Automatic segmentation of the arterial lumen from ultrasound images is an important task in clinical diagnosis. In this paper, the Hough transform (HT) was used to automatically extract straight lines and circles from sequences of B-mode ultrasound images of longitudinal and transverse sections, respectively, of the carotid artery. In 10 normal subjects, the specificity and accuracy of HT-based segmentation were on average higher than 0.96 for both sections, whereas the sensitivity was higher than 0.96 in longitudinal and higher than 0.82 in transverse sections. The intima-media thickness (IMT) was also estimated from images of longitudinal sections; the corresponding validation parameters were generally higher than 0.90. To further validate the results, arterial distension waveforms (ADW) were estimated from sequences of images using the HT technique as well as motion analysis using block matching (BM). In longitudinal sections, diastolic and systolic diameters and relative diameter changes using HT and BM were not significantly different. In transverse sections, diastolic and systolic diameters were significantly lower using the HT technique; the differences were <7%. Relative diameter changes in transverse sections were not significantly different from BM-estimated ones. The HT technique was also applied to four subjects with atherosclerosis, in which sensitivity, specificity and accuracy were comparable to those of normal subjects; the low values of sensitivity in transverse sections may reflect departure from the circular model because of the presence of plaque. In conclusion, the HT technique provides a reliable way to segment ultrasound images of the carotid artery and can be used in clinical practice to estimate indices of arterial wall physiology, such as the IMT and the ADW.