AI for IoMT security: a comprehensive survey of intrusion detection and system architectures

• IoMT architecture proposed with a four-layer model for connected medical devices • Attacks classified per IoMT layer using the CIA security model • AI-based IDS deployed to detect intrusions in IoMT networks • Comparative study of ML models identifies key features for IoMT threat detection • FL enhances IoMT security while preserving patient privacy Recent advances in the Internet of Medical Things (IoMT) have significantly improved data processing and patient care within Smart Healthcare systems. However, these developments have also expanded the surface of potential cyber threats targeting sensitive medical infrastructures. To address these challenges, a variety of security approaches both traditional and Artificial Intelligence (AI)-based have been proposed to strengthen the resilience of IoMT environments. In particular, Machine Learning (ML) and Deep Learning (DL) techniques have demonstrated strong capabilities in detecting and mitigating abnormal behaviors and malicious activities. This paper provides a comprehensive survey of recent AI-driven methods applied to IoMT security, with a particular focus on intrusion detection systems (IDS), the availability and characteristics of public datasets, and architectural considerations for deploying security solutions across Cloud, Fog, and Edge computing layers. The paper also discusses legal and ethical concerns related to data protection in healthcare contexts. Finally, the study outlines open challenges and future research directions for developing robust, adaptive, and trustworthy security frameworks in the IoMT ecosystem.