It is well known that the acoustic properties of soft tissue have a dependence on tissue temperature. This is of particular interest in focused ultrasound surgery since the mechanism of action of focused ultrasound surgery is to kill targeted tissue by inducing localized heating by ultrasound absorption, and hence cautery of that tissue. However, the act of localized heating induces a change in the acoustic properties of the targeted tissue and tissue surrounding it. This phenomenon distorts the incoming acoustic wavefront, and has been termed the thermal lens effect for this reason. Furthermore, nonlinear effects in acoustic propagation become non-negligible at the ultrasound intensities required for therapeutic action.

This paper examines the importance of the thermal lens effect and nonlinear tissue properties by simulating a variety of clinically applicable phased array transducer configurations that have not yet been appropriately analysed using a full three-dimensional nonlinear treatment of acoustic propagation. The significance of the thermal lens effect is characterized by comparing the simulation of coupled acoustic and thermal propagation with an uncoupled treatment; neglecting thermal lensing typically produces a movement of 1 to 2 mm in the predicted position of the focus towards the transducer.

The results also show that the classical methods of acoustic propagation can produce grossly erroneous results under certain clinically relevant transducer configurations and that an acoustic field scan with a hydrophone may not accurately predict therapeutic effect.