Digital medical system not only facilitates the storage and transmission of medical information but also brings information security problems. Aiming at the security of medical images, a robust zero watermarking algorithm for medical images based on Zernike-DCT is proposed. The algorithm first uses a chaotic logic sequence to preprocess and encrypt the watermark, then performs edge detection and Zernike moment processing on the original medical image to get the accurate edge points, and then performs discrete cosine transform (DCT) on them to get the feature vector. Finally, it combines perceptual Hash and zero watermark technology to generate the key to complete the watermark embedding and extraction. The algorithm has good robustness to conventional and geometric attacks, strong antinoise ability, high positioning accuracy, and processing efficiency and is superior to the classical edge detection algorithm in extraction effect. It is a stable and reliable image edge detection algorithm.