CVE-2022-2121 in DCMTK
Summary
by MITRE • 06/24/2022
OFFIS DCMTK's (All versions prior to 3.6.7) has a NULL pointer dereference vulnerability while processing DICOM files, which may result in a denial-of-service condition.
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Analysis
by VulDB Data Team • 02/01/2025
The vulnerability identified as CVE-2022-2121 affects OFFIS DCMTK software library versions prior to 3.6.7 and represents a critical NULL pointer dereference flaw that can be exploited to cause denial-of-service conditions during DICOM file processing operations. This vulnerability specifically manifests when the library encounters malformed or specially crafted DICOM files that trigger improper memory handling during parsing operations, leading to application crashes or system unresponsiveness. The issue stems from inadequate input validation and error handling mechanisms within the DICOM file processing pipeline, where the software fails to properly check for null references before attempting to access memory locations. This type of vulnerability falls under the CWE-476 category of NULL Pointer Dereference, which is classified as a fundamental memory safety issue that has been consistently identified as a primary attack vector in cybersecurity incidents.
The technical exploitation of this vulnerability occurs when an attacker submits a malicious DICOM file that contains malformed data structures or missing required fields that cause the DCMTK library to attempt to dereference a null pointer during the parsing process. When the library encounters such conditions, it typically results in an application crash or segmentation fault, effectively rendering the service unavailable to legitimate users. The operational impact extends beyond simple service disruption as this vulnerability can be leveraged in automated attack scenarios where multiple malicious DICOM files are processed in sequence, potentially causing cascading failures in medical imaging systems or network infrastructure that relies on DCMTK for DICOM protocol handling. The vulnerability affects systems that utilize OFFIS DCMTK for medical image processing, archiving, or transmission, including Picture Archiving and Communication Systems (PACS), Radiology Information Systems (RIS), and various medical imaging workstations that depend on this library for DICOM protocol compliance.
Organizations implementing systems that utilize DCMTK for medical image processing face significant operational risks from this vulnerability, particularly in healthcare environments where system availability is critical for patient care delivery. The attack surface is broad as DICOM files can be transmitted through various channels including network protocols, file transfers, and direct system interfaces, making it difficult to completely isolate and protect against such attacks. From an ATT&CK framework perspective, this vulnerability aligns with the T1499.004 technique related to Network Denial of Service and represents a critical weakness in the system's resilience against adversarial input manipulation. The vulnerability's exploitation does not require elevated privileges or specialized knowledge, making it particularly dangerous as it can be exploited by attackers with minimal technical expertise. The root cause of this issue demonstrates a common pattern in software development where input validation is insufficient, particularly in protocols like DICOM that handle complex binary data structures with numerous optional fields and nested components that can be manipulated to trigger unexpected behavior in parsing libraries.
The recommended mitigation strategy involves immediate upgrading to OFFIS DCMTK version 3.6.7 or later, which contains the necessary patches to address the NULL pointer dereference conditions. Organizations should also implement additional input validation measures at network boundaries and application layers to detect and filter potentially malicious DICOM files before they reach the DCMTK processing components. Network segmentation and monitoring solutions should be deployed to detect unusual patterns of DICOM file processing that might indicate exploitation attempts. The vulnerability highlights the importance of maintaining up-to-date security patches in medical imaging systems, where the combination of high availability requirements and the complexity of DICOM protocols creates unique challenges for vulnerability management. Security teams should also consider implementing automated scanning tools that can identify systems using vulnerable DCMTK versions and prioritize remediation efforts based on the criticality of the affected systems within their network infrastructure. Organizations should conduct thorough testing of the patched versions to ensure that the security updates do not introduce compatibility issues with existing medical imaging workflows or data processing requirements.