Providing integrity, authenticity, and confidentiality for header and pixel data of DICOM images

Exchange of medical images over public networks is subjected to different types of security threats. This has triggered persisting demands for secured telemedicine implementations that will provide confidentiality, authenticity, and integrity for the transmitted images. The medical image exchange standard (DICOM) offers mechanisms to provide confidentiality for the header data of the image but not for the pixel data. On the other hand, it offers mechanisms to achieve authenticity and integrity for the pixel data but not for the header data. In this paper, we propose a crypto-based algorithm that provides confidentially, authenticity, and integrity for the pixel data, as well as for the header data. This is achieved by applying strong cryptographic primitives utilizing internally generated security data, such as encryption keys, hashing codes, and digital signatures. The security data are generated internally from the header and the pixel data, thus a strong bond is established between the DICOM data and the corresponding security data. The proposed algorithm has been evaluated extensively using DICOM images of different modalities. Simulation experiments show that confidentiality, authenticity, and integrity have been achieved as reflected by the results we obtained for normalized correlation, entropy, PSNR, histogram analysis, and robustness.