Real-time scanning was applied to the sonically guided puncture technique. A special puncture attachment connected to the ultrasound sector scanner was developed for this purpose. A puncture needle is introduced into the scanning plane through the canal in the attachment. Excellent real-time images of both the target lesion and the needle can be clearly seen on the oscilloscope during the puncture procedure. Puncture not only for cystic structures but also for solid masses can be made easily and safely by this new technique. Successful applications of the technique have been carried out for renal cyst puncture, percutaneous antegrade pyelography, percutaneous nephrostomy, percutaneous renal biopsy, and perineal prostatic biopsy.