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Image filtering techniques have numerous potential applications in biomedical imaging and image processing. The design of filters largely depends on the a-priori knowledge about the type of noise corrupting the image and image features. This makes the standard filters to be application and image specific. The most popular filters such as average, Gaussian and Wiener reduce noisy artifacts by smoothing. However, this operation normally results in smoothing of the edges as well. On the other hand, sharpening filters enhance the high frequency details making the image non-smooth. An integrated general approach to design filters based on discrete cosine transform (DCT) is proposed in this study for optimal medical image filtering. This algorithm exploits the better energy compaction property of DCT and re-arrange these coefficients in a wavelet manner to get the better energy clustering at desired spatial locations. This algorithm performs optimal smoothing of the noisy image by preserving high and low frequency features. Evaluation results show that the proposed filter is robust under various noise distributions.