Digital storage and review is now the state of the art in echocardiography, and practitioners are urged to move quickly to an all-digital solution in their laboratories. Although secondary digitization from videotape may be an acceptable transitional solution, the ultimate benefits of the digital laboratory can only be achieved with direct digital output from a contemporary echocardiography machine. Standardization of storage format is critical to enable interoperability within and between laboratories; adherence to the DICOM (Digital Imaging and Communications in Medicine) standard should be ensured in all applications. To achieve studies of acceptably small size, one must use both clinical compression (ie, storage of 1 or several cardiac cycles from selected views) and digital compression (more efficient storage of individual frames and loops). Lossless compression (Packbits run-length encoding) is used by DICOM and is useful for storing still frames such as spectral Doppler or M-mode. Motion-JPEG is the only lossy compression approved by the DICOM committee, and compression ratios as high as 20:1 are supported by the literature and used by manufacturers (see Section 3.3.1 for an explanation of Packbits and lossless/lossy terminology). More aggressive compression schemes (eg, MPEG-1, Reprint of these documents, beyond single use, is prohibited without the prior written authorization of the ASE. Address reprint requests to the American Society of Echocardiography
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