The development of cloud computing technology reduces the storage burden of medical image retrieval systems; however, it also introduces significant risks of privacy leakage for medical data stored in the cloud. Conventional linear chaotic encryption approaches are mainly restricted to pixel-level operations, lack sufficient sensitivity to small variations in the plaintext, and therefore do not satisfy the strict security requirements of medical images. Furthermore, existing mechanisms for dynamic data verification frequently depend on complex hash structures, which result in high computational costs and provide inadequate protection against the illegal distribution and misuse of sensitive medical images. To overcome these limitations, we present a privacy-preserving medical image retrieval framework with traceability and verifiability (PPTV). In PPTV embedding space first reserved by employing a nonlinear chaotic encryption approach, followed by bit-level three-channel sequential encryption applied to color medical images, and user information is embedded through ciphertext watermarking based on chaotic mapping. A strongly balanced dynamic verification tree with unique indexing is constructed to support efficient verification of dynamic image data. Traceability of malicious access is realized by extracting the embedded ciphertext watermark that carries user information. Experimental evaluation indicates that PPTV achieves retrieval accuracies of 92.8 % and 97.7 % on the IDRiD and COVID datasets, respectively, confirming its ability to provide both high retrieval precision and robust privacy preservation.
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