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The development of ultrasound image analysis over the last 2 decades is reviewed.Progress in model-based ultrasound image analysis, 3D ultrasound and ultrasound tissue characterized are discussed.Machine-learning for ultrasound imaging, integration of low-cost ultrasound devices and image analysis, and research at the interface of HCI and medical image analysis are highlighted as possible areas of scientifically interesting growth.Ultrasound Image Analysis advances have been made (from top left, clockwise) in understanding of ultrasound feature extraction, multi-modality registration involving ultrasound (here fetal MRI and fetal ultrasound), ultrasound-based biomarker discovery using machine learning, ultrasound tissue characterization, and organ tracking in 3D and 2D ultrasound using multiple and single scans respectively. All examples taken from research findings published in Medical Image Analysis journal.Ultrasound (US) image analysis has advanced considerably in twenty years. Progress in ultrasound image analysis has always been fundamental to the advancement of image-guided interventions research due to the real-time acquisition capability of ultrasound and this has remained true over the two decades. But in quantitative ultrasound image analysis - which takes US images and turns them into more meaningful clinical information - thinking has perhaps more fundamentally changed. From roots as a poor cousin to Computed Tomography (CT) and Magnetic Resonance (MR) image analysis, both of which have richer anatomical definition and thus were better suited to the earlier eras of medical image analysis which were dominated by model-based methods, ultrasound image analysis has now entered an exciting new era, assisted by advances in machine learning and the growing clinical and commercial interest in employing low-cost portable ultrasound devices outside traditional hospital-based clinical settings. This short article provides a perspective on this change, and highlights some challenges ahead and potential opportunities in ultrasound image analysis which may both have high impact on healthcare delivery worldwide in the future but may also, perhaps, take the subject further away from CT and MR image analysis research with time.