Nested Quantization Index Modulation for Reversible Watermarking and Its Application to Healthcare Information Management Systems

Digital watermarking has attracted lots of researches to healthcare information management systems for access control, patients' data protection, and information retrieval. The well-known quantization index modulation-(QIM-) based watermarking has its limitations as the host image will be destroyed; however, the recovery of medical images is essential to avoid misdiagnosis. In this paper, we propose the nested QIM-based watermarking, which is preferable to the QIM-based watermarking for the medical image applications. As the host image can be exactly reconstructed by the nested QIM-based watermarking. The capacity of the embedded watermark can be increased by taking advantage of the proposed nest structure. The algorithm and mathematical model of the nested QIM-based watermarking including forward and inverse model is presented. Due to algorithms and architectures of forward and inverse nested QIM, the concurrent programs and special processors for the nested QIM-based watermarking are easily implemented

Digital watermarking : applicability for developing trust in medical imaging workflows state of the art review

Medical images can be intentionally or unintentionally manipulated both within the secure medical system environment and outside, as images are viewed, extracted and transmitted. Many organisations have invested heavily in Picture Archiving and Communication Systems (PACS), which are intended to facilitate data security. However, it is common for images, and records, to be extracted from these for a wide range of accepted practices, such as external second opinion, transmission to another care provider, patient data request, etc. Therefore, confirming trust within medical imaging workflows has become essential. Digital watermarking has been recognised as a promising approach for ensuring the authenticity and integrity of medical images. Authenticity refers to the ability to identify the information origin and prove that the data relates to the right patient. Integrity means the capacity to ensure that the information has not been altered without authorisation. This paper presents a survey of medical images watermarking and offers an evident scene for concerned researchers by analysing the robustness and limitations of various existing approaches. This includes studying the security levels of medical images within PACS system, clarifying the requirements of medical images watermarking and defining the purposes of watermarking approaches when applied to medical images

ROI-based reversible watermarking scheme for ensuring the integrity and authenticity of DICOM MR images

Reversible and imperceptible watermarking is recognized as a robust approach to confirm the integrity and authenticity of medical images and to verify that alterations can be detected and tracked back. In this paper, a novel blind reversible watermarking approach is presented to detect intentional and unintentional changes within brain Magnetic Resonance (MR) images. The scheme segments images into two parts; the Region of Interest (ROI) and the Region of Non Interest (RONI). Watermark data is encoded into the ROI using reversible watermarking based on the Difference Expansion (DE) technique. Experimental results show that the proposed method, whilst fully reversible, can also realize a watermarked image with low degradation for reasonable and controllable embedding capacity. This is fulfilled by concealing the data into ‘smooth’ regions inside the ROI and through the elimination of the large location map required for extracting the watermark and retrieving the original image. Our scheme delivers highly imperceptible watermarked images, at 92.18-99.94dB Peak Signal to Noise Ratio (PSNR) evaluated through implementing a clinical trial based on relative Visual Grading Analysis (relative VGA). This trial defines the level of modification that can be applied to medical images without perceptual distortion. This compares favorably to outcomes reported under current state-of-art techniques. Integrity and authenticity of medical images are also ensured through detecting subsequent changes enacted on the watermarked images. This enhanced security measure, therefore, enables the detection of image manipulations, by an imperceptible approach, that may establish increased trust in the digital medical workflow

Paperless Transfer of Medical Images: Storing Patient Data in Medical Images

Medical images have become an integral part ofpatient diagnosis in recent years. With the introduction of HealthInformation Management Systems (HIMS) used for the storageand sharing of patient data, as well as the use of the PictureArchiving and Communication Systems (PACS) formanipulating and storage of CT Scans, X-rays, MRIs and othermedical images, the security of patient data has become a seriousconcern for medical professionals. The secure transfer of theseimages along with patient data is necessary for maintainingconfidentiality as required by the Data Protection Act, 2011 inTrinidad and Tobago and similar legislation worldwide. Tofacilitate this secure transfer, different digital watermarking andsteganography techniques have been proposed to safely hideinformation in these digital images. This paper focuses on theamount of data that can be embedded into typical medical imageswithout compromising visual quality. In addition, ExploitingModification Direction (EMD) is selected as the method of choicefor hiding information in medical images and it is compared tothe commonly used Least Significant Bit (LSB) method.Preliminary results show that by using EMD there little to nodistortion even at the highest embedding capacity

Assessment of perceptual distortion boundary through applying reversible watermarking to brain MR images

The digital medical workflow faces many circumstances in which the images can be manipulated during viewing, extracting and exchanging. Reversible and imperceptible watermarking approaches have the potential to enhance trust within the medical imaging pipeline through ensuring the authenticity and integrity of the images to confirm that the changes can be detected and tracked. This study concentrates on the imperceptibility issue. Unlike reversibility, for which an objective assessment can be easily made, imperceptibility is a factor of human cognition that needs to be evaluated within the human context. By defining a perceptual boundary of detecting the modification, this study enables the formation of objective guidelines for the method of data encoding and level of image/pixel modification that translates to a specific watermark magnitude. This study implements a relative Visual Grading Analysis (VGA) evaluation of 117 brain MR images (8 original and 109 watermarked), modified by varying techniques and magnitude of image/pixel modification to determine where this perceptual boundary exists and relate the point at which change becomes noticeable to the objective measures of the image fidelity evaluation. The outcomes of the visual assessment were linked to the images Peak Signal to Noise Ratio (PSNR) values, thereby identifying the visual degradation threshold. The results suggest that, for watermarking applications, if a watermark is applied to the 512x512 pixel (16 bpp grayscale) images used in the study, a subsequent assessment of PSNR=82dB or greater would mean that there would be no reason to suspect that the watermark would be visually detectable. Keywords: Medical imaging; DICOM; Reversible Watermarking; Imperceptibility; Image Quality; Visual Grading Analysis

Sensor Data Integrity Verification for Real-time and Resource Constrained Systems

Sensors are used in multiple applications that touch our lives and have become an integral part of modern life. They are used in building intelligent control systems in various industries like healthcare, transportation, consumer electronics, military, etc. Many mission-critical applications require sensor data to be secure and authentic. Sensor data security can be achieved using traditional solutions like cryptography and digital signatures, but these techniques are computationally intensive and cannot be easily applied to resource constrained systems. Low complexity data hiding techniques, on the contrary, are easy to implement and do not need substantial processing power or memory. In this applied research, we use and configure the established low complexity data hiding techniques from the multimedia forensics domain. These techniques are used to secure the sensor data transmissions in resource constrained and real-time environments such as an autonomous vehicle. We identify the areas in an autonomous vehicle that require sensor data integrity and propose suitable water-marking techniques to verify the integrity of the data and evaluate the performance of the proposed method against different attack vectors. In our proposed method, sensor data is embedded with application specific metadata and this process introduces some distortion. We analyze this embedding induced distortion and its impact on the overall sensor data quality to conclude that watermarking techniques, when properly configured, can solve sensor data integrity verification problems in an autonomous vehicle.Ph.D.College of Engineering & Computer ScienceUniversity of Michigan-Dearbornhttp://deepblue.lib.umich.edu/bitstream/2027.42/167387/3/Raghavendar Changalvala Final Dissertation.pdfDescription of Raghavendar Changalvala Final Dissertation.pdf : Dissertatio

Data Hiding and Its Applications

Data hiding techniques have been widely used to provide copyright protection, data integrity, covert communication, non-repudiation, and authentication, among other applications. In the context of the increased dissemination and distribution of multimedia content over the internet, data hiding methods, such as digital watermarking and steganography, are becoming increasingly relevant in providing multimedia security. The goal of this book is to focus on the improvement of data hiding algorithms and their different applications (both traditional and emerging), bringing together researchers and practitioners from different research fields, including data hiding, signal processing, cryptography, and information theory, among others

Reversible and imperceptible watermarking approach for ensuring the integrity and authenticity of brain MR images

The digital medical workflow has many circumstances in which the image data can be manipulated both within the secured Hospital Information Systems (HIS) and outside, as images are viewed, extracted and exchanged. This potentially grows ethical and legal concerns regarding modifying images details that are crucial in medical examinations. Digital watermarking is recognised as a robust technique for enhancing trust within medical imaging by detecting alterations applied to medical images. Despite its efficiency, digital watermarking has not been widely used in medical imaging. Existing watermarking approaches often suffer from validation of their appropriateness to medical domains. Particularly, several research gaps have been identified: (i) essential requirements for the watermarking of medical images are not well defined; (ii) no standard approach can be found in the literature to evaluate the imperceptibility of watermarked images; and (iii) no study has been conducted before to test digital watermarking in a medical imaging workflow. This research aims to investigate digital watermarking to designing, analysing and applying it to medical images to confirm manipulations can be detected and tracked. In addressing these gaps, a number of original contributions have been presented. A new reversible and imperceptible watermarking approach is presented to detect manipulations of brain Magnetic Resonance (MR) images based on Difference Expansion (DE) technique. Experimental results show that the proposed method, whilst fully reversible, can also realise a watermarked image with low degradation for reasonable and controllable embedding capacity. This is fulfilled by encoding the data into smooth regions (blocks that have least differences between their pixels values) inside the Region of Interest (ROI) part of medical images and also through the elimination of the large location map (location of pixels used for encoding the data) required at extraction to retrieve the encoded data. This compares favourably to outcomes reported under current state-of-art techniques in terms of visual image quality of watermarked images. This was also evaluated through conducting a novel visual assessment based on relative Visual Grading Analysis (relative VGA) to define a perceptual threshold in which modifications become noticeable to radiographers. The proposed approach is then integrated into medical systems to verify its validity and applicability in a real application scenario of medical imaging where medical images are generated, exchanged and archived. This enhanced security measure, therefore, enables the detection of image manipulations, by an imperceptible and reversible watermarking approach, that may establish increased trust in the digital medical imaging workflow

Design of a secure architecture for the exchange of biomedical information in m-Health scenarios

El paradigma de m-Salud (salud móvil) aboga por la integración masiva de las más avanzadas tecnologías de comunicación, red móvil y sensores en aplicaciones y sistemas de salud, para fomentar el despliegue de un nuevo modelo de atención clínica centrada en el usuario/paciente. Este modelo tiene por objetivos el empoderamiento de los usuarios en la gestión de su propia salud (p.ej. aumentando sus conocimientos, promocionando estilos de vida saludable y previniendo enfermedades), la prestación de una mejor tele-asistencia sanitaria en el hogar para ancianos y pacientes crónicos y una notable disminución del gasto de los Sistemas de Salud gracias a la reducción del número y la duración de las hospitalizaciones. No obstante, estas ventajas, atribuidas a las aplicaciones de m-Salud, suelen venir acompañadas del requisito de un alto grado de disponibilidad de la información biomédica de sus usuarios para garantizar una alta calidad de servicio, p.ej. fusionar varias señales de un usuario para obtener un diagnóstico más preciso. La consecuencia negativa de cumplir esta demanda es el aumento directo de las superficies potencialmente vulnerables a ataques, lo que sitúa a la seguridad (y a la privacidad) del modelo de m-Salud como factor crítico para su éxito. Como requisito no funcional de las aplicaciones de m-Salud, la seguridad ha recibido menos atención que otros requisitos técnicos que eran más urgentes en etapas de desarrollo previas, tales como la robustez, la eficiencia, la interoperabilidad o la usabilidad. Otro factor importante que ha contribuido a retrasar la implementación de políticas de seguridad sólidas es que garantizar un determinado nivel de seguridad implica unos costes que pueden ser muy relevantes en varias dimensiones, en especial en la económica (p.ej. sobrecostes por la inclusión de hardware extra para la autenticación de usuarios), en el rendimiento (p.ej. reducción de la eficiencia y de la interoperabilidad debido a la integración de elementos de seguridad) y en la usabilidad (p.ej. configuración más complicada de dispositivos y aplicaciones de salud debido a las nuevas opciones de seguridad). Por tanto, las soluciones de seguridad que persigan satisfacer a todos los actores del contexto de m-Salud (usuarios, pacientes, personal médico, personal técnico, legisladores, fabricantes de dispositivos y equipos, etc.) deben ser robustas y al mismo tiempo minimizar sus costes asociados. Esta Tesis detalla una propuesta de seguridad, compuesta por cuatro grandes bloques interconectados, para dotar de seguridad a las arquitecturas de m-Salud con unos costes reducidos. El primer bloque define un esquema global que proporciona unos niveles de seguridad e interoperabilidad acordes con las características de las distintas aplicaciones de m-Salud. Este esquema está compuesto por tres capas diferenciadas, diseñadas a la medidas de los dominios de m-Salud y de sus restricciones, incluyendo medidas de seguridad adecuadas para la defensa contra las amenazas asociadas a sus aplicaciones de m-Salud. El segundo bloque establece la extensión de seguridad de aquellos protocolos estándar que permiten la adquisición, el intercambio y/o la administración de información biomédica -- por tanto, usados por muchas aplicaciones de m-Salud -- pero no reúnen los niveles de seguridad detallados en el esquema previo. Estas extensiones se concretan para los estándares biomédicos ISO/IEEE 11073 PHD y SCP-ECG. El tercer bloque propone nuevas formas de fortalecer la seguridad de los tests biomédicos, que constituyen el elemento esencial de muchas aplicaciones de m-Salud de carácter clínico, mediante codificaciones novedosas. Finalmente el cuarto bloque, que se sitúa en paralelo a los anteriores, selecciona herramientas genéricas de seguridad (elementos de autenticación y criptográficos) cuya integración en los otros bloques resulta idónea, y desarrolla nuevas herramientas de seguridad, basadas en señal -- embedding y keytagging --, para reforzar la protección de los test biomédicos.The paradigm of m-Health (mobile health) advocates for the massive integration of advanced mobile communications, network and sensor technologies in healthcare applications and systems to foster the deployment of a new, user/patient-centered healthcare model enabling the empowerment of users in the management of their health (e.g. by increasing their health literacy, promoting healthy lifestyles and the prevention of diseases), a better home-based healthcare delivery for elderly and chronic patients and important savings for healthcare systems due to the reduction of hospitalizations in number and duration. It is a fact that many m-Health applications demand high availability of biomedical information from their users (for further accurate analysis, e.g. by fusion of various signals) to guarantee high quality of service, which on the other hand entails increasing the potential surfaces for attacks. Therefore, it is not surprising that security (and privacy) is commonly included among the most important barriers for the success of m-Health. As a non-functional requirement for m-Health applications, security has received less attention than other technical issues that were more pressing at earlier development stages, such as reliability, eficiency, interoperability or usability. Another fact that has contributed to delaying the enforcement of robust security policies is that guaranteeing a certain security level implies costs that can be very relevant and that span along diferent dimensions. These include budgeting (e.g. the demand of extra hardware for user authentication), performance (e.g. lower eficiency and interoperability due to the addition of security elements) and usability (e.g. cumbersome configuration of devices and applications due to security options). Therefore, security solutions that aim to satisfy all the stakeholders in the m-Health context (users/patients, medical staff, technical staff, systems and devices manufacturers, regulators, etc.) shall be robust and, at the same time, minimize their associated costs. This Thesis details a proposal, composed of four interrelated blocks, to integrate appropriate levels of security in m-Health architectures in a cost-efcient manner. The first block designes a global scheme that provides different security and interoperability levels accordingto how critical are the m-Health applications to be implemented. This consists ofthree layers tailored to the m-Health domains and their constraints, whose security countermeasures defend against the threats of their associated m-Health applications. Next, the second block addresses the security extension of those standard protocols that enable the acquisition, exchange and/or management of biomedical information | thus, used by many m-Health applications | but do not meet the security levels described in the former scheme. These extensions are materialized for the biomedical standards ISO/IEEE 11073 PHD and SCP-ECG. Then, the third block proposes new ways of enhancing the security of biomedical standards, which are the centerpiece of many clinical m-Health applications, by means of novel codings. Finally the fourth block, with is parallel to the others, selects generic security methods (for user authentication and cryptographic protection) whose integration in the other blocks results optimal, and also develops novel signal-based methods (embedding and keytagging) for strengthening the security of biomedical tests. The layer-based extensions of the standards ISO/IEEE 11073 PHD and SCP-ECG can be considered as robust, cost-eficient and respectful with their original features and contents. The former adds no attributes to its data information model, four new frames to the service model |and extends four with new sub-frames|, and only one new sub-state to the communication model. Furthermore, a lightweight architecture consisting of a personal health device mounting a 9 MHz processor and an aggregator mounting a 1 GHz processor is enough to transmit a 3-lead electrocardiogram in real-time implementing the top security layer. The extra requirements associated to this extension are an initial configuration of the health device and the aggregator, tokens for identification/authentication of users if these devices are to be shared and the implementation of certain IHE profiles in the aggregator to enable the integration of measurements in healthcare systems. As regards to the extension of SCP-ECG, it only adds a new section with selected security elements and syntax in order to protect the rest of file contents and provide proper role-based access control. The overhead introduced in the protected SCP-ECG is typically 2{13 % of the regular file size, and the extra delays to protect a newly generated SCP-ECG file and to access it for interpretation are respectively a 2{10 % and a 5 % of the regular delays. As regards to the signal-based security techniques developed, the embedding method is the basis for the proposal of a generic coding for tests composed of biomedical signals, periodic measurements and contextual information. This has been adjusted and evaluated with electrocardiogram and electroencephalogram-based tests, proving the objective clinical quality of the coded tests, the capacity of the coding-access system to operate in real-time (overall delays of 2 s for electrocardiograms and 3.3 s for electroencephalograms) and its high usability. Despite of the embedding of security and metadata to enable m-Health services, the compression ratios obtained by this coding range from ' 3 in real-time transmission to ' 5 in offline operation. Complementarily, keytagging permits associating information to images (and other signals) by means of keys in a secure and non-distorting fashion, which has been availed to implement security measures such as image authentication, integrity control and location of tampered areas, private captioning with role-based access control, traceability and copyright protection. The tests conducted indicate a remarkable robustness-capacity tradeoff that permits implementing all this measures simultaneously, and the compatibility of keytagging with JPEG2000 compression, maintaining this tradeoff while setting the overall keytagging delay in only ' 120 ms for any image size | evidencing the scalability of this technique. As a general conclusion, it has been demonstrated and illustrated with examples that there are various, complementary and structured manners to contribute in the implementation of suitable security levels for m-Health architectures with a moderate cost in budget, performance, interoperability and usability. The m-Health landscape is evolving permanently along all their dimensions, and this Thesis aims to do so with its security. Furthermore, the lessons learned herein may offer further guidance for the elaboration of more comprehensive and updated security schemes, for the extension of other biomedical standards featuring low emphasis on security or privacy, and for the improvement of the state of the art regarding signal-based protection methods and applications