A controllable medical image security scheme using selective encryption and watermarking for bit-planes in the TSH domain

Abstract With the rapid adoption of smart healthcare systems, medical image distribution is expected to become increasingly prevalent. However, such distribution faces significant threats of privacy breaches. Although conventional encryption schemes can prevent unauthorized access during transmission, they cannot control the illegal redistribution of decrypted content. To prevent medical images from being accessed by unauthorized personnel, we propose a dual-level security scheme that integrates robust watermarking with selective encryption for smart healthcare environments. The primary objective is to protect medical images throughout their entire lifecycle. The key innovation of our approach lies in its ability to perform watermarking operations directly on encrypted content. Additionally, the scheme is designed to satisfy diverse security requirements across various medical scenarios. This dual-level security mechanism enables tracing of medical content usage and controlling unauthorized redistribution. Comprehensive experimental evaluations and security analyses demonstrate that our method outperforms existing approaches in computational efficiency while maint