The Interplay of CBOM and SBOM in Medical Device Cybersecurity

CBOM and SBOM in Medical Device Cybersecurity

In the intricate world of medical device cybersecurity, there’s a growing focus on two critical elements: the Cyber Bill of Materials (CBOM) and the Software Bill of Materials (SBOM). Though rich in technicality, these components play a pivotal role in ensuring the safety and efficacy of medical devices. As we navigate the nuances of these terms, understanding their interrelation and significance becomes vital, especially in light of the stringent requirements set forth by the U.S. Food and Drug Administration (FDA). This exploration aims to shed light on these concepts, offering clarity and insight into their roles in fortifying medical device cybersecurity.

Unraveling the SBOM: The Foundation of Device Security

What is an SBOM?

At its core, an SBOM is a detailed inventory. It lists every software component in a medical device, from the operating system down to the smallest library or module. It’s akin to a chef meticulously listing every ingredient in a recipe, ensuring nothing is overlooked. This includes:

  • Operating systems
  • Commercial software
  • Open-source components
  • Internal custom-developed software

Why the SBOM is Critical

  1. Vulnerability Management: The healthcare sector is increasingly targeted by cyber threats. An SBOM allows manufacturers and healthcare providers to quickly identify if they use software containing known vulnerabilities, thereby facilitating timely remedial action.
  2. Software Transparency: It offers a transparent view of what’s inside a device’s software. This is crucial for trust and assurance, particularly in devices critical to patient health and safety.
  3. Regulatory Compliance: Regulatory bodies, like the FDA, increasingly recognize the importance of SBOMs. They are moving towards making SBOMs a standard requirement, pushing for greater transparency in the software supply chain.
  4. Life Cycle Management: The life of a medical device doesn’t end at sale. SBOMs are key in maintaining and managing the device, particularly in patching software and updating systems.

Challenges and Considerations in Creating an SBOM

  1. Complexity: Modern medical devices can contain thousands of software components. Cataloging each one in the SBOM is a meticulous and complex task.
  2. Dynamic Nature: Software is not static. It gets updated, patched, and changed. Keeping the SBOM up-to-date is a continuous effort.
  3. Security vs. Transparency: There’s a delicate balance between providing enough detail in an SBOM to be helpful and not revealing so much that it could aid potential attackers.

SBOM in Action: A Practical Scenario

Imagine a hospital using a network of smart infusion pumps. An SBOM for each pump would detail all the software components, including the operating system, encryption libraries, and network communication modules. When a vulnerability is reported in one of these components, the hospital can quickly refer to the SBOMs to determine which pumps are affected and need urgent patching.

Statistical Backdrop

According to a report by Kaspersky, 27% of healthcare devices have at least one unpatched vulnerability. This highlights the importance of an SBOM in identifying and addressing these vulnerabilities before they can be exploited.

SBOM Thoughts

An SBOM is not just a list; it’s a crucial tool in the cybersecurity arsenal for medical devices. It enables proactive vulnerability management, ensures regulatory compliance, aids in lifecycle management, and upholds the safety and trust in medical technology. As we navigate the complexities of medical device security, the role of the SBOM will only grow in significance, making it an indispensable component in the quest for a secure and resilient healthcare ecosystem.

The Rise of the CBOM: Beyond Software

As we delve deeper into the cybersecurity landscape of medical devices, the emergence of the Cyber Bill of Materials (CBOM) becomes increasingly prominent. While the SBOM focuses on software elements, the CBOM expands this view, offering a more comprehensive lens through which we can understand and secure our medical devices. But what exactly is a CBOM, and why is it rising to such importance?

Understanding the CBOM

A Cyber Bill of Materials (CBOM) essentially extends the SBOM concept. It goes beyond just software components to encompass all elements related to cybersecurity within a medical device. This includes:

  • Hardware components: From chips and processors to sensors and network interfaces.
  • Firmware: The semi-permanent software programmed into the hardware.
  • External dependencies: Cloud services, external data sources, or any third-party services.
  • Network architecture: Details about how the device connects and communicates within a network.
  • Data flows: How data is transmitted, stored, and processed within the device ecosystem.

Why the CBOM is Gaining Traction

  1. Holistic Security View: A CBOM offers a bird’s-eye view of the entire cybersecurity landscape of a medical device. It provides insights not just into what the device is made of, but also how it operates and interacts within its environment.
  2. Supply Chain Transparency: Medical devices are a product of complex supply chains. A CBOM helps trace each component’s origins, crucial for assessing security risks and vulnerabilities across the supply chain.
  3. Regulatory Adherence: Regulatory bodies increasingly recognize the importance of comprehensive cybersecurity measures. A CBOM is a step towards meeting these evolving regulatory requirements.
  4. Risk Management and Response: In the event of a cybersecurity incident, a CBOM enables quicker and more effective response strategies, as it provides a complete picture of the affected components and their interdependencies.

CBOM in Practice: A Real-World Scenario

Consider a smart insulin pump. A CBOM for this device would detail its software and the hardware, like the Bluetooth module used for connectivity, the cloud service where patient data is stored, and the encryption mechanisms protecting data transfer. When a vulnerability in the Bluetooth protocol is discovered, the CBOM allows for a swift risk assessment and the formulation of a mitigation strategy.

Challenges in Implementing a CBOM

  1. Complexity and Detail: Developing a CBOM can be significantly more complex than an SBOM, given the variety of components involved.
  2. Dynamic Nature: Like SBOMs, CBOMs must be continuously updated to reflect changes in hardware, firmware, and external dependencies.
  3. Balancing Detail and Security: The CBOM needs to be detailed enough for effective risk management, yet it shouldn’t expose too much information that could aid potential attackers.

Statistical Perspective

The Healthcare Information and Management Systems Society (HIMSS) survey revealed that over 75% of healthcare organizations have experienced a significant security incident in the past year. This statistic underscores the need for comprehensive cybersecurity measures, including CBOMs, to safeguard against evolving threats.

CBOM Thoughts

The rise of the CBOM in medical device cybersecurity is a testament to the evolving nature of cyber threats and the need for more comprehensive security strategies. While implementing and maintaining a CBOM can be challenging, its role in ensuring the safety and security of medical devices is invaluable. As technology advances, the CBOM will become an increasingly essential tool in the cybersecurity toolkit, enabling a safer and more secure healthcare ecosystem.

The FDA’s Stance on SBOMs and CBOMs

Regarding medical device cybersecurity, the U.S. Food and Drug Administration (FDA) plays a pivotal role. Their stance on Software Bills of Materials (SBOMs) and Cyber Bills of Materials (CBOMs) is particularly significant, shaping how manufacturers approach device security. Let’s delve into what the FDA expects and why it matters.

The FDA’s Perspective on SBOMs

The FDA has been increasingly vocal about the importance of SBOMs in medical device security. Their guidelines are steering the industry towards greater transparency and accountability. Here’s what they focus on:

  1. Premarket Transparency: The FDA recommends device manufacturers include an SBOM in their premarket submissions. This requirement ensures a device’s software components are well-documented and scrutinized for vulnerabilities before the product hits the market.
  2. Risk Assessment: An SBOM aids in the risk assessment process by providing a clear picture of the software components. The FDA expects manufacturers to conduct thorough risk analyses, leveraging the information contained in the SBOM.
  3. Continuous Monitoring and Updating: The FDA’s guidance extends beyond the initial approval of the device. They emphasize the importance of maintaining an up-to-date SBOM throughout the device’s lifecycle, reflecting any software updates or changes.

The Emerging Importance of CBOMs

While the FDA has not yet formalized guidelines specifically for CBOMs, their growing significance in cybersecurity is clear. The FDA’s overall approach to medical device security suggests that the CBOM will soon become integral to its regulatory focus. Key aspects include:

  1. Comprehensive Device Security: The FDA will likely favor a holistic approach to device security, where the CBOM comes in. It provides a complete view of a device’s cybersecurity profile, encompassing software and hardware components.
  2. Supply Chain Security: The FDA’s increasing attention to the security of the medical device supply chain aligns well with the CBOM concept. Manufacturers can better manage supply chain risks by understanding a device’s components.
  3. Adapting to Technological Advancements: As medical devices become more interconnected and reliant on complex technologies, the FDA’s guidelines are expected to evolve to address these changes. CBOMs could become a critical tool in this regard.

Real-World Implications

For manufacturers, adhering to the FDA’s guidelines on SBOMs and CBOMs means a more rigorous design and development process. It also implies ongoing vigilance throughout the lifecycle of the device. For healthcare providers, it translates to greater assurance of the medical devices’ security.

Statistical Backdrop

According to the Cybersecurity and Infrastructure Security Agency (CISA) report, over 400 medical devices were affected by cybersecurity vulnerabilities in 2021 alone. This statistic highlights the critical need for stringent cybersecurity measures underpinned by comprehensive SBOMs and CBOMs.


In summary, CBOMs and SBOMs in medical device cybersecurity constitute a cornerstone of the FDA’s regulatory framework. These components are not just checkboxes for compliance; they are fundamental tools that enhance medical devices’ safety, reliability, and trustworthiness. As technology evolves and cyber threats become more sophisticated, the roles of CBOMs and SBOMs will undoubtedly expand and become more intricate. For manufacturers and healthcare providers, staying informed and proactive in incorporating these elements is crucial. The FDA’s guidelines, while stringent, pave the way for a safer and more secure healthcare ecosystem. By embracing these guidelines, we step forward into a future where medical devices are technologically advanced and securely designed to protect and preserve human health.

For more insightful and detailed discussions on the dynamic world of medical device cybersecurity, stay tuned to Blue Goat Cyber. Here, we continuously explore and unravel the complexities of cybersecurity, ensuring you’re always a step ahead in this vital and ever-evolving field.

Contact us if you need help with SBOM creation or medical device security.

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