Distal radial access (DRA) is an innovative and valuable approach to vascular access in interventional cardiology and interventional radiology. While conventional transradial access has been widely adopted, DRA offers distinct advantages due to its unique anatomical features. Ultrasound imaging of the distal radial artery, which runs over the carpal bones, facilitates puncture at the anatomic segment that is ideal for hemostasis. The DRA above the trapezium in the hand is seen by ultrasound as the optimal access site due to its proximity to the bone below and the short distance to the skin above. In comparison, the radial artery at the wrist is at the same distance from the skin but does not have an immediate transverse bone below it to oppose pressure during hemostasis, and there are layers of muscle tissue that can collect blood. This anatomical difference between the carpal and wrist bones, as observed by ultrasound imaging, is one of the fundamental advantages of DRA in hemostasis and hematoma prevention. Ultrasound expertise can reduce the learning curve for DRA access and support its use in unstable patients. This chapter provides a comprehensive overview of the technique and practical tips for the routine use of ultrasound in DRA access based on the authors’ extensive experience.