When performing a double-contrast gastrogram, which view order is recommended?

• A. Left lateral, Ventrodorsal, Right lateral, Dorsoventral
• B. Left lateral, Dorsoventral, Right lateral, Ventrodorsal
• C. Right lateral, Ventrodorsal, Left lateral, Dorsoventral
• D. Left lateral, Ventrodorsal, Dorsoventral, Right lateral

Answer: (A)

In a double-contrast gastrogram, you want to use gravity and multiple projections to coat the mucosal lining with air and contrast so the folds and any subtle irregularities are clearly visible. The best view sequence starts with a left lateral position because gravity places the stomach so the fundus is down and air can rise to coat the mucosal folds there, giving a sharp outline of the rugae in the most dependent part. This early distribution sets up good visualization of the stomach’s surfaces.

Moving to a ventrodorsal view provides a broad, non-rotated image of the entire stomach against the spine, allowing assessment of the body, fundus, and pyloric region in a single shot without superimposition that would occur in some lateral views. It serves as a reliable, comprehensive reference view before changing the patient’s position again.

A right-lateral view then lets you see the opposite gastric wall, confirming that the mucosal pattern is symmetrical and helping detect lesions that might be hidden on the first lateral projection. Finally, a dorsoventral view gives a top-down perspective, ensuring any remaining areas are evaluated from a different angle and confirming that the distribution of air and contrast provides a complete, consistent picture of the mucosa.

If a different sequence were used, parts of the mucosal surface might be obscured by superimposition or by uneven gas distribution, making subtle abnormalities harder to detect. This order maximizes detail and reliability across all gastric surfaces.