RATIONALE AND OBJECTIVES: To assess the impact of adaptive filter postprocessing on quality of ultrasound images. METHODS: Ultrasound images acquired with real-time spatial compound imaging (SonoCT imaging) were subsequently processed with an adaptive real time algorithm (XRES imaging). Conventional and XRES-processed images from abdominal, pediatric or small parts ultrasound explorations were compared. The delineation of borders, tissue contrast, amount of noise, and overall image quality were evaluated. RESULTS: Delineation of borders and tissue contrast were improved on all images (P < 0.05). The amount of noise was reduced (P < 0.05). The overall image quality was improved for abdominal, pediatric and small parts ultrasound explorations (P < 0.05). No image degradation was found. CONCLUSIONS: Adaptive processing provided better image quality without loss of clinically useful information.