The widespread availability, negligible risk, and versatility of transthoracic echocardiography make it a powerful and appealing diagnostic tool. However, these same characteristics may encourage overuse. Matulevicius and coauthors report the proportion of transthoracic echocardiographies that affect clinical care in an academic medical center overall and in subgroups defined as appropriate and inappropriate by the Appropriate Use Criteria (AUC), and found that although most (92%) were appropriate by AUC, only 32% led to an active change in clinical care, 47% resulted in continuation of current care, and 21% resulted in no change in care. The proportion resulting in active change did not correlate with AUC classification. An Editor’s Note by Redberg supplements Invited Commentaries by Armstrong and Eagle and Ioannidis.