<![CDATA[The security of medical image data within electronic medical record systems has become a critical issue due to the increasing threat of health data breaches. Steganography is a promising technique for protecting patient information by concealing secret data within medical images without significantly altering their visual appearance. However, the application of steganography to retinal fundus images, which carry high diagnostic value, has never been comprehensively evaluated in terms of image quality or its impact on artificial intelligence-based diagnostic model performance. This study compares Least Significant Bit (LSB) and Most Significant Bit (MSB) steganography methods applied to 3,200 retinal fundus images from the Retinal Fundus Multi-disease Image Dataset (RFMiD) dataset across four payload levels (0.1-0.4 bpp), evaluated using PSNR, SNR, SSIM, and FSIM for image quality, and VGG19 classification accuracy and AUC for diagnostic impact. Results show LSB achieves substantially superior image quality (PSNR: 59.97-65.93 dB; SNR: 49.34-55.30 dB; SSIM: 0.9981-0.9997; FSIM: 0.9999-1.0000) compared to MSB (PSNR: 12.98-18.99 dB; SNR: 2.35-8.37 dB; SSIM: 0.5979-0.9003; FSIM: 0.5342-0.7500), while VGG19 classification accuracy remains stable for both methods (LSB: 0.8938-0.9000; MSB: 0.8953-0.9031) with a maximum difference of 0.62% from baseline. This study demonstrates that LSB is the more appropriate steganography method for retinal fundus images, delivering superior visual quality while preserving VGG19 diagnostic capability.]]>
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