brasfield scoring system

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The Brasfield scoring system is a scoring system for patients with cystic fibrosis. The score is based on conventional chest radiographic findings and has been reported to have good correlation with pulmonary function. There can be intra- and interobserver variability between radiologists.

There is a maximum score of 25 with points subtracted based on the score from each of the following categories:

Air trapping

Definition: generalized pulmonary overdistension (sternal bowing, depression of diaphragms, or thoracic kyphosis)

0: absent
1: increasing severity
2: increasing severity
3: increasing severity
4: most severe

Linear markings

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: increasing severity
2: increasing severity
3: increasing severity
4: most severe

Nodular cystic lesions

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 lesion

0: absent
1: increasing severity
2: increasing severity
3: increasing severity
4: most severe

Large lesions

Definition: segmental or lobar atelectasis or consolidation, including acute pneumonia.

0: absent
3: segmental or lobar atelectasis and pneumonia
5: multiple atelectasis and pneumonia

General severity

Definition: impression of overall severity on chest x-ray

0: absent
1: increasing severity
2: increasing severity
3: increasing severity
4: complications (e.g. cardiac enlargement, pneumothorax)
5: most severe

Overall score: 25 total points in which points are subtracted based on categorical scoring (the lower overall score, the greater the disease severity). Therefore, a score of 25 is a normal exam.

Minimum possible score (most severe disease): 3