This document discusses various quality assurance processes for low volume cardiac catheterization operators, including data audits, angiographic reviews, and external reviews. It notes that while low volume operators think they are doing a good job, validation of their appropriateness, technical proficiency, and documentation is important. The document outlines the objective and unbiased review process used by ACE E3, including corrective action plans and support for operators. Contact information is provided for further questions.