CVE-2025-25474 is a buffer overflow vulnerability identified in the DCMTK (DICOM Toolkit) software, version 3.6.9+ DEV, specifically within the /dcmimgle/diinpxt.h component. DCMTK is widely used for handling DICOM (Digital Imaging and Communications in Medicine) files, which are standard in medical imaging systems. The vulnerability arises from improper bounds checking when processing certain image data, leading to a classic stack-based buffer overflow (CWE-120). This flaw can be triggered remotely without authentication or user interaction, as it involves processing crafted DICOM files that exploit the vulnerable code path. The CVSS v3.1 base score is 6.5, indicating a medium severity with network attack vector, low attack complexity, no privileges required, and no user interaction needed. The impact affects confidentiality and integrity, potentially allowing an attacker to execute arbitrary code or manipulate image data, but does not affect availability. No patches or known exploits are currently reported, but the vulnerability's presence in a critical medical imaging library poses a risk to healthcare environments. The lack of a patch emphasizes the need for proactive mitigation and monitoring. This vulnerability highlights the importance of secure coding practices in medical software and the risks posed by buffer overflows in critical healthcare infrastructure components.

For European organizations, especially those in healthcare, this vulnerability poses a significant risk due to the widespread use of DCMTK in medical imaging workflows. Exploitation could lead to unauthorized disclosure or alteration of sensitive patient imaging data, undermining confidentiality and data integrity. While availability is not directly impacted, the potential for arbitrary code execution could allow attackers to pivot within healthcare networks, potentially compromising other systems. The risk is heightened in environments where DCMTK is exposed to untrusted networks or where DICOM files are received from external sources without adequate validation. Given the critical nature of healthcare data and regulatory requirements such as GDPR, any compromise could result in severe legal and reputational consequences. The vulnerability also threatens the trustworthiness of diagnostic imaging, potentially impacting patient care quality. European healthcare providers, research institutions, and medical device manufacturers using DCMTK are particularly vulnerable. The absence of known exploits currently reduces immediate risk but does not eliminate the threat, as attackers may develop exploits once the vulnerability is publicly known.

Organizations should immediately inventory their use of DCMTK, particularly versions 3.6.9+ DEV, and identify systems processing DICOM files. Until an official patch is released, implement strict network segmentation to isolate medical imaging systems from untrusted networks and limit exposure to external DICOM sources. Employ application-layer filtering or validation to detect and block malformed or suspicious DICOM files before processing. Use intrusion detection/prevention systems (IDS/IPS) with updated signatures to monitor for exploitation attempts targeting DCMTK. Conduct code audits and fuzz testing on custom integrations involving DCMTK to identify similar vulnerabilities. Engage with DCMTK maintainers to obtain patches or mitigations and apply them promptly once available. Additionally, enforce strict access controls and logging on systems handling medical images to detect anomalous activity. Educate staff on the risks associated with processing external medical imaging data and establish incident response procedures tailored to healthcare environments. Consider deploying runtime application self-protection (RASP) or sandboxing techniques to limit the impact of potential exploitation.