# DIGITAL CERTIFICATION IN TELERADIOLOGY: A NECESSARY WARNING*

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3 Digital certification in teleradiology: a necessary warning What is cryptography? From the Greek kryptós hidden and the verb gráphein write cryptography is the practice and study of rewriting a text hiding information. Also, in information technology, cryptography is related to the utilization of techniques allowing writing in ciphers and codes making the message incomprehensible. When words in a message are transposed or replaced according to a predetermined code, this process is called encoding. When a mathematical method is utilized to change the message, this process is known as ciphering. The ciphering process is based on a mathematical rule for replacement of letters by numbers in a way that in a message ciphered with different numbers, different results will be obtained. This number is called key, and the higher the number, the higher is the ciphering security. This process is aimed at ensuring that only the addressee can read an electronic message, by means of an inverse process, the deciphering. When both ciphering and deciphering are performed with a sole password or key, the process is called symmetrical cryptography (Figure 2). The disadvantage of this process is that it is necessary to stipulate a key to be utilized in agreement with the person who will send us a ciphered message, and, in this process, this key may be intercepted. The asymmetrical cryptography, or public key cryptography, is based on a different concept, with a mathematically related key pair called private key and public key. These keys are constituted of very large numbers. Documents or messages encrypted with one key may only be decrypted by using the other half of the key pair. The private key is held and known only by the sender of the electronic document. On the other hand, the public key, as the term already indicates, is widely known and normally is available in the internet. How does one make information available on internet while guaranteeing its confidentiality? Asymmetrical cryptography allows a safe and flexible exchange of confidential data on the internet. A cryptographic protocol called SSL/TLS (secure socket layer/ transport layer security) provides a secure access, guaranteeing the confidentiality and secret in the transference of data, whether regarding a banking transaction or a patient. When a confidential webpage is accessed, this type of secure encapsulating process is established between the computer and the server of the bank or telemedicine service. For this purpose, the computer browser utilizes a specific public/private key pair different from those utilized by other browsers in other computers. Once the internet connection is established, the computer and the remote server will exchange their public keys, allowing a personalized encryption of the messages or data that they send to each other. As an additional security measure to ensure the public key sender identity, avoiding interception by hackers pretending to be a telemedicine provider, the server must send not only its public key, but an identifiable digital certificate. What is a digital certificate? A digital certificate is an electronic file containing personal information about its ownership. Also it is the proof of a cryptographic key ownership. In this certificate, a trusted third party called certification authority testifies the authenticity of the attached public or private key, confirming the identity of the certificate issuer. Besides the public key, a digital certificate includes data from the subject such as name, , CPF, and the name of the digital certificate issuer, as well as the public key hash digitally signed by the certification authority. In practice, it works like a virtual identity card authenticated by a trusted entity guaranteeing a safe counterpart identification in a transaction over a computer network (Figure 3). Several companies and government agencies issue digital certificates in the Brazilian market. ICP Brasil (3) is the sole certification authority for this country, linked to Instituto Nacional de Tecnologia da Informação, attached to the Presidency of the Republic. The Brazilian PKI (public key infrastructure) or ICP Brasil is comprised of a chain of certification authorities including a root certification authority, certification authorities and register authorities, and also a policy management authority (management committee). This committee comprised of government and civil society representatives, is responsible for defining a set of regulations and standards for digital certification based on international public standards. How can one know if a site is reliable? A safe website offers encrypted access by means of a digital certificate authenticated by a trusted certification authority. The following sequence of examples demonstrates how to differentiate between re- Figure 2. Symmetric-key cryptography: the ciphertext of a clinical report is transmitted over the internet. A same digital key is utilized both by the sender and the recipient for encryption and decryption of the document content. 417

5 Digital certification in teleradiology: a necessary warning Figure 5. Lay-out of a digital certificate of Palácio do Planalto (Brazilian government headquarters), showing (a) data and purposes of the certificate, and, on top, (b) the certification chain. Figure 6. (a) List of trusted certification authorities know in the browser and (b) window for inclusion or rejection of a digital certificate issued by an unknown certification authority that could not be checked. can be easily copied and inserted into another document. As previously discussed, non-certified and digitally-signed electronic documents present a potential risk for alteration and easy falsification. However, it is important to note that a digital signature does not make the electronic document secret, because it is not ciphered. The confidentiality of an electronic document only can be safeguarded by the encryption of the message with the receiver s public key, because only the receiver s private key can decrypt its contents. The signature on a digital document is made with a personal code included in the private key. With this code, a document can be ciphered to be deciphered only with the respective public key, so identifying its subscriber. When the owner of a digital key produces a document digitally signing it, this document is encrypted and sent with his/her public key, and only can accessed by means of this public key. Security and reliability can be 419

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