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Abstract: To evaluate the cardiac hypertrophy from chest radiograph images, radiologists usually examine the cardiothoracic ratio (frequently called CTR) which is a standard diagnostic index. The CTR is computed by the maximum transverse diameter of the heart shadow divided by the maximum transverse diameter of right and left lung boundaries. In this paper, we present a method to evaluate the cardiac hypertrophy by comparing the area of heart with that of lung, instead of the cardiothoracic ratio to get more desirable diagnostic results. We introduce a new index, a cardiothoracic area ratio (CTAR), which is computed by dividing the area of heart region by the area of lung region of specific interest. We first segment a chest region of interest in a radiograph image and then automatically compute the traditional CTR and the CTAR to evaluate the cardiac hypertrophy. And finally, we provide the visual presentation of those ratios on the chest radiograph image. The experimental results using a set of radiograph images show that the proposed method can be used effectively for determining the cardiac hypertrophy in a real-time diagnostic environment. It provides the higher discrimination power than the CTR to identify hypertrophied hearts by recognizing the heart enlargement. It also can be used together with the traditional CTR as a complementary measure when it is difficult to determine abnormalities by the CTR, reducing the rate of wrong diagnosis. [Copyright &y& Elsevier]