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

An Optimized Medical Image Watermarking Approach for E-Health Applications

Background: In recent years, information and communication technologies have been widely used in the healthcare sector. This development enables E-Health applications to transmit medical data, as well as their sharing and remote access by healthcare professionals. However, due to their sensitivity, medical data in general, and medical images in particular, are vulnerable to a variety of illegitimate attacks. Therefore, suitable security and effective protection are necessary during transmission. Method: In consideration of these challenges, we put forth a security system relying on digital watermarking with the aim of ensuring the integrity and authenticity of medical images. The proposed approach is based on Integer Wavelet Transform as an embedding algorithm; furthermore, Particles Swarm Optimization was employed to select the optimal scaling factor, which allows the system to be compatible with different medical imaging modalities. Results: The experimental results demonstrate that the method provides a high imperceptibility and robustness for both secret watermark and watermarked images. In addition, the proposed scheme performs better for medical images compared with similar watermarking algorithms. Conclusion: As it is suitable for a lossless-data application, IWT is the best choice for medical images integrity. Furthermore, using the PSO algorithm enables the algorithm to be compatible with different medical imaging modalities

A dual adaptive watermarking scheme in contourlet domain for DICOM images

<p>Abstract</p> <p>Background</p> <p>Nowadays, medical imaging equipments produce digital form of medical images. In a modern health care environment, new systems such as PACS (picture archiving and communication systems), use the digital form of medical image too. The digital form of medical images has lots of advantages over its analog form such as ease in storage and transmission. Medical images in digital form must be stored in a secured environment to preserve patient privacy. It is also important to detect modifications on the image. These objectives are obtained by watermarking in medical image.</p> <p>Methods</p> <p>In this paper, we present a dual and oblivious (blind) watermarking scheme in the contourlet domain. Because of importance of ROI (region of interest) in interpretation by medical doctors rather than RONI (region of non-interest), we propose an adaptive dual watermarking scheme with different embedding strength in ROI and RONI. We embed watermark bits in singular value vectors of the embedded blocks within lowpass subband in contourlet domain.</p> <p>Results</p> <p>The values of PSNR (peak signal-to-noise ratio) and SSIM (structural similarity measure) index of ROI for proposed DICOM (digital imaging and communications in medicine) images in this paper are respectively larger than 64 and 0.997. These values confirm that our algorithm has good transparency. Because of different embedding strength, BER (bit error rate) values of signature watermark are less than BER values of caption watermark. Our results show that watermarked images in contourlet domain have greater robustness against attacks than wavelet domain. In addition, the qualitative analysis of our method shows it has good invisibility.</p> <p>Conclusions</p> <p>The proposed contourlet-based watermarking algorithm in this paper uses an automatically selection for ROI and embeds the watermark in the singular values of contourlet subbands that makes the algorithm more efficient, and robust against noise attacks than other transform domains. The embedded watermark bits can be extracted without the original image, the proposed method has high PSNR and SSIM, and the watermarked image has high transparency and can still conform to the DICOM format.</p

Robust watermarking for magnetic resonance images with automatic region of interest detection

Medical image watermarking requires special considerations compared to ordinary watermarking methods. The first issue is the detection of an important area of the image called the Region of Interest (ROI) prior to starting the watermarking process. Most existing ROI detection procedures use manual-based methods, while in automated methods the robustness against intentional or unintentional attacks has not been considered extensively. The second issue is the robustness of the embedded watermark against different attacks. A common drawback of existing watermarking methods is their weakness against salt and pepper noise. The research carried out in this thesis addresses these issues of having automatic ROI detection for magnetic resonance images that are robust against attacks particularly the salt and pepper noise and designing a new watermarking method that can withstand high density salt and pepper noise. In the ROI detection part, combinations of several algorithms such as morphological reconstruction, adaptive thresholding and labelling are utilized. The noise-filtering algorithm and window size correction block are then introduced for further enhancement. The performance of the proposed ROI detection is evaluated by computing the Comparative Accuracy (CA). In the watermarking part, a combination of spatial method, channel coding and noise filtering schemes are used to increase the robustness against salt and pepper noise. The quality of watermarked image is evaluated using Peak Signal-to-Noise Ratio (PSNR) and Structural Similarity Index (SSIM), and the accuracy of the extracted watermark is assessed in terms of Bit Error Rate (BER). Based on experiments, the CA under eight different attacks (speckle noise, average filter, median filter, Wiener filter, Gaussian filter, sharpening filter, motion, and salt and pepper noise) is between 97.8% and 100%. The CA under different densities of salt and pepper noise (10%-90%) is in the range of 75.13% to 98.99%. In the watermarking part, the performance of the proposed method under different densities of salt and pepper noise measured by total PSNR, ROI PSNR, total SSIM and ROI SSIM has improved in the ranges of 3.48-23.03 (dB), 3.5-23.05 (dB), 0-0.4620 and 0-0.5335 to 21.75-42.08 (dB), 20.55-40.83 (dB), 0.5775-0.8874 and 0.4104-0.9742 respectively. In addition, the BER is reduced to the range of 0.02% to 41.7%. To conclude, the proposed method has managed to significantly improve the performance of existing medical image watermarking methods

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

Digital watermarking in medical images

This thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University, 05/12/2005.This thesis addresses authenticity and integrity of medical images using watermarking. Hospital Information Systems (HIS), Radiology Information Systems (RIS) and Picture Archiving and Communication Systems (P ACS) now form the information infrastructure for today's healthcare as these provide new ways to store, access and distribute medical data that also involve some security risk. Watermarking can be seen as an additional tool for security measures. As the medical tradition is very strict with the quality of biomedical images, the watermarking method must be reversible or if not, region of Interest (ROI) needs to be defined and left intact. Watermarking should also serve as an integrity control and should be able to authenticate the medical image. Three watermarking techniques were proposed. First, Strict Authentication Watermarking (SAW) embeds the digital signature of the image in the ROI and the image can be reverted back to its original value bit by bit if required. Second, Strict Authentication Watermarking with JPEG Compression (SAW-JPEG) uses the same principal as SAW, but is able to survive some degree of JPEG compression. Third, Authentication Watermarking with Tamper Detection and Recovery (AW-TDR) is able to localise tampering, whilst simultaneously reconstructing the original image

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