Despite significant advances made over the past decade in ultrasound (US) and magnetic resonance imaging (MRI) for guidance and assessment of high intensity focused ultrasound (HIFU) treatments many challenges remain. Recent developments address clinically relevant barriers to image guidance of therapeutic ultrasound. This session will feature invited presentations on (1) the use of MRI temperature mapping in presence of fat, within bone, and moving tissues, (2) dual mode ultrasound array (DMUA) systems for imaging and therapy with the advantage of inherent registration between the image‐guidance and therapeutic coordinate systems, (3) echo decorrelation imaging, providing real‐time feedback about cumulative heat‐induced tissue changes, (4) laparoscopic US imaging and HIFU treatments with special emphasis on the use of US to assess temperature change as well as tissue characteristics; and (5) opportunities for medical physicists to participate in the development, treatment planning, and quality control aspects of image‐guided HIFU therapy. Learning Objectives: 1. To understand the role of various MRI and US technologies in guidance and monitoring of HIFU therapy, including MR temperature mapping, dual mode ultrasound array systems, echo decorrelation imaging for ablation assessment, and laparoscopic US‐guided HIFU 2. To identify opportunities for medical physicists in assessment and deployment of technologies in image‐guided therapeutic ultrasound Dr. Carol is the Chief Development Officer for US HIFU, LLC.