Secure Exchange of Medical Images Via Extended Visual Cryptography

  • Luis Angel Olvera-Martinez Instituto Politecnico Nacional- Escuela Superior de Ingenieria Mecanica y Electrica (ESIME)
  • Manuel Cedillo-Hernandez Instituto Politecnico Nacional- Escuela Superior de Ingenieria Mecanica y Electrica (ESIME)
  • Carlos Adolfo Diaz-Rodriguez Instituto Politecnico Nacional- Escuela Superior de Ingenieria Mecanica y Electrica (ESIME)
  • Enrique Tonatiuh Jimenez-Borgonio Instituto Politecnico Nacional- Escuela Superior de Ingenieria Mecanica y Electrica (ESIME)
Keywords: DICOM imaging, visual cryptography, information security, circular shifting, least significant bit replacement


Medical image security is acquiring its importance to preserve the integrity and confidentiality of information (medical data) from malicious users given its importance in timely and successful diagnosis. In this context, several techniques have been developed to protect medical images, such as encryption, data hiding, image tagging, application of Hash algorithms, etc. This paper proposes a technique to cipher medical images by adding the metadata inside a cover image, based on extended visual cryptography as well as the inclusion of a Hash-like function to verify the integrity of the image and the metadata once they are recovered. The method proposed in this work is implemented using medical images with a grayscale resolution of [0,4095] that is a depth of 12 bits/pixel and color images with 24 bits/pixel depth. Experimental results prove the effectiveness of the proposed method in the task of secure exchange of medical images by allowing higher hiding capability, lower distortion in the visual quality of the image with the hidden medical data, as well as a means to verify the integrity of the sent data, compared to state-of-the-art.


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National Electrical Manufacturers Association. DICOM Security [Internet]. DICOM Digital Imaging and Communication in Medicine; 2019. Available from:

Coatrieux G, Quantin C, Montagner J, Fassa M, et al. Watermarking medical images with anonymous patient identification to verify authenticity. Stud Health Technol Inform [Internet]. 2008;136:667-672. Available from:

Qasim AF, Meziane F, Aspin R. Digital watermarking: Applicability for developing trust in medical imaging workflows state of the art review. Comput Sci Rev [Internet]. 2018;27:45–60. Available from:

Mousavi SM, Naghsh A, Abu-Bakar SAR. Watermarking Techniques used in Medical Images: a Survey. J Digit Imaging [Internet]. 2014;27(6):714–729. Available from:

Cedillo-Hernandez M, Cedillo-Hernandez A, Nakano-Miyake M, Perez-Meana H. Improving the management of medical imaging by using robust and secure dual watermarking. Biomed Signal Process Control [Internet]. 2020;56:101695. Available from:

Mirsky Y, Mahler T, Shelef I, Elovici Y. CT-GAN: malicious tampering of 3D medical imagery using deep learning. In: Proceedings of the 28th USENIX Conference on Security Symposium [Internet]. Santa Clara, CA; 2019:461-478. Available from:

Stallings W. Cryptography and network security: Principles and practice [Internet]. New York: Prentice Hall; 2011. 719p. Available from:

Medina Velandia LN. Criptografía y mecanismos de seguridad [Internet]. Bogotá: Fundación Universitaria del Área Andina; 2017. 141p. Available from: https: //

Blackledge J, Bezobrazov S, Tobin P, Zamora F. Cryptography using evolutionary computing. In: 24th IET Irish Signals and Systems Conference (ISSC 2013) [Internet]. Letterkenny: Institution of Engineering and Technology; 2013:1-8. Available from:

Diffie W, Hellman M. New directions in cryptography. Secure communications and asymmetric cryptosystems. IEEE Trans Inf Theory [Internet]. 1976;22(6):644-654. Available from:

Menezes AJ, van Oorschot PC, Vanstone SA. Handbook of Applied Cryptography [Internet]. Boca Raton: CRC press; 2018. 810p. Available form:

Naor M, Shamir A. Visual cryptography. In: De Santis A (eds). EUROCRYPT'94. EUROCRYPT 1994. Lecture Notes in Computer Science, vol 950 [Internet]. Berlin: Springer; 1994:1-12. Available from:

Olvera-Martinez L, Jimenez-Borgonio T, Frias-Carmona T, Abarca-Rodriguez M, et al. First SN P visual cryptographic circuit with astrocyte control of structural plasticity for security applications. Neurocomputing [Internet]. 2021;457(7):67–73. Available from:

Morkel T, Eloff J, Olivier M. An overview of image steganography. In: Eloff JHP, Labuschagne L, Eloff MM, Venter HS (eds). Proceedings of the ISSA 2005 New Knowledge Today Conference [Internet]. Pretoria: ISSA; 2005. 1–11p.

Cox IJ, Pakura G, Sheel M. Information Transmission and Steganography. In: Barni M, Cox I, Kalker T, Kim HJ (eds). Digital Watermarking. IWDW 2005. Lecture Notes in Computer Science, vol 3710 [Internet]. Siena, Itlay: Springer; 2005. 15-17. Available from:

Wu X, Qiao T, Chen Y, Xu M, et al. Sign steganography revisited with robust domain selection. Signal Process [Internet]. 2022;196:108522. Available from:

Yousefi Valandar M, Ayubi P, Jafari Barani M, Yosefnezhad Irani B. A chaotic video steganography technique for carrying different types of secret messages. J Inf Secur Appl [Internet]. 2022;66:103160. Available from:

Vinothkanna R. A secure steganography creation algorithm for multiple file formats. J Innov Image Process [Internet]. 2019;1(01):20–30. Available from:

Gupta A, Goyal A, Bhushan B. Information Hiding Using Least Significant Bit Steganography and Cryptography. Int J Mod Educ Comput Sci [Internet]. 2012;4(6):27–34. Available from:

Dhiman K, Kasana SS. Extended visual cryptography techniques for true color images. Comput Electr Eng [Internet]. 2018;70:647-658. Available from:

Maurya R, Kannojiya AK, Rajitha B. An Extended Visual Cryptography Technique for Medical Image Security. In: 2020 2nd Int Conf on Innov Mech for Ind App (ICIMIA) [Internet]. Bangalore, India: IEEE; 2020: 415-421. Available from:

Omari AH, Al-Kasasbeh BM, Al-Qutaish RE, Muhairat MI. A new cryptographic algorithm for the real time applications. In: Zaharim A, Mastorakis N, Gonos I (eds). Proceedings of the 7th WSEAS international conference on Information security and privacy [Internet]. Cairo, Egypt; World Scientific and Engineering Academy and Society (WSEAS). 2008: 33–38. Available from:

Schneier B. Applied Cryptography [Internet]. Indianapolis: John Wiley & Sons; 1996. 784p. Available from: books/applied-cryptography/

Horé A, Ziou D. Image Quality Metrics: PSNR vs. SSIM. 20th Int Conf on Pat Rec [Internet]. Istanbul, Turkey; IEEE. 2010: 2366-2369. Available from:

Sara U, Akter M, Uddin MS. Image Quality Assessment through FSIM, SSIM, MSE and PSNR-A Comparative Study. J Comput Commun [Internet]. 2019;7(3):8-18. Available from:

Wang Z, Bovik AC, Sheikh HR, Simoncelli EP. Image quality assessment: from error visibility to structural similarity. IEEE Trans Image Process [Internet]. 2004;13(4):600-612. Available from:

How to Cite
Olvera-Martinez, L. A., Cedillo-Hernandez, M., Diaz-Rodriguez, C. A., & Jimenez-Borgonio, E. T. (2022). Secure Exchange of Medical Images Via Extended Visual Cryptography. Mexican Journal of Biomedical Engineering, 43(2), 64-77. Retrieved from
Research Articles