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The optimal order for performing these examinations is crucial for several reasons, including the potential for contrast interference and the types of imaging techniques utilized. In this case, starting with a barium enema is appropriate because it involves the lower gastrointestinal tract and requires the introduction of barium into the bowel. It is essential to perform this test first because the barium can linger in the gastrointestinal system, which might interfere with subsequent imaging studies of the upper GI tract and urinary tract.

Following the barium enema with an upper gastrointestinal (UGI) examination allows for the visualization of the esophagus, stomach, and duodenum without the risk of barium remaining from the previous study affecting the results. Once these gastrointestinal examinations are completed, the intravenous urogram (IVU) can be performed. This study evaluates the urinary tract and requires contrast administered intravenously. Performing it last helps ensure that any remaining barium from earlier studies does not obscure the kidney and urinary structures.

This sequence—barium enema, followed by UGI, and finally IVU—optimally balances the need for clear imaging while avoiding any potential complications from residual contrast material from previous examinations.