(IPA) The pulse average intensity is the average intensity during the ultrasound pulse.

Pulsed ultrasounds are cycles of ultrasound separated in time with gaps of no signal. Pulsed sound waves are generated by short, strong pulses of sound from a phased array of piezoelectric crystals. The transducer, though emitting ultrasound in rapid pulses, acts as a receiver most of the time. In sonography, pulsed ultrasound is used to perform diagnostic or therapeutic procedures.

See also Pulse Average Intensity, Release Burst Imaging.

(ITA) The time average intensity is the average ultrasound intensity calculated over the time between pulses.
Time average intensity = Pulse average intensity x Duty factor
For ultrasound systems, the instantaneous intensity is averaged over one or more scan repetition periods for a specified scan mode.

(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.

(HIFU / FUS) High intensity focused ultrasound is used in thermotherapy or thermoablation e.g., for the treatment of benign prostate hyperplasia or under study for the treatment of cancer.
An applied ultrasound probe (see transrectal sonography) focuses sound waves at one spot, elevating the tissue temperature to a point that the tissue destroys. Generally, lower frequencies (from 250 kHz to 2000 kHz) are used than for medical diagnostic ultrasound, but significantly higher time-averaged intensities.

See also Magnetic Resonance Guided Focused Ultrasound, Low Intensity Pulsed Ultrasound, and Lithotripsy.