PURPOSE: To develop a superconducting magnetic resonance (MR) imager that provides direct access to the patient and permits interactive MR-guided interventional procedures. MATERIALS AND METHODS: A 0.5-T superconducting magnet that allows a region of vertical access to the patient was designed and constructed. This magnet was integrated with newly designed shielded gradient coils, flexible surface coils, and nonmagnetic displays and with position-monitoring probes and device-tracking instrumentation. RESULTS: The magnet homogeneity was 12.3 ppm, and the gradient field was linear to within 1% over an imaging region 30 cm in diameter. The signal-to-noise ratio was 10% higher than in a comparable 0.5-T superconducting imager. Images were obtained in several anatomic regions with use of routine pulse sequences. Interactive image plane selection and near real-time imaging, with use of fast gradient-recalled echo sequences, were demonstrated at a rate of one image every 1.5 seconds. CONCLUSION: MR-guided interventional procedures can be performed with full patient access with use of an open-configuration, superconducting MR magnet with near real-time imaging and interactive image plane control.