This chapter presents an overview of prominent structural health monitoring (SHM) techniques for damage detection and localization utilizing ultrasonic guided waves (UGWs). The basic principles of SHM described include the application of permanently fixed sensors on the structure combined with the necessity of minimum manual intervention to monitor the structural integrity. The techniques used in SHM, especially tomography and delay-and-sum (DAS) approach, are described in detail. Particular attention is paid to the development of advanced technical capabilities for making the integration of sensors in modern composite structures practical and efficient so as to facilitate industrialization and certification. Therefore, key aspects that have been included are optimization of sensor positioning and influence of changes in environmental conditions on damage detection algorithms. The theoretical descriptions are combined with several benchmark examples involving finite element analysis and experimental measurements. Finally, application to a curved fuselage composite panel with frames and stringers is presented to demonstrate how a multilevel approach could be used to efficiently detect damage in complex structures.