Ultrasound imaging is now in very widespread clinical use. The most important underpinning technologies include transducers, beam forming, pulse compression, tissue harmonic imaging, contrast agents, techniques for measuring blood flow and tissue motion, and three-dimensional imaging. Specialized and emerging technologies include tissue characterization and image segmentation, microscanning and intravascular scanning, elasticity imaging, reflex transmission imaging, computed tomography, Doppler tomography, photoacoustics and thermoacoustics. Phantoms and quality assurance are necessary to maintain imaging performance. Contemporary ultrasonic imaging procedures seem to be safe but studies of bioeffects are continuing. It is concluded that advances in ultrasonic imaging have primarily been pushed by the application of physics and innovations in engineering, rather than being pulled by the identification of specific clinical objectives in need of scientific solutions. Moreover, the opportunities for innovation to continue into the future are both challenging and exciting.