In this communication, a new three-dimensional (3-D) discrete cosine transform (DCT) coder for medical images is presented. In the proposed method, a segmentation technique based on the local energy magnitude is used to segment subblocks of the image into different energy levels. Then, those subblocks with the same energy level are gathered to form a 3-D cuboid. Finally, 3-D DCT is employed to compress the 3-D cuboid individually. Simulation results show that the reconstructed images achieve a bit rate lower than 0.25 bit per pixel even when the compression ratios are higher than 35. As compared with the results by JPEG and other strategies, it is found that the proposed method achieves better qualities of decoded images than by JPEG and the other strategies.