An Improved Quad and RDE-based Medical Data
Hiding Method
Tohari Ahmad1, Muhammad Holil2, Waskitho Wibisono3, Royyana Muslim I4
Department of Informatics
Institut Teknologi Sepuluh Nopember (ITS)
Kampus ITS Keputih Sukolilo, Surabaya, Indonesia, 60111
{1tohari, 3waswib, 4roy}@if.its.ac.id, 2holil12@mhs.if.its.ac.id
Abstract—Difference Exapansion is one of popular reversible
steganography methods which can be used for authenticating
images. By using this method, the reconstructed image is exactly
the same as the original one. However, the stego image generated
is relatively different from the original. Based on Quad and RDE
methods, we propose an algorithm which can improve the quality
of the stego image, in terms of PSNR, in particular. The
experimental results show that while the capacity of embedded
message is slightly higher, the PSNR is significantly better.
Keywords—steganography, medical image, data hiding, security
I. INTRODUCTION
Patient images have played an important role in medical
environment. Many health problems require a doctor to analyze
the patient medical image, for example, abdominal, chest and
leg images. Based on them, the doctor draws a conlusion what
kind of treatment should be given to the patient. After being
analyzed, patient medical images are stored in a database along
with his/her health record. This data will be used for next
processes such as transferred to other doctors so that a decision
on how the patient is treated can be made as soon as possible.
Nevertheless, in terms of security, privacy and accuracy,
there are at least two problems of transferring or accessing the
stored images. First, the user (e.g., a doctor) must not have an
access to unrelated patient data in order to avoid incorrect
treatment. Furthermore, the user must be able to authenticate
those medical images. So, ensuring this process works properly
is critical to the accuracy factor. Secondly, the identity of the
image owner must be secret. In case an adversary has been able
to compromise the image, he/she does not know who this data
belong to, so, security and privacy of the patient are maintained.
One possible solution of those problems is to insert the
identity of the patient to its corresponding medical image
property. However, this method is not secure because public can
still read or even modify the information in it. Therefore, this
method is not applicable to use. Another solution is to employ
steganography, which embeds the identity of the patient to the
corresponding medical image. By using this method, the
information cannot be seen easily by public.
Applying steganography is also useful for authenticating the
medical image itself [1]. There are some factors should be taken
into consideration when implementing this method, such as the
978-1-4673-6053-1/13/$31.00 ©2013 IEEE
capacity of message (e.g., identity of the user) to be embedded
into the image [2]. In this case, the capacity must not less than
the size of the message itself. It means that the information or
identity of the patient can be embedded properly into the medical
image. Another factor is reversibility, that the stegano image
resulted from the process can be reconstructed into the exactly
same as the original image. Medical environment needs this
properties because downgrading the image quality most likely to
lead to incorrect analyzing result by the doctor. In addition, the
message embedded to the image itself must also be
reconstructed correctly, so, the doctor knows that it corresponds
to the right person. Therefore, fulfilling these requirements,
reversibility in particular, can protect both the security and
privacy of the patient and its corresponds data. Also, the the
original image can be extracted without any distortion[3]. This
is appropriate to the environment which prioritizes the quality as
in medical and military environment[4].
One of reversible data hiding methods is Difference
Expansion (DE) which is introduced by Tian[5] and improved
by Alattar[8]. Compared to other reversible methods, it is
superior in terms of the capacity of the message to be embedded
to the image[6]. However, similar to other introduced methods,
the quality of the stego image (embedded image) can still be a
problem. If its quality significantly decreases, public is able to
identify that the image has been embedded by other data. This
can attract the adversary to investigate the stego image
intensively and reveal both the message and the original medical
image.
In this paper, we propose a Quad and RDE-based method
which can increase the stego image quality as well as the
capacity of the embedded message. We believe that by rising up
its quality, public may not be suspicious about this stego image.
Furthermore, the exactly same original image and message can
be extracted from this image. The rest of this paper is organized
as follows. Section 2 explains the related works, section 3
describes the proposed method. The experimental result and
conclusion are provided in section 4 and 5, respectively.
II. RELATED WORKS
By considering the specified requirements (e.g, capacity,
reversibility) described in the previous section, some methods
have been introduced. This includes difference expansion (DE)
141 CYBERNETICSCOM 2013
[5], reduce difference expansion (RDE) [2] and some modified = + 2log2 | |−1
(7)
DE [7,8,9].
= + 2log2 | |
(8)
A. Difference Expansion (DE)
DE [5] is constructed by modifying the difference value C. Different Expansion of Quads
between two pixels but maintaining their average value. This Alattar [8] improves the DE method introduced by Tian [5]
method groups every two pixels, so, there are pixel pairs. in terms of the capacity of the message can be embedded to the
Selection is made to them such that the embedded value is only image. In [5], a bit of data can be embedded into a pixel pair;
done to the pairs whose value is neither overflow nor underflow. while in [8], 3 bit of data can be for a quad pixel. Therefore, there
In this case, a bit of data is only applied to the pairs which meet is a significant increase of maximum amount of data can be
the requirements. embedded.
Specifically, this method groups 8 bit grayscale pixels into In this method, an image is divided into square blocks
(x,y) pairs where 0≤ x, y ≤255. It is defined in (1) that: contain 4 pixels each. In the image, blocks are constructed from
left to right and from top to bottom. Every pixel block is
= , = − (1) converted into a vector. For every block = ( , , , ),
Alattar [8] defines an integer transformation as in (9). Here, the
where m and v are the average and difference two pixel values, vector = ( , , , ) is the difference value of block =
respectively. The embedding bit data is performed according to ( , , , ).
(2), where v’ is the result of embedding process, and b is bit data
to be embedded. In this case, b is either 0 or 1. =
⎧
′ = 2 x + (2) = − (9)
⎨ = −
The equation (2) is actually the inverse of (1) as it is provided
in (3). ⎩ = −
In order to reconstruct the original image, the invers of (9) is
= + , = − (3) used. This is provided in (10) below.
In order to avoid overflow and underflow, the value of v’ has ⎧ = −
to meet (4). If v’ fulfills (4) then it is classified as expandable; ⎪
otherwise, it is unexpandable. = + (10)
⎨ = +
| | ( ) , ⎪ = +
{| | , (4) ⎩
The embedding process is done by modifying the values of
B. Reduced Difference Expansion (RDE) , and . The embedding process itself can be done in two
RDE is an improvement of the previous DE method. In the ways. Those are:
previous DE, the difference pixel value is two times bigger after
being processed. In case the resulted value is more than 255, it  By using expanding
will be ignored. This is intended to keep the quality of the image. ′ = 2 x +
However, this ignorance leads to reducing the capacity of the ′ = 2 x + (11)
message can be embedded into the image. Because of this
condition, Lou et al. [2] proposes this reduced difference ′ = 2 x +
expansion method.  By modifying LSB
RDE works by reducing the difference value between pixels
used in the DE embedding process. RDE is represented in (5), ⎧ ′ = 2 x +
⎪
where v’ is the difference value which has been reduced by using ′ = 2 x + (12)
RDE. ⎨
⎪ ′ = 2 x +
̅={ ,
(5) ⎩
⌊ ⌋ ,
where , and ∈ {0,1} are the bits of data to be embedded
In order to get the correctly original diffence value in the into pixel blocks. Once the embedding process has finished, the
reconstruction step, location map is applied whenever the vector = ( ′ , ′ , ′ , ′ ) is transformed by using (10) into
reduction is occured. The size of the location map itself is similar = ( ′ , ′ , ′ , ′ ). Pixel block u is then replaced by u’
to the number of pixel pairs. This location map is specified in which has been embedded by the bit of data, so, the imagae I
(6). will be I’.
, ⌊ ⌋ ⌊ ⌋
Location map = { (6) Block = ( , , , ) is expandable if it meets two
, ⌊ ⌋ ⌊ ⌋
criterias. First, it fulfills (9-12); second, the final embedding
The reconstruction of the original value is performed by result does not cause overflow or underflow. A pixel block is
using (7) if the location map is 0; and by using (8) if the location overflow if the value of the modified pixel is higher than the
map is 1. maximum pixel value being used; while underflow if it is lower

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than the minimum pixel value being used [5]. If the embedding
process is sucessfully done by using (11), then vector u is
classified as expandable; and if (12) is sucessfully used, then
vector u is changeable. If those two embedding methods in (11-
12) can cause either overflow or underflow to the expendable
vector u, then the vector is non-changeable.
Similar to Tian [5], Alattar [8] also implements location map
M to store the embedding technique information for each block.
Bit 0 in M means that the expansion method is applied for the
corresponding block, and bit 1 means that the LSB modification
method is implemented for the block.
III. PROPOSED METHOD
Our proposed method is developed by considering the quad
of DE method by Alattar [8] and RDE by Lou et al. [2]. These
two methods are combined by reducing the difference pixel
value using RDE. The overall algorithm is described in Fig 1.
Different from the method proposed in [8] that the difference of
pixels is directly embedded by a message with expansion, we
propose that the difference is firstly reduced by using RDE. This
makes only the smaller expansion.
A. Data Embedding
As in [8], we classify pixel blocks into three categories:
expandable, changeable and non-changeable. The embedding
process is only applied for the first two categories. This is
because those two categories produce new pixels in an ideal
condition (neither overflow nor underflow). As in the previous
description, the expandable blocks are processed by using (11)
while changeable ones are by using (12). Non-changeable
blocks are ignored in the embedding process since it can cause
either overflow or underflow. In the grayscale environment, it is
defined that underflow is when the pixel value is negative, and
overflow is when it is higher than 255 [5].
Alattar[8] Proposed Method
Calculate Calculate
difference v difference v
Reduce v
Embed data to v
Embed data to v
Calculate new Calculate new
pixel pixel
Figure 1 Differences between Alattar's method [8] and the
proposed method
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The embedding process is begun by determining the
difference between pixel as in (9). Different from Alattar [8],
however, we only calculate the pixel differences of , , .
Here, is not used. In the expandable blocks, before the
embedding process is run, the difference of pixels where ∈
{1,2,3} is reduced by using RDE.
Reduction of pixel differences is done by improving the
original method proposed in [2]. The differences between theirs
and ours are explained as follows. Lou et. al [2] proposes the
reduction method which is only applied when the difference of
pixels is higher than 2. It means that any value other than that
will not be reduced. Different from this, we propose a method
which the reduction is performed for both positive and negative
differences of pixels except −1 ≤ ≤ 1. This is because the
image reconstruction by using a value in this range causes
incorrect both image and message. The reduction process
employs two methods. The first is applied for > 1, where it
is similar to the one proposed by Lou et. al [2] as described in
(13). The second is for < −1, as provided in (14).
= − 2⌊ ( )⌋
(13)
⌊ (| |)⌋
= +2 (14)
Reduction is only applied for expandable pixel blocks. After
reduction is performed, there is a smaller number . The
embedding process is done to this reduced number by
applying (11). This results to ́ which contains embedded data.
Once the data embedding has finished, the pixel value is
determined by using the difference of pixel ́ . In [8,9], Alattar
proposes to use (10) to obtain a new pixel value. Here, we
propose (15). Different from that in [8,9], ours does not change
the value of . For the other new three pixels, we still use those
provided by Alattar [8,9].
=
= ́ +
(15)
= ́ +
= ́ +
For expandable non RDE and changeable pixel blocks, the
data embedding process is done similar to [8] except for
determining new pixels. That is, [8] uses (10) while we use (15)
to calculate the value of new pixels.
Similar to other DE-based methods, the proposed method
also uses a location map for the recontruction purpose. Different
from the one of Alattar [8], however, we do not embed it to the
stego image. Equivalent to the classification of the pixel blocks,
the location map is also grouped into three. Those are
expandable, changeable and non-changeable. Because
expandable pixel blocks will be reduced, it needs a location map
which performs further grouping the pixel blocks into
expandable RDE and expandable non-RDE. Furthermore, in
order to obtain the exactly same original image, RDE also
requires a location map for each pixel reduction process.
The location map fo each pixel block is saved into vector
=( , , , , ). The value of each block in
the location map is shown in Fig. 2, where those in expandable,
changeable and non-changeable groups are assigned 1, 0 and -1,
respectively. In this case, if is 1, which means expandable,
then = 1 means that the corresponding block is expandable B. Data extraction
RDE; and = 0 means that that block is expandable non- Extraction of expandable RDE pixel blocks will be done if
RDE. For those in expandable RDE, the location map only both and are 1. This extraction is performed by
, , is 0 if ± 2 | | = ; and firstly calculating the difference of pixels ́ =
| |
, , is 1 if ±2 ≠ . This is different { , , } using (9). Bit data is obtained by extracting LSB
from Lou et al. [2] as described in (7,8). For = 0, which of ́ . It is then right shifted to have . Because is previously
means that the corresponding block is changeable, the value of reduced, in order to get the original data, (7) is used if
, , is 1 if each difference of pixels , , is odd; , , is 0 and ≥ 1; and (8) is used if
and 0 if it is even. The overall data embedding process is , , is 1 and ≥ 1. In case ≤ −1 and
depicted in Fig. 3. , , is 0, (16) is applied; and if ≤ −1 and
, , is 1, then (17) is employed. After each value of
has been recoverd, the value of pixels is determined by (15).
Expandable
RDE = − 2log2 | |−1
(16)
LM2=1
Expandable log2 | |
= −2 (17)
LM1=1
Expandable Extraction of expandable non-RDE pixel blocks will be
NON RDE performed by using a method proposed by Alattar [8], and the
LM2=0 new pixel value is determined according to (15). Lastly,
Changeable extraction of changeable pixel blocks will be performed by
Pixel blocks
LM1=0 taking LSB bit of each . After that, is returned back to the
original difference by using (18) if , , is 0, and
by using (19) if , , is 1.

Non Changeable = 2 x (18)

LM1=-1
= 2 x +1 (19)
Figure 2 Location map IV. EXPERIMENTAL RESULTS
Once the extraction process has finished, the extracted data
Calculate
can be compared to its corresponding original data. If both of
Set block to them are same, then it is classified as authentic. The experiment
differences
unchangeable is done to the grayscale radiography images obtained from [10]
v1,v2,v3
whose size are 512 x 512 pixel each. Data embedded to the
No image is a bitstream whose size is corresponding to the
maximum bit can be embedded to the image.
Expandable No Changeable The quality of stego images is measured by using common
methods. Those are peak signal-to-noise-ratio (PSNR) to
measure how close the original and stego images. The PSNR
Yes Yes value itself is specified as in (20).
Set block to = 10 log
|v1|,|v2|,& |v3| Set block to
YES expandable (20)
≥ 2 changeable
RDE = ∑ ∑ ( − )
NO MSE is mean square error which shows the difference
between the original image Y and the stego image Y’. Higher
Set block to Reduction Data embedding PSNR obtained means better.
expandable process (Eq. 12)
In addition, we also measure the capacity of the embedded
data. This is the maximum bit can be embedded to the image. It
is to investigate whether changes in the quality of images affect
the capacity.
Data embedding Calculate new
(Eq. 11) pixel (Eq. 15) From the experimental result showed in Table 1, it can be
inferred that the capacity of the embedded data of the proposed
method is higher than that of Alattar [8]. The highest increase is
Figure 3 Data embedding process in “Head” image where there are more than 2.5 kilo bits, while
the lowest is in “Hand” image where there are about 100 bits. In

144
terms of capacity, the proposed method is more appropriate to
implement.
7
Table 2 depicts the PSNR values of both Alattar [8] and the
proposed method. It shows that the proposed method delivers 6
higher PSNR values than that of Alattar [8]. Similar to Table 1, 5
the highest increase of PSNR is obtained from “Head” image
4
with 6.258. Different trend from Table 1, the lowest increase of
PSNR is “Leg” image. From those two tables, the increasing of 3
both capacity and PSNR can be drawn in Fig. 4. Overall, they 2
have similar trend.
1
0
Table 1 Capacity of embedded data

Capacity (bits)
Image
Alattar [8] Proposed Method
Abdominal 187677 189408 Capacity (kilo bits) PSNR
Chest 194982 195978
Hand 196491 196587 Figure 4 The increase of capacity and PSNR values
Head 184428 186948
Leg 196323 196605 REFERENCES

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ACKNOWLEDGMENT http://www.idimages.org/images/browse/ImageTechnique/
This project is supported by Ministry of Education and
Culture, and Institut Teknologi Sepuluh Nopember (ITS) under
LBE research grant.

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