Contrast media are essential for diagnostic and interventional procedures. Iodinated contrast media are the most commonly used agents, with CT requiring the largest overall quantities. Data show that these iodinated contrast media are found in sewage water, surface water and drinking water in many regions in the world. Because standard drinking water purification techniques only provide poor to moderate removal of iodinated contrast media, these substances pose a problem for drinking water preparation that has not yet been solved. There is a growing body of evidence supporting the negative environmental effects of iodinated contrast media via their breakdown products. The environmental impact of iodinated contrast media can be mitigated by measures focusing on the application of contrast media or the excretion of contrast media. Measures with respect to contrast application include reducing the utilization of contrast media, reducing the waste of contrast media and collecting residues of contrast media at the point of application. The amount of contrast media excreted into the sewage water can be decreased by introducing urine bags and/or special urine collection and waste-water processing techniques in the hospital. To tackle the problem of contrast media in the water system in its entirety, it is necessary for all parties involved to cooperate, from the producer of contrast medium to the consumer of drinking water. This paper aims to make health professionals aware of the opportunity to take the lead now in more conscious decisions regarding use of contrast media and gives an overview of the different perspectives for action.