Enabling practical and privacy-preserving medical image processing

Many analytics tasks require secure computation over encrypted data. In particular, fine-grained data such as pixel-level images demand higher precision, as every pixel can directly affect outcomes in tasks like tumor segmentation and anomaly detection. While Multi-Party Computation (MPC) is interactive, Differential Privacy (DP) protects only aggregate values, and Partially Homomorphic Encryption (PHE) lacks multiplicative support, none of them can efficiently handle fine-grained data analytics. Fully Homomorphic Encryption (FHE) uniquely enables arbitrary operations on encrypted pixels but remains computationally expensive, posing significant challenges for both software and hardware accelerators. We present PixCrypt, a caching-based acceleration mechanism for fine-grained fully homomorphic encryption. PixCrypt replaces expensive fresh ciphertext generation with cache retrieval and coefficient-level operations across CKKS, BFV, and BGV, while randomized reconstruction ensures that ciphertexts do not repeat. Its linear noise growth reduces the need for bootstrapping and lowers NTT load, improving hardware accelerator efficiency. This design yields up to 35× faster fine-grained encryption and maintains INDCPA (Indistinguishability under Chosen Plaintext Attack) security. Experiments on five real-world pixel-level image processing tasks show that PixCrypt significantly improves the practicality of FHE for privacy-preserving analytics.