Low-Osmolar Contrast Agents

To the Editor.—  I have two observations concerning the article entitled "The Introduction of Low-Osmolar Contrast Agents in Radiology" by Mr Jacobson and Dr Rosenquist¹ in the September 16 issue of The Journal and the accompanying editorial²: The projected saving of $1 billion is based on using the contrast media in only 15% to 20% of the patients. I doubt very much that only 15% to 20% of the patients fall into the long list of high-risk patients on page 1588 of the article (ie, infants, elderly patients, diabetic patients, patients with a history of allergy, patients with asthma, patients with a history of reaction to previous contrast media, and patients with renal or cardiac disease). Particularly if you include patients with a history of allergy, you will place the vast majority of patients in the high-risk category, thereby reducing the saving considerably.Second, the article and the