Once a year, a routine baseline chest x-ray (CXR) is performed on our CF community. Just like the person's medical history, physical exam, and pulmonary function tests (PFTs), CXRs help to provide information that your CF care providers use in watching over you, and directing your care. And similarly to medical history, physical exam, or PFTs, the changes in CXRs over time are most significant.
When we look at a CXR, we evaluate several different aspects of the x-ray that relate to changes that may occur as CF progresses. X-rays scoring systems have been developed by CF researchers to help compare x-rays between centers and over time. At CCCFC we use the Brasfield score. It grades 5 aspects (see below); a perfect score, absolutely normal, is assigned a score of 25. Points are taken off as changes develop in the features assessed. These include:
Hyperinflation - people with CF often develop mucus plugging that can cause air trapping. When this occurs, x-rays look "hyperinflated".
Line markings - this refers to inflammation and scarring (fibrosis) that can occur.
Nodular and cystic changes - the airways may dilate (bronchiectasis), mucus plugs increase and the lung tissue may change and become more cystic.
Large lesions - most of the time, changes are scattered. Occasionally specific areas may become focally impacted with mucus or more consolidated as the lung tissue compresses down on itself, like a sponge being 'squished'.
Overall - this part of the score is the general 'overall' impression of the evaluator.
Generally, scores of 23 - 25 are essentially normal. Mild changes would be associated with scores of 18 - 22, moderate disease with 13 to 17, and a severe score would be less than 13.