The continuous evolution of information technology underscores the growing emphasis on data security. In the realm of medical imaging, various diagnostic images represent the privacy of individuals, and the potential repercussions of their unauthorized disclosure are substantial. Therefore, this study introduces a novel chaotic system (TLCMCML) and employs it to propose a multi-image medical image encryption algorithm. To simultaneously augment security and optimize encryption efficiency, we undertake a dual-pronged approach. Firstly, we identify the regions of interest (ROIs) within individual medical images, subsequently applying an independent scrambling technique based on an odd-even interleaving configuration. Secondly, we integrate all medical images through horizontal concatenation, forming a comprehensive large-scale image, upon which we implement a synchronized bit-level permutation-diffusion encryption mechanism. Following extensive testing, enhancements were verified across various metrics including information entropy analysis, adjacent pixel correlation examination, differential attack simulations, and robustness assessments, thereby attesting to the exceptional encryption efficacy of the proposed algorithm.
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