A joint FED watermarking system using spatial fusion for verifying the security issues of teleradiology

Teleradiology allows transmission of medical images for clinical data interpretation to provide improved e-health care access, delivery, and standards. The remote transmission raises various ethical and legal issues like image retention, fraud, privacy, malpractice liability, etc. A joint FED watermarking system means a joint fingerprint/encryption/dual watermarking system is proposed for addressing these issues. The system combines a region based substitution dual watermarking algorithm using spatial fusion, stream cipher algorithm using symmetric key, and fingerprint verification algorithm using invariants. This paper aims to give access to the outcomes of medical images with confidentiality, availability, integrity, and its origin. The watermarking, encryption, and fingerprint enrollment are conducted jointly in protection stage such that the extraction, decryption, and verification can be applied independently. The dual watermarking system, introducing two different embedding schemes, one used for patient data and other for fingerprint features, reduces the difficulty in maintenance of multiple documents like authentication data, personnel and diagnosis data, and medical images. The spatial fusion algorithm, which determines the region of embedding using threshold from the image to embed the encrypted patient data, follows the exact rules of fusion resulting in better quality than other fusion techniques. The four step stream cipher algorithm using symmetric key for encrypting the patient data with fingerprint verification system using algebraic invariants improves the robustness of the medical information. The experiment result of proposed scheme is evaluated for security and quality analysis in DICOM medical images resulted well in terms of attacks, quality index, and imperceptibility.