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As the dairy cow uses body energy reserves in early lactation, body condition scoring has become an integral part of dairy herd management. Several methods based on visual and tactile evaluation have been developed. Problems caused by the subjectivity of these techniques have been reported. Alternative approaches to predict energy reserves or energy balance in dairy cattle include metabolic profiling and measurement of live weight, heart girth, or skinfold thickness. A less common method to assess fat reserves in body tissues is measuring backfat thickness (BFT) by using ultrasound. An ultrasound technique has been established to predict carcass quality in beef cattle. A new aspect is the application of ultrasound as a monitoring tool in dairy herd management where another location has to be evaluated. This technique has been validated by relating BFT to total body fat (TBF) content and carcass BFT. Backfat thickness also has been related to other methods of body condition scoring. Target values for the development of BFT throughout lactation are available. The relationship between BFT and TBF content is highly significant although biased by multiple factors. A change in BFT of 1 mm equates to approximately 5 kg of TBF content. Measuring BFT by ultrasound is of added value compared with other body condition scoring systems because it is objective and precise. Changes in body condition can be detected and evaluated properly.