Study of a surgical robot’s security vulnerability wins DSN Test of Time Award

In 2016, a group of Grainger engineers published an attention-grabbing paper at the IEEE/IFIP International Conference on Dependable Systems and Networks (DSN), which is widely regarded as the top conference in the field of dependability. Ten years later, that paper has just won a Test of Time Award at the 2026 DSN in recognition of its “sustained and important impact on the theory and/or practice of dependable systems and networks computing research.”

The paper, “Targeted Attacks on Teleoperated Surgical Robots: Dynamic Model-Based Detection and Mitigation” by Homa Alemzadeh, Daniel Chen, Xiao Li, Thenkurussi Kesavadas, Zbigniew T. Kalbarczyk, and Ravishankar K. Iyer, describes a vulnerability the authors found in a surgical robot control system — a vulnerability so serious that a would-be murderer could have taken control of a robot during surgery and harmed the patient. The paper also introduced a framework the team developed to help defend the robot against such attacks.

It may sound like the stuff of a fanciful Hollywood thriller, but the problem it revealed was all too real. It was just one part of the award-winning dissertation work of lead author Alemzadeh, who earned a Ph.D. in electrical & computer engineering (ECE) under Ravishankar K Iyer’s guidance in 2016 and is now on the faculty of the University of Virginia. Her graduate research attracted a lot of attention, not all of it friendly, for its unprecedented examination of reliability and security problems with medical devices.

Iyer, who is the George and Ann Fisher Distinguished Professor of ECE, recently reflected back on the novelty and importance of Alemzadeh’s work.

“When surgical robots were being introduced, and in fact were becoming commonplace, the problem of how they respond to failures, attacks and instabilities had clearly not been well addressed,” he said. Surgeons were grumbling about problems they encountered with surgical robots in real life. Robots sometimes malfunctioned in the middle of a surgery, forcing the surgical team to transition to a more invasive nonrobotic surgery or to postpone the procedure; occasionally, people died.

“So Homa went and looked at all the recalls and adverse-event data on surgical robots,” Iyer recalled. “That’s where we started to look at what really happens in practice. And that data from the U.S. Food and Drug Administration, and its analysis published in PLOS One, became particularly well known.” He said that it attracted the interest of various high-profile figures in medicine and safety. But not everyone appreciated the findings.

“We started to get calls from lawyers,” Iyer said. One particular manufacturer “didn’t like us, because we were saying they were not as safe as they claimed to be.” The University sometimes had to step in and defend the team’s right to pursue the research.

The findings from that analysis motivated the 2016 DSN paper, which brought the problem to the fault-tolerance community and introduced methods for detecting and mitigating targeted attacks that could cause similar adverse effects in real-world settings.

The paper has been cited several times in patents filed by surgical robotics companies.

A year after the DSN paper was published, Alemzadeh won the 2017 William C. Carter PhD Dissertation Award in Dependability for her thesis, Data-Driven Resiliency Assessment of Medical Cyber-Physical Systems, which covered her graduate work across this area.

“The impact [of Alemzadeh’s work] on medicine, I think that was very unique,” Iyer said. He said that the movement of resilience research into a multidisciplinary space, in this case surgical robots, remains “an ongoing problem that Homa noticed early in the game.”

“As I recall, Homa’s was the first work looking at this combination of safety, reliability, and security,” he said. “This... was probably the first to demonstrate this problem, coupled with what had been seen in the real world. That, I think, was the unique aspect, why this work attracted so much attention.”

Iyer also singled out the contributions of Daniel Chen, who helped analyze how attackers could exploit vulnerabilities in a robot’s operating system, and Xiao Li, who introduced a dynamic model of robotic actions within the confines of a patient’s body.

The work was performed on an experimental surgical robot housed in Kesavadas’s lab at the Health Care Engineering Systems Center at Illinois.

Alemzadeh expressed gratitude for the award. “Seeing the research that capped off my Ph.D. journey stand the test of time and continue to shape the field of dependable systems and the safety of medical cyber-physical systems feels like a real honor,” she said. 

She noted that the paper’s model-based approach to real-time detection and mitigation of attacks has since been widely adopted in cyber-physical system security and safety — and added that the work, far from becoming outdated, has only become more relevant over time.

“The need for safety and security assurance has only grown as medical robots and devices are far more complex and connected, with increasing artificial intelligence capabilities, than they were ten years ago,” she said.

The Test of Time Award is one of three accolades won by Iyer group members at the 2026 DSN conference. A new paper lead-authored by graduate student Shengkun Cui won a Best Paper Award, and a 1992 paper co-authored by group alumnus Ram Chillarege (Ph.D., electrical engineering, 1986) received the prestigious Jean-Claude Laprie Award.

Grainger Engineering Affiliations

Ravishankar K Iyer is the George and Ann Fisher Distinguished Professor of Electrical and Computer Engineering in the Department of Electrical & Computer Engineering in The Grainger College of Engineering. He is also affiliated with the Siebel School of Computing and Data Science, the Coordinated Science Laboratory, and the Information Trust Institute in The Grainger College of Engineering. He has additional affiliations with the Carl R. Woese Institute for Genomic Biology, the National Center for Supercomputing Applications, and the Carle Illinois College of Medicine at the University of Illinois Urbana-Champaign.

Zbigniew Kalbarczyk is a research professor in the Coordinated Science Laboratory in The Grainger College of Engineering. He is also affiliated with the Illinois Advanced Research Center at Singapore.