Low-osmolality contrast media: premises and promises.

After more than 30 years of experience in the United States with high-osmolality, ionic, radiopaque contrast media (HOCM), low-osmolality contrast media (LOCM), both ionic and nonionic, have recently been introduced into the marketplace. Under the current atmosphere of cost controls (prospective payment system) and consumerism in medicine, the higher cost of these newer agents has sparked heated debate, with the lingering question, "Can we afford to use them?" The new LOCM are not the only "expensive" drugs undergoing an economically constrained introduction into clinical practice, but they represent a significant challenge for radiologists in terms of our doctor-patient relationships and the monetarization of medical care. Review of the extensive literature documenting improvement in patient acceptance, tolerance, and safety, with equal or improved diagnostic efficacy, suggests that the question now at hand is, "Can we afford not to use them?" This premise is discussed with text and references designed to aid the practicing radiologist and referring physician in developing guidelines for utilization of the new LOCM.