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Protecting patient privacy and medical records is a legal requirement. Traditional encryption methods fall short of handling the large volume of medical image data and their peculiar statistical properties. In this paper, we propose a generic medical image encryption framework based on a novel arrangement of two very efficient constructs, dynamic substitution boxes (S-boxes) and chaotic maps. The arrangement of S-box substitution before and after chaotic substitution is shown to successfully resist chosen plaintext and chosen ciphertext attacks. Special precautions are taken to fend off the reset attack against pseudorandom number generators. We show how to implement the generic framework using any key-dependent dynamic S-box construction method and any chaotic map. Experimental results show that the proposed framework successfully passes all security tests regardless of the chaotic map used for …