As an ultrasound wave propagates nonlinearly, energy is transferred to higher frequencies where it is more strongly attenuated. Compared to soft tissue, the skull has strongly heterogeneous material parameters. The authors characterize with experiments and establish a numerical method that can describe the effects of the skull on the nonlinear components of ultrasonic wave propagation for application to high intensity focused ultrasound (HIFU) therapy in the brain. The impact of nonlinear acoustic propagation on heat deposition and thermal dose delivery is quantified and compared to linear assumptions by coupling an acoustic simulation with a heating model for brain tissue.
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