PITTSBURGH -- Planning, collaboration, and risk mitigation are key to managing downtimes in emergency radiology from cyberattacks, according to a presentation given April 14 at ARRS 2026. 

Ellen Sun, MD, outlines how emergency radiologists can prepare for downtimes caused by system malfunctions or cyberattacks at ARRS 2026.

In her talk, Ellen Sun, MD, from Brigham and Women’s Hospital in Boston, shared how emergency radiologists can weather the storm while informational technology (IT) teams work to get imaging systems back to being functional. 

“As a primarily digital specialty, radiology is particularly vulnerable due to the reliance on specialized technology and network connectivity,” Sun said. “This is even more so in emergency radiology, for which 24/7 business continuity is crucial.” 

Medical care is becoming more dependent on IT systems, and with that come more vulnerabilities for potential cyberattacks and system failures. Healthcare in the U.S. faced over 500 compromises in 2025, second only to the finance industry, according to a 2026 report by the Identify Theft Resource Center, she noted. 

Radiology IT systems have several weak points that may lead to vulnerabilities to system failures. These include aging modalities and hardware, legacy and insecure software tools, home workstations, and end users, among others. 

Prior reports suggest that radiologists who work after hours are more likely to encounter downtime events and are more vulnerable due to unplanned downtime, Sun said. This is due to reduced staffing during these times and the change for malfunctions during planned software maintenance and upgrades. 

A 2015 study that Sun cited found that about 30% of unplanned radiology IT downtimes occur for 12 hours or more. These lengthy downtimes risk disrupting clinical workflows, delaying patient care, and losing patient data permanently. 

Sun outlined four phases of disaster response:  

• Mitigation and prevention – This includes analyzing hazards, risk, and vulnerability, including referencing earlier downtime experiences to better prepare for future incidents. Sun said teams should also identify potential fixes, think about potential failures, and refine current solutions. 

• Planning and preparedness – Sun said plans should be detailed and involve stakeholders. Planning should also define roles and responsibilities for team leaders and their staff, as well as define clear processes and reliable communication channels. Sun added that considerations should be made for specific healthcare sites, whether they are single- or multisite health systems for appropriate staffing. 

• Response – This includes plan activation and notification via structured messages that provide instructions to relevant staff. Being organized in planning next steps while emergency departments deal with downtimes, implementing disaster plans to continue imaging operations, and addressing the causes of downtimes are also needed. Some practical steps include using communication channels such as Microsoft Teams or WhatsApp and keeping a centralized log of imaging exams, interpreting radiologists, critical findings, and timestamped communications to ordering providers. 

• Recovery – Emergency radiology teams should hold debriefing sessions after the system downtime ends. This includes identifying successes and failures and coming up with ways to refine responses processes.

Sun said collaboration should be multidisciplinary and lead to iterative adaptation to meet needs for the emergency department, coverage sites, and enterprises. She added that competency can be reinforced with routine simulation drills.  

Radiologists can also actively engage leadership to “accelerate changes and hold accountability,” as well as ensure improvements are sustained, Sun said. 

“Early detection and rapid response are critical to mitigate damage,” she added.