Preliminary radiograph for barium enema examination: is it necessary?

In a study of 200 barium enema examinations, the value of the preliminary radiograph, both in demonstrating abnormalities not detectable on the contrast radiographs and in showing the amount of residual fecal material in the colon, was assessed. No clinically significant abnormalities were seen on the preliminary film alone. Estimation of residual fecal material from the preliminary radiograph was frequently faulty and could have resulted in needless additional preparation of patients. This study suggests that inclusion of the preliminary radiograph does not affect the overall diagnostic accuracy of the barium enema examination. Its elimination would yield large savings in health care costs and radiation exposure.