A Double Chaotic Layer Encryption Algorithm for Clinical Signals in Telemedicine

Perceptions and utilization of tele-orthodontics: a survey of the members of the American Association of Orthodontists

OBJECTIVE

This study aimed to investigate orthodontists' utilization and perceptions of tele-orthodontics.

MATERIALS AND METHODS

A 30-item online survey was distributed to members of the American Association of Orthodontists (AAO). The questionnaire encompassed topics concerning the orthodontists' utilization, perceptions, clinical applications, limitations, and concerns regarding tele-orthodontics. Descriptive statistics were employed, and comparisons between responses from users and non-users were conducted  using Wilcoxon rank-sum tests and Fisher's exact tests.

RESULTS

152 members completed the survey, (response rate: 2.4%). More than two third of respondents (69.74%) were users of tele-orthodontics. Users were more aligned with the belief that tele-orthodontics facilitates effective communication (mean ± standard deviation (SD) 4.06 ± 0.83 vs. 3.33 ± 0.94, p < 0.001). Both groups agreed on the requirement of patient fees for tele-orthodontic visits (mean ± SD: 3.62 ± 1.11 users vs. 3.74 ± 1.02 non-users, p = 0.659), and on the capability  of the system to reduce unwarranted referrals (p = 0.20). The majority of participants acknowledged  the utility of the system in monitoring aligners' patients (89% in users vs. 61% in non-users, p < 0.001). Non-users expressed greater concerns regarding privacy risks (mean ± SD: 3.06 ± 0.97 users vs. 3.57 ± 0.86 non-users, p = 0.002). Both groups stressed the significance of obtaining informed consent before utilizing tele-orthodontics.

CONCLUSIONS

The widespread acceptance of tele-orthodontics among AAO members was apparent, as demonstrated by their recognition of its effectiveness. There was notable variation in how users and non-users perceived tele-orthodontics. The study's results offer valuable insights into both the potential benefits and drawbacks of incorporating this technology into clinical practice from the clincians' perspective.

Smartphone oral self-photography in teledentistry: Recommendations for the patient

In the current context of the coronavirus disease 2019 pandemic, the deployment of telemedicine has accelerated considerably. Like telemedicine, teledentistry involves the use of telecommunication technologies to provide medical information and services. Teledentistry can contribute to remote assessment (teletriage) and continuity of care (telemonitoring). This evaluation at a distance can be done by sending photos taken by the patient with a smartphone. Providing patients with a simple and reproducible protocol and explaining how to take a photo is important for sufficient image quality. The aim of this technical note is to help clinicians advise their patients on how to take photographs of their oral cavity simply and with sufficient quality to be reproducible.

Establishment of Neural Series Transmission Keys (NSTKs) and Security in the Field of COVID-19 Telepediatric Oral Health

In this exceptional COVID-19 crisis, telemedicine had arisen as a substitute technique for medicines. Even more unequivocally, pediatric children were at high risk to outside homes. The spread of COVID-19 has suddenly ascended. Because of lockdown conventions and isolation protocols, kids were confined to live inside their homes. Non-emergency youngsters ought to be managed remotely through the telepediatric health. An establishment of Neural Series Transmission Keys (NSTKs) has been created and security had been planned on the intraoral data. Oral cavity is a kind of dental disease occurring in children. It is for the most cases caused due to drawn out bacterial invasions. Bacterial attacks are more because of sticky chocolates, desserts, sugar, and so forth. Homeopathy medicines are the best prescribed to fix such dental diseases in this current unprecedented COVID-19. Since, it needs no dental medical procedure for the non-invasive kids, which is the reason that the homeopathy medicines are most appropriate in this COVID-19 lockdown stages. The doctor can gather symptoms of the kids from their parents through online interfaces. Some of the normal homeopathy drugs are: Kreasotum, Mercurius, Mezereum, etc. Moreover, in this pandemic situation online telepediatric homeopathy medicines were better alternatives to investigate from home disengages. Additionally it bears no voyaging consumptions and costs. Secure online transmission of clinical pediatric information has been the most challenging issue in COVID-19 telepediatric oral wellbeing. Data mystery factor is protected with tendency in this proposed cryptographic technique. Neural Series Transmission Keys (NSTKs) were established based on neural network based hamming codes. It has been diffused inside the intraoral pediatric data. The proposed key was so particularly amazing that it gives assorted blend after each bit of evolving. Beginning seeds were kept at the dentists and the patients, in order to go against external attacks inside the public channel, especially during this hyper digitized COVID-19 times. Standard graphs were drawn with accuracy using the proposed cryptographic method. The absolute cryptographic time in this strategy was 2.88 ms which was significantly important. By applying Chi Square test, we have noted χ 2 = 17.012, under 5% level of significance.

Telehealth Secure Solution to Provide Childhood Obesity Monitoring

Childhood obesity causes not only medical and psychosocial problems, it also reduces the life expectancy of the adults that they will become. On a large scale, obese adults adversely affect labor markets and the gross domestic product of countries. Monitoring the growth charts of children helps to maintain their body weight within healthy parameters according to the World Health Organization. Modern technologies allow the use of telehealth to carry out weight control programs and monitoring to verify children's compliance with the daily recommendations for risk factors that can be promoters of obesity, such as insufficient physical activity and insufficient sleep hours. In this work, we propose a secure remote monitoring and supervision scheme of physical activity and sleep hours for the children based on telehealth, multi-user networks, chaotic encryption, and spread spectrum, which, to our knowledge, is the first attempt to consider this service for safe pediatric telemedicine. In experimental results, we adapted a recent encryption algorithm in the literature for the proposed monitoring scheme using the assessment of childhood obesity as an application case in a multi-user network to securely send and receive fictitious parameters on childhood obesity of five users through the Internet by using just one communication channel. The results show that all the monitored parameters can be transmitted securely, achieving high sensitivity against secret key, enough secret key space, high resistance against noise interference, and 4.99 Mb/sec in computational simulations. The proposed scheme can be used to monitor childhood obesity in secure telehealth application.

Mathematically Based Assessment of the Accuracy of Protection of Cardiac Data Realized with the Help of Cryptography and Steganography

This paper describes the application of cryptography and steganography in the protection of cardiac databases. The original cardiac data studied were transformed using a Daubechies wavelet transform. The next step is to conduct Energy Packing Efficiency-based compression. A watermark is added to the received data to protect against unauthorized access, before hybrid cryptography is performed using a suitably selected encryption algorithm. The presented and analyzed algorithm includes protection using public and symmetric key cryptography. The proposed software algorithm is performed on real electrocardiographic, photoplethysmographic, and Holter cardio data. We have evaluated the effectiveness of the applied approach and concluded that a sufficient level of protection of the studied data has been achieved, with methods of authentication and accuracy applied to the users.

Metaheuristic secured transmission in Telecare Medical Information System (TMIS) in the face of post-COVID-19

The outbreak of novel corona virus had led the entire world to make severe changes. A secured healthcare data transmission has been proposed through Telecare Medical Information System (TMIS) based on metaheuristic salp swarm. Patients need proper medical remote treatments in this Post-COVID-19 time from their quarantines. Secured transmission of medical data is a significant challenge of digitally overwhelmed environment. The objective is to impart the patients' data by encryption with confidentiality and integrity. Eavesdroppers can carry sniffing and spoofing in order to deluge the data. In this paper, a novel scheme on metaheuristic salp swarm based intelligence has been sculptured to encrypt electrocardiograms (ECG) for data privacy. Metaheuristic approach has been blended in cryptographic engineering to address the TMIS security issues. Session key has been derived from the weight vector of the fittest salp from the salp population. The exploration and exploitation control the movements of the salps. The proposed technique baffles the eavesdroppers by the key strength and other robustness factors. The results, thus obtained, were compared with some existing classical techniques with benchmark results. The proposed MSE and RMSE were 28,967.85, and 81.17 respectively. The time needed to decode 128 bits proposed session key was 8.66 × 1052 years. The proposed cryptographic time was 8.8 s.

Medical Images Encryption Based on Adaptive-Robust Multi-Mode Synchronization of Chen Hyper-Chaotic Systems

In this paper, a novel medical image encryption method based on multi-mode synchronization of hyper-chaotic systems is presented. The synchronization of hyper-chaotic systems is of great significance in secure communication tasks such as encryption of images. Multi-mode synchronization is a novel and highly complex issue, especially if there is uncertainty and disturbance. In this work, an adaptive-robust controller is designed for multimode synchronized chaotic systems with variable and unknown parameters, despite the bounded disturbance and uncertainty with a known function in two modes. In the first case, it is a main system with some response systems, and in the second case, it is a circular synchronization. Using theorems it is proved that the two synchronization methods are equivalent. Our results show that, we are able to obtain the convergence of synchronization error and parameter estimation error to zero using Lyapunov's method. The new laws to update time-varying parameters, estimating disturbance and uncertainty bounds are proposed such that stability of system is guaranteed. To assess the performance of the proposed synchronization method, various statistical analyzes were carried out on the encrypted medical images and standard benchmark images. The results show effective performance of the proposed synchronization technique in the medical images encryption for telemedicine application.

Tree parity machine guided patients' privileged based secure sharing of electronic medical record: cybersecurity for telehealth during COVID-19

In the COVID-19 pandemic, telehealth plays a significant role in the e-healthcare. E-health security risks have also risen significantly with the rise in the use of telehealth. This paper addresses one of e-health's key concerns, namely security. Secret sharing is a cryptographic method to ensure reliable and secure access to information. To eliminate the constraint that in the existing secret sharing schemes, this paper presents Tree Parity Machine (TPM) guided patients' privileged based secure sharing. This is a new secret sharing technique that generates the shares using a simple mask based operation. This work considers addressing the challenges presents in the original secret sharing scheme. This proposed technique enhances the security of the existing scheme. This research introduces a concept of privileged share in which among k number of shares one share should come from a specific recipient (patient) to whom a special privilege is given to recreate the original information. In the absence of this privileged share, the original information cannot be reconstructed. This technique also offers TPM based exchange of secret shares to prevent Man-In-The-Middle-Attack (MITM). Here, two neural networks receive common inputs and exchange their outputs. In some steps, it leads to full synchronization by setting the discrete weights according to the specific rule of learning. This synchronized weight is used as a common secret session key for transmitting the secret shares. The proposed method has been found to produce attractive results that show that the scheme achieves a great degree of protection, reliability, and efficiency and also comparable to the existing secret sharing scheme.

Neural Synchronization-Guided Concatenation of Header and Secret Shares for Secure Transmission of Patients' Electronic Medical Record: Enhancing Telehealth Security for COVID-19

This paper deals with one of the key problems of e-healthcare which is the security. Patients are worried about the confidentiality of their electronic medical record (EMR) which could be used to expose their identities. It is high time to revisit the confidentiality and security issues of the existing telehealth system. Intruders can perform sniffing, spoofing, or phishing operations effortlessly during the online exchange of the EMR using a digital platform. The EMR must be transmitted anonymously with a high degree of hardness of encryption by protecting the authentication, confidentiality, and integrity criteria of the patient. These requirements recommend the security of the current system to be improved. In this paper, a neural synchronization-guided concatenation of header and secret shares with the ability to transmit the EMR with an end-to-end security protocol has been proposed. This proposed methodology breaks down the EMR into the n number of secret shares and transmits to the n number of recipients. The original EMR can be reconstructed after the amalgamation of a minimum k (threshold) number of secret shares. The novelty of the technique is that one share should come from a specific recipient to whom a special privilege is given to recreate the EMR among such a predefined number of shares. In the absence of this privileged share, the original EMR cannot be reconstructed. This proposed technique has passed various parametric tests. The results are compared with existing benchmark techniques. The results of the proposed technique have shown robust and effective potential.

Telemedicine in Oral and Maxillo-Facial Surgery: An Effective Alternative in Post COVID-19 Pandemic

The aim of this work was to demonstrate the advantages of using telemedicine (TM) in the management of the outpatients with maxillofacial surgical pathologies during the COVID-19 pandemic. The study was conducted at the MaxilloFacial Surgery Unit of “Magna Graecia” University of Catanzaro, on two different groups of patients: a group of follow-up patients (A₁: patients in oncological follow-up after surgical treatment performed before the COVID-19 pandemic; A₂: suffering from chronic lesions such as precancerous lesions), and a group B of patients with first urgent visits (B₁: patients with suspected oncological pathology; B₂: patients with suspected urgent disease such as medication-related osteonecrosis of the jaws (MRONJ), odontogenic abscesses, temporomandibular joint (TMJ) dislocation, etc.). Participation in the study required possession of a smartphone with Internet access, e-mail and the use of a messaging service (WhatsApp or Telegram) to send photos and messages; completion by the patient of a COVID-19 screening questionnaire; submission of a satisfaction questionnaire by the doctors and patients. A total of 90 patients were included in this study. A high percentage of satisfaction emerged from the analysis of the satisfaction questionnaires of both patients and doctors.TM thus represents an excellent opportunity to improve accessibility to oncological and non-management activities, reducing the risk of Covid-19 dissemination and should be promoted and implemented in the post-pandemic era.

Self-reported dental treatment needs during the COVID-19 outbreak in Brazil: an infodemiological study

The aim of the present infodemiological study was to evaluate whether the COVID-19 outbreak has influenced the volume of content related to the dental treatment needs of Brazilian Twitter users to summarize the trends, and to identify the perceptions of the treatment needed. We collected tweets related to dental care needs of individuals exposed to the COVID-19 outbreak scenario between March 23 to May 4, 2020 and of those not exposed to the COVID-19 pandemic (unexposed group) on the same reported days of 2019 using the terms "dentista (dentist), dente (tooth), siso (third molar), and aparelho (orthodontic appliance)." Descriptive analysis was performed to provide summary statistics of the frequencies of tweets related to different dental treatment needs and also the differences in volume content between the years 2019 and 2020. Moreover, the data were analyzed by qualitative analysis using an inductive approach. A total of 1,763 tweets from 2020 and 1,339 tweets from 2019 were screened. Those tweets posted by non-Brazilian users, duplicates, and those unrelated to dental treatment needs were removed and, therefore 1,197 tweets from 2020 and 719 tweets from 2019 were selected. Content volume related to dental treatment needs greatly increased during the COVID-19 outbreak. Findings from the word cloud and content analysis suggest that dental pain, related or not to the third molar, and problems with orthodontic appliances were the topics most commonly related to dental treatment needs discussed during the COVID-19 outbreak, mainly conveying anxiety and distress. The volume of tweets related to dental treatment needs posted by Brazilian users increased during the COVID-19 outbreak and self-reported pain and urgencies were the most popular topics.

Can Teledentistry Improve the Monitoring of Patients during the Covid-19 Dissemination? A Descriptive Pilot Study

The aim of this pilot study was to describe the advantages of telemedicine (TM) in dental practice during the current national emergency condition due to the Covid-19 dissemination. At Department of Oral Surgery and Pathology—Magna Graecia University of Catanzaro, regional reference center for Covid-19—two groups of patients were determined: patients with urgent conditions (group U) and patients in follow-up (group F). Both groups were instructed to implement remote consultations using a messaging service (WhatsApp Messenger, WhatsApp Inc., Mountain View, California, USA) to send photos. A total of 418 photos were collected by 57 patients. Thirty-four photos were obtained by five patients in the U group after surgical procedures. All patients sent photos on the established evening, except for two patients who sent two photos outside the set days. In the F group, 384 photos were collected by 52 patients. None of them sent more photos than the number that was established by the protocol. Telemedicine allowed a monitoring of all patients, reducing costs and limiting human contact, decreasing the risk of Covid-19 dissemination.

Suggested Integral Analysis for Chaos-Based Image Cryptosystems

Currently, chaos-based cryptosystems are being proposed in the literature to provide confidentiality for digital images, since the diffusion effect in the Advance Encryption Standard (AES) algorithm is weak. Security is the most important challenge to assess in cryptosystems according to the National Institute of Standard and Technology (NIST), then cost and performance, and finally algorithm and implementation. Recent chaos-based image encryption algorithms present basic security analysis, which could make them insecure for some applications. In this paper, we suggest an integral analysis framework related to comprehensive security analysis, cost and performance, and the algorithm and implementation for chaos-based image cryptosystems. The proposed guideline based on 20 analysis points can assist new cryptographic designers to present an integral analysis of new algorithms. Future comparisons of new schemes can be more consistent in terms of security and efficiency. In addition, we present aspects regarding digital chaos implementation, chaos validation, and key definition to improve the security of the overall cryptosystem. The suggested guideline does not guarantee security, and it does not intend to limit the liberty to implement new analysis. However, it provides for the first time in the literature a solid basis about integral analysis for chaos-based image cryptosystems as an effective approach to improve security.

Development of Public Key Cryptographic Algorithm Using Matrix Pattern for Tele-Ultrasound Applications

A novel public key cryptographic algorithm using a matrix pattern is developed to improve encrypting strength. Compared to the Rivest–Sharmir–Adleman (RSA) and Elliptic Curve Cryptography (ECC) algorithms, our proposed algorithm has superior encrypting strength due to several unknown quantities and one additional sub-equation during the encrypting process. Our proposed algorithm also provides a faster encoding/decoding speed when the patient’s images for tele-ultrasound applications are transmitted/received, compared to the RSA and ECC encrypting algorithms, because it encodes/decodes the plain memory block by simple addition and multiplication operations of n terms. However, the RSA and ECC algorithms encode/decode each memory block using complex mathematical exponentiation and congruence. To implement encrypting algorithms for tele-ultrasound applications, a streaming server was constructed to transmit the images to the systems using ultrasound machines. Using the obtained ultrasound images from a breast phantom, we compared our developed algorithm, utilizing a matrix pattern, with the RSA and ECC algorithms. The elapsed average time for our proposed algorithm is much faster than that for the RSA and ECC algorithms.

Secured Transmission of Clinical Signals Using Hyperchaotic DNA Confusion and Diffusion Transform

Secured transmission of electrophysiological signals is one of the crucial requirements in telemedicine, telemonitoring, cardiovascular disease diagnosis (CVD) and telecardiology applications. The chaotic systems have good potential in secured transmission of ECG/EEG signals due to their inherent characteristics relevant to cryptography. This article introduces a new cryptosystem for clinical signals such as electrocardiograms (ECG) and electroencephalograms (EEG) based on hyperchaotic DNA confusion and diffusion transform (HC-DNA-CDT). The algorithm uses a hyperchaotic system with cubic nonlinearity and deoxyribonucleic acid (DNA) encoding rules. The performance of the cryptosystem is evaluated for different clinical signals using different encryption/decryption quality metrics. Simulation and comparison results show that the cryptosystem yield good encryption results and is able to resist various cryptographic attacks. The proposed algorithm can also be used in picture archiving and communication systems (PACS) to provide an efficient sharing of medical image over the networks.

Multiuser communication scheme based on binary phase-shift keying and chaos for telemedicine

BACKGROUND AND OBJECTIVES

Currently, telemedicine is levered upon the improvement in communication network technology such as Body Area Sensor Networks (BASN) to provided biomedicine solutions. Nevertheless, information security is an important issue since biomedical data is exchanged through insecure channels, which exposes private information that can be intercepted by malicious intruder. Therefore, secure communication protocols for multiuser networks in telemedicine applications are a big challenge. Recent chaos-based encryption works have been conducted in the area of medical secure communications with high security capabilities. However, none of them has considered multiuser network, which is used in several e-health applications. Up to our knowledge, the proposed protocol is the first attempt to consider this service in secure telemedicine. In this paper, we propose a novel scheme based on binary phase-shift key (BPSK) and chaos to provide information security at biosignals in a multiuser network system transmitting data over single channel.

METHODS

The proposed scheme uses the two-dimensional Hénon map with enhance pseudorandom sequences and CDMA technique to achieve multiuser encryption process and transmit data over a single channel. We use biosignals such as electrocardiograms (ECG) and blood pressure (PB) signals from PhisioBank ATM data base for simulation results at MatLab software. We evaluate the security and performance by determining the secret key space, secret key sensitivity, resistance against noise attack with quality analysis by using BER, MSE, and PSNR, encryption-decryption time, and throughput.

RESULTS

In simulations tests, biosignals of ECG and BP in a BANS network are encrypted and transmitted over shared wireless channels and just authorized medical personal can retrieve such information with corresponding secret key from the cryptogram, that appears as noise to any intruder. The proposed multiuser scheme support high noise and interference attacks efficiently in contrast with classic chaos-based encryption works for telemedicine, where some scenarios are simulated with very low BER, very low MSE, and high PSNR between plain biosignals and recovered biosignals when high AWGN noise is added to encrypted-transmitted signal. In addition, the encryption process presents enough key space and high sensitivity at secret key. A comparative analysis of proposed method and recent existing works was also presented.

CONCLUSIONS

Patients can be monitored and diagnosed opportunely remotely and all their medical information is transmitted securely to the correct specialist. Also, it is possible to transmit several electrophysiological signals in a single channel in a secure multiuser network at low cost optimizing the use of available bandwidth for telemedicine applications.

A Symmetric Plaintext-Related Color Image Encryption System Based on Bit Permutation

Recently, a variety of chaos-based image encryption algorithms adopting the traditional permutation-diffusion structure have been suggested. Most of these algorithms cannot resist the powerful chosen-plaintext attack and chosen-ciphertext attack efficiently for less sensitivity to plain-image. This paper presents a symmetric color image encryption system based on plaintext-related random access bit-permutation mechanism (PRRABPM). In the proposed scheme, a new random access bit-permutation mechanism is used to shuffle 3D bit matrix transformed from an original color image, making the RGB components of the color image interact with each other. Furthermore, the key streams used in random access bit-permutation mechanism operation are extremely dependent on plain image in an ingenious way. Therefore, the encryption system is sensitive to tiny differences in key and original images, which means that it can efficiently resist chosen-plaintext attack and chosen-ciphertext attack. In the diffusion stage, the previous encrypted pixel is used to encrypt the current pixel. The simulation results show that even though the permutation-diffusion operation in our encryption scheme is performed only one time, the proposed algorithm has favorable security performance. Considering real-time applications, the encryption speed can be further improved.