The piezoelectric effect and its converse are the primary means used in biomedical ultrasound for converting acoustical energy into electrical energy and vice versa. Piezoelectricity has found many bioengineering applications ranging from ultrasound imaging and therapeutics, to piezoelectric surgery and microelectromechanical systems, and to biomedical implants with associated energy harvesting. Because of its fundamental importance to the proper functioning of most medical ultrasound systems, it is important to gain a general understanding of the effect, the history of its development and from this, an appreciation of its limitations and advantages in the generation and detection of ultrasound. This article describes the historical evolvement associated with its use in relation to most medical ultrasound applications and is intended to serve as an introduction for non-expert readers.