Assessment of cardiac size on portable chest films

Milne, Eric N. C.; Burnett, K.; Aufrichtig, D; McMillan, J H; Imray, Thomas J.

doi:10.1097/00005382-198804000-00008

Cited by 15 publications

(4 citation statements)

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“…Although in the literature we find appropriate values of the coefficient, for example, for the AP projection [ 5 ], we should approach them with care and be aware of their limitations [ 5 ]. Chest radiograph, and thus also CTR determination, is an easy and beneficial parameters in patient assessment in hospital emergency departments (HEDs) and in the course of treatment and patient care in intensive care units (ICUs) [ 6 ]. The clinical condition of such patients, however, often does not allow for the execution of a chest radiograph in the PA projection, which is most often substituted with bedside examinations of the AP projection.…”

Section: Ctr—the Importance Of Radiograph Projectionmentioning

confidence: 99%

Radiological Cardiothoracic Ratio in Evidence-Based Medicine

Truszkiewicz¹,

Poręba

Gać

2021

JCM

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The cardiothoracic ratio (CTR), expressing the relationship between the size of the heart and the transverse dimension of the chest measured on a chest PA radiograph, is a commonly used parameter in the assessment of cardiomegaly with a cut-off value of 0.5. A value of >0.5 should be interpreted as enlargement of the heart. The following review describes the current state of available knowledge in terms of contentious issues, limitations and useful aspects regarding the CTR. The review was carried out on the basis of an analysis of scientific articles available in the PubMed database, searched for using the following keywords: “CTR”, “cardiothoracic ratio”, “cardiopulmonary ratio”, “cardiopulmonary index”, and “heart-lung ratio”. According to the accumulated knowledge, the CTR can still be used as an important parameter that can be easily determined in establishing enlargement of the heart. However, an increased CTR does not directly relate to heart function. In the era following the development of diagnostic methods such as computed tomography, magnetic resonance imaging, and ultrasonography, CTR modifications based on these methods are used with varying clinical usefulness. It is important to consider the definition of the CTR and remember to base measurements on PA radiographs, as attempts to mark it in other projections face many limitations.

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Section: Ctr—the Importance Of Radiograph Projectionmentioning

confidence: 99%

Radiological Cardiothoracic Ratio in Evidence-Based Medicine

Truszkiewicz¹,

Poręba

Gać

2021

JCM

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“…Portable films taken in the anteroposterior and supine position enlarge the appearance of the cardiac silhouette. An investigation by Milne and colleagues (31) determined that for portable anteroposterior CXRs with a focal film distance of 40 inches (the type used in this investigation), a correction factor of Ϫ12.5% for the CT ratio can be used to approximate whether or not cardiomegaly exists. However, this determination was made in healthy patients and was not correlated with hemodynamic parameters.…”

Section: The Cardiothoracic Ratiomentioning

confidence: 99%

Appraising Pulmonary Edema Using Supine Chest Roentgenograms in Ventilated Patients

Thomason

Ely

Chiles

et al. 1998

Am J Respir Crit Care Med

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The role of portable, anteroposterior, supine chest X-rays (CXRs) in distinguishing hydrostatic pulmonary edema (HPE) from permeability pulmonary edema (PPE) in mechanically ventilated patients is controversial. We prospectively obtained and evaluated such CXRs in 33 supine, mechanically ventilated intensive-care-unit patients with pulmonary artery catheters. Three chest radiologists independently reviewed CXRs without clinical information and recorded the cardiothoracic (CT) ratio, vascular pedicle width (VPW), and other radiographic features commonly used to evaluate pulmonary edema. Hydrostatic pulmonary edema was associated with a larger CT ratio (p < 0.001), subjective impressions of cardiomegaly (p < 0.01), and increased VPW (p = 0.02). There was a significant correlation between the pulmonary artery occlusion pressure and the VPW (r = 0.45, p = 0.0076) and CT ratio (r = 0.52, p = 0.0016), as well as between the VPW and CT ratio (r = 0.49, p = 0.0032). Despite this detailed evaluation of the CXRs, the mean accuracy of the radiologists' clinical diagnosis of HPE versus PPE was 41%, and 15 of 19 (79%) of PPE patients showed one or more roentgenographic signs of volume overload. Receiver-operating-characteristic curves were constructed to determine optimum cut-off values of VPW and CT ratio associated with HPE. Hydrostatic pulmonary edema was found to correlate best using a VPW > 63 mm coupled to a CT ratio > 0.52 (p = 0.027). With this combination of objective criteria, radiologists' diagnostic accuracy could have been increased to 73%. We therefore conclude that measurements of CT ratio and VPW correlate with pulmonary artery occlusion pressure in supine, mechanically ventilated patients. Distinction of hydrostatic from permeability pulmonary edema is difficult using portable, supine CXRs, but readily assessed radiologic signs may contribute to the correct diagnosis.

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“…In 3 previous studies, to our knowledge, investigators tried to calculate CTR from chest AP (13-15). However, there were several limitations in these studies: cases showing partial inhalation were excluded in one study (13), only the patients who could easily undergo chest PA were included in another (14), and phantoms were used in the other (15).…”

Section: Discussionmentioning

confidence: 99%

“…However, there were several limitations in these studies: cases showing partial inhalation were excluded in one study (13), only the patients who could easily undergo chest PA were included in another (14), and phantoms were used in the other (15). Additionally, the effect of radiation distances on CTR was considered only in one (15). Despite these limitations, CD Chest PA /CD Chest AP ratio at 150 cm was 0.93 in a previous study (13), while that was 0.94 in this study.…”

Section: Discussionmentioning

confidence: 99%

Calculation of the Cardiothoracic Ratio from Portable Anteroposterior Chest Radiography

Chon

Cho

et al. 2011

J Korean Med Sci

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Cardiothoracic ratio (CTR), the ratio of cardiac diameter (CD) to thoracic diameter (TD), is a useful screening method to detect cardiomegaly, but is reliable only on posteroanterior chest radiography (chest PA). We performed this cross-sectional 3-phase study to establish reliable CTR from anteroposterior chest radiography (chest AP). First, CDChest PA/CDChest AP ratios were determined at different radiation distances by manipulating chest computed tomography to simulate chest PA and AP. CDChest PA was inferred from multiplying CDChest AP by this ratio. Incorporating this CD and substituting the most recent TDChest PA, we calculated the 'corrected' CTR and compared it with the conventional one in patients who took both the chest radiographies. Finally, its validity was investigated among the critically ill patients who performed portable chest AP. CDChest PA/CDChest AP ratio was {0.00099 × (radiation distance [cm])} + 0.79 (n = 61, r = 1.00, P < 0.001). The corrected CTR was highly correlated with the conventional one (n = 34, difference: 0.00016 ± 0.029; r = 0.92, P < 0.001). It was higher in congestive than non-congestive patients (0.53 ± 0.085; n = 38 vs 0.49 ± 0.061; n = 46, P = 0.006). Its sensitivity and specificity was 61% and 54%. In summary, reliable CTR can be calculated from chest AP with an available previous chest PA. This might help physicians detect congestive cardiomegaly for patients undergoing portable chest AP.

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Assessment of cardiac size on portable chest films

Cited by 15 publications

References 0 publications

Radiological Cardiothoracic Ratio in Evidence-Based Medicine

Radiological Cardiothoracic Ratio in Evidence-Based Medicine

Appraising Pulmonary Edema Using Supine Chest Roentgenograms in Ventilated Patients

Calculation of the Cardiothoracic Ratio from Portable Anteroposterior Chest Radiography

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