For all of us involved in quality improvement measures within our lab our goal is to drive change. Reporting physician compliance with turnaround time or participating in group peer review sessions to track interpretive variability can often generate some lively conversations! As an educator and consultant, I have facilitated meetings where I have seen first hand interpretive variability or had to report on non-compliance with physician turnaround time. Take ejection fraction as an example of interpretive variability. Although ASE provides guidelines regarding best quantification techniques (Biplane Simpsons Method), the physicians are still faced with the reality of the sonographer’s ability to perform correct techniques while performing the exam! How do we close the loop on subjective ultrasound interpretation and tip the scales to consistently provide accurate interpretations? How do we understand the many issues involved with a physician that may not read a study on time?