By Kintur Sanghvi, MD, FACC, FSCAI, Deborah Heart & Lung Institute, Browns Mills, New Jersey Last week, I was in the beautiful city of Québec for AIM Radial 2012. The experience was one of a kind, with the breathtaking architecture of the city and the extravagant hospitality of the organizing team. As a true “master class” of the radial technique, we went beyond the basics and discussed why one should do radial in all difference subsets of interventional procedures. Dr. Olivier Bertrand and the whole international organizing team had a tremendous three-day program inclusive of live telecasts from Japan, France, Canada and US. On the opening day, Dr. Gérald Barbeau performed an extremely complex, multivessel percutaneous coronary intervention (PCI) using rotational atherectomy through a sheathless 7 French guide. Japan’s “Slender club,” led by Dr. Shigeru Saito, demonstrated a complex left circumflex PCI using a virtual 3 French guide. Dr. Tift Mann performed a transradial carotid stenting. As it was the 20th anniversary for Dr. Ferdinand Kiemeneij, who did the first transradial percutaneous intervention, he delivered the keynote address at the gala dinner. He walked us through a mesmerizing presentation about the evolution and future of transradial interventions. What a great legacy! The faculty presented clinical trial data not biased by any commercial funding, very different from the standard interventional meets. Most of the data was from investigator-generated and executed clinical trials. Presenters from France, Macedonia, United Kingdom, Japan, etc., are using radial access for coronary procedures in more than 65% of procedures. On the other hand, the American College of Cardiology’s National Cardiovascular Data Registry (ACC-NCDR) in April 2012 revealed that the US was using radial in approximately 11% of procedures. In the US, both low individual intervention volume and a longer learning curve together are responsible for the lesser adoption rates of radial access. The average volume of an interventionalist in the US is 45 PCIs/year. In my opinion, soon, like internal medicine, we will see the hospitalist cardiologist and outpatient cardiologist. With more practices acquired by hospitals, individuals with low PCI procedure volumes may not have the incentive to carry on doing PCIs, which may redistribute the PCI volume. During the AIM RADIAL meeting, a physician from Japan showed a diagnostic angiogram performed with 3 French catheters in an obese patient and a virtual 3 French PCI. Our field is a dynamic environment. Five years ago people were skeptical about using the radial access in the US. Today, I am hopeful that we will soon be using the 3 French radial access and catheter system.