The acoustic power of sound and ultrasound is the energy delivered per unit of time. The power is measured in Watt (W) and is proportional to the square of the amplitude.
1 W = 1 joule/second.

See also Directivity Index, Spatial Average Intensity, and Source Level.

(MI) The mechanical index is an estimate of the maximum amplitude of the pressure pulse in tissue. It is an indicator of the likelihood of mechanical bioeffects (streaming and cavitation). The mechanical index of the ultrasound beam is the amount of negative acoustic pressure within a ultrasonic field and is used to modulate the output signature of US contrast agents and to incite different microbubble responses.
The mechanical index is defined as the peak rarefactional pressure (negative pressure) divided by the square root of the ultrasound frequency.
The FDA ultrasound regulations allow a mechanical index of up to 1.9 to be used for all applications except ophthalmic (maximum 0.23). The used range varies from 0.05 to 1.9.
At low acoustic power, the acoustic response is considered as linear. At a low MI (less than 0.2), the microbubbles undergo oscillation with compression and rarefaction that are equal in amplitude and no special contrast enhanced signal is created. Microbubbles act as strong scattering objects due to the difference in impedance between air and liquid, and the acoustic response is optimized at the resonant frequency of a microbubble.
At higher acoustic power (MI between 0.2-0.5), nonlinear oscillation occurs preferentially with the bubbles undergoing rarefaction that is greater than compression. Ultrasound waves are created at harmonics of the delivered frequency. The harmonic response frequencies are different from that of the incident wave (fundamental frequency) with subharmonics (half of the fundamental frequency), harmonics (including the second harmonic response at twice the fundamental frequency), and ultra-harmonics obtained at 1.5 or 2.5 times the fundamental frequency. These contrast enhanced ultrasound signals are microbubble-specific.
At high acoustic power (MI greater than 0.5), microbubble destruction begins with emission of high intensity transient signals very rich in nonlinear components. Intermittent imaging becomes needed to allow the capillaries to be refilled with fresh microbubbles. Microbubble destruction occurs to some degree at all mechanical indices. A mechanical index from 0.8 to 1.9 creates high microbubble destruction. The output signal is unique to the contrast agent.

Increasing the frequency of the transmitted power improves the image quality of ultrasound, but the improvement in resolution results in a decreased signal to noise ratio (SNR). Higher acoustic power levels can prevent the loss in SNR, but among other reasons, ultrasound regulations limit this to avoid heating or cavitation.
Coded excitation increase the signal to noise ratio without the loss of resolution by using coded waveforms. Coded excitation allows transmitting a long wide-band pulse with more acoustic power and high penetration of the sound beam.

Cross-section scattering is a measure of the scattering strength of a point scatterer. The scattering strength is dependent on the size of the scatterer, the density and compressibility of the scatterer and the surrounding medium, and the ultrasound wavelength.
If a transducer emits ultrasound with a total acoustic power of P, and the power is assumed to be uniform distributed over the US beam cross-sectional area, then the ultrasound intensity at a certain range, is defined by:
I = P/A
where I is the intensity, and A is the cross-sectional beam area at that range.
A point scatterer located in the ultrasound beam at this range, will scatter the ultrasound with a total acoustic power of Ps, defined by:
Ps = I s
where s is the scattering cross-section of the point scatterer.

(ESWL) Extracorporeal shock wave lithotripsy is a special use of kidney ultrasound, where high intensity focused ultrasound pulses are used to break up calcified stones in the kidney, bladder, or urethra. Pulses of sonic waves pulverize dense renal stones, which are then more easily passed through the ureter and out of the body in the urine. The ultrasound energy at high acoustic power levels is focused to a point exactly on the stone requiring an ultrasound scanning gel for maximum acoustic transmission.
Air bubbles in the ultrasound couplant, regardless of their size, degrade the performance of Lithotripsy and have the following effect:
Air bubbles smaller that 1/4 wavelength cause scattering of the sound waves as omni directional scatterers and less acoustic energy reaches the focal point. The result is less acoustic power at the focal point to disintegrate the kidney stone.
Air bubbles larger than 1/4 wavelength act as reflectors and deflects the acoustic energy off in a different direction. These results in less acoustic energy at the focal point.
Microbubbles dispersed throughout the ultrasound couplant layer change the average acoustic impedance of the gel layer (which reduces the total transmitted energy) and, due to refraction, change the focal point.