IMDfence: Architecting a Secure Protocol for Implantable Medical Devices

Over the past decade, focus on the security and privacy aspects of implantable medical devices (IMDs) has intensified, driven by the multitude of cybersecurity vulnerabilities found in various existing devices. However, due to their strict computational, energy and physical constraints, conventional security protocols are not directly applicable to IMDs. Custom-tailored schemes have been proposed instead which, however, fail to cover the full spectrum of security features that modern IMDs and their ecosystems so critically require. In this paper we propose IMDfence, a security protocol for IMD ecosystems that provides a comprehensive yet practical security portfolio, which includes availability, non-repudiation, access control, entity authentication, remote monitoring and system scalability. The protocol also allows emergency access that results in the graceful degradation of offered services without compromising security and patient safety. The performance of the security protocol as well as its feasibility and impact on modern IMDs are extensively analyzed and evaluated. We find that IMDfence achieves the above security requirements at a mere less than 7% increase in total IMD energy consumption, and less than 14 ms and 9 kB increase in system delay and memory footprint, respectively

Compiler-Aided Methodology for Low Overhead On-line Testing

Reliability is emerging as an important design criterion in modern systems due to increasing transient fault rates. Hardware fault-tolerance techniques, commonly used to address this, introduce high design costs. As alternative, software Signature-Monitoring (SM) schemes based on compiler assertions are an efficient method for control-flow-error detection. Existing SM techniques do not consider application-specific-information causing unnecessary overheads. In this paper, compile-time Control-Flow-Graph (CFG) topology analysis is used to place best-suited assertions at optimal locations of the assembly code to reduce overheads. Our evaluation with representative workloads shows fault-coverage increase with overheads close to Assertion- based Control-Flow Correction (ACFC), the method with lowest overhead. Compared to ACFC, our technique improves (on average) fault coverage by 17%, performance overhead by 5% and power-consumption by 3% with equal code-size overhead

Zero-Power Defense Done Right: Shielding IMDs from Battery-Depletion Attacks

The wireless capabilities of modern Implantable Medical Devices (IMDs) make them vulnerable to security attacks. One prominent attack, which has disastrous consequences for the patient’s wellbeing, is the battery Denial-of-Service attack whereby the IMD is occupied with continuous authentication requests from an adversary with the aim of depleting its battery. Zero-Power Defense (ZPD), based on energy harvesting, is known to be an excellent protection against these attacks. This paper raises essential design considerations for employing ZPD techniques in commercial IMDs, offers a critical review of ZPD techniques found in literature and, subsequently, gives crucial recommendations for developing comprehensive ZPD solutions

A system architecture, processor, and communication protocol for secure implants

Secure and energy-efficient communication between Implantable Medical Devices (IMDs) and authorized external users is attracting increasing attention these days. However, there currently exists no systematic approach to the problem, while solutions from neighboring fields, such as wireless sensor networks, are not directly transferable due to the peculiarities of the IMD domain. This work describes an original, efficient solution for secure IMD communication. A new implant system architecture is proposed, where security and main-implant functionality are made completely decoupled by running the tasks onto two separate cores. Wireless communication goes through a custom security ASIP, called SISC (Smart-Implant Security Core), which runs an energy-efficient security protocol. The security core is powered by RF-harvested energy until it performs external-reader authentication, providing an elegant defense mechanism agai

BrainFrame: A node-level heterogeneous accelerator platform for neuron simulations

Objective. The advent of high-performance computing (HPC) in recent years has led to its increasing use in brain studies through computational models. The scale and complexity of such models are constantly increasing, leading to challenging computational requirements. Even though modern HPC platforms can often deal with such challenges, the vast diversity of the modeling field does not permit for a homogeneous acceleration platform to effectively address the complete array of modeling requirements. Approach. In this paper we propose and build BrainFrame, a heterogeneous acceleration platform that incorporates three distinct acceleration technologies, an Intel Xeon-Phi CPU

Comparison of Psychological Distress between Type 2 Diabetes Patients with and without Proteinuria

We investigated the link between proteinuria and psychological distress among patients with type 2 diabetes mellitus (T2DM). A total of 130 patients with T2DM aged 69.1±10.3 years were enrolled in this cross-sectional study. Urine and blood parameters, age, height, body weight, and medications were analyzed, and each patient’s psychological distress was measured using the six-item Kessler Psychological Distress Scale (K6). We compared the K6 scores between the patients with and without proteinuria. Forty-two patients (32.3%) had proteinuria (≥±) and the level of HbA1c was 7.5±1.3%. The K6 scores of the patients with proteinuria were significantly higher than those of the patients without proteinuria even after adjusting for age and sex. The clinical impact of proteinuria rather than age, sex and HbA1c was demonstrated by a multiple regression analysis. Proteinuria was closely associated with higher psychological distress. Preventing and improving proteinuria may reduce psychological distress in patients with T2DM

Functional Ultrasound (fUS) During Awake Brain Surgery: The Clinical Potential of Intra-Operative Functional and Vascular Brain Mapping

Background and Purpose: Oncological neurosurgery relies heavily on making continuous, intra-operative tumor-brain delineations based on image-guidance. Limitations of currently available imaging techniques call for the development of real-time image-guided resection tools, which allow for reliable functional and anatomical information in an intra-operative setting. Functional ultrasound (fUS), is a new mobile neuro-imaging tool with unprecedented spatiotemporal resolution, which allows for the detection of small changes in blood dynamics that reflect changes in metabolic activity of activated neurons through neurovascular coupling. We have applied fUS during conventional awake brain surgery to determine its clinical potential for both intra-operative functional and vascular brain mapping, with the ultimate aim of achieving maximum safe tumor resection. Methods: During awake brain surgery, fUS was used to image tumor vasculature and task-evoked brain activation with electrocortical stimulation mapping (ESM) as a gold standard. For functional imaging, patients were presented with motor, language or visual tasks, while the probe was placed over (ESM-defined) functional brain areas. For tumor vascular imaging, tumor tissue (pre-resection) and tumor resection cavity (post-resection) were imaged by moving the hand-held probe along a continuous trajectory over the regions of interest. Results: A total of 10 patients were included, with predominantly intra-parenchymal frontal and temporal lobe tumors of both low and higher histopathological grades. fUS was able to detect (ESM-defined) functional areas deep inside the brain for a range of functional tasks including language processing. Brain tissue could be imaged at a spatial and temporal resolution of 300 μm and 1.5–2.0 ms respectively, revealing real-time tumor-specific, and healthy vascular characteristics. Conclusion: The current study presents the potential of applying fUS during awake brain surgery. We i

WhiskEras: A New Algorithm for Accurate Whisker Tracking

Rodents engage in active touch using their facial whiskers: they explore their environment by making rapid back-and-forth movements. The fast nature of whisker movements, during which whiskers often cross each other, makes it notoriously difficult to track individual whiskers of the intact whisker field. We present here a novel algorithm, WhiskEras, for tracking of whisker movements in high-speed videos of untrimmed mice, without requiring labeled data. WhiskEras consists of a pipeline of image-processing steps: first, the points that form the whisker centerlines are detected with sub-pixel accuracy. Then, these points are clustered in order to distinguish individual whiskers. Subsequently, the whiskers are parameterized so that a single whisker can be described by four parameters. The last step consists of tracking individual whiskers over time. We describe that WhiskEras performs better than other whisker-tracking algorithms on several metrics. On our four video segments, WhiskEras detected more whiskers per frame than the Biotact Whisker Tracking Tool. The signal-to-noise ratio of the output of WhiskEras was higher than that of Janelia Whisk. As a result, the correlation between reflexive whisker movements and cerebellar Purkinje cell activity appeared to be stronger than previously found using other tracking algorithms. We conclude that WhiskEras facilitates the study of sensorimotor integration by markedly improving the accuracy of whisker tracking in untrimmed mice

Cerebellar control of gait and interlimb coordination

Synaptic and intrinsic processing in Purkinje cells, interneurons and granule cells of the cerebellar cortex have been shown to underlie various relatively simple, single-joint, reflex types of motor learning, including eyeblink conditioning and adaptation of the vestibulo-ocular reflex. However, to what extent these processes contribute to more complex, multi-joint motor behaviors, such as locomotion performance and adaptation during obstacle crossing, is not well understood. Here, we investigated these functions using the Erasmus Ladder in cell-specific mouse mutant lines that suffer from impaired Purkinje cell output (Pcd), Purkinje cell potentiation (L7-Pp2b), molecular layer interneuron output (L7-Δγ2), and granule cell output (α6-Cacna1a). We found that locomotion performance was severely impaired with small steps and long step times in Pcd and L7-Pp2b mice, whereas it was mildly altered in L7-Δγ2 and not significantly affected in α6-Cacna1a mice. Locomotion adaptation triggered by pairing obstacle appearances with preceding tones at fixed time intervals was impaired in all four mouse lines, in that they all showed inaccurate and inconsistent adaptive walking patterns. Furthermore, all mutants exhibited altered front–hind and left–right interlimb coordination during both performance and adaptation, and inconsistent walking stepping patterns while crossing obstacles. Instead, motivation and avoidance behavior were not compromised in any of the mutants during the Erasmus Ladder task. Our findings indicate that cell type-specific abnormalities in cerebellar microcircuitry can translate into pronounced impairments in locomotion performance and adaptation as well as interlimb coordination, highlighting the general role of the cerebellar cortex in spatiotemporal control of complex multi-joint movements

Universal Processor Architecture for Biomedical Implants: The SiMS Project

HEALTHCARE in the 21st century is changing rapidly. In advanced countries, in particular, healthcare is moving from a public to a more personalized nature. However, the costs of healthcare worldwide are increasing every year. Better use of technology can and should be used to get control of these costs. At the same time, implants have clearly benefitted from the astounding technology-miniaturization trends of late, boasting smaller sizes, lower power consumption and increased performance of the transistor devices. However, such advances do not come for free. Adverse effects in current implant designs are being witnessed, such as increasing power consumption, absence of design for reliability and highly application-specific nature. Operating under the assumption that implants will constitute an important means towards improved, personal healthcare and, in view of the aforementioned design phenomena, we believe that a new paradigm in implant design is required. This dissertation establishes the concept of Smart implantable Medical Systems (SiMS). SiMS is a systematic approach – a framework – for providing biomedical researchers and, hopefully, industry with a toolbox of ready-to-use, highly reliable implant sub-systems and models in order to construct optimal implants for various medical applications. The SiMS framework has to guarantee essential attributes, such as high dependability, modular design, ultra-low power consumption and miniature size. Having defined the SiMS framework, this dissertation is, then, concerned with exploring the optimal microarchitectural details of a crucial SiMS component: the SiMS processor. Contrary to the current state of the art, this processor aspires to be a new universal, low-power and low-cost processor and capable of efficiently serving a wide range of diverse implant applications.Computer Science and EngineeringElectrical Engineering, Mathematics and Computer Scienc