An Effective Telemedicine Security Using
Wavelet Based Watermarking
Jaskaran Singh, Anoop Kumar Patel
Department of Computer Engineering
National Institute of Technology, Kurukshetra
Haryana, India-136119
jaskaran36@gmail.com, akp@nitkkr.ac.in
Abstract—Telemedicine enables expert diagnosis and better
healthcare access to distant patients especially in remote or rural
areas by allowing the transmission of medical images through
telecommunication. Privacy of data being transmitted and the
underlying technologies raise issues related to security. The
paper proposes an algorithm for digital watermarking of medical
images to ensure secure and confidential telemedicine diagnosis.
In the proposed algorithm, medical images are embedded as
watermark into a special cover image. In this process, the cover
image is transformed by discrete wavelet transform and the LL
sub-band obtained, is then transformed by discrete cosine
transform. Watermark generation and embedding is performed
by modifying the transformed coefficients of watermark and
cover image by varying the value of scaling factor. Finally inverse
discrete cosine and discrete wavelet transforms are applied on
modified sub-bands to obtain the watermarked image.
Watermark extraction is done using an extraction algorithm.
Various quality parameters have been used to test and evaluate
the performance of the proposed method for varying scale factors
and different set of images. PSNR value for watermark and
extracted watermark image is found in the range of 33.45 dB to
40.15 dB.
Keywords—wavelet transform; telemedicine; watermarking;
discrete cosine transform
I. INTRODUCTION
Today, technology is changing very fast with a purpose to
facilitate the last person of the society. Health sector is also
looking forward to facilitate both urban as well as rural area,
but due to lack of resources (both manpower and hardware),
its aim becomes difficult to be achieved. To conquer this
challenge, telemedicine has proved itself to be one of the
satisfactory solutions [1]. Advances in telecommunication
have made this solution even more prominent. In
telemedicine, patients present at remote locations are
diagnosed with the help of telecommunication. It also helps in
providing services in ambulances and at accident sites.
However, this advancement has lead to ease of data piracy,
unauthorized access and credibility of medical images,
eventually resulting to an immense need for authentication and
copyright protection of digital data [2]. Confidentiality of
health related data is essentially required because it contains
patient's personal and private information. Although
cryptography has remarkably reduced the amount of
unauthorized access but illegal replication of decrypted
message by an authorized user is still an issue [3]. But
978-1-5090-0612-0/16/$31.00 ©2016 IEEE
cryptography has certain limitations on maintaining
confidentiality of medical data. This has encouraged
researchers to figure out better techniques to tackle the
problem.
Steganography is one such technique that protects the
original data by hiding it behind some cover media and is
widely used for the purpose of data confidentiality since years
[4]. But authentication and protection against removal cannot
be ensured with the help of steganography. Digital
watermarking is another solution to provide copyright
authentication and protection against removal [5]. Digital
watermarking is a process of embedding information into
audio, video or image, commonly known as cover data.
Digital watermarking, based on domain of processing the
image, can be broadly classified into two categories, (i) spatial
domain and (ii) transform domain [6]. In spatial domain
techniques, direct manipulation of the pixel value is performed
for the purpose of processing the image. The watermarking
methods in spatial domain modify only the least significant bit
(LSB) of the pixels of image using some methodology [7].
These techniques are simple and straightforward but do not
strongly ensure protection against removal and robustness of
the watermarked image. Transform domain techniques on the
other hand are much more robust and trustworthy, but are
computationally complex. In transform domain techniques [7]-
[9], the multimedia data is transformed into transform domain,
such as frequency, wavelet, etc. that provides corresponding
transform coefficient. The processing of the signals is done
using signal processing technique as needed by the algorithm
and then inverse transformed. The inverse transformed
multimedia data represent watermarked data. Two or more
domains of processing for digital image watermarking have
been used by several authors [10]-[14].
The proposed watermarking algorithm is based on discrete
wavelet transform (DWT) and discrete cosine transforms
(DCT). The algorithm embeds watermark image into a cover
image that is retained after transmission over network. During
embedding process, 2-Dimensional DWT is applied to the
cover image which transforms the image into first level DWT
coefficients. In the next step, DCT is applied to the DWT
transformed sub-band (LL) of the cover image and an average
value of rest sub-bands (LH, HL, HH) is estimated. The
watermark image and the average sub-band are transformed
by DCT and arithmetically modified with some scaling factor
 2016 IEEE International Conference on Computational Intelligence and Computing Research
to obtain generated watermark. The generated watermark is
then embedded into the LL sub-band to produce modified LL
sub-band. Finally, watermarked image is obtained by first
inverse DCT of modified LL sub-band and then inverse DWT
of all four components of modified sub-bands. The extraction
process is reverse of embedding algorithm that is discussed in
detail in section V. The proposed algorithm has been tested for
various security parameters and the results have been
evaluated for various set of cover and watermark images. The
algorithm correctly extracts the watermark image and the
visual perception of watermarked image is also very good i.e.
similar to cover image. The proposed algorithm shows a good
performance at scale factor α = 0.5, β =0.4 with PSNR =
40.1587 and MSE = 6.2692.
The layout of the paper is drawn as follows: fundamental
of watermarking is discussed in detail in section II. This
section talks about different types of watermarking methods
and its category. Watermarking methods are basically
mathematical formulations which needs a theoretical
background that is discussed in section III. The proposed
algorithm with its explanation is discussed in section IV.
Result of the algorithm and its analysis is covered in section
V. A proper discussion regarding the proposed algorithm and
existing algorithm is done in section VI. In section VII,
conclusion is presented that also discusses about future scope.
II. FUNDAMENTALS OF WATERMARKING
Digital watermarking is the process of hiding digital
information into a digital signal, i.e. image, video or audio, for
the purpose of authenticity and integrity of the original data
[6]. Watermark embedding process and watermark extraction
process constitutes core structures of any watermarking
algorithm. During embedding process, watermarking
algorithm accepts cover and watermark images as inputs and
produces watermarked image as output. This watermarked
image is transmitted over network for telemedicine diagnosis.
Fig. 1 describes the embedding process of the algorithm.
Extraction of the watermark image at the receiver end is
highly important for diagnosis purpose. The extraction method
is derived from the embedding method using reverse
approach, restoring data at each step. The fundamental step of
extraction is shown in Fig. 2.
Fig. 1. Watermarking Embedding Process
Fig. 2. Watermark Extraction Process
Digital watermarking is categorized into various types
depending upon its robustness and blindness properties.
1) Robustness: Robustness categorizes watermarking
scheme into robust, fragile and semi-fragile schemes [15]. A
watermark is robust if it retains its form even after a set of
modifications is applied on the watermarked image. It is used
for the application of copyright protection. A fragile
watermark cannot be extracted even after slightest
modifications. It is suitable for the purpose of integrity. A
semi-fragile watermark retains its form after fine
modifications but fails against strong signal processing
attacks.
2) Blindness: Watermarking systems under blindness
are categorized on the basis of inputs and outputs of the
embedding-extraction process [16]. In blind watermarking,
extraction algorithm does not require original cover image or
its characteristics to extract the watermark image. In non-blind
watermarking, cover image or/and watermark image are
essentially required to extract the watermark image. This
scheme of watermarking is more robust against any attack on
the signal as compared to blind watermark. In semi-blind
watermarking, the extraction algorithm demands special
characteristics of the original image to extract the watermark
image.
III. THEORETICAL BACKGROUND
In this paper 2-dimensional DWT and DCT are used for
estimating the transform coefficients of the input image. These
coefficients are processed by proposed algorithm to produce
the watermarked image as output. DWT and DCT are
discussed in detail as follows.
A. Discrete Wavelet Transform
DWT transforms an image into four band limited
components called sub bands, which on inverse DWT
reassembles to form the original image [17]. DWT is used to
analyze an image at multi resolution scale, into various
frequency components, which provides both of its spatial and
frequency attributes simultaneously [18].
Two dimensional DWT is applied on an image in two
steps. Firstly, both high pass and low pass wavelet filters are
applied on the rows of input image matrix, and secondly, both
the filters are applied on the columns of the output matrix of
first step [9]. The output of the second step contains four non-
overlapping sub bands: Approximation sub band (LL),
Horizontal sub band (LH), Vertical sub band (HL), Diagonal
 2016 IEEE International Conference on Computational Intelligence and Computing Research

sub band (HH). Same process is repeated for multilevel

wavelet decomposition as shown in Fig. 3.

Fig. 3. Two-Dimensional DWT: (a) Input Image. (b) First level DWT
Coefficients. (c) Second level DWT coefficients (Only LL sub-band is
transformed)

B. Discrete Cosine Transform

DCT decomposes the image coefficients into low, middle
and high frequencies. It is easy to embed information into
middle frequency band as compared to high and low
frequency bands [19]. This process makes it robust against
compression. DCT also shows good energy compaction
property. DCT coefficient (D) for input image (I) of size N X
N is computed as (1)

( , ) = ( ) ( )∑ ∑ ( , )× (1)
√
Fig. 4. Flow Chart of Proposed Watermark Embedding Process
(2 + 1) (2 + 1)
where, = cos cos , A. Watermark Embedding Algorithm
2 2
Input: Cover Image, Watermark Image and scale factor of
(i, j) represents the co-ordinates of the corresponding pixels in the algorithm
image, Output: Watermarked Image
Step1. Variable Declaration
( ), ( ) = 1 , = 0 CI: Cover image
√
WI: Watermark image
α: Scale factor for watermark generation
( ), ( ) = 2 , = 1, 2, … −1 β: Scale factor for watermark embedding
LLC , LHC ,HLC and HHC: First level DWT coefficients for
IV. PROPOSED ALGORITHM cover image
L: Average sub-band of cover image
The proposed algorithm is based on two transforms DWT DW: DCT coefficient of watermark image
and DCT. The algorithm proposed has two processes: DC: DCT coefficient of LLC component
watermark embedding process and watermark extraction DL: DCT coefficient of L sub-band
process, as shown in Fig. 4 and Fig. 5 respectively. DLmodi: DCT coefficient of generated watermark
LLCmodi: Inverse DCT coefficient of modified LLC
component
WD: Watermarked Image
Step2. Read the Images
CI  Cover Image (512 x 512)
WI  Watermark Image (256 x 256)
 2016 IEEE International Conference on Computational Intelligence and Computing Research

Step3. Perform DWT on CI and L DC  DCT (LLC);

Apply first level DWT on cover image (CI) Step4. Extract generated watermark
[LLC, LHC, HLC, HHC]  DWT (CI, ‘haar wavelet filter’);
L = (LHC + HLC + HHC) / 3; DLmodi = (DCmodi– DC) / β;

Step4. Obtain DCT coefficient of chosen sub-band (LLC), L Step5. Watermark extraction
and WI DW = (DLmodi – DL) / α;
DC  DCT (LLC); Step6. Inverse transform and extracted watermark
DL  DCT (L); WEW = Inverse DCT (DW);
DW  DCT (WI);
Step5. Watermark generation
DLmodi = DL + (α x DW);
Step6. Watermark embedding
DCmodi = DC + (β x DLmodi);
Step7. Inverse transform and watermarked image
generation
LLCmodi  Inverse DCT (DCmodi);
WD  Inverse DWT (LLCmodi, LHC, HLC, HHC, ‘haar
wavelet filter’);
In this algorithm, first level DWT is applied on the cover
image (CI) and an average sub-band (L) is computed using
LH, HL and HH sub-bands. Then DCT is applied on the
watermark image (WI) and the LL sub-band of cover image.
DCT coefficient of L (DL) and WI (DW) are arithmetically
modified into DLmodi (generated watermark). DCT coefficient
of LL (DC) is then modified using the generated watermark.
The modified LL sub-band (DCmodi) is inverse DWT
transformed with other sub-bands and finally, inverse DCT is
applied to obtain the watermarked image (WD).
B. Watermark Extraction Algorithm
Input: Watermarked image, Cover image and scale factor
for algorithm
Output: Extracted watermark image
Step1. Variable Declaration
α: scale factor for original watermark extraction Fig. 5. Flow Chart of Proposed Watermark Extraction Process
β: scale factor for generated watermark extraction
LLC, LHC, HLC and HHC: First level DWT coefficients for In this algorithm, first level DWT is applied to both the
cover image watermarked image (WD) as well as the cover image (CI).
LLCmodi, LHD, HLD and HHD: First level DWT coefficients Average sub-band (L) is computed from three sub-bands LH,
for watermarked image HL and HH. Then DCT is applied to LL sub-band of cover
DCmodi: DCT coefficient of LLD component image (LLC), LL sub-band of watermarked image (LLCmodi)
WEW: Extracted watermark and the computed sub-band (L). Generated watermark (DLmodi)
is obtained from DCT coefficients of watermarked image and
Step2. Perform DWT on WD, CI and extract L cover image LL sub-band. Finally, the original watermark is
Apply first level DWT on watermarked image and cover obtained from DLmodi and DCT coefficient of the average sub-
image band (DL), which signifies extracted watermark (WEW).
[LLCmodi, LHD, HLD, HHD]  DWT (WD, ‘haar wavelet
filter’); V. RESULTS AND ANALYSIS
[LLC, LHC, HLC, HHC]  DWT (CI, ‘haar wavelet filter’); The results of the proposed algorithm have been analyzed
L = (LHC + HLC + HHC) / 3; for performance estimation over various parameters. Gray-
scale images of ‘girl’, ‘butterfly’ of size 512 x 512 are used as
Step3. Obtain DCT coefficient of extracted LL component cover (Fig, 6) and images of ‘X-ray scan’, ‘MRI scan’ of size
(LLCmodi), L and LLC 256 x 256 are used as watermark image (Fig. 7).
DCmodi  DCT (LLCmodi);
DL DCT (L); Parameters used for evaluation of quality of watermarked
image (Fig. 8) and extracted watermark image (Fig. 9) are
 2016 IEEE International Conference on Computational Intelligence and Computing Research

Peak Signal to Noise Ratio (PSNR), Bit Error Rate (BER) and
Mean Square Error (MSE). Normalized Correlation (NC) is
used to analyze the robustness of our proposed algorithm.
In table I and II, performance of the algorithm is presented
for ‘girl’ image as cover and ‘MRI scan’ image as watermark.
Table I shows PSNR, NC and MSE values between
watermark and extracted watermark image for various
manually defined scale factors. The PSNR values obtained
ranges from 36.58 dB to 40.15 dB and NC values for all set of
α and β were found to be 1.

TABLE I. MRI WATERMARK AND EXTRACTED WATERMARK

IMAGE

S.No. α β PSNR NC MSE

1 0.4 0.4 38.2405 1 9.7507

2 0.5 0.3 38.0625 1 10.1522

Fig. 6. Cover Image. (a) Girl (b) Butterfly 3 0.5 0.4 40.1587 1 6.2692

4 0.6 0.2 36.5840 1 14.2783

5 0.6 0.3 39.4993 1 7.2971

Table II shows PSNR, NC and BER values between cover

and watermarked image for various manually defined scale
factors. Best result is obtained at α = 0.6 and β = 0.2 with
PSNR = 38.0753 (maximum) and BER = 0.1445 (minimum).

TABLE II. GIRL COVER AND WATERMARKED IMAGE

S.No. α β PSNR NC BER

1 0.4 0.4 35.4559 1 0.1672
Fig. 7. Watermark Image. (a) MRI (b) X-ray
2 0.5 0.3 36.1027 1 0.1580

3 0.5 0.4 33.6185 1 0.1650

4 0.6 0.2 38.0753 1 0.1445

5 0.6 0.3 34.5735 1 0.1628

In table III and IV, performance of the algorithm is

Fig. 8. Watermarked Image. (a) MRI image embedded in Girl image (b)
X-ray image embedded in Butterfly image
presented for ‘butterfly’ image as cover and ‘X-ray scan’
image as watermark.
Table III shows PSNR, NC and MSE values between
watermark and extracted watermark image for various
manually defined scale factors. The PSNR values obtained
ranges from 34.44 dB to 37.06 dB and NC values for all set of
α and β were found to 1.

TABLE III. X-RAY WATERMARK AND EXTRACTED

WATERMARK IMAGE

S.No. α β PSNR NC MSE

1 0.4 0.4 36.9470 1 13.1334

2 0.5 0.3 36.4237 1 14.8155

3 0.6 0.2 34.4448 1 23.3669

4 0.7 0.2 35.8428 1 16.9357

5 0.8 0.2 37.0639 1 12.7848

Fig. 9. Extracted Watermark Image. (a) MRI (b) X-ray
Table IV shows PSNR, NC and BER values between cover
and watermarked image for various manually defined scale
factors. Best result is obtained at α = 0.6 and β = 0.2 with
PSNR = 36.0803 (maximum) and BER = 0.2367 (minimum).
 2016 IEEE International Conference on Computational Intelligence and Computing Research
TABLE IV. BUTTERFLY COVER AND WATERMARKED
IMAGE
S.No. α β PSNR NC BER
1 0.4 0.4 33.4516 1 0.2574
2 0.5 0.3 34.0982 1 0.2521
3 0.6 0.2 36.0803 1 0.2367
4 0.7 0.2 34.7805 1 0.2495
5 0.8 0.2 33.6449 1 0.2550
VI. DISCUSSION
The main objective of this paper is to provide an efficient
algorithm that can solve the authentication and integrity
problem of image data in telemedicine. Telemedicine deals
with both categories of medical images i.e. radiology and non-
radiology. All kind of medical imaging information is
described in radiology which requires various security and
privacy standards [20]. These standards can be broadly
categorized as: (i) set of standards for security and privacy that
are desired in teleradiology, (ii) set of security measures that
stratify the security principles. These guidelines are defined in
different national and international cyber laws that come under
constitutional rights. In the proposed algorithm, authentication
and confidentiality issues are tackled using semi-fragile
watermarking technique. In order to maintain the robustness of
the algorithm, we have embedded the information into the
coefficients of domain transformed cover image. For better
visual perception, algorithm demands an intelligent selection
of cover image corresponding to the watermark image. This
selection process increases the confidentiality of embedded
information. In certain existing algorithms, the performance
evaluation is done between cover and watermarked image
[10], but in our proposed algorithm, we have compared
performance of both cover and watermarked as well as
watermark and extracted watermark image. PSNR for various
values of scaling factor is more than 33 which implies that our
algorithm is producing above standard output [8]. Also NC,
BER and MSE values of the proposed method are showing
good results, especially NC which is 1 for all the values of
scale factor.
VII. CONCLUSION
In this paper, a digital image watermarking technique has
been proposed based on DWT and DCT, where DCT
coefficients of generated watermark are embedded with DCT
coefficients of the cover image’s DWT sub band. The quality
of extracted watermark image and visual imperceptibility of
the watermarked image are dependent on the choice of scale
factors. The BER for α = 0.6 and β = 0.2 is minimum in every
set of image, which indicates high visual quality of the
watermarked image. The algorithm shows higher PSNR and
lower MSE values with NC = 1, that signifies strong and
authentic watermarked image. Since the performance of
algorithm is highly dependent on intelligent selection of the
scaling factor, automation of this selection on the basis of
features of the input image can be worked upon in future.
Also, an improved version of algorithm may focus only on
special regions of interest instead of considering the whole
image.
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