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Note that the additional blue items may have a specific position to be functional. For example, Operating Room, Operating Table requires surgical instruments. These instruments must be in a specific location indicated by the blue arrow. If the blue item isn't blue, then it's not in the right, functional place, and it just becomes decoration.
I nearly put my fist through my monitor when I saw your post. Then I decided instead to say something inflammatory. Then I cooled down even more, and decided since I had the opportunity, I'd go in game, and take another screenshot.
I restarted the final scenario, only this time I made a more sensibly-sized 15x7 Sonography room, put walls all the way around the room, and added a door. This time I also included the buy mode catalogue to prove that I did in fact purchase all of the items the game infers are mandatory for the oporation of a Sonography room. (Believe me, there's nothing on page two of the catalogue listed as mandatory or recommended.) At least now I can say that all attempts have been exhausted.
https://steamcommunity.com/sharedfiles/filedetails/?id=1597420604
https://steamcommunity.com/sharedfiles/filedetails/?id=1597697332
Hovering the cursor over the exam table shows either an equipment table or square table is required (as well as USG). The equipment table must be placed at the end of exam table as indicated by the blue down arrow. Placing the equipment table results in it becoming blue also. This means that the equipment table also requires additional equipment. This is either the ECG or the Shockwave Therapy. Once that equipment is placed on the equipment table. The exam table and the equipment table both lose their blue color as shown in the first picture.
https://steamcommunity.com/sharedfiles/filedetails/?id=1597691471
You are missing either an equipment table or square table, and a ECG or Shockwave Therapy.
ECG and Shockwave Therapy machines cannot be placed in Cardiography rooms. (My Cardiography room did in fact have the required USG machine.)
The culprit was the equipment table at the end of the bed. I thought I had satisfied all of the requirements because of what the build/buy mode catalogue inferred.
https://steamcommunity.com/sharedfiles/filedetails/?id=1597720764
I'm still convinced this is an issue, and the developers either need to get rid of the equipment table requirement for Sonography, or have equipment tables listed as being mandatory in the catalogue.
Also, I found it quite curious that the game didn't blue out your beds for not having any sort of lighting.
Edit: I thought I'd provide a catalogue picture to show that the equipment table isn't listed as being mandatory.
https://steamcommunity.com/sharedfiles/filedetails/?id=1597726996
The light is a requirement for the room, but not a requirement for the exam table, hence the exam table is not blue without it. I believe this is because there are two different lights you can choose from and no SPECIFIC requirement for where that light is placed. The USG machine must be placed in a SPECIFIC and only 1 location. The same is true of the equipment table and whichever equipment is required on it.