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To the Editor.—
I agree with Dr Miller (237:63, 1977) that plain films and noncontrast roentgenographic examinations be done first. Second, any radioisotope examination should be done before procedures in which barium is used. However, I disagree with the order of preference for barium studies.If a patient is known or suspected of needing gastrointestinal (GI) and barium enema studies, the barium studies should always precede the GI examination. The intravenous pyelogram-barium enema combination should be done the first day, with an optional cleansing enema following the barium enema examination. The cleansing enema only insures that the colon be free of any barium pocketing in the folds. The gall-bladder-GI combination examination should be done the second day, following the barium enema examination.The basic reasons for this are the following. (1) Barium used in GI studies is much finer and therefore adheres to the intestinal lining better. (2) Barium for
Chancy LW. Order of Roentgenographic Examinations. JAMA. 1977;237(25):2720–2721. doi:10.1001/jama.1977.03270520030014
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