CVE-2024-52333 is a vulnerability identified in OFFIS DCMTK version 3.6.8, a widely used open-source toolkit for handling DICOM files in medical imaging. The root cause is improper array index validation within the determineMinMax function, which processes DICOM data arrays. This flaw allows an attacker to craft a malicious DICOM file that triggers an out-of-bounds write operation, a classic buffer overflow scenario categorized under CWE-119. Such out-of-bounds writes can corrupt memory, potentially enabling arbitrary code execution, privilege escalation, or denial of service. The vulnerability is exploitable without authentication or user interaction but requires the attacker to supply a malicious DICOM file to the vulnerable system. The CVSS v3.1 score of 8.4 reflects the high impact on confidentiality, integrity, and availability, with low attack complexity and no privileges required. Although no public exploits have been reported yet, the vulnerability poses a significant risk to systems processing medical images, especially in healthcare environments where DCMTK is integrated into PACS (Picture Archiving and Communication Systems) or other medical imaging workflows. The lack of an official patch at the time of reporting necessitates immediate risk mitigation through alternative controls.

For European organizations, particularly healthcare providers and medical imaging centers, this vulnerability could lead to severe consequences. Exploitation may allow attackers to execute arbitrary code on systems handling sensitive patient imaging data, compromising patient confidentiality and data integrity. It could also disrupt availability of critical imaging services, delaying diagnosis and treatment. Given the reliance on DCMTK in many European medical institutions, a successful attack could propagate through hospital networks, impacting multiple systems. The breach of protected health information (PHI) could also result in regulatory penalties under GDPR. Moreover, the potential for malware deployment or ransomware attacks leveraging this vulnerability could further exacerbate operational and financial damages. The threat is especially critical in countries with advanced healthcare IT infrastructure and high volumes of medical imaging data processing.

Organizations should immediately audit their use of DCMTK version 3.6.8 and isolate systems processing DICOM files to limit exposure. Until an official patch is released, implement strict input validation and filtering of incoming DICOM files to detect and block malformed or suspicious files. Employ network segmentation to restrict access to DICOM processing servers and monitor logs for unusual activity related to DICOM file handling. Use application whitelisting and endpoint protection to detect potential exploitation attempts. Engage with vendors or the OFFIS project for updates on patches or mitigations. Additionally, conduct regular backups of critical imaging data and ensure incident response plans include scenarios involving medical imaging system compromise. Training staff to recognize and report anomalies in imaging workflows can also reduce risk.