Routine echocardiograms are not handled digitally because of enormous storage needs. Image compression techniques can reduce memory requirements, but the impact on diagnostic content is unknown. We studied the effect of an internationally accepted compression algorithm called Joint Photographic Experts Group (JPEG) on digital echocardiographic images. Diagnostic and image quality of JPEG compressed, two-dimensional echocardiograms at ratios ranging from 4:1 to 40:1 was compared with that of uncompressed images both subjectively by a blinded expert panel (540 observations) and objectively by quantitative image-processing parameters (180 images). Accuracy of 432 measurements performed on compressed M-mode and spectral Doppler tracings was determined. Simultaneously acquired videotaped images and their never-compressed digital counterparts were compared quantitatively for image fidelity. This study demonstrates that the JPEG compression algorithm produces little degradation of echocardiographic images at compression ratios of at least 20:1, with less measured distortion than is produced by videotape recording. With JPEG, digital storage and retrieval in routine echocardiography are feasible.