The drugs hepatotoxicity represents a major problem of the iatrogenic pathology, with various manifestations, directly through the hepatotoxic effect or through idiosycrasy reactions. The hepatic affection induced by chemotherapy appears in children in cases of prolonged therapy, chronic diseases, or other associated conditions. Hepatotoxicity clinically develops through hepatic disorder, cholestatic or mixed hepato-cholestatic manifestations and systematic affection. There are no specific hystological or biochemical characteristics for diagnostic of hepatotoxicity. The international criteria for asessing the hepatotoxicity includes the bilirubin, the transaminasis, GGT, FA, albumin and the flow on the vein. It has been noticed that these parameters are not enough for the right assesssment of the chemotherapics' hepatotoxicity. Thus it is required the abdominal ultrasonography and computerised tomography for the identification of billiary tract, vascularisation, associated conditions and the degree of fibrosis; also, the hepatic biopsy may be necessary. The ultrasound elastography is a method which can give information related to the elasticity/stiffness of the examined tissue and degree of fibrosis. Acustic radiation force imaging(ARFI) is an elastographic method which allows valid, accurate and flexible evaluation of liver stiffness, a quantification with a strong correlation with the fibrosis stage, not influenced by steatosis. In conclusion, the hepatic toxicity showed by alterated hepatic biochemical tests and by symptomes of hepatopathy needs a proper appreciation of the hepatic modifications, which can be obtained through hepatic biopsy or by assessing the hepatic elasticity through elastography. Thus, real-time elastography is an useful tool in assessing the chemotherapics hepatotoxicity in children with cancer.