Cardiovascular magnetic resonance (CMR) imaging is a comprehensive clinical tool for assessing a large variety of cardiovascular diseases. Using the clinical service of the Duke Cardiovascular Magnetic Resonance Center as an example, we describe how to perform image contractile function, myocardial perfusion at stress and rest, myocardial viability, cardiovascular morphology, vascular anatomy and blood flow tests. The emergence of successful dedicated CMR services presents an opportunity to optimize patient throughput by streamlining the user interface of CMR scanners, standardizing the viewing format and reporting software, and customizing training programs to focus on the standardized CMR approaches. Accordingly, we discuss potential pathways to create these standards. Finally, we discuss several promising new CMR techniques we expect will complement existing clinical procedures.