BACKGROUND: Many craniofacial teams are interested in using velopharyngeal magnetic resonance imaging (MRI) clinically for surgical planning for management of velopharyngeal insufficiency (VPI). However, many teams report training and resources are barriers that prevent them from implementing MRI. OBJECTIVE: (1) To describe a training program for implementation of velopharyngeal magnetic resonance imaging (MRI) in the clinical setting, (2) to assess the effectiveness of the training program, and (3) to identify factors associated with successful implementation of velopharyngeal MRI. MATERIALS AND METHODS: Eleven metropolitan-based hospitals with craniofacial clinics participated in a prospective observational study. From these 11 hospitals, 53 patients with VPI completed a velopharyngeal MRI aged 3 to 21 years in pediatric hospital settings. A training program was created and modified while launching velopharyngeal MRI at each hospital. The main outcome measures were (1) overall success rate of velopharyngeal MRI, (2) number of MRIs to achieve competence, and (3) success rate with velopharyngeal MRI after achieving competence. RESULTS: Ten of the 11 hospitals achieved competence. The overall success rate was 81% (43/53), which improved to 89% after hospitals achieved competence (33/37). It took hospitals an average of 1.5 MRI scans to achieve competence (range 1-3 MRI scans). Factors associated with successful implementation of velopharyngeal MRI were having a speech-language pathologist present for the MRI, having consistent MRI staff, having previous experience with velopharyngeal MRI, and the use of video conferencing during MRI collection. CONCLUSIONS: The training program led to successful implementation of velopharyngeal MRI. Hospitals benefited from having resources that were friendly to use during real-time data collection. The use of consistent MRI staff, speech-language pathologists, or doing video conferencing with someone with experience implementing velopharyngeal MRI may improve velopharyngeal MRI scan success.