Goal-Driven Risk Assessment for LLM-Powered Systems: A Healthcare Case Study

Large Language Models (LLMs) are increasingly integrated into safety-critical workflows, yet existing security analyses remain fragmented and often isolate model behavior from the broader system context. This work introduces a goal-driven risk assessment framework for LLM-powered systems that combines system modeling with Attack-Defense Trees (ADTrees) and Common Vulnerability Scoring System (CVSS)-based exploitability scoring to support structured, comparable analysis. We demonstrate the framework through a healthcare case study, modeling multi-step attack paths targeting intervention in medical procedures, leakage of electronic health record (EHR) data, and disruption of service availability. Our analysis indicates that threats spanning (i) conventional cyber, (ii) adversarial ML, and (iii) conversational attacks that manipulate prompts or context often consolidate into a small number of dominant paths and shared system choke points, enabling targeted defenses to yield meaningful reductions in path exploitability. By systematically comparing defense portfolios, we align these risks with established vulnerability management practices and provide a domain-agnostic workflow applicable to other LLM-enabled critical systems.

Large language model (LLM) agents are rapidly moving from conversational interfaces to software components that plan, invoke tools, maintain memory, and act on external environments. This transition changes the nature of security risk. In agentic settings, failures are no longer limited to unsafe text generation. Untrusted content may redirect control flow, misuse tool privileges, corrupt persistent state, leak sensitive information, or trigger harmful external actions. At the same time, research on LLM agent security is expanding quickly but remains fragmented across attack families, defense layers, application domains, and evaluation settings. This paper synthesizes 247 papers through a lifecycle-based, systems-oriented framework that models agent security around the interaction of information flow, delegated authority, and persistent state. We organize the literature around four questions: how LLM agent security should be modeled, which threat surfaces and attack families dominate, what defenses have been proposed and with what tradeoffs, and how security claims are evaluated. We find that prompt injection and tool-mediated control-flow hijacking still dominate the field, while persistent state corruption and multi-agent propagation are becoming central emerging concerns. We further find that current defenses provide useful building blocks but remain weakly compositional, and that existing benchmarks still underrepresent long-horizon, stateful, and deployment-sensitive risks. We argue that secure LLM agents require explicit trust boundaries, principled privilege control, provenance-aware state management, and evaluation practices aligned with realistic operational settings.

LLMs are increasingly deployed as autonomous agents with access to tools, databases, and external services, yet practitioners (across different sectors) lack systematic methods to assess how known threat classes translate into concrete risks within a specific agentic deployment. We present MATRA, a pragmatic threat modeling framework for agentic AI systems that adapts established risk assessment methodology to systematically assess how known LLM threats translate into deployment-specific risks. MATRA begins with an asset-based impact assessment and utilizes attack trees to determine the likelihood of these impacts occurring within the system architecture. We demonstrate MATRA on a personal AI agent deployment using OpenClaw, quantifying how architectural controls such as network sandboxing and least-privilege access reduce risk by limiting the blast radius of successful injections.