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OrthancApplication · Orthanc Server

CVE-2026-5444

HIGH · 7.1 CVSS v3.1 Published 2026-04-09
Fix available
A fix is available. Upgrade to 1.12.11 or later.
See remediation →
74/100
Remediation priority · Elevated
No privileges

Official description Straight from the sourceThe vendor's or NVD's own wording, published unedited. Authoritative, but often terse — it says what broke, rarely what to do.

NVD · unedited
A heap buffer overflow vulnerability exists in the PAM image parsing logic. When Orthanc processes a crafted PAM image embedded in a DICOM file, image dimensions are multiplied using 32-bit unsigned arithmetic. Specially chosen values can cause an integer overflow during buffer size calculation, resulting in the allocation of a small buffer followed by a much larger write operation during pixel processing.

Technical summary Written by usOur analysis, written from the advisory, the CVSS vector and the affected-version data. It adds context the advisory leaves out, and never invents facts that are not in the source.

dbcve analysis · moderate confidence

Heap buffer overflow in Orthanc's PAM image parsing. When processing crafted PAM images embedded in DICOM files, 32-bit unsigned multiplication of image dimensions can overflow during buffer size calculation, causing a small buffer to be allocated followed by an oversized write during pixel processing.

MitigationApply vendor patch when available. Until then, sanitize or reject PAM images with unusually large dimension values before processing. Implement bounds checking on dimension multiplication using checked arithmetic or 64-bit integers.

Verify against the referenced sources before acting — the references below are authoritative for this CVE, this summary is not.

Affected products & versions What the vendor confirmedThe version ranges the vendor confirmed as vulnerable. If your version sits inside a range here, treat yourself as exposed until you have upgraded.

NVD · CPE data
OrthancApplication
Affected:< 1.12.11

CVSS breakdown How the score is builtThe industry scoring standard. It rates how the flaw is reached, what it takes to exploit, and what an attacker gains — the score is derived from those, not the other way round.

From the vector
Attack vector
Local
Complexity
Low
Privileges
None
User interaction
Required
Scope
Unchanged
Confidentiality
None
Integrity
High
Availability
High

CVSS:3.1/AV:L/AC:L/PR:N/UI:R/S:U/C:N/I:H/A:H

Am I affected? How to checkSteps we derive from the advisory and the affected-version data, so you can decide whether this CVE reaches your setup. They are a guide, not a scan — your own configuration is the authority.

dbcve checks

Work through these to decide whether this CVE applies to you.

  1. Check Orthanc version
    Run 'orthanc --version' or check the version displayed in the Orthanc web interface under 'System' or 'About'. If using a package manager, use 'dpkg -l orthanc' or 'rpm -qi orthanc' depending on your system.
    Affected if The installed version is lower than 1.12.11 (e.g., 1.12.10, 1.12.9, etc.)
  2. Confirm Orthanc is running and processing DICOM data
    Verify the Orthanc service is active via 'systemctl status orthanc' or by accessing the Orthanc REST API at http://localhost:8042/system to check the status.
    Affected if Orthanc is running and accepting DICOM files for processing
  3. Determine if PAM image decoding is active
    Orthanc decodes PAM images as part of standard DICOM image processing. Check if the 'DecodeDicom' configuration option in orthanc.json is not explicitly disabled, or verify that the built-in DICOM decoding is not overridden.
    Affected if DICOM decoding is enabled (default behavior) - the vulnerability applies automatically when PAM images are processed
  4. Inspect for PAM images in recent DICOM transfers
    Review Orthanc logs or check the /instances endpoint via the REST API to identify if DICOM files containing PAM (PAM = Pixel Arithmetic Module, part of DICOM Transfer Syntax) are being received or processed.
    Affected if DICOM files using PAM transfer syntax are being processed by the Orthanc instance

You are affected if Orthanc version is below 1.12.11 AND the system is processing DICOM files that may contain PAM images, since the overflow occurs during PAM image parsing regardless of configuration (DICOM decoding is enabled by default).

Generated from the published advisory. Verify against your own configuration.

Check your environment

Paste your version and any relevant configuration and it will be compared against the affected criteria above. Do not include secrets or credentials.

AI-assisted, checked against the advisory. Informational, not a guarantee.

Remediation Closing itWhat it takes to close this. Where a vendor fix exists we point at it; where none exists we say so plainly, and can build one. Effort estimates are scoped from the advisory, not from your codebase.

dbcve · scoped
Upgrade available Upgrade to 1.12.11 or later
Fixed in 1.12.11
Interim mitigation

Apply vendor patch when available. Until then, sanitize or reject PAM images with unusually large dimension values before processing. Implement bounds checking on dimension multiplication using checked arithmetic or 64-bit integers.

Recommended fix High confidence

Orthanc 1.12.11

  1. 1. Back up your current Orthanc configuration and any custom plugins.
  2. 2. Stop the Orthanc service.
  3. 3. Upgrade Orthanc to version 1.12.11 or later.
  4. 4. Verify the upgrade by checking the Orthanc version (e.g., orthanc --version).
  5. 5. Test that DICOM file processing works correctly with your workflow.
  6. 6. Restart the Orthanc service.
  7. 7. Monitor logs for any issues and verify the vulnerability is no longer present.
Caveat Review the Orthanc 1.12.11 release notes for any compatibility changes or deprecations before upgrading

Generated from the published advisory — verify against the referenced sources before acting.

Fix this in Orthanc Scoped from the published advisory
  • Consultation3.0 h
  • Implementation6.0 h
  • Testing5.0 h
  • Review / QA3.0 h
17.0 hours of engineering $2,970
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References Go to the primary sourcePrimary sources — vendor advisories, patches and trackers. Where our summary and a reference disagree, the reference wins.

Primary sources

Practitioner notes

Contributed

Peer-ranked notes from engineers who’ve handled CVE-2026-5444 in production — separate from our analysis above.

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What this is

A place for practitioners to share what actually worked: a mitigation you’ve tested, a configuration change, a version- or environment-specific caveat, or a link to a verified patch. The most useful notes rise to the top as peers upvote them, so the signal stays high.

What belongs here
  • Verified mitigations, workarounds, and config changes
  • Version or environment caveats, and links to real fixes
  • No weaponised exploit code, or anything meant to cause harm
  • No spam, self-promotion, credentials, or personal data