Summary We are requesting funds to purchase an interventional ultrasound system (Epiq CVxi, Philips) with 2D and 3D transthoracic, 3D transesophageal, high frequency vascular imaging probes, abdominal probe, and non-imaging Doppler probes for a wide range of NIH funded projects. This system will replace an ultrasound imaging system (iE33, Philips Healthcare) that has been successfully operated as a shared imaging resource in the Yale Translational Research Imaging Center (Y-TRIC) for over 10 years. The existing system was initially acquired as part of a NIH funded Bioengineering Research Partnership with Philips Healthcare in 2006 to develop radiofrequency (RF) based 3-dimensional (3D) echocardiography speckle tracking for comprehensive analysis of regional myocardial strain. The existing ultrasound system has reached end of life and was equipped with a prototype RF capture board that can no longer be serviced. The EPIQ CVxi system is a state-of-the-art ultrasound system that includes hardware upgrades that are specifically tailored for interface and use with our existing interventional fluoroscopic C-arm X-ray unit (Allura Xper FD20, Philips) for ultrasound image guidance, as well as interface with our existing hybrid CZT SPECT 64-slice CT system (Discovery NMCT570, GE Healthcare). Integration of echocardiographic images with x-ray fluoroscopy is critical for image guided interventions in the current era of catheter-based treatment of congenital heart disease and adult structural heart disease, ischemic heart disease, and electrophysiological interventions. Fused real-time 3D transesophageal echocardiography and x-ray fluoroscopy is currently used for percutaneous mitral valve and aortic valve procedures, and treatment of complex congenital anomalies. Multimodality image guided percutaneous procedures are now replacing conventional cardiac surgery for treatment of these conditions. In the future multimodality image fusion will help to guide intramyocardial delivery of novel therapeutics and theranostics to the heart, including; gene therapy, stem cell therapy, or drug releasing polymer therapies. The use of the system goes beyond application in the cardiovascular system and involves projects related to assessment of neurovascular function, optimization of SPECT and PET imaging, treatment of hepatic cancer, and evaluation of organs for transplantation. The system will be used for 7 major and 4 additional minor NIH funded projects by investigators at the School of Medicine and School of Engineering and Applied Sciences. The imaging resources within Y-TRIC and associated faculty are highly qualified to optimize the utilization of the interventional ultrasound system and are uniquely positioned to facilitate training of the new leaders in multimodality imaging and ultrasound guided interventions.