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We propose a unifying framework for efficient encoding, transmission, and quality assessment of atherosclerotic plaque ultrasound video. The approach is based on a spatially varying encoding scheme, where video-slice quantization parameters are varied as a function of diagnostic significance. Video slices are automatically set based on a segmentation algorithm. They are then encoded using a modified version of H.264/AVC flexible macroblock ordering (FMO) technique that allows variable quality slice encoding and redundant slices (RSs) for resilience over error-prone transmission channels. We evaluate our scheme on a representative collection of ten ultrasound videos of the carotid artery for packet loss rates up to 30%. Extensive simulations incorporating three FMO encoding methods, different quantization parameters, and different packet loss scenarios are investigated. Quality assessment is based on a new clinical rating system that provides independent evaluations of the different parts of the video (subjective). We also use objective video-quality assessment metrics and estimate their correlation to the clinical quality assessment of plaque type. We find that some objective quality assessment measures computed over the plaque video slices gave very good correlations to mean opinion scores (MOSs). Here, MOSs were computed using two medical experts. Experimental results show that the proposed method achieves enhanced performance in noisy environments, while at the same time achieving significant bandwidth demands reductions, providing transmission over 3G (and beyond) wireless networks.