Adversarial Attacks Against Medical Deep Learning Systems
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Abstract (arXiv)
The discovery of adversarial examples has raised concerns about the practical deployment of deep learning systems. In this paper, we demonstrate that adversarial examples are capable of manipulating deep learning systems across three clinical domains. For each of our representative medical deep learning classifiers, both white and black box attacks were highly successful. Our models are representative of the current state of the art in medical computer vision and, in some cases, directly reflect architectures already seeing deployment in real world clinical settings. In addition to the technical contribution of our paper, we synthesize a large body of knowledge about the healthcare system to argue that medicine may be uniquely susceptible to adversarial attacks, both in terms of monetary incentives and technical vulnerability. To this end, we outline the healthcare economy and the incentives it creates for fraud and provide concrete examples of how and why such attacks could be realistically carried out. We urge practitioners to be aware of current vulnerabilities when deploying deep learning systems in clinical settings, and encourage the machine learning community to further investigate the domain-specific characteristics of medical learning systems.
Key facts. Cited by 61 papers in the map (data through 7 Oct 2026). First posted on arXiv 15 Apr 2018.
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Citing papers per year: 2021: 21; 2022: 11; 2023: 6; 2024: 11; 2025: 10; 2026: 2.
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- 2021Transparency of Deep Neural Networks for Medical Image Analysis: A Review of Interpretability Methodscited by 83
- 2021Adversarial Example Detection for DNN Models: A Review and Experimental Comparisoncited by 51
- 2022A Taxonomy of Human and ML Strengths in Decision-Making to Investigate Human-ML Complementaritycited by 22
- 2021Towards Evaluating the Robustness of Deep Diagnostic Models by Adversarial Attackcited by 15
- 2021Explainable Deep Learning in Healthcare: A Methodological Survey from an Attribution Viewcited by 15
- 2023IPMix: Label-Preserving Data Augmentation Method for Training Robust Classifierscited by 14
- 2021Exploiting epistemic uncertainty of the deep learning models to generate adversarial samplescited by 12
- 2022Improving Adversarial Robustness by Putting More Regularizations on Less Robust Samplescited by 11
- 2022Interpretation of Black Box NLP Models: A Surveycited by 9
- 2021Adversarial Transfer Attacks With Unknown Data and Class Overlapcited by 8
- 2021Adversarial Attacks and Defenses in Physiological Computing: A Systematic Reviewcited by 7
- 2021Attack-agnostic Adversarial Detection on Medical Data Using Explainable Machine Learningcited by 7
38 more
- 2021Now You See It, Now You Dont: Adversarial Vulnerabilities in Computational Pathologycited by 7
- 2021Selection of Source Images Heavily Influences the Effectiveness of Adversarial Attackscited by 6
- 2025Enhanced Estimation Techniques for Certified Radii in Randomized Smoothingcited by 6
- 2022Current State of Community-Driven Radiological AI Deployment in Medical Imagingcited by 5
- 2023CALLOC: Curriculum Adversarial Learning for Secure and Robust Indoor Localizationcited by 5
- 2021Multi-stage Optimization based Adversarial Trainingcited by 4
- 2021Federated Learning: Issues in Medical Applicationcited by 4
- 2021Adversarial Attacks and Defenses for Social Network Text Processing Applications: Techniques, Challenges and Future Research Directionscited by 4
- 2022The Security of Deep Learning Defences for Medical Imagingcited by 4
- 2022Robust Graph Neural Networks using Weighted Graph Laplaciancited by 4
- 2025Beyond Vulnerabilities: A Survey of Adversarial Attacks as Both Threats and Defenses in Computer Vision Systemscited by 4
- 2021The Effect of Prior Lipschitz Continuity on the Adversarial Robustness of Bayesian Neural Networkscited by 3
- 2021Adversarial Robustness Study of Convolutional Neural Network for Lumbar Disk Shape Reconstruction from MR imagescited by 3
- 2022On Evaluating Adversarial Robustness of Chest X-ray Classification: Pitfalls and Best Practicescited by 3
- 2023Adversarial Medical Image with Hierarchical Feature Hidingcited by 3
- 2024SENTINEL: Securing Indoor Localization against Adversarial Attacks with Capsule Neural Networkscited by 3
- 2025CoRPA: Adversarial Image Generation for Chest X-rays Using Concept Vector Perturbations and Generative Modelscited by 3
- 2021Application of Adversarial Examples to Physical ECG Signalscited by 2
- 2023Enhancement attacks in biomedical machine learningcited by 2
- 2024Systematically Assessing the Security Risks of AI/ML-enabled Connected Healthcare Systemscited by 2
- 2024Leveraging Expert Input for Robust and Explainable AI-Assisted Lung Cancer Detection in Chest X-rayscited by 2
- 2024SoK: Security and Privacy Risks of Healthcare AIcited by 2
- 2024Classification under strategic adversary manipulation using pessimistic bilevel optimisationcited by 2
- 2025Adversarial Robustness Analysis of Vision-Language Models in Medical Image Segmentationcited by 2
- 2025How to make Medical AI Systems safer? Simulating Vulnerabilities, and Threats in Multimodal Medical RAG Systemcited by 2
- 2021Adversarial Heart Attack: Neural Networks Fooled to Segment Heart Symbols in Chest X-Ray Imagescited by 1
- 2021Medical Aegis: Robust adversarial protectors for medical imagescited by 1
- 2022Unreasonable Effectiveness of Last Hidden Layer Activations for Adversarial Robustnesscited by 1
- 2023Adversarial AI in Insurance: Pervasiveness and Resiliencecited by 1
- 2024S-E Pipeline: A Vision Transformer (ViT) based Resilient Classification Pipeline for Medical Imaging Against Adversarial Attackscited by 1
- 2024DFT-Based Adversarial Attack Detection in MRI Brain Imaging: Enhancing Diagnostic Accuracy in Alzheimer's Case Studiescited by 1
- 2021Predicting Disease Progress with Imprecise Lab Test Resultscited by 0
- 2021Deep Bayesian Image Set Classification: A Defence Approach against Adversarial Attackscited by 0
- 2021Attack-Centric Approach for Evaluating Transferability of Adversarial Samples in Machine Learning Modelscited by 0
- 2022Scoring Black-Box Models for Adversarial Robustnesscited by 0
- 2022Adversarial Attacks and Defences for Skin Cancer Classificationcited by 0
- 2022Analysis of Explainable Artificial Intelligence Methods on Medical Image Classificationcited by 0
- 2023Adversarial attacks on hybrid classical-quantum Deep Learning models for Histopathological Cancer Detectioncited by 0
50 most cited of 61 All 61 (JSON)
- 2026Large-scale Testing Global Optimization Methods with Black-box Adversarial Attacks13 Aug 2026
- 2026CutisAI: Deep Learning Framework for Automated Dermatology and Cancer Screening5 Jan 2026
- 2025Perturbations in the Orthogonal Complement Subspace for Efficient Out-of-Distribution Detection2 Nov 2025
- 2025Adversarial training with restricted data manipulation26 Sep 2025
- 2025Countering adversarial evasion in regression analysis26 Sep 2025
- 2025How to make Medical AI Systems safer? Simulating Vulnerabilities, and Threats in Multimodal Medical RAG System24 Aug 2025
- 2025Beyond Vulnerabilities: A Survey of Adversarial Attacks as Both Threats and Defenses in Computer Vision Systems3 Aug 2025
- 2025Systems-Theoretic and Data-Driven Security Analysis in ML-enabled Medical Devices18 Jun 2025
- 2025Black-box Adversarial Attacks on CNN-based SLAM Algorithms30 May 2025
- 2025Adversarial Robustness Analysis of Vision-Language Models in Medical Image Segmentation5 May 2025
- 2025Enhanced Estimation Techniques for Certified Radii in Randomized Smoothing11 Mar 2025
- 2025CoRPA: Adversarial Image Generation for Chest X-rays Using Concept Vector Perturbations and Generative Models4 Feb 2025
38 more
- 2024Adversarial Training in Low-Label Regimes with Margin-Based Interpolation27 Nov 2024
- 2024Classification under strategic adversary manipulation using pessimistic bilevel optimisation26 Oct 2024
- 2024SoK: Security and Privacy Risks of Healthcare AI11 Sep 2024
- 2024DFT-Based Adversarial Attack Detection in MRI Brain Imaging: Enhancing Diagnostic Accuracy in Alzheimer's Case Studies16 Aug 2024
- 2024S-E Pipeline: A Vision Transformer (ViT) based Resilient Classification Pipeline for Medical Imaging Against Adversarial Attacks23 Jul 2024
- 2024SENTINEL: Securing Indoor Localization against Adversarial Attacks with Capsule Neural Networks14 Jul 2024
- 2024Leveraging Expert Input for Robust and Explainable AI-Assisted Lung Cancer Detection in Chest X-rays28 Mar 2024
- 2024Adversary-Robust Graph-Based Learning of WSIs21 Mar 2024
- 2024NeuralSentinel: Safeguarding Neural Network Reliability and Trustworthiness12 Feb 2024
- 2024Hidden in Plain Sight: Undetectable Adversarial Bias Attacks on Vulnerable Patient Populations8 Feb 2024
- 2024Systematically Assessing the Security Risks of AI/ML-enabled Connected Healthcare Systems30 Jan 2024
- 2023Adversarial Medical Image with Hierarchical Feature Hiding4 Dec 2023
- 2023CALLOC: Curriculum Adversarial Learning for Secure and Robust Indoor Localization10 Nov 2023
- 2023IPMix: Label-Preserving Data Augmentation Method for Training Robust Classifiers7 Oct 2023
- 2023Adversarial attacks on hybrid classical-quantum Deep Learning models for Histopathological Cancer Detection8 Sep 2023
- 2023Adversarial AI in Insurance: Pervasiveness and Resilience17 Jan 2023
- 2023Enhancement attacks in biomedical machine learning5 Jan 2023
- 2022Current State of Community-Driven Radiological AI Deployment in Medical Imaging29 Dec 2022
- 2022On Evaluating Adversarial Robustness of Chest X-ray Classification: Pitfalls and Best Practices15 Dec 2022
- 2022Adversarial Attacks and Defences for Skin Cancer Classification13 Dec 2022
- 2022Analysis of Explainable Artificial Intelligence Methods on Medical Image Classification10 Dec 2022
- 2022Scoring Black-Box Models for Adversarial Robustness31 Oct 2022
- 2022Robust Graph Neural Networks using Weighted Graph Laplacian3 Aug 2022
- 2022Improving Adversarial Robustness by Putting More Regularizations on Less Robust Samples7 Jun 2022
- 2022A Taxonomy of Human and ML Strengths in Decision-Making to Investigate Human-ML Complementarity22 Apr 2022
- 2022Interpretation of Black Box NLP Models: A Survey31 Mar 2022
- 2022Unreasonable Effectiveness of Last Hidden Layer Activations for Adversarial Robustness15 Feb 2022
- 2022The Security of Deep Learning Defences for Medical Imaging21 Jan 2022
- 2021Explainable Deep Learning in Healthcare: A Methodological Survey from an Attribution View5 Dec 2021
- 2021Attack-Centric Approach for Evaluating Transferability of Adversarial Samples in Machine Learning Models3 Dec 2021
- 2021Medical Aegis: Robust adversarial protectors for medical images22 Nov 2021
- 2021Transparency of Deep Neural Networks for Medical Image Analysis: A Review of Interpretability Methods1 Nov 2021
- 2021Adversarial Attacks and Defenses for Social Network Text Processing Applications: Techniques, Challenges and Future Research Directions26 Oct 2021
- 2021Adversarial Transfer Attacks With Unknown Data and Class Overlap23 Sep 2021
- 2021Federated Learning: Issues in Medical Application1 Sep 2021
- 2021Deep Bayesian Image Set Classification: A Defence Approach against Adversarial Attacks23 Aug 2021
- 2021Application of Adversarial Examples to Physical ECG Signals20 Aug 2021
- 2021Predicting Disease Progress with Imprecise Lab Test Results8 Jul 2021
50 newest of 61 All 61 (JSON)
- 2021Transparency of Deep Neural Networks for Medical Image Analysis: A Review of Interpretability Methodscited by 83
- 2021Adversarial Example Detection for DNN Models: A Review and Experimental Comparisoncited by 51
- 2022A Taxonomy of Human and ML Strengths in Decision-Making to Investigate Human-ML Complementaritycited by 22
- 2021Towards Evaluating the Robustness of Deep Diagnostic Models by Adversarial Attackcited by 15
- 2021Explainable Deep Learning in Healthcare: A Methodological Survey from an Attribution Viewcited by 15
- 2023IPMix: Label-Preserving Data Augmentation Method for Training Robust Classifierscited by 14
- 2021Exploiting epistemic uncertainty of the deep learning models to generate adversarial samplescited by 12
- 2022Improving Adversarial Robustness by Putting More Regularizations on Less Robust Samplescited by 11
- 2022Interpretation of Black Box NLP Models: A Surveycited by 9
- 2021Adversarial Transfer Attacks With Unknown Data and Class Overlapcited by 8
- 2021Adversarial Attacks and Defenses in Physiological Computing: A Systematic Reviewcited by 7
- 2021Attack-agnostic Adversarial Detection on Medical Data Using Explainable Machine Learningcited by 7
12 most cited of 59 All 59 (JSON)
- 2026Large-scale Testing Global Optimization Methods with Black-box Adversarial Attacks13 Aug 2026
- 2026CutisAI: Deep Learning Framework for Automated Dermatology and Cancer Screening5 Jan 2026
- 2025Perturbations in the Orthogonal Complement Subspace for Efficient Out-of-Distribution Detection2 Nov 2025
- 2025Adversarial training with restricted data manipulation26 Sep 2025
- 2025Countering adversarial evasion in regression analysis26 Sep 2025
- 2025Beyond Vulnerabilities: A Survey of Adversarial Attacks as Both Threats and Defenses in Computer Vision Systems3 Aug 2025
- 2025Systems-Theoretic and Data-Driven Security Analysis in ML-enabled Medical Devices18 Jun 2025
- 2025Black-box Adversarial Attacks on CNN-based SLAM Algorithms30 May 2025
- 2025Enhanced Estimation Techniques for Certified Radii in Randomized Smoothing11 Mar 2025
- 2025CoRPA: Adversarial Image Generation for Chest X-rays Using Concept Vector Perturbations and Generative Models4 Feb 2025
- 2024Adversarial Training in Low-Label Regimes with Margin-Based Interpolation27 Nov 2024
- 2024Classification under strategic adversary manipulation using pessimistic bilevel optimisation26 Oct 2024
12 newest of 59 All 59 (JSON)