Abstract Ultrasound image segmentation deals with delineating the boundaries of structures, as a step towards semi-automated or fully automated measurement of dimensions or for characterizing tissue regions. Ultrasound tissue characterization (UTC) is driven by knowledge of the physics of ultrasound and its interactions with biological tissue, and has traditionally used signal modelling and analysis to characterize and differentiate between healthy and diseased tissue. Thus, both aim to enhance the capabilities of ultrasound as a quantitative tool in clinical medicine, and the two end goals can be the same, namely to characterize the health of tissue. This article reviews both research topics, and finds that the two fields are becoming more tightly coupled, even though there are key challenges to overcome in each area, influenced by factors such as more open software-based ultrasound system architectures, increased computational power, and advances in imaging transducer design.