In clinical practice, it is important to assess the severity of liver fibrosis in patients with various liver diseases to determine the prognosis, decide treatment, and monitor disease progression and response to treatment. Liver biopsy is limited by its invasiveness and patient acceptability. The development of transient elastography provides clinicians with a non-invasive, accurate, and reproducible tool to estimate liver fibrosis. The technique has been validated among many liver diseases and requires only simple training. Due to its non-invasive nature and ease of use, transient elastography can be used repeatedly on patients, and is optimal for large-scale epidemiological studies, in which stable patients with no indication for liver biopsy can also be included. However, falsely-high liver stiffness measurements might occur during acute hepatitis, extrahepatic cholestasis, congestive heart failure, and amyloidosis. Failed acquisition is also common in obese patients. The development of S and XL probes might cater for different population groups, but calibration in patients with liver biopsy is essential.