SQAHO-IoMT: A Post-Quantum Secure and AI-Resilient Aggregation Framework for Smart Healthcare Systems

The integration of smart technology into the Internet of Medical Things (IoMT) offers transformative capabilities for precision medicine, enabling real-time, patient specific modeling, predictive diagnostics, and secure re mote monitoring. However, the growing complexity of AI enabled healthcare systems introduces heightened risks from both conventional and emerging threats, including quantum computing and Artificial Intelligence (AI)-driven attacks. We propose SQAHO-IoMT, Secure Quantum Aggregation with Hardened Obfuscation, a unified security framework designed to protect resource-constrained med ical devices and their digital counterparts. SQAHO-IoMT employs Ring-LWE-based post-quantum encryption with a hierarchical key structure to support efficient homo morphic aggregation of patient data, ensuring privacy preserving synchronization between different entities of IoMT. To counter AI-based reverse engineering of aggre gation logic and device behavior, the framework introduces noise-flooded obfuscation. A threshold-based key-sharing mechanism further strengthens compromise tolerance and supports decentralized resilience in IoMT ecosystems. For mal security analysis confirms 100-bit quantum resistance against key recovery and logic extraction, along with 128-bit post-quantum integrity through optimized digital signatures. Evaluation on a 32-bit ARM Cortex-M4 demonstrates low latency performance (81.1 ms end-to-end) and minimal energy consumption (0.13 mJ per device per sample) for 100-node deployments. By combining post-quantum cryp tography with AI-aware obfuscation, SQAHO-IoMT advances secure, trustworthy data aggregation in smart healthcare, facilitating reliable analytics for personalized treatment, critical care monitoring, and remote patient management.