Ensuring the quality of healthcare delivery is critical, particularly in low- and middle-income countries (LMICs), where access to high-quality services is limited. This chapter explores the role of medical imaging in healthcare systems and examines approaches to measuring and improving its quality. It highlights the gap in access to imaging technologies across different economic settings, emphasizing the significant disparities between high-income countries and LMICs, where limited access to essential imaging technologies like ultrasound, X-ray, computed tomography (CT), and magnetic resonance (MR) scanners significantly hampers timely diagnosis and treatment, further exacerbating health inequities. Tools such as the RAD-AID Radiology-Readiness™ Assessment are employed to assess radiology infrastructure and guide the implementation of optimized, resource-appropriate systems. Monitoring and evaluation frameworks are discussed as essential tools for tracking progress and ensuring continuous improvement in care quality. By employing appropriate key performance indicators, organizations can measure service effectiveness, patient satisfaction, and other critical outcomes against baseline measures. The implementation of accreditation and ongoing staff training is highlighted as critical to maintaining imaging quality, particularly in resource-constrained environments. Root cause analyses further identify the reasons behind poor performance, enabling targeted interventions. This chapter also underscores the importance of patient-reported outcomes in evaluating patient satisfaction and care experiences. Through iterative quality improvement processes, radiology systems can be continuously refined to meet the specific needs of different settings. Ultimately, building effective and sustainable imaging systems requires a context-specific approach that balances resources, patient care priorities, and health system infrastructure.