The idea of a hands-on pediatric cardiac magnetic resonance (CMR) teaching course came about during a causal after-dinner conversation between Shi-Joon Yoo and Taylor Chung at the Chung’s residence in Houston, TX, in the Fall of 2001. Joon had traveled from Toronto to Houston and attended a week-long adult CMR hands-on basic course organized by Scott Flamm and Raja Muthupillai at the Texas Heart Institute/St. Lukes Episcopal Hospital. In this course, there were very effective small group sessions, which was modeled after the International 6-Day Symposium in Congenital Heart Disease, a cardiac pathology course that was organized by the World Heart Association in the 1990s [1]. Joon was very inspired by this adult CMR course and suggested to Taylor that there ought to be a similar hands-on basic pediatric cardiac MR course for pediatric radiologists.

Joon and Taylor agreed that it was an opportune time for such an educational course. The clinical trend at the time was leaning towards utilizing MR to obtain both morphologic and, importantly, functional information. However, the pediatric radiology community was not ready to meet this reality. At the time, pediatric CMR was a small niche topic sparingly covered in the annual meetings of the Radiological Society of North America (RSNA), the Society for Cardiovascular Magnetic Resonance (SCMR), and the North American Society for Cardiac Imaging (NASCI). The focus was mostly on adult CMR. At the same time, CMR was hardly a major frontline topic of the annual meetings of the Society for Pediatric Radiology (SPR). Thus, the aim of the teaching course was to “jump start” interested pediatric radiologists to build up their CMR clinical service at their respective institutions to address growing clinical demands.

To sustain a long-term educational course, Joon and Taylor realized that they would need support and endorsement by an international professional society. Taylor approached his then chief of Department of Diagnostic Imaging at Texas Children’s Hospital, Bruce Parker, who was the President of the SPR. Bruce believed SPR should increase the educational efforts for its members beyond the annual scientific meeting and post-graduate course. Bruce secured approval from the Board and, hence, the planning of the 1st SPR CMR Hands-on Basic Course was underway. The SPR and the hosting institution jointly supported the course. In retrospect, this course proved to be an example for the now popular SPR Winter and Fall educational courses that SPR members have come to expect.

The announcement of this hands-on educational course was made to the SPR members in early of 2003 for the first course to be held on October 23–25, 2003, hosted by Joon’s institution, The Hospital for Sick Children in Toronto, with support from Paul Babyn, the Radiologist-in-Chief. The course was free for SPR members and enrollment was limited to 15 attendees. Joon and Taylor solicited help from their good friend, Gordon Culham, a world-renowned pediatric cardiovascular radiologist and Radiologist-in-Chief of the BC Children’s Hospital in Vancouver, to join them in conducting the first course. Gordon, at the time, was active in cardiac MRI and also performed cardiac catheterization and interventions. The course was designed by Joon, Gordon, and Taylor to have introductory lectures on MR techniques/MR physics, congenital heart anatomy, surgical procedures, and cardiovascular hemodynamics. Then, there would be small group sessions in MR scanning techniques during live examination at the MR scanner, hands-on session for post-processing the MR data, and small group discussions on the MR examinations that were completed during scanning and post-processing sessions. Specific lectures on common pathologies such as obstructive lesions of the aorta, cardiomyopathy, tetralogy of Fallot, and transposition of the great arteries were also designed to fit into the schedule on the days of the small group sessions for each group.

It was obvious that more faculty members were needed to support this educational effort. Paul Julsrud, an adult cardiac radiologist from Mayo Clinic who has strong interests in congenital heart disease, also joined the faculty at the request of Joon. Gordon brought along his colleague, John Mawson, as faculty; to allow for both himself and John to be away, Gordon also arranged for temporary faculty support at his department during their absence. All visiting faculty donated their time and travel expenses. Local faculty included Cathy MacDonald, Joon’s colleague at Sick Kids, and Christian Kellenberger, Joon’s fellow (Figs. 1 and 2).

The attendees and faculty members of the inaugural SPR course in 2003

The faculty members of the inaugural SPR course in 2003. From left, Drs. Gordon Culham, Paul Julsrud, Cathy MacDonald, Taylor Chung, Paul Babyn, Christian Kellenberger, Shi-Joon Yoo, and John Mawson

To the surprise and delight of Joon, Gordon, and Taylor, there were 30 SPR members who applied for the course. To accommodate this demand, the planning for the 2nd course in 2004 to be hosted and supported by Taylor’s institution, Texas Children’s Hospital, was already underway prior to conducting the 1st course. There was a tremendous sense of excitement and satisfaction among both faculty and attendees during the first and second courses. In retrospect, the first 30 attendees of this course played a pivotal role in the evolution and continued success of this course. Among the attendees were senior members of the SPR who were in leadership positions at their institutions. There were also dedicated younger SPR members who are now our current leaders. There were corresponding SPR members from Europe, Asia, and South America also. They all helped to promote this course at all levels.

Importantly, during the first and second courses, Joon and Taylor received significant support from their cardiology and cardiothoracic surgery colleagues in teaching the attendees. The local radiology and cardiology trainees also audited the course. At the time of the planning of the 3rd course, Joon and Taylor received many requests from the attendees of the 1st and 2nd courses to have additional more advance topics to be included in the course. Joon, Gordon, and Taylor decided to create the 1st SPR Advanced Symposium in Pediatric Cardiovascular Imaging to follow the Hands-on Basic Course. The Basic Course was condensed from 4 1/2 days to 3 days to be followed by a 2 1/2 days of the Advanced Symposium. The enrollment for both Basic Course and Advanced Symposium was no longer limited to SPR members and open for all in hopes to promote opportunity for all cardiac imagers to work together, thereby providing the most optimal imaging care for our patients. The number of attendees to the Basic Course remains limited to preserve the small group teaching environment and preferences were given to a pair of radiologist and cardiologist from the same institution to attend who would be collaboratively providing cardiac imaging services.

Over the many years, the Basic Course and the Advanced Symposium gradually gained traction among the international pediatric cardiovascular imaging community and was affectionately known as the “SPR course” (Figs. 1 and 2). The increased recognition enabled successful recruitment of prominent international radiology and cardiology faculty from both adult and pediatric institutions to educate the audience on the latest advances in CMR and review of important topics. A core group of pediatric institutions also agreed to openly discuss their works-in-progress, a testimony to the collegial environment of this unique course. This course remains the only annual course that is solely dedicated to pediatric CMR imaging in North America, and many attendees and faculty look forward every year to participate in the course. This course has also expanded beyond The Hospital for Sick Children and Texas Children’s Hospital as hosting institutions. The rotation of hosting institutions included UCSF Benioff Children’s Hospital Oakland, Ann & Robert H. Lurie Children’s Hospital of Chicago, Nationwide Children’s Hospital, and Children’s Hospital Colorado. Each hosting institution supports this course jointly with SPR. The local directors from these hosting institutions form the organizing committee to determine the content of the annual program. The Basic Course design remains quite similar each year whereas the content of the Advanced Symposium changes from year to year.

Joon, Gordon, and Taylor have passed on their responsibilities to a most capable group of dedicated individuals, pediatric radiologists, and cardiologists in the hosting institutions, while remaining available as consultants. Most gratifying for Joon, Gordon, and Taylor is to observe the continued success of this course through the direction of the next generation of pediatric cardiovascular imagers, some of whom were once the attendees of this very course! From an idea during a casual after-dinner conversation in 2001 to the 20th SPR Cardiac MR Hands-on Course and 18th SPR Advanced Symposium in Pediatric Cardiovascular Imaging in October 2024 has been a most rewarding journey for Joon, Gordon, and Taylor! We recall the past to wisely prepare and transform ourselves for the better future.