OBJECTIVES: In the 2001 policy statement from the American College of Emergency Physicians, they  considered a large number of conditions as primary indications for emergency ultrasonography (US). Early trials of US did not take place in emergency departments (EDs) and the US interpreter was not an emergency physician (EP). The objective of this review was to determine if there is evidence to evaluate whether US conducted by non-radiologists in a small emergency department is an effective diagnostic tool. METHODS: A systematic review was conducted to identify health technology assessments (HTAs), systematic reviews (SRs), meta-analyses (MAs), randomized controlled trials (RCTs), and controlled clinical trials published in the last 5 years. RESULTS: The search identified nine trials, and two systematic reviews. The primary indications in these reports were: trauma, deep vein thrombosis (DVT), pain, undifferentiated hypotension and US-guided procedures. Reports regarding US-guided procedures took place in small EDs and the success rates of US-guided cannulation were significantly larger compared to the traditional technique. Sensitivity and specificity estimates for EP performed US in the diagnosis of trauma, and DVT are high, and similar to those reported when radiologists interpreted the US scans. The addition of US in diagnosing pelvic pain increases physician confidence and was especially valuable in the evaluation of a patient who is also obese. The addition of an US protocol to standard care afforded physicians the ability to compile a significantly shorter and more accurate list of possible causes of non-traumatic undifferentiated hypotension. These results are inferred from trials from large urban hospitals. CONCLUSIONS: Diagnostic estimates obtained when EPs perform the US are comparable to those obtained when the US was performed by a radiologist. US is an effective tool in the hands of EPs in EDs, both small and large.