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July 30, 1973

The Cardiothoracic Ratio

JAMA. 1973;225(5):525. doi:10.1001/jama.1973.03220320053024

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To the Editor.—  I am writing a letter to protest the first "cardiovascular anachronisms" mentioned in the article by that title by Dr. Marvin L. Daves in The Journal (224:879, 1973).The first anachronism that Dr. Daves would like deleted concerns the cardiothoracic ratio. I would agree that probably this largely applies to chest films, but as I do it by cardiac fluoroscopy with orthodiagraphic attachments, I have found for many years that the cardiothoracic ratio can be relied on if it is consistently and carefully done.In my own patients I fluoroscopically take into account the motion of the diaphragm, the condition of the lungs, and the general and cardiac health of the individual. My technique is to look fluoroscopically at the entire chest first and have the patient take one or two deep breaths. I observe the position of the diaphragm and whether or not the left leaf is