Polaroid used to make a very simple device with an ultrasonic transducer and a digital counting timer. the device would send out a ping, count up until the return pulse was detected. once the return pulse was detected, the count was stopped, and passed to a motor driver circuit, which would step the motor that number of steps. the motor was the focus mechanism for a camera. the count was accurate to within a few inches. i was one of the techs that built the automated test fixture for the camera electronics under contract.
the problem with measuring in nanoseconds is that you need an RTOS (real time operating system) do do the software part of it, and you have to take into account the propagation delays of the signals through the various parts of the electronics.
you could measure in 10 nanosecond increments with a 100Mhz clock, 5 nanosecond increments with a 200Mhz clock or 2 nanoseconds increments with a 500Mhz clock, but the higher the clock frequency, the more propagation delays within the electronics skews the accuracy of the measurements