Abstract: Ultrasound-guidance for fine-needle aspiration (USFNA) is being increasingly utilized by physicians outside of the specialty of radiology. Pathologists use USFNA to guide FNA biopsies in FNA clinics primarily outside of major academic centers. FNA clinics in academic centers are not yet routinely using USFNA due to the logistical difficulties in setting up such a practice. In this review, two cytopathologists who were early adopters of USFNA in large academic centers outline their personal experience in doing so. They share their experience in addressing the issues of obtaining equipment and supplies, USFNA training and hospital credentialing of FNA staff, the use of anesthesia, work flow issues, reporting and image database, and marketing strategies. The authors also highlight lessons learned and pitfalls encountered in the process.