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: generalised 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 centres (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.

See also

• Chrispin-Norman scoring system