Systems and methods for ultrasound shear wave elastography (SWE) are described. According to examples, an ultrasound SWE system includes an ultrasound probe (120), an actuation assembly (130) coupled to the probe and configured to apply an external force against a subject for generating a shear wave within a target region, a controller (140) coupled to the actuation assembly to control the actuation assembly to apply the force responsive to a trigger signal, and ultrasound scanner (110) configured to generate the trigger signal, and further configured to generate an elastography image based at least in part on echo signals received from the target region.