Cardiovascular disease is the major cause of morbidity and mortality in the United States. In fact, nearly 1 in 3 deaths in 2011 was due to cardiovascular disease (CVD), most of those due to coronary heart disease and 34% of the deaths occur before age 75. The need for improved noninvasive methods to detect early disease and to help manage patients with chronic disease has therefore never been as critical. Technical advances in noninvasive cardiovascular imaging have resulted in increasing use over recent years. Nuclear cardiology and echocardiography are mature technologies that are commonly used in clinical practice. Cardiovascular magnetic resonance imaging (CMR), computed tomographic angiography (CTA), and positron emission tomography (PET) are playing a growing role in the clinical assessment of CVD and are relatively new to cardiovascular training programs. The number of physicians who have in-depth expertise in the physics, engineering, and molecular applications in all 5 major cardiovascular imaging modalities remains limited. The University of Virginia (UVA) is one of a handful of centers in the U.S. that have high-level clinical, physics, engineering, and molecular expertise in all cardiovascular imaging modalities, as well as a track record of training physicians in research. Over the past decade, trainees have been highly productive in terms of publication and the majority have gone on to academic careers in outstanding institutions around the U.S. Two former trainees joined the UVA faculty and both are funded by K23 awards. The purpose of this grant renewal proposal is to continue and further develop the training program that provides comprehensive training in cardiovascular imaging research. The program provides trainees with outstanding opportunities to interact closely with imaging physicists and engineers who together offer the promise of improvements in both the clinical applications of these newer technologies and further development of and applications of translational imaging. Trainees have dual mentorship from a PhD imaging scientist and a MD clinician investigator. The goal of the training is to develop the next generation of academic investigators in cardiovascular imaging who can interact across disciplines. Trainees undergo a rigorous 2-year research training program following a 2-year clinical cardiovascular training program completed at the UVA or a 3-year program completed at another institution. Two fellows per year enter the program such that there are up to 4 fellows enrolled at any one time. A complete didactic program is offered including instruction in imaging physics and engineering, biostatistics, epidemiology, clinical research methodology, and medical ethics. Fellows receive training in clinical CMR, CTA, and PET. Research training is comprehensive and combines clinical and basic cardiovascular imaging research for each trainee with any of the modalities.