Optimum overhead views in double-contrast barium-enema examinations

On 100 consecutive double-contrast barium-enema examinations demonstrating a benign or malignant mass in the colon, 10 overhead views were analyzed to determine the smallest number of projections that would permit an accurate diagnosis. The combination of six overhead views (anteroposterior, posteroanterior, angled view of the rectosigmoid, lateral view of the rectum, right and left decubitus) and fluoroscopic spot films of the cecum, transverse colon, and flexures was sufficient to demonstrate all colonic masses. In no instance was a lesion seen only on overhead views performed with the patient in an oblique position. Elimination of the four oblique views from the routine double-contrast barium-enema examination can result in substantial savings in cost and radiation exposure without adversely affecting diagnostic accuracy.