Abstract In recent years, Plaintext-Related Image Encryption (PRIE) algorithms have been introduced, demonstrating a commendable level of plaintext sensitivity to resist chosen plaintext attack (CPA). However, these approaches suffer from several drawbacks, including inability to fully reconstruct the original image, limited practical value and excessive computational demands etc.. Moreover, the exponential expansion of medical data necessitates the formulation of more secure and efficient encryption algorithms. In this paper, firstly, a novel one-dimensional chaotic map, designated as 1D-SAM, which strikes an excellent balance between structural complexity and chaotic performance is proposed. The 1D-SAM achieve a larger chaotic range and an elevated Lyapunov exponent, signifying enhanced dynamical complexity. Subsequently, we devise a lightweight medical image encryption system leveraging the 1D-SAM and an innovative diffusion architecture, termed the plaintext-related and ciphertext feedback mechanism(PRCFM). This encryption system is a symmetric-key cryptosystem, eliminating the need for transmitting supplementary data beyond the secret keys to the recipient. Notably, the encrypted image maintains identical dimensions to its original counterpart and is fully recoverable. Complete simulation experiments were conducted on a personal computer equipped with MATLAB R2021a, OS Windows 11, 2.60GHz CPU and 16GB RAM. The experimental results indicate that our encryption system, employing a single permutation-diffusion round, efficiently encrypts a 512×512 image in approximately 0.2854 seconds. Leveraging the advantages of the PRCFM, our approach demonstrates superior plaintext sensitivity, achieving an average number of pixels changing rate (NPCR) of 99.6051 and a unified average changed intensity (UACI) of 33.4452. In summary, our work addresses key limitations of contemporary encryption frameworks, exhibiting acceptable performance in both encryption speed and security strength.