Effects of focused ultrasound exposure parameters and microbubble concentration on cavitation dose

<b>Objective</b>: Focused ultrasound (FUS) with intravenously administered microbubbles (MBs) enables different therapeutic effects, e.g. localized opening of the blood-brain barrier (BBB). Acoustic activation of MBs under FUS induces mechanical effects-primarily stable or inertial cavitation - that can reversibly disrupt endothelial tight junctions without permanent tissue damage. MB acoustic emissions are widely used as indicators of cavitation activity and, by extension, treatment efficacy and safety. While some aspects of microbubble behavior under different exposure conditions are known, the overall influence of various parameter combinations on cavitation dose remains incompletely described.<b>Approach</b>: This study examined how MB concentration (0.0008-0.4% V/V), peak negative pressure (61.5-2600 kPa), pulse duration (95-952 μs), and effective sonication time affect cavitation activity in a flow setup. Cavitation was quantified as a cavitation dose which was divided into three types: stable harmonic (SCD_har), ultraharmonic (SCD_ultra), and broadband (ICD) emissions.<b>Results</b>: SCD_harand ICD increased mostly monotonically with pressure and MB concentration, while SCD_ultrapeaked at intermediate values suggesting optimal parameters for the control of the ultrasound BBB opening procedure. Cavitation metrics showed 10% reproducibility. Critically, we found that for fixed effective sonication times, increasing the number of pulses led to significantly change the response of cavitation dose in time. To our knowledge, this relationship has not been studied before, change of pulse length was always related to effective sonication time. Our results suggests that pulse number is an important factor of how MB oscillate, introducing a potentially pivotal control parameter for therapeutic ultrasound.<b>Significance</b>: These findings provide new insights into MB dynamics and highlight pulse count as an underrecognized yet potentially important factor in protocol design. This perspective may inform refinements of FUS treatments, contributing to greater safety, consistency, and efficacy, and represents a step toward optimizing ultrasonic BBB opening strategies.