We have provided an overview of state-of-the-art ROI coding techniques applied to medical images. These techniques are classified according to the image type they apply to; thus the first class includes ROI coding schemes developed for two-dimensional (2-D) still medical images whereas the second class consists of ROI coding in the case of volumetric images. In the third class, a prototype ROI encoder for compression of angiogram video sequences is presented. ROI coding preserves image quality in diagnostically critical regions by performing advanced image compression, enabling better image examination and addressing issues regarding image handling and transmission in telemedicine systems. The mapping of the ROI from the spatial domain to the wavelet domain is dependent on the used wavelet filters and it is simplified for rectangular and circular regions. Therefore, ROI coding is considered quite important in distributed and networked electronic healthcare.