A GUIDELINE FOR THE USE OF IMAGE

COMPRESSION IN DIAGNOSTIC IMAGING

THE ROYAL AUSTRALIAN AND NEW ZEALAND COLLEGE OF RADIOLOGISTS

The Royal Australian and New Zealand College of Radiologists Eligibility to Attempt the Radiology Part 1 Examination & Successful Completion of the Part 1 Examination

Name of document and version:

A Guideline for the Use of Image Compression in Diagnostic Imaging, version 1

Approved by:
College Council

Date of approval:
5 November 2010

ABN 37 000 029 863

Copyright for this publication rests with The Royal Australian and New Zealand College of Radiologists

The Royal Australian and New Zealand College of Radiologists

Level 9, 51 Druitt Street
Sydney NSW 2000, Australia

Email: ranzcr@ranzcr.edu.au
Website: www.ranzcr.edu.au
Telephone: + 61 2 9268 9777
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Disclaimer: The information provided in this document is of a general nature only and is not intended as a substitute
for medical or legal advice. It is designed to support, not replace, the relationship that exists between a patient and
his/her doctor.

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TABLE OF CONTENTS

1. Introduction 3
2. Data compression in medical imaging 3
3. Appropriate application of data compression 3
4. Recommendations 5
5. References 5

A Guideline for the Use of Image Compression in Diagnostic Imaging

The Royal Australian and New Zealand College of Radiologists
November 2010

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1. INT R ODUC T ION
Medical imaging is integral to the provision of modern medical care; it provides a wealth of information
that is increasingly relied upon in the clinical management of patients and treatment planning. Medical
imaging data is acquired at some cost to the community in terms of radiation exposure, and the
human resources, infrastructure and time involved in the acquisition of medical images. Once
acquired, such information should not be discarded lightly, and indeed should be preserved in such a
way, and for such a period of time, as to maximise the value gained from the initial imaging
procedure, and minimise the risk of unnecessary repeat tests.
Advances in technology have created the opportunity for radiology systems to use complex
compression algorithms to reduce the file size of each image in an effort to partially offset the
increase in data volume created by new or more complex modalities. The purpose of this document is
to provide guidance to radiologists about the appropriate levels of compression medical imaging
practices may use.

2. DAT A C OMP R E S S ION IN ME DIC AL IMAG ING

Considerable effort has been expended in the wider community to produce destructive (irreversible or
lossy) methods of image compression that still allow for the convenient transmission of large datasets
with minimal appreciable loss of data fidelity. Examples include MP3 music files, JPEG photos and
MPEG movies.
Broadly speaking, there are currently two main groups of image compression options available in
medical imaging: lossless and lossy compression.

Lossless, or reversible compression is intended to reduce the size of the original image data set and
1
so speed up image transmission and reduce required data storage space . The image obtained after
2
compression and then decompression is identical to the original image . Typical compression ratios
achieved range from 1.5-3.6:1.

Lossy, or irreversible compression techniques use algorithms which can compress images at much
higher compression ratios than are achievable using lossless compression, resulting in faster image
3
transmission speeds and smaller image storage space requirements . With these techniques, the
regenerated image is not guaranteed to be identical to the original image, as certain elements may
4
have been removed when reducing the image size ; that is, some data are lost during the
compression process, and some distortion may occur when the image is decompressed. Typical
compression ratios achieved range from 5-50:1.
In the wider community, lossy data compression is often acceptable. Data from medical imaging
examinations, however, may be out to many different uses, with potentially different requirements for
fidelity:
Extensive post-processing of large datasets (both from CT & MRI) is commonplace
Semi-automated analysis of large datasets is commonplace and often necessary (e.g. breast
MRI)
Automated follow-up for lung nodules and other pathology requires repeat access to the
complete 3D dataset
Accurate, serial studies are often key to appropriate clinical management decisions

A loss of clinical data either compromises or has the potential to compromise the value of an imaging
examination to a patient.

3. AP P R OP R IAT E AP P L IC AT ION OF DAT A C OMP R E S S ION

a. Inconsistency in approaches internationally

5,6,7
A number of studies overseas have examined the issue of lossy compression in medical imaging.
There are numerous examples of studies testing the acceptable limits of image compression ratios,
on many different modalities. While a general conclusion could be drawn that some levels of lossy

A Guideline for the Use of Image Compression in Diagnostic Imaging

The Royal Australian and New Zealand College of Radiologists
November 2010

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compression are suitable for some purposes and some modalities, there remains considerable
uncertainty as to exactly what level and type of compression is enough, or too much, for any particular
examination or modality. For example, while compression of digital mammograms is not permitted in
the USA by the Food and Drug Administration, the Royal College of Radiologists, and the German
Radiology Society in Europe, have published acceptable lossy compression ratios of 20:1 and 15:1
respectively.
b. Emerging technology
The majority of studies to date have concentrated on 2D image compression, since the commonly
available (and commercially implemented) algorithms are thus focused. It has, however, been shown
8
that new algorithms are required to best deal with the particular needs of 3D datasets . These often
large 3D datasets are no longer restricted to CT, but are commonly generated with MRI, and also,
more recently, ultrasound. The effects of 2D image compression on 3D datasets, and how such
effects may affect subsequent automated or semi-automated follow-up, have yet to be carefully
examined in the literature.
Compression of very thin section CT images has been shown to cause artefacts more frequently than
that of images reconstructed at 5 mm or greater thickness; there is no data on the effects on
Radiotherapy (RT) planning images. Given, however, that treatment planning scans for RT are
usually thick-section reconstructions, and of limited number, some may argue that these are small
enough datasets to be stored uncompressed.
c. Preserving clinical data for the future
It is well recognised that the availability of previous imaging studies often decisively influences the
interpretation of a new study, by allowing the identification of changes in the findings, and an estimate
of the rate of any such change.
Further, there is the potential in the future for new techniques to make use of data obtained and
stored today in ways that are not currently possible. New techniques, new contexts and new insights
will inevitably develop. Information could then be derived that was not immediately apparent at the
time of the initial assessment. The methods of viewing and interpretation might be very different to
current practice. Stored images have the potential to be used in the future for more than simple visual
comparisons.
Both the real value of the availability of historical images for comparison, and the hypothetical value of
such potential future uses of losslessly compressed data, must be set against the real and immediate
costs of storing and maintaining such data.
d. Medico-legal issues
Legal reviews of lossy compression have been conducted by the CAR, and concluded that the use of
such compression would not increase the liability of physicians, if used and implemented
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appropriately . However, this conclusion leaves much room for interpretation. This may lead to
inconsistent application of compression as demonstrated in 3.a. above: what is considered by some
as appropriate may not be seen as such by others.
e. Barriers to using lossless compression
It is acknowledged that there are constraints that may arise when using lossless compression
techniques.

Bandwidth
Bandwidth issues in parts of Australia and New Zealand may hinder transmission of an
uncompressed or lossless compressed image. In these cases, the radiologist may make judicious use
of appropriate levels of lossy image compression to speed the initial arrival of the images, with the
patients interests foremost in their consideration.
If this approach is required, the practice should make the original images available for subsequent
download as required. Poor bandwidth should not lead to the provision of a sub-optimal image data
set to a patient or a referring practitioner, where the clinical context suggests that any data loss might
put the patient at risk.
Storage costs

A Guideline for the Use of Image Compression in Diagnostic Imaging

The Royal Australian and New Zealand College of Radiologists
November 2010

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There is an argument that the costs of storing full data sets for every imaging examination would be
prohibitively expensive, and will become more so as imaging modalities become more complex,
powerful and productive. The CAR considers this ample justification for introducing lossy (irreversible)
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compression techniques . However, it is noted that, at least in the past, costs of digital data storage
have fallen steadily.
Record retention
11
The RANZCR Standards of Practice under Sections 1 and 7 address the retention of a medical
record. Public and private radiology clinics, practices or hospital departments across Australia and
New Zealand should defer to this section of the RANZCR Standards of Practice in conjunction with
any State or local legislation regarding disposal/retention/archiving.

4. R E C OMME NDAT IONS

Image compression is a useful tool in the use of data transmission and storage, and should be used
appropriately. In medical imaging, the level of compression should suit the needs of the examination,
ensuring that the level of compression used does not adversely affect the diagnostic value of the
examination. It remains the responsibility of the Radiologist to ensure that archived and interpreted
images are of diagnostic quality. The RANZCR recognises that in the future, as technological
advances are made, this recommendation may require modification.
The RANZCR recommends the use of lossless compression where possible. However, where
necessitated by infrastructure or cost barriers, conservative levels of data compression may be used,
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as per the RCR guidelines ; if more aggressive lossy compression is used, compression levels
13
should generally be within the guidelines adopted by CAR .
Where higher compression ratios are used, they must be justifiable on the basis of prior published trial
evidence that such ratios do not result in clinically significant data loss. Where 3-D very thin slice
imaging is performed, data compression may adversely impact image quality, hence compression of
such data should be used with caution.

5. R E F E R E NC E S
1. Seeram, E. Digital image compression. Entrepreneur.com. 2005. accessed 2 Dec 2009 from
http://www.entrepreneur.com/tradejournals/article/134676840_1.html
2. Canadian Association of Radiologists (CAR). CAR Standards for irreversible compression in
digital diagnostic imaging within radiology. Ottawa. 2008: p5;
http://www.car.ca/Files/Standard_Lossy_Compression_EN.pdf
3. Seeram, E. 2005. op.cit.
4. CAR. 2008. op.cit.
5. American College of Radiology. ACR Technical Standard for Electronic Practice of Medical
Imaging. ACR Practice Guideline. Reston VA. 2007.
6. CAR. 2008. op.cit; p3.
7. Loose, R (R); Braunschweig, R (R); Kotter, E (E); Mildenberger, P (P); Simmler, R (R);
Wucherer, M (M) Compression of digital images in radiology - results of a consensus
conference, RFo: Fortschritte auf dem Gebiete der Rntgenstrahlen und der Nuklearmedizin
(Rofo), published in Germany, 2009-Jan; vol 181 (issue 1) : pp 32-7
8. Kim, B et al. JPEG2000 3D compression vs. 2D compression: an assessment of artifact
amount and computing time in compressing thin-section abdomen CT images. Medical Physics
2009; Mar; 36 (3): pp835-844
9. CAR. 2008. op. cit.; p3
10. CAR. 2008. op.cit.; p2
11. RANZCR. RANZCR Standards of Practice for Diagnostic and Interventional Radiology, 2009;
www.ranzcr.edu.au
12. The adoption of lossy image data compression for the purpose of clinical interpretation.The
Royal College of Radiologists, April 2008 version 1;
http://www.rcr.ac.uk/docs/radiology/pdf/IT_guidance_LossyApr08.pdf
13. CAR. 2008. op.cit,; p 6 - 8

A Guideline for the Use of Image Compression in Diagnostic Imaging

The Royal Australian and New Zealand College of Radiologists
November 2010

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THE ROYAL AUSTRALIAN AND NEW ZEALAND COLLEGE OF RADIOLOGISTS