Blockchain Integrated Secure Healthcare Output Protocol (BISHOP)

The explosive growth of diagnostic imaging and the global push for healthcare digital transformation (DX) have brought the security, traceability, and governance of medical imaging data into sharp focus. This paper proposes the Blockchain Integrated Secure Healthcare Output Protocol (BISHOP), a next-generation security protocol for healthcare data built upon Web3.0 principles.BISHOP extends the DICOM standard by integrating blockchain technology, cryptographically signed JWT tokens, and invisible watermarking to establish an immutable and verifiable trail of image exports. The protocol enforces multi-factor authentication and allows for purpose-specific anonymization, thereby addressing the growing demand for transparency, regulatory compliance, and patient privacy.This version presents a theoretical framework and simulated use cases, as real-world implementations are still in development. We aim to invite collaboration and feedback from the healthcare, research, and security communities to further validate and refine the protocol toward formal standardization.