In lossy medical image compression, the requirements for the preservation of diagnostic integrity cannot be easily formulated in terms of a perceptual model. Especially since, in reality, human visual perception is dependent on numerous factors such as the viewing conditions and psycho-visual factors. Therefore, we investigate the possibility to develop alternative measures for data loss, based on the characteristics of the acquisition system, in our case, a digital cardiac imaging system. In general, due to the low exposure, cardiac x-ray images tend to be relatively noisy. The main noise contributions are quantum noise and electrical noise. The electrical noise is not correlated with the signal. In addition, the signal can be transformed such that the correlated Poisson-distributed quantum noise is transformed into an additional zero-mean Gaussian noise source which is uncorrelated with the signal. Furthermore, the systems modulation transfer function imposes a known spatial-frequency limitation to the output signal. In the assumption that noise which is not correlated with the signal contains no diagnostic information, we have derived a compression measure based on the acquisition parameters of a digital cardiac imaging system. The measure is used for bit- assignment and quantization of transform coefficients. We present a blockwise-DCT compression algorithm which is based on the conventional JPEG-standard. However, the bit- assignment to the transform coefficients is now determined by an assumed noise variance for each coefficient, for a given set of acquisition parameters. Experiments with the algorithm indicate that a bit rate of 0.6 bit/pixel is feasible, without apparent loss of clinical information.