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A Review on the Security Vulnerabilities of the IoMT against Malware Attacks and DDoS

Lily Dzamesi, Nelly Elsayed

TL;DR

This systematic review assesses security vulnerabilities in the Internet of Medical Things (IoMT), focusing on malware and DDoS threats within IoMT deployments. By surveying 2019–2024 literature from ACM, IEEE Xplore, and Elsevier, it identifies weak encryption, weak authentication, and irregular firmware updates as core vulnerabilities, compounded by device resource limits. The review evaluates mitigation strategies—cryptography, blockchain, machine‑learning–driven anomaly detection, and edge computing—highlighting trade‑offs in effectiveness, complexity, and scalability, with blockchain achieving high apparent success but imposing substantial overhead. It concludes that advancing lightweight security measures and standardized protocols is critical for protecting patient data and ensuring reliable healthcare delivery, calling for collaboration among researchers and device manufacturers to translate these findings into practice.

Abstract

The Internet of Medical Things (IoMT) has transformed the healthcare industry by connecting medical devices in monitoring treatment outcomes of patients. This increased connectivity has resulted to significant security vulnerabilities in the case of malware and Distributed Denial of Service (DDoS) attacks. This literature review examines the vulnerabilities of IoMT devices, focusing on critical threats and exploring mitigation strategies. We conducted a comprehensive search across leading databases such as ACM Digital Library, IEEE Xplore, and Elsevier to analyze peer-reviewed studies published within the last five years (from 2019 to 2024). The review shows that inadequate encryption protocols, weak authentication methods, and irregular firmware updates are the main causes of risks associated with IoMT devices. We have identified emerging solutions like machine learning algorithms, blockchain technology, and edge computing as promising approaches to enhance IoMT security. This review emphasizes the pressing need to develop lightweight security measures and standardized protocols to protect patient data and ensure the integrity of healthcare services.

A Review on the Security Vulnerabilities of the IoMT against Malware Attacks and DDoS

TL;DR

This systematic review assesses security vulnerabilities in the Internet of Medical Things (IoMT), focusing on malware and DDoS threats within IoMT deployments. By surveying 2019–2024 literature from ACM, IEEE Xplore, and Elsevier, it identifies weak encryption, weak authentication, and irregular firmware updates as core vulnerabilities, compounded by device resource limits. The review evaluates mitigation strategies—cryptography, blockchain, machine‑learning–driven anomaly detection, and edge computing—highlighting trade‑offs in effectiveness, complexity, and scalability, with blockchain achieving high apparent success but imposing substantial overhead. It concludes that advancing lightweight security measures and standardized protocols is critical for protecting patient data and ensuring reliable healthcare delivery, calling for collaboration among researchers and device manufacturers to translate these findings into practice.

Abstract

The Internet of Medical Things (IoMT) has transformed the healthcare industry by connecting medical devices in monitoring treatment outcomes of patients. This increased connectivity has resulted to significant security vulnerabilities in the case of malware and Distributed Denial of Service (DDoS) attacks. This literature review examines the vulnerabilities of IoMT devices, focusing on critical threats and exploring mitigation strategies. We conducted a comprehensive search across leading databases such as ACM Digital Library, IEEE Xplore, and Elsevier to analyze peer-reviewed studies published within the last five years (from 2019 to 2024). The review shows that inadequate encryption protocols, weak authentication methods, and irregular firmware updates are the main causes of risks associated with IoMT devices. We have identified emerging solutions like machine learning algorithms, blockchain technology, and edge computing as promising approaches to enhance IoMT security. This review emphasizes the pressing need to develop lightweight security measures and standardized protocols to protect patient data and ensure the integrity of healthcare services.
Paper Structure (18 sections, 6 figures, 1 table)

This paper contains 18 sections, 6 figures, 1 table.

Table of Contents

  1. Introduction
  2. Method
  3. Search Process
  4. Inclusion and Exclusion Criteria
  5. Inclusion Criteria
  6. Exclusion Criteria
  7. Quality Assessment
  8. Data Collection
  9. Data Extraction Process
  10. Synthesis of Findings
  11. Synthesis of Findings
  12. Vulnerabilities in IoMT Devices
  13. Malware Attacks
  14. Distributed Denial of Service (DDoS) Attacks
  15. Mitigation Strategies
  16. ...and 3 more sections

Figures (6)

  • Figure 1: Examples of IoMT devices.
  • Figure 2: The IoMT system architecture layers diagram.
  • Figure 3: The workflow used in our systematic search process for IoMT security literature.
  • Figure 4: Distribution of paper sources. Alt: The diagram shows the distribution of paper sources that have been used at the systematic review.
  • Figure 5: The success rate.
  • ...and 1 more figures