Evaluating Cardiothoracic Ratio (CTR) and Its Correlation with Clinical Indications and Body Parameters for Heart Size Assessment in Resource-Limited Settings: A Cross-sectional Study.

Authors

  • Alen Musisi Department of Physics, Ernest Cook University Author https://orcid.org/0009-0006-1737-078X (unauthenticated)
  • Rebecca Nakatudde Department of Radiology and Radiotherapy, College of Health Sciences, Makerere University, Kampala, Uganda Author
  • Oliver Namuwonge Department of Physics, Ernest Cook University, P.O.Box 7161, Mengo - kampala Uganda Author
  • Deborah Babirye Department of Radiology, Ernest Cook University, P.O.Box 7161, Mengo - kampala Uganda Author
  • Ismail Kintu Department of Radiology, Interventional Radiology Wing, Mulago National Referral Hospital, P.O.Box 7051, Kampala, Uganda Author
  • Francis Olweny Clinical Epidemiology Unit, School of Medicine, College of Health Sciences, Makerere University, Kampala Uganda. Author
  • Richard Malumba Department of Research, Ernest Cook University, P.O.Box 7161, Mengo - kampala Uganda Author
  • Victoria Nakalanzi Department of Research, Ernest Cook University, P.O.Box 7161, Mengo - kampala Uganda Author
  • Aloysius Gonzaga Mubuuke Department of Radiology and Radiotherapy, College of Health Sciences, Makerere University, Kampala, Uganda Author

DOI:

https://doi.org/10.51168/gv087c32

Keywords:

Cardiomegaly, Cardiothoracic Ratio, Body Mass Index, Body Surface Area, Body Surface Index

Abstract

Introduction 

Cardiologists must always determine heart size, which varies with physiological changes. Advanced measurement techniques are costly and often inaccessible to the common man. Measuring the cardiothoracic ratio (CTR) using Chest X-rays (CXR) is a common and more affordable option, but there's a need for even cheaper alternatives. Therefore, the objective of this study was to determine the relationship between CTR and presenting clinical indications and to relate CTR to the body parameters to find an appropriate relationship that can be utilized in low-resource facilities in determining heart size.

Methodology: 

This cross-sectional study involved 386 patients undergoing CXR at Mulago National Specialized Hospital's radiology department. Data were summarized using frequencies and percentages. Associations between the CTR and independent variables were analyzed using Pearson’s chi-square, Fisher’s exact test, Spearman’s correlation coefficient, simple linear regression, and multivariate regression. Statistical significance was set at a p-value of < 0.05.

Results: 

The median CTR was 0.46, with an interquartile range of 0.42 to 0.50. Female patients had a higher CTR than males. Significant positive correlations were found between CTR and BMI (p < 0.001, correlation 0.21), BSA (p = 0.016, correlation 0.12), and BSI (p < 0.001, correlation 0.19). The relationship between CTR and BSA showed a fair performance as a predictive tool, with sensitivity, specificity, and positive and negative predictive values of 29.2%, 86.0%, 63.6%, and 59.0% for males, and 8.3%, 98.1%, 75.0%, and 60.7% for females, respectively. Thus, BSA was considered a relatively better predictor of CTR.

Conclusion: 

BSA shows a moderately good relationship with CTR, while the influence of body habitus on CTR is minimal. Thus, using body parameters to predict CTR should be approached cautiously.

Recommendation: 

We recommend conducting a similar study on a more diverse general population.

Author Biographies

  • Alen Musisi, Department of Physics, Ernest Cook University

    Mr. Alen Musisi is Medical Physicist and lecturer in the Department of Physics at Ernest Cook University, Kampala, Uganda. His research expertise lies in Diagnostic Reference Levels in CT and conventional x-ray, and radiation protection practice and training. He holds a MSc. Medical Physics from Universiti Sains Malaysia.

  • Rebecca Nakatudde, Department of Radiology and Radiotherapy, College of Health Sciences, Makerere University, Kampala, Uganda

    She is a Medical Physicist, an Assistant Lecturer in the Department of Radiology and Radiotherapy, College of Health Sciences, Makerere University

  • Oliver Namuwonge, Department of Physics, Ernest Cook University, P.O.Box 7161, Mengo - kampala Uganda

    She is a Medical Physicist, an Assistant Lecturer in the Department of Physics, Ernest Cook University

  • Deborah Babirye, Department of Radiology, Ernest Cook University, P.O.Box 7161, Mengo - kampala Uganda

    She is a Radiologist at Ernest Cook University in the Department of Radiology

  • Ismail Kintu, Department of Radiology, Interventional Radiology Wing, Mulago National Referral Hospital, P.O.Box 7051, Kampala, Uganda

    He is an Imaging Technologists in the Department of Radiology, Mulago Hospital

  • Francis Olweny, Clinical Epidemiology Unit, School of Medicine, College of Health Sciences, Makerere University, Kampala Uganda.

    He is a Stastician at Clinical Epidemiology Unit in School of Medicine, College of Health Sciences in Makerere University

  • Richard Malumba, Department of Research, Ernest Cook University, P.O.Box 7161, Mengo - kampala Uganda

    He is a Senior Research Officer at Ernest Cook University in the Department of Research

  • Victoria Nakalanzi, Department of Research, Ernest Cook University, P.O.Box 7161, Mengo - kampala Uganda

    She is a Research Officer and Data analysist in the Department of Research at Ernest Cook University

  • Aloysius Gonzaga Mubuuke, Department of Radiology and Radiotherapy, College of Health Sciences, Makerere University, Kampala, Uganda

    He is a Senior Lecturer in the Department of Radiology and Radiotherapy, College of Health Sciences, Makerere University

References

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Published

2025-12-27

Issue

Vol. 2 No. 12 (2025): December 2025 issue

Section

Section of peer-reviewed articles

License

Copyright (c) 2025 Alen Musisi, Rebecca Nakatudde, Oliver Namuwonge, Deborah Babirye, Ismail Kintu, Francis Olweny, Richard Malumba, Victoria Nakalanzi, Aloysius Gonzaga Mubuuke (Author)

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

How to Cite

Musisi, A., Nakatudde, R., Namuwonge, O., Babirye, D., Kintu, I., Olweny, F., Malumba, R., Nakalanzi, V., & Mubuuke, A. G. . (2025). Evaluating Cardiothoracic Ratio (CTR) and Its Correlation with Clinical Indications and Body Parameters for Heart Size Assessment in Resource-Limited Settings: A Cross-sectional Study. Journal of Imaging Science for Diagnosis, 2(12), 19. https://doi.org/10.51168/gv087c32

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