Vibration-Controlled Transient Elastography (TE) has become the standard of care for the assessment of liver fibrosis, which is crucial in chronic liver diseases in order to determine the prognosis, the need of treatment, as well as monitor disease progression and response to treatment. TE has been well validated in major liver diseases including chronic hepatitis B and C, non-alcoholic fatty liver disease (NAFLD), alcoholic liver disease, primary biliary cirrhosis, and primary sclerosing cholangitis. Otherwise falsely-high LSM results up to cirrhotic range may occur during ALT flare. TE is also useful in predicting patient prognosis such as development of hepatocellular carcinoma (HCC), portal hypertension, post-operative complications in HCC patients, and also survival. Failed acquisition of TE may happens up to 25% in obese patients. Furthermore, obese patients may have higher LSM results even in the same stage of liver fibrosis. The XL probe, a larger probe with lower ultrasound frequency and deeper penetration, increases the success rate of TE in obese patients. The median LSM value with XL probe was found to be lower than that by the conventional M probe, hence cutoff values approximately 1.2 to 1.3 kPa lower than those of M probe should be adopted. Recent studies revealed a novel ultrasonic controlled attenuation parameter (CAP) of the machine is a useful parameter to detect even low-grade steatosis noninvasively. CAP may also be used to quantify liver steatosis by applying different cutoff values. As both LSM and CAP results are instantly available at same measurement, this makes TE a very convenient tool to assess any patients who are at risk or confirmed to suffer from chronic liver diseases.