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Introduction Limited access to advanced cardiovascular imaging contributes to delayed diagnosis and suboptimal management of cardiomyopathy and heart failure in many health systems. Centres of excellence in the UK have demonstrated the value of advanced imaging services supported by multidisciplinary collaboration, training pathways, and robust governance. This project describes the development of a cardiac magnetic resonance (CMR) service within the public health sector in Uganda through a phased and iterative implementation approach delivered through a partnership between the Uganda Heart Institute (UHI) and Barts Heart Centre (BHC).Methods A multidisciplinary CMR service development programme was implemented through collaboration between UHI and BHC. The first phase (2024) focused on workforce exposure and foundational training through multidisciplinary education, supervised hands-on acquisition, and reporting workshops aligned with established imaging practice and delivered jointly by local and international faculty from BHC, UHI, Essex Cardiothoracic Centre and the University of Cape Town. Phase two (2025) transitioned towards clinical service delivery and sustainability, including establishment of referral pathways within Mulago National Referral Hospital, structured case review processes, and initiation of an online mentorship programme to support longitudinal skill development and quality assurance. Outcomes assessed included workforce training, clinical utilisation, and impact on patient management.Results Across the two training phases, over 100 clinicians, including cardiologists, radiologists and radiographers, received structured CMR training with 30 of these attending focused acquisition and reporting workshops. A total of 33 locally acquired CMR scans were performed, with 75% resulting in changes to diagnosis or clinical management. A CMR service has been established using newly established public-sector clinical pathways. Four clinicians enrolled in a structured mentorship programme supporting progression towards independent reporting.Conclusions Introduction of advanced cardiovascular imaging within a resource-limited public health system is feasible when supported by phased service design, distributed leadership, and longitudinal mentorship. Transition from education to clinical service delivery was facilitated by early integration into existing care pathways and locally led implementation. Our experience demonstrates a scalable approach to developing sustainable advanced imaging services while strengthening workforce capability and clinical governance, with potential applicability to other low-resource cardiovascular services. As a result of integrating CMR into routine public-sector pathways for cardiac care, subsequent phases of this collaboration will establish the clinical capability and capacity necessary to address the newly identified healthcare needs.Abstract 482 Figure 1CMR diagnoses from 33 scans performed during CMR image acquisition and reported during specialist training workshops in Uganda.Abstract 482 Figure 2Case: 34 year old male presented with decompensated heart failure and features of systemic vasculitis. Echo diagnosis of apical HCM with restrictive pathology. CMR performed demonstrated classical features of endomyocardial fibrosis including ‘Double V’ sign; apical sub-endocardial late-enhancement with underlying apical thrombus.