A core principle of quality improvement for better outcomes is consistency. With the increased use of medical imaging, incidental findings are more commonly being discovered. There is significant variability in the reporting and follow-up regarding incidental findings. This can lead to confusion for the referring physician unless specific guidance is offered by the radiologist. Other guidelines have also been developed for specific conditions and to help guide the management of the patient. The development, implementation, and use of guidelines can help foster consistency and lead to quality improvement. In this chapter, the scope of the problem and process for development of guidelines will be addressed. Medicolegal and ethical implications of using guidelines are also discussed. Quality is enhanced by decreasing variation in practice and guidelines are an important tool. Guidelines should be broadly acceptable, easy to access, and straightforward to understand and apply. Development of guidelines under the auspices of established professional societies allows for endorsement and dissemination of recommendations. Radiologist adherence to guidelines can enhance informed decision-making, decrease variations in recommendations, decrease cost, and limit medical liability. This has potential to provide standardization, to improve patient care, and to improve confidence of the referring physicians.