Hack the PACS: DICOM, Ransomware, and the Future of Healthcare Cybersecurity | Dr. Benoit Desjardins

What happens when a radiologist, a former hacker, and a cybersecurity leader live in the same person? You get Dr. Benoit Desjardins, and this conversation is one of the most eye-opening we've had on Imaging Informatics Unplugged. Benoit is a Professor of Radiology at the University of Montreal and the first Chief Medical Cybersecurity Officer in Canada at CHUM. He's a consultant for the FBI, a 2025 CEH Hall of Fame inductee, and a past NSA Codebreaker Challenge winner. If you manage a PACS, run an imaging department, or support radiology IT, hit play. This one will change how you think about your environment. Here's some of what we dig into. Benoit shares how a packed DEF CON room in 2017 pulled him back into hacking, and why he frames healthcare cybersecurity as a patient safety issue rather than an IT one. We talk about what really happens to care when imaging goes dark, including the loss of priors and delayed diagnoses. We also compare the US and Canadian approaches to ransomware, why paying a ransom is a risky bet, and how double extortion works when you have good backups.Then we get into the imaging-specific stuff. Benoit explains how he put PHP code into the 128-byte DICOM preamble and took over a test PACS, proving that an image can be part of your attack surface. We cover practical steps your PACS team can take on Monday morning: treat incoming DICOM as untrusted, validate and sanitize inputs, patch the apps that parse images, segment older infrastructure, and monitor for odd behavior. We also get honest about DICOM security, why encryption is often off by default, and the key management problem nobody wants to own.We wrap with what secure by design means for a province-wide PACS in Quebec, what it takes to train a true cyber physician, and Benoit's warning about AI-powered hacking tools and what hospitals should expect over the next six to eight months. It touches AI in radiology, enterprise imaging, VNA strategy, and vendor procurement along the way.If conversations like this make you want to go deeper on the fundamentals, check out the Imaging Informatics Primer course, the CIIP Foundations Program, and the hands-on DICOM Learning Lab at nagelsconsulting.com. They're built for people like you who live in PACS, DICOM, HL7 and Radiology IT every day.Learn more at nagelsconsulting.com#ImagingInformatics #PACS #DICOM #HealthcareIT #RadiologyIT #Cybersecurity #HealthcareCybersecurity #Ransomware #EnterpriseImaging #MedicalImaging #PatientSafety #RadiologyAI #InfoSec #SecureByDesign #CHUM