The Brasfield scoring system is a scoring system for patients with cystic fibrosis based on scoring conventional chest radiograph findings 1. It has good correlation with pulmonary function 2.
Points are assigned in five categories:
Air trapping (0-4)
Definition: generalized pulmonary overdistension (sternal bowing, depression of diaphragms, or thoracic kyphosis).
0: absent
1-4: for increasing severity, 4 being most severe
Linear markings (0-4)
Definition: Linear opacification due to prominence of bronchi; may be seen as parallel line densities, branching, or “end-on” circular densities (bronchial wall thickening)
0: absent
1-4: for increasing severity, 4 being most severe
Nodular cystic lesions (0-4)
Definition: multiple discrete rounded densities ≥0.5 cm in diameter, with either radiopaque or radiolucent centers (bronchiectasis); does not refer to irregular linear markings; confluent nodules not classified as large lesions.
0: absent
1, 2, 3, or 4: for involvement of 1, 2, 3, or 4 quadrants
Large lesions (0, 3, or 5)
Definition: segmental or lobar atelectasis or consolidation, includes acute pneumonia.
0: absent
3: segmental or lobar atelectasis and pneumonia
5: large lesions
General severity (0-5)
Definition: impression of overall severity of changes on chest x-ray
0: normal
1-4: increasing severity for increasing severity of abnormalities
5: cardiac enlargement or pneumothorax
Calculation
Starting at 25, the points assigned to each category are subtracted to give a final score. The lower the score, the greater the disease severity. Therefore, a score of 25 is a normal exam, and a score of 3 (the minimum possible) is the most severe disease.
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