The k-means algorithm is widely used to design image codecs using vector quantization (VQ). In this paper, we focus on an adaptive approach to implement a VQ technique using the online version of k-means algorithm, in which the size of the codebook is adapted continuously to the statistical behavior of the image. Based on the statistical analysis of the feature space, a set of thresholds are designed such that those codewords corresponding to the low-density clusters would be removed from the codebook and hence, resulting in a higher bit-rate efficiency. Applications of this approach would be in telemedicine, where sequences of highly correlated medical images, e.g. consecutive brain slices, are transmitted over a low bit-rate channel. We have applied this algorithm on magnetic resonance (MR) images and the simulation results on a sample sequence are given. The proposed method has been compared to the standard k-means algorithm in terms of PSNR, MSE, and elapsed time to complete the algorithm.