It is of great importance in telemedicine to protect authenticity and integrity of medical images. They are mainly addressed by two technologies, which are region of interest (ROI) lossless watermarking and reversible watermarking. However, the former causes biases on diagnosis by distorting region of none interest (RONI) and introduces security risks by segmenting image spatially for watermark embedding. The latter fails to provide reliable recovery function for the tampered areas when protecting image integrity. To address these issues, a novel robust reversible watermarking scheme is proposed in this paper. In our scheme, a reversible watermarking method is designed based on recursive dither modulation (RDM) to avoid biases on diagnosis. In addition, RDM is combined with Slantlet transform and singular value decomposition to provide a reliable solution for protecting image authenticity. Moreover, ROI and RONI are divided for watermark generation to design an effective recovery function under limited embedding capacity. Finally, watermarks are embedded into whole medical images to avoid the risks caused by segmenting image spatially. Experimental results demonstrate that our proposed lossless scheme not only has remarkable imperceptibility and sufficient robustness but also provides reliable authentication, tamper detection, localization, and recovery functions, which outperforms existing schemes for protecting medical images. INDEX TERMS Robust reversible watermarking, authenticity, integrity, medical image.

Enhanced depth imaging-spectral domain optical coherence tomography is a productive imaging method to study the choroidal thickness. Subfoveal choroidal thickness is not significantly correlated with ethnicity. The study reproduced previously found relations between thinner choroids and longer axial lengths, and increasing myopic refraction and showed no significant associations between subfoveal choroidal thickness and age and sex. Either the right or left eye can be used in future studies.

Purpose To determine the correlations between peripapillary vessel density, retinal nerve fibre layer (RNFL) thickness, and myopic indices at retina quadrants with optical coherence tomography angiography (OCTA) in Chinese. Methods Fifty-six subjects with a mean spherical equivalent (MSE) of −3.63 ± 0.29 D were included. Peripapillary RNFL thickness and retinal vessel density in four sectors (superior, nasal, inferior, and temporal quadrants) were determined by OCTA, and correlations of the main outcomes were analyzed. Results Negative correlations were found between the peripapillary RNFL thickness and axial length (AL) at superior (r = −0.335, P = 0.001) and inferior (r = −0.551, P < 0.001) quadrants. There was a significant positive correlation with spherical equivalent (SE) at the corresponding quadrants as well as at the nasal quadrant (r = 0.339, P = 0.001; r = 0.379, P < 0.001; and r = 0.209, P = 0.039, resp.). Peripapillary retinal vessel density was also negatively correlated with AL at the nasal quadrant (r = −0.392, P < 0.001), and only at the nasal quadrant, there was a positive correlation between the peripapillary vessel density and SE (r = 0.319, P = 0.001). Conclusions The degree of myopia and elongation of AL were negatively correlated with peripapillary RNFL thickness at superior and inferior quadrants and with peripapillary retinal vessel density at the nasal quadrant.