We propose a 3D medical image coding method with optimal channel protection for wireless transmission. The proposed method employs the 3D integer wavelet transform and a modified EBCOT with 3D contexts to create a scalable layered bit-stream. Optimal channel protection is attained by assigning protection bits to the different sections of the compressed bit-stream according to their mean energy content. The robustness of the proposed method is evaluated over a Rayleigh-fading channel with a concatenation of a cyclic redundancy check code and a rate-compatible convolutional code. Comparisons are made with the cases of equal channel protection and unequal channel protection. Simulation results show a significant improvement in reconstruction quality of the received 3D images.