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The burrows-wheeler transform (BWT) is a combinatorial algorithm originally created for text compression such as bzip2, and that has been recently applied to image compression field. This paper focuses on the impact of compression scheme based on the combinatorial transform on high-level resolution medical images. It overviews the original scheme and some improvements that have been develop in post processing of BWT in this context. The performances of these techniques are compared and discussed. Moreover, considerations on the imagepsilas sizes and data formats are also considered.