Over the past 20 years, since the first reports, transradial vascular access for coronary angiography and intervention has flourished in many countries while still accounting for less than 2% of all cases performed in the United States due, in part, to difficulties in introducing change to established practice patterns. The benefits of transradial access include decreased bleeding risk, increased patient comfort, lessened post-procedure nursing workload, and decreased hospital costs. A learning curve to gain the specific set of skills for transradial access has been well described. Although published data suggest that 100-200 cases are necessary to become proficient, the learning curve is likely highly individual, and some operators may become proficient sooner. The equipment to start a transradial program is minimal and includes modified sheaths and catheters. Patients with morbid obesity, peripheral vascular disease, and anticoagulation clearly benefit from this approach. To establish a transradial program and offer the benefits of this approach to most patients, a dedicated interventionalist must incorporate peers and hospital staff to create a multidisciplinary team.