements for Medical Device Security (MDS2, Version 2019) offer relevant information, they are rarely integrated into cybersecurity workflows. Existing studies are limited in scope and lack scalable methodologies for systematic evaluation. Concept: This study analyzed 209 MDS2 documents and 161 security white papers to extract structured information on ports, protocols, and protective measures. Over 52,000 question-answer pairs were converted into a machine-readable format using customized parsing and validation routines. The aim was to establish whether this dataset could inform risk assessments and future applications involving Large Language Models (LLMs). Implementation: The analysis revealed 367 distinct ports, including common protocols such as HTTPS (443), DICOM (104), and RDP (3389), as well as vendor-specific proprietary ports. Approximately 40\% of the devices used over 20 ports, indicating a broad attack surface. OCR errors and inconsistent formatting required manual corrections. A consolidated dataset was developed to support clustering, comparison across vendors and versions, and preparation for downstream LLM use, particularly via structured SBOM and configuration data. Lessons learned: Although no model training was conducted, the structured dataset can support AI-based OT security workflows. The findings highlight the critical need for up-to-date, machine-readable manufacturer data in standardized formats and schemas. Such information could greatly enhance the automation, comparability, and scalability of hospital cybersecurity measures.}, language = {en} } @article{KhuntsariaGachechiladzeLipartaetal.2025, author = {Khuntsaria, Irakli and Gachechiladze, Konstantine and Liparta, Elene and Kobulashvili, Tamar and Jorbenadze, Mariam and Revazishvili, Tamaz and Mamiseishvili, Ana and Kekelia, Elene and Topuridze, Marina and Sturua, Lela and Schrader, Thomas and Kldiashvili, Ekaterina}, title = {Strategic implementation of HPV vaccination to eliminate cervical cancer in Georgia}, series = {Public Health in Practice}, volume = {2025}, journal = {Public Health in Practice}, number = {10}, publisher = {Elsevier}, doi = {10.1016/j.puhip.2025.100679}, pages = {1 -- 4}, year = {2025}, abstract = {Objectives Human Papillomavirus (HPV) is a prevalent sexually transmitted infection and a leading cause of cervical cancer. In Georgia, cervical cancer ranks as the fifth most common cancer among women, with approximately 330 new cases and 200 deaths reported annually. Despite the availability of effective HPV vaccines, national vaccination coverage remains low. This study aimed to evaluate HPV vaccination coverage, analyze cervical cancer incidence trends, and model the potential impact of increased vaccination uptake on cancer prevention outcomes in Georgia. Study design A retrospective observational study was conducted using national health registry data and modeling projections to assess the burden of cervical cancer and estimate the effect of scaled vaccination coverage. Methods National health databases were used to analyze HPV vaccination rates and cervical cancer incidence. Descriptive statistics, chi-square tests, and linear regression were applied to identify trends and disparities. Additionally, a dynamic transmission model was developed to simulate the 10-year impact of increasing HPV vaccination coverage on cervical cancer incidence. Results The crude cervical cancer incidence rate was 15.7 per 100,000 women, with an age-standardized rate of 10.6 per 100,000. In 2022, only 38 \% of eligible girls aged 13-18 received the first HPV vaccine dose, and 26 \% completed the second dose. Regional disparities in vaccination and screening were noted, and overall screening coverage declined to 13,890 women screened in 2022. Modeling showed that increasing vaccine coverage to 60 \% could reduce cervical cancer incidence by 50 \% (preventing ∼163 cases); coverage of 80 \% and 90 \% could reduce incidence by 70 \% and 85 \%, preventing 228 and 276 cases, respectively. Conclusion Low HPV vaccination uptake in Georgia (38 \% first dose and 26 \% dull coverage) and declining screening limit cervical cancer prevention. Modeling shows that increasing vaccination coverage to 60-90 \% could prevent 163-276 cases over the next decade. Strengthening vaccination and screening strategies is essential to move forward elimination.}, language = {en} } @article{SteinPilgermannWeberetal.2025, author = {Stein, Stefan and Pilgermann, Michael and Weber, Simon and Sedlmayr, Martin}, title = {Leveraging MDS2 and SBOM data for LLM-assisted vulnerability analysis of medical devices}, series = {Computational and Structural Biotechnology Journal}, volume = {28}, journal = {Computational and Structural Biotechnology Journal}, publisher = {Elsevier}, doi = {10.1016/j.csbj.2025.07.012}, pages = {267 -- 280}, year = {2025}, abstract = {This study investigated the use of a semi-automated, Retrieval-Augmented Generation (RAG)-based multi-agent architecture to analyze security-relevant data and assemble specialized exploitation paths targeting medical devices. The input dataset comprised device-specific sources, namely, the Manufacturer Disclosure Statement for Medical Device Security (MDS2) documents and Software Bills of Materials (SBOMs), enriched with public vulnerability databases, including Common Vulnerabilities and Exposures (CVE), Known Exploited Vulnerabilities (KEV), and Metasploit exploit records. The objective was to assess whether a modular, Large Language Model (LLM)-driven agent system could autonomously correlate device metadata with known vulnerabilities and existing exploit information to support structured threat modeling. The architecture follows a static RAG design based on predefined prompts and fixed retrieval logic, without autonomous agent planning or dynamic query adaptation. The developed Vulnerability Intelligence for Threat Analysis in Medical Security (VITAMedSec) system operates under human-prompted supervision and successfully synthesizes actionable insights and exploitation paths without requiring manual step-by-step input during execution. Although technically coherent results were obtained under controlled conditions, real-world validation remains a critical avenue for future research. This study further discusses the dual-use implications of such an agent-based framework, its relevance to patient safety in medical device cybersecurity, and the broader applicability of the proposed architecture to other critical infrastructure sectors. These findings emphasize both the technical potential and ethical responsibility for applying semi-automated AI workflows in medical cybersecurity contexts.}, language = {en} } @article{PrinzOrlowskiBecketal.2025, author = {Prinz, Alexander and Orlowski, Katja and Beck, Eberhard and Witte, Kerstin}, title = {Serious Games for Seniors With Dementia: A Pilot Study}, series = {Journal of Applied Gerontology}, volume = {2025}, journal = {Journal of Applied Gerontology}, publisher = {SAGE}, doi = {10.1177/07334648251350846}, url = {http://nbn-resolving.de/urn:nbn:de:kobv:522-opus4-33440}, pages = {1 -- 11}, year = {2025}, abstract = {Dementia, marked by cognitive decline, significantly impacts daily life. With global prevalence rising, traditional treatments manage symptoms but have side effects and offer no cure. Non-pharmacological interventions, like serious games, are gaining importance. This study assesses the feasibility and benefits of serious games for people with mild to moderate dementia over a 10-week intervention. Sixty-one patients were recruited, with 35 completing the study. The intervention included six games focusing on physical and cognitive training. Outcome measures were motor function, cognitive assessments, quality of life, and depression. Results showed significant improvements in dynamic balance (p = .013) but no significant changes in other measures. The findings suggest that serious games are feasible and can improve motor functions like balance. However, short intervention periods may limit their impact on cognitive function and quality of life. Longer interventions and personalized game designs are recommended for greater benefits.}, language = {en} } @article{KantJohannsenCreutzburg2021, author = {Kant, Daniel and Johannsen, Andreas and Creutzburg, Reiner}, title = {Analysis of IoT Security Risks based on the exposure of the MQTT Protocol}, series = {IS and T International Symposium on Electronic Imaging Science and Technology}, volume = {33}, journal = {IS and T International Symposium on Electronic Imaging Science and Technology}, publisher = {Society for Imaging Science and Technology (IS\&T)}, doi = {10.2352/ISSN.2470-1173.2021.3.MOBMU-096}, pages = {096-1 -- 096-8}, year = {2021}, language = {en} } @article{KantCreutzburgJohannsen2020, author = {Kant, Daniel and Creutzburg, Reiner and Johannsen, Andreas}, title = {Investigation of risks for Critical Infrastructures due to the exposure of SCADA systems and industrial controls on the Internet based on the search engine Shodan}, series = {IS and T International Symposium on Electronic Imaging Science and Technology}, journal = {IS and T International Symposium on Electronic Imaging Science and Technology}, publisher = {Society for Imaging Science and Technology (IS\&T)}, address = {Springfield, VA}, issn = {2470-1173}, doi = {10.2352/ISSN.2470-1173.2020.3.MOBMU-253}, pages = {253-1 -- 253-16}, year = {2020}, language = {en} } @article{JohannsenKantCreutzburg2020, author = {Johannsen, Andreas and Kant, Daniel and Creutzburg, Reiner}, title = {Measuring IT security, compliance and data governance within small and medium-sized IT enterprises}, series = {IS and T International Symposium on Electronic Imaging Science and Technology}, journal = {IS and T International Symposium on Electronic Imaging Science and Technology}, publisher = {Society for Imaging Science and Technology (IS\&T)}, address = {Springfield, VA}, issn = {2470-1173}, doi = {10.2352/ISSN.2470-1173.2020.3.MOBMU-252}, pages = {252-1 -- 252-11}, year = {2020}, language = {en} }