Recently, cardiovascular magnetic resonance imaging (CMR) has emerged as a new noninvasive imaging modality providing high-resolution images in any desired plane of the heart, combined with the potential to assess and monitor left and right ventricular function. Although early attempts to use stress CMR, combined with dipyridamole or dobutamine stress, with standard (low temporal resolution) gradient echo techniques date back to the early 1990s, the scientific and clinical interest in stress CMR has risen strikingly in the last 5 years as a consequence of technological improvements. For functional (wall motion) stress imaging, stress CMR should not be used as a "rich doctor's super stress echo," as a first-line tool to evaluate left ventricular function under stress: this would be a waste of resources, in many cases, with no benefit for the patient and the system. It should be used, rather, as the "smart cardiologist's second choice," when stress echocardiography is not feasible and/or yields ambiguous results. For perfusion imaging, stress CMR (with adenosine or dipyridamole) can already be used as "the smart cardiologists' SPECT." In fact, when compared with stress SPECT, stress CMR has no radiation exposure ("smart patient's SPECT") and at least comparable accuracy. Regarding viability assessment, low-dose dobutamine echocardiography is well established as a specific test with which to predict recovery of function. In ambiguous situations, particularly with high interventional risk due to severely reduced global left ventricular function, late gadolinium enhancement of CMR can add valuable information to help predict outcome after surgery. In this way, we reconcile the top priority of granting the patient the highest possible quality of care with the principle of optimizing use of resources and minimizing long-term risks of radiation exposure.