In this article, we set out the current context and case for change in radiology in England and how quality-improvement approaches can support the development of sustainable Imaging services and networks to meet the challenges faced now and in the future. • Radiology is facing significant financial and operational pressures. • There are urgent calls for change in Radiology across the entire healthcare system. • National radiology reports and guidance recommend the use of Quality Improvement. • Research shows that Quality Improvement can lead to improvements in Radiology. • Radiology needs support to develop improvement capability, capacity, and confidence. [ABSTRACT FROM AUTHOR]