Today, with the rapid development of the Internet, improving image security becomes more and more important. To improve image encryption efficiency, a novel region of interest (ROI) encryption algorithm based on a chaotic system was proposed. First, a new 1D eλ-cos-cot (1D-ECC) with better chaotic performance than the traditional chaotic system is proposed. Second, the chaotic system is used to generate a plaintext-relate keystream based on the label information of a medical image DICOM (Digital Imaging and Communications in Medicine) file, the medical image is segmented using an adaptive threshold, and the segmented region of interest is encrypted. The encryption process is divided into two stages: scrambling and diffusion. In the scrambling stage, helical scanning and index scrambling are combined to scramble. In the diffusion stage, two-dimensional bi-directional diffusion is adopted, that is, the image is bi-directionally diffused row by column to make image security better. The algorithm offers good encryption speed and security performance, according to simulation results and security analysis.