AJR:193, July 2009 using these new nonionic LOCM for intravascular studies selectively rather than universally for patients at higher risk of an allergic reaction. By the early 1990s, 80% of institutions had switched to using only nonionic LOCM intravascularly [5]. Gradually, as the differential cost dropped to 3:1, more radiology departments changed to using only nonionic LOCM for intravascular use, and we advocated that position in 2005 [6]. However, our department still kept 50and 100-mL bottles of conventional HOCM for use in nonvascular studies, such as sinography, retrograde pyelography, and other nonvascular catheter injections. But retaining HOCM within the department can create the potential situation in which an incorrect bottle of contrast medium might be used for an intrathecal injection, as noted in the scenarios listed. The costs of contrast agents have continued to change and for many departments the acquisition costs for nonionic LOCM are now less than for HOCM. What happened? While the cost of nonionic LOCM continued to slowly decrease, the cost of HOCM increased substantially over the past decade. What we have discovered recently in our practice association purchase contracts is that nonionic LOCM are now clearly less expensive than HOCM by a number of dollars per 100 mL. Therefore, we have removed the smaller 50and 100-mL bottles of HOCM from our department to avoid any confusion. If such a cost change has occurred in your department, why even have HOCM in these smaller-sized bottles? Why allow a potential situation to exist in which a mistake might be made? We propose the following recommendations. First, review carefully what you now pay for your HOCM and your LOCM contrast agents. Second, if the cost of LOCM is similar or less than that of HOCM, eliminate the standard 50and 100-mL bottles of HOCM from Should You Remove Ionic, High-Osmolality Contrast Media From Your Department?