Endoscopic ultrasonography (EUS) has become integral to the diagnosis and staging of gastrointestinal (GI) and mediastinal mass lesions. EUS-guided fine-needle aspiration (FNA) allows the endoscopist to obtain tissue or fluid for cytologic and chemical analysis, adding to the procedure’s utility. Furthermore, the recent development of EUS guided tru-cut biopsy techniques enable histologic sampling in selected cases. The clinical effectiveness of EUS and EUSFNA depends on the judicious use of these techniques and the skill of the endosonographer. Requiring both advanced endoscopic ability and radiologic interpretation, sufficient training in EUS is generally beyond the realm of a standard GI fellowship. Recognizing the specialized nature of EUS and EUSFNA, the American Society for Gastrointestinal Endoscopy (ASGE) has published specific criteria for the training of, and the granting of clinical privileges for, individuals who want to perform these procedures (1, 2). The American College of Gastroenterology (ACG)/ASGE task force has also established the following indicators to aid in the recognition of high-quality EUS examinations. The levels of evidence supporting these quality indicators were graded according to Table 1. Such indicators would permit the development of quality assurance programs and enable endosonographers to share their personal quality measures with patients and other interested parties.