A Review of Medical Image Watermarking Requirements for Teleradiology <s> Medical Information Security Requirements <s> Abstract The use of teleradiological systems for medical image communication is increasing significantly. Digital images can be transferred over public telephone (e.g. ISDN) lines to colleagues for interpretation and/or consultation. Thus, a new quality is being introduced into the process of radiological diagnostics. However, technical implementation of such systems is accompanied by little consideration of legal, i.e. data protection and security, issues. In this paper we describe a concept for data protection in teleradiology which unites aspects of privacy and security as well as user aspects. After highlighting the legal situation in Germany we describe the methodology used for deriving the security profile for teleradiology in Germany. As a result the set of security measures which have to be employed with a teleradiology system is listed. A detailed description follows of how the software requirements are implemented in the teleradiology software MEDICUS. <s> BIB001 </s> A Review of Medical Image Watermarking Requirements for Teleradiology <s> Medical Information Security Requirements <s> Because of the importance of the security issues in the management of medical information, we suggest the use of watermarking techniques to complete the existing measures for protecting medical images. We discuss the necessary requirements for such a system to be accepted by medical staff and its complementary role with respect with existing security systems. We present different scenarios, one devoted to the authentication and tracing of the images, the second to the integrity control of the patient's record. <s> BIB002 </s> A Review of Medical Image Watermarking Requirements for Teleradiology <s> Medical Information Security Requirements <s> Recently, the medical image has been digitized by the development of computer science and digitization of the medical devices. There are needs for database service of the medical image and long term storage because of the construction of PACS (Picture Archiving and Communication System) following DICOM (Digital Imaging Communications in Medicine) standards, telemedicine, and et al. Furthermore, authentication and copyright protection are required to protect the illegal distortion and reproduction of the medical information data. In this paper, we propose digital watermarking technique for medical image that prevents illegal forgery that can be caused after transmitting medical image data remotely. A wrong diagnosis may be occurred if the watermark is embedded into the whole area of image. Therefore, we embed the watermark into some area of medical image, except the decision area that makes a diagnosis so called region of interest (ROI) area in our paper, to increase invisibility. The watermark is the value of bit-plane in wavelet transform of the decision area for certification method of integrity verification. The experimental results show that the watermark embedded by the proposed algorithm can survive successfully in image processing operations such as JPEG lossy compression. <s> BIB003 </s> A Review of Medical Image Watermarking Requirements for Teleradiology <s> Medical Information Security Requirements <s> Privacy and integrity of medical records is expected by patients. This privacy and integrity is often mandated by regulations. Traditionally, the security of medical records has been based on physical lock and key. As the storage of patient record information shifts from paper to digital, new security concerns arise. Digital cryptographic methods provide solutions to many of these new concerns. In this article we give an overview of new security concerns, new legislation mandating secure medical records and solutions providing security. <s> BIB004 </s> A Review of Medical Image Watermarking Requirements for Teleradiology <s> Medical Information Security Requirements <s> Title XIII of Division A and Title IV of Division B of the American Recovery and Reinvestment Act (ARRA) of 2009 [1] include a provision commonly referred to as the “Health Information Technology for Economic and Clinical Health Act” or “HITECH Act” that is intended to promote the electronic exchange of health information to improve the quality of health care. Subtitle D of the HITECH Act includes key amendments to strengthen the privacy and security regulations issued under the Health Insurance Portability and Accountability Act (HIPAA). The HITECH act also states that “the National Coordinator” must consult with the National Institute of Standards and Technology (NIST) in determining what standards are to be applied and enforced for compliance with HIPAA. This has led to speculation that NIST will recommend that the government impose the Federal Information Security Management Act (FISMA) [2], which was created by NIST for application within the federal government, as requirements to the public Electronic Health Records (EHR) community in the USA. In this paper we will describe potential impacts of FISMA on medical image sharing strategies such as teleradiology and outline how a strict application of FISMA or FISMA-based regulations could have significant negative impacts on information sharing between care providers. <s> BIB005 </s> A Review of Medical Image Watermarking Requirements for Teleradiology <s> Medical Information Security Requirements <s> Teleradiology is probably the most successful eHealth service available today. Its business model is based on the remote transmission of radiological images (e.g. X-ray and CT-images) over electronic networks, and on the interpretation of the transmitted images for diagnostic purpose. Two basic service models are commonly used teleradiology today. The most common approach is based on the message paradigm (off-line model), but more developed teleradiology systems are based on the interactive use of PACS/RIS systems. Modern teleradiology is also more and more cross-organisational or even cross-border service between service providers having different jurisdictions and security policies. This paper defines the requirements needed to make different teleradiology models trusted. Those requirements include a common security policy that covers all partners and entities, common security and privacy protection principles and requirements, controlled contracts between partners, and the use of security controls and tools that supporting the common security policy. The security and privacy protection of any teleradiology system must be planned in advance, and the necessary security and privacy enhancing tools should be selected (e.g. strong authentication, data encryption, non-repudiation services and audit-logs) based on the risk analysis and requirements set by the legislation. In any case the teleradiology system should fulfil ethical and regulatory requirements. Certification of the whole teleradiology service system including security and privacy is also proposed. In the future, teleradiology services will be an integrated part of pervasive eHealth. Security requirements for this environment including dynamic and context aware security services are also discussed in this paper. <s> BIB006
The standards and their technical frameworks, strict ethics, and legislatives rules, as mentioned above, give rights to the patient and duties to the health professionals. Development and implementation of the security and privacy protection services derived from the standards depends upon the model or infrastructure of the teleradiology and its concerned entities. Two widely used models in today's teleradiology are referred by Ruotsalainen BIB006 to develop their security requirements. The most common model used in teleradiology is based on offline messaging. The other model incorporates the online delivery of distributed imaging services and allows a radiological information system to be spread over a large distributed area. Irrespective of the communication type (i.e., offline or online), three individual domains, namely: (1) host organization/hospital's PACS/RIS (domain A), (2) communication network (domain B), and (3) consultant (domain C) can be considered from Fig. 1 , which are responsible for providing the required security in a teleradiology system. On the other hand, in radiology, security concerns arise only from the domain A (e.g., from acquisition of medical images to storing them in PACS of the same hospital). Therefore, as we mentioned in "Introduction," the security requirements of teleradiology also include the security requirements of radiology. In an offline model, the security domains are isolated, and communication is made via interfaces whereas online teleradiology maintains communication with a remote consultant allowing access to the local PACS/RIS services of the legacy system BIB006 . However, based on the technological and organisational models used in teleradiology, their various security requirements can be outlined below BIB006 BIB001 : -All concerned entities/domains (e.g., the PACS/RIS in hospital or clinic, communication network, and consultant/radiologist at distant place) must have the same level of security and protection. -In all domains, proper authorization process must be employed through various access and user controls, transmission controls, and directive controls. -Integrity, authenticity, and confidentiality of all radiological information have to be ensured during teleradiology session, consultation process, and information processing, management, and preservation. The principle of those requirements imposes three mandatory characteristics for security of medical information BIB002 BIB001 BIB004 : confidentiality, reliability, and availability. -Confidentiality-ensures that only the entitled users have access to the information. -Reliability based on the outcomes of: (1) integrity-the information has not been modified by non-authorized people-and (2) authenticity-a proof that the information belongs to the correct patient and issued from the right source. -Availability-warrants an information system to be used in the normal scheduled conditions of access. On the other hand, the security concept derived from the related standards mentioned in the preceding section can be established through different stages. For example, as outlined by Baur et al. BIB001 , the major stages can be: BIB003 determination of the appropriate level of security, (2) threat analysis, (3) risk analysis, and (4) establishment of security concept. Determination of the appropriate level of security may include determining security levels of all entities and objects (e.g., IT applications and information sets) linked with the teleradiology system. Threat analysis helps determine the expected threats from the involved objects (e.g., infrastructure, hardware, software, paper-ware). Risk analysis helps quantify the damages for all the identified threats and their occurring frequency. Establishment of security concept deals with either reducing the probability of occurrence of the threats or reducing the damage if an adverse event is unavoidable. This includes selection of suitable measures that reduce the risks to a tolerant level, evaluation of the selected measures, examining the cost-effect relationship as well as analyzing any further risk. All these comprise the security requirements of different domains in teleradiology. Besides, for computer and network security, various requirements are entitled in different standards such as USA's Federal Information Processing Standards BIB005 and Germany's Bundesdaten-schutzgesetz BIB001 , the general categories of which includes: access control; audit and accountability; certification, accreditation, and security assessment; configuration management; identification, and authentication; media protection; physical and environmental protection; system and communications protection; and system and information integrity. However, as an important aspect of security and risk management in the context of information security [29], we restrict our attention to recognizing the value of information and defining appropriate procedures and protection requirements for the information.