I nitially, ultrasound was practiced by any physician who had access to an ultrasound machine and a patient who might benefit from the study. There were no training requirements for physician or technologist, no assurance that the equipment worked appropriately, no guides as to technical support, and no guarantees that the study met any standard of care in the community. As might be expected, the quality of ultrasound care varied from superb to incompetent. Concerns arose that inadequate examinations inappropriately done by unqualified persons would lead to a general disenchantment with ultrasound as a diagnostic modality, in addition to a cascade of legal entanglements for malpractice. A consensus developed that basic standards needed to be set. Vascular ultrasound accreditation began with the Intersocietal Commission for the Accreditation of Vascular Laboratories in an effort to bring some standardization into the practice of vascular ultrasound, since it was practiced by a broad spectrum of clinicians, including vascular surgeons, radiologists, neurologists, and others. Thereafter, the American College of Radiology (ACR) developed an ultrasound accreditation program, as did the American Institute of Ultrasound in Medicine. To allow radiologists to get all their ultrasound accreditation under one umbrella, the ACR begins a Vascular Ultrasound Accreditation Program in January 1998, to complement the already existing ultrasound accreditation program. Some agencies across the country have begun to require vascular ultrasound accreditation as a condition of reimbursement in order to ensure a quality product. Accreditation programs in general require adequate education and training of both the physician and the technologist, with continuing educational requirements over the ensuing years, adequate instrumentation for the tasks performed with maintenance checks on performance, patient safeguards as to infection and safety, appropriate reasons for performing the study, documentation of the process, standards for the necessary views in each category, correlation with other imaging studies to note accuracy of the work performed, a documented examination available for review, and a thorough dictated report. In the short time that accreditation programs have been in effect, there have been associated responses in the community. Since a registered vascular technologist is required in a laboratory that does vascular ultrasound, ultrasound technologists have migrated toward that subspecialization. As accreditation looms as a requirement for reimbursement, laboratories are seeking to become accredited. Courses on vascular ultrasound are proliferating to meet the need for continuing education in vascular ultrasound. Anecdotal responses from those who review laboratories for accreditation consistently suggest that the examinations are improving and that these programs are elevating the level of practice and, hopefully, the quality of patient care. While some radiologists are complaining that these programs are disenfranchising them from their practice because of their inability to meet certain criteria, such as volume requirements, the overall results have been rewarding in that the process itself has served as an educational vehicle to improve patient care. Take advantage of the new Vascular Ultrasound Accreditation Program of the A C R and begin the process.