Abstract Background Ultrasound is a useful and popular imaging modality. Our aim was to assess the association between the use and repeat use of abdominal ultrasound and diagnosis, physicians, and hospital characteristics according to a Taiwanese national database. Methods The Taiwan National Health Insurance database contains data for approximately 22,134,270 insured individuals during 2004–2005 (>98% of the population in Taiwan). Patients who were scanned with abdominal ultrasound once or more during that period were identified. Associations between physicians, hospital characteristics, diagnoses, and repeat use of abdominal ultrasound were analyzed. Logistic regression with generalized estimating equations was used. Results A total of 2,319,164 abdominal ultrasound scans were performed (approximately 6.42% of the population in Taiwan). Among these, 38.34% received repeat examinations. Multiple logistic regression analysis showed that gastroenterologists [odds ratio (OR) = 1.07], male physicians, physicians younger than 40 years of age, and physicians in medical centers were more likely to use repeat abdominal ultrasound. The analysis also showed that male patients, older patients, patients with liver and biliary disease (OR = 1.17), and patients with other abdominal disease (OR = 1.37) were more likely to receive repeat abdominal ultrasound. Conclusion Our study shows that the use and repeat use of abdominal ultrasound is very high and is related to diagnosis and physician and hospital characteristics.