Ultrasound image is the primary (input) information for every ultrasound examination. Despite the difficulties of ultrasound image interpretation, this source of information is still significant for diagnosis decision making. This paper describes the experience of SonaRes diagnostic decision support system (DDSS) for ultrasound examination development. Considering two-layer structure of the information contained in ultrasound images, two main approaches in DDSS creation may be distinguished: Image-based systems and Knowledge-based systems. In the SonaRes the advantages of both are combined. In the process of any DDSS development there are three points of major importance, influencing essential the success: i) knowledge acquisition and formalization; ii) image processing and search for similar ones, and iii) interaction with user [1]. SonaRes – represents one of the possible solutions to these problems aimed at increasing the DDSS functionality, user attitude and, as a result, adequacy of generated conclusions.