Radiographic examination of the small bowel: Survey of practice patterns in the United States

PURPOSE: To obtain understanding of the current practice patterns of academic and private radiology groups in the United States in radiographic examination of the small bowel. MATERIALS AND METHODS: The survey consisted of questions about small-bowel follow-through (SBFT) examinations, including frequency of overhead radiographs, use of fluoroscopic spot images, personnel performing fluoroscopy, practice settings, and degree of specialization. By using a standard sampling technique, the country was divided into nine regions, and one state from each region was randomly selected. The survey was mailed to 452 full-time chief technologists. The responses were tabulated, and statistical analysis of the data was performed with the X-2 test. RESULTS: Completed questionnaires were returned by 236 (52%) of 452 chief technologists; 219 (93%) respondents, 176 (80%) in private and 43 (20%) in academic groups, indicated that their group performed SBFT studies. The studies were performed by general radiologists in 205 (94%) of the 219 groups and by gastrointestinal or abdominal radiologists in 11 (5%). Studies included overhead radiographs in all 219 groups, with spot images of the terminal ileum in 201 (92%). Thirty (14%) of 219 groups routinely obtained spot images of the remaining small bowel, 104 (48%) obtained spot images only if there were questionable findings on overhead radiographs, and 82 (37%) obtained no spot images. Eighteen (8%) of 219 groups performed peroral pneumocolon examinations and 80 (37%) performed enteroclysis. CONCLUSION: The majority of radiology groups perform SBFT studies. Regardless of the practice setting, these studies usually consist of a series of overhead radiographs, with routine spot images of the terminal ileum but not of the remaining small bowel. This approach may need to be reassessed in light of the American College of Radiology standards that all accessible small-bowel loops be visualized at fluoroscopy with representative radiographs to optimize the diagnostic yield of the examination. (C) RSNA, 2004