<![CDATA[Reliable transfer of brain magnetic resonance imaging (MRI) data over atmospheric free-space optical (FSO) links is a key enabler of telemedicine, yet conventional FSO studies judge link quality by communication metrics such as the bit error rate (BER) alone, which cannot guarantee the structural and contrast fidelity that diagnosis demands. This study proposes a quality-aware FSO transmission framework for brain MRI in which link performance is assessed jointly through BER, peak signal-to-noise ratio (PSNR), and the structural similarity index (SSIM). A physical-layer FSO channel is modelled in OptiSystem 20 and co-simulated with MATLAB R2023b, which performs image serialization, reconstruction, and quality analysis. Thirty axial T2-weighted slices (256×256, 8-bit) from the public IXI dataset are transmitted at 1550 nm over clear-air, rain, and fog channels at 500, 1000, and 2000 m. Adopting conservative diagnostic thresholds of PSNR ≥ 30 dB and SSIM ≥ 0.85, the link is diagnostically usable in clear air at all tested distances (PSNR = 42.1 dB, SSIM = 0.98 at 500 m) and in rain up to 2000 m (PSNR ≥ 31.2 dB), whereas fog degrades quality below the thresholds at every distance, reaching PSNR = 22.7 dB and SSIM = 0.68 at 2000 m. A concatenated forward-error-correction (FEC) scheme is then shown to restore diagnostic quality under fog up to 1000 m, extending the usable fog range, while 2000 m remains infeasible and motivates hybrid FSO/RF operation. The framework provides quantitative deployment limits for FSO-based medical image transport.]]>
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