title: Is digital image compression acceptable within diabetic retinopathy screening?
abstract: OBJECTIVE
  The National Screening Committee (NSC), whilst recommending the use of digital mydriatic retinal photography for diabetic retinopathy screening, has not yet accepted the use of digitally compressed images for grading. By greatly reducing the file size, however, compression of images is invaluable for storage and for its rapid transmission across computer networks. We undertook a study to compare the different levels of JPEG compression with the original bit-mapped image to determine whether there was any loss of clinical detail following compression.
  
  
  METHODS
  Three hundred and thirty images were analysed in this study. These images had been captured from 66 eyes consecutively photographed in a diabetic retinopathy screening programme, using a Sony DXC-950 P 3CCD colour video camera mounted on a Canon CR6-45NMf fundus camera. Single 45 degrees macula-centred images were taken from each eye. The images were compressed using the JPEG algorithm within Adobe Photoshop (version 4.0) and then displayed with a Sony Trinitron colour monitor. Four different levels of compression were used, JPEG-1, JPEG-2, JPEG-3, JPEG-4, and an objective analysis was undertaken using 'lesion counts'. The compressed images were assessed separately and blindly and the results compared with their original BMP images.
  
  
  RESULTS
  Eight BMP images could not be evaluated (five right eye and three left eye). A total of 290 images were therefore used in the final evaluation. All the JPEG-1 images with file sizes between 16 and 24 kb were found to be 'pixelated', while the JPEG-4 images (66-107 kb) appeared similar to the original BMP (1.3 Mb) images. Both JPEG-2 and JPEG-3 images had significantly lower counted lesions than the BMP images.
  
  
  CONCLUSIONS
  From our findings we can conclude that only some degree of image compression (compression ratios of 1 : 20 to 1 : 12) with file sizes of 66-107 kb is permissible using JPEG format, whereas the images obtained after higher compression ratios may not be suitable for diabetic retinopathy screening.
authors.affiliation: Department of Diabetes, Endocrinology and Metabolism, City Hospital, Birmingham, UK. ansu.basu@cityhospbham.wmids.nhs.uk
authors.forename: A
authors.initials: A
authors.lastname: Basu
authors.forename: A D
authors.initials: AD
authors.lastname: Kamal
authors.forename: W
authors.initials: W
authors.lastname: Illahi
authors.forename: M
authors.initials: M
authors.lastname: Khan
authors.forename: P
authors.initials: P
authors.lastname: Stavrou
authors.forename: R E J
authors.initials: RE
authors.lastname: Ryder
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003930:Diabetic Retinopathy / Q000175:diagnosis*; D004739:England; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010781:Photography; D016037:Single-Blind Method; D017216:Telemedicine / Q000379:methods; D015351:Vision Screening / Q000379:methods*