The double-contrast barium enema is a highly accurate and readily available procedure which is capable of diagnosing benign and malignant disease of the colon at an early state. The level of accuracy is a function of the radiologist's knowledge and willingness to assume complete responsibility for the patient. While reasonable results may be obtained with the high-kilovoltage single-contrast method, it is our opinion that the double contrast examination is the more sensitive procedure and therefore the technique of choice. The double-contrast examination ideally compliments the colonoscope and offers an alternative method for initial survey procedures or low cost follow-up examinations.