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This study introduces SELAM, a lightweight multifactor authentication framework optimized for critical IoMT applications. Unlike traditional designs, SELAM selectively confines elliptic-curve cryptography (ECC) to user\/device registration, while relying on lightweight primitives (XOR, hashing\/HMAC, and timestamp-freshness checks) in online operation to minimize runtime cost. The scheme is validated using the CICIoMT-2024 dataset through Python-based cryptographic simulation and ns-3 network emulation. Under standardized 16-byte online field accounting, SELAM reduces payload-only online communication to 6,144 bits\/device versus 7,680 bits\/device for a Heavy+Verify ECC baseline; in ns-3 header-inclusive accounting, this corresponds to 39,416 versus 45,703 bits\/device at\n                    <jats:inline-formula>\n                      <jats:tex-math>$$\\:N=136$$<\/jats:tex-math>\n                    <\/jats:inline-formula>\n                    . At 1\u00a0Mb\/s, SELAM achieves 6.24 ms total per-device authentication overhead (communication\u2009+\u2009computation) compared to 31.27 ms for Heavy+Verify, while reducing online computation from 23.59 ms to 0.10 ms per device. Across cohort sizes\n                    <jats:inline-formula>\n                      <jats:tex-math>$$\\:N=136$$<\/jats:tex-math>\n                    <\/jats:inline-formula>\n                    \u2013\n                    <jats:inline-formula>\n                      <jats:tex-math>$$\\:2000$$<\/jats:tex-math>\n                    <\/jats:inline-formula>\n                    over 20 seeds (mean \u00b1\u200995% CI), SELAM maintains attack-regime authentication success ratio (ASR) at 0.88\u20130.90 (baseline: 0.90\u20130.92), with protocol-level FAR=0 (no accepted replay\/impersonation) and benign FRR=0 observed in PhaseLogs. Security analysis using BAN logic confirms mutual authentication and key confirmation on a fresh session key in Phases 4\u20135, with replay\/impersonation resistance under the stated Dolev\u2013Yao adversary and standard MAC\/AEAD assumptions. The results indicate that confining ECC to registration preserves strong authentication while removing public-key operations from the performance-critical online path.\n                  <\/jats:p>","DOI":"10.1038\/s41598-026-53641-x","type":"journal-article","created":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T13:16:12Z","timestamp":1783084572000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["SELAM: selective ECC-based lightweight authentication for the internet of medical things"],"prefix":"10.1038","volume":"16","author":[{"given":"Azlina Ahmadi","family":"Julaihi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Md. 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