High intensity focused ultrasound has considerable potential for the noninvasive treatment of localised disease. A detailed understanding of the kinetics of tissue coagulation is required to optimise ultrasonic parameters. In this presentation a theoretical model was used to examine the effects of temperature dependent ultrasonic attenuation and absorption on the transient tissue temperature distributions and lesion dimensions. A finite difference algorithm was used to solve numerically the nonlinear form of the bioheat transfer equation in cylindrical coordinates. The lesion dimensions were calculated based on the time-temperature distributions in tissue by using a thermal dose threshold to define the lesion boundaries. The results were compared to published experimental data in which the the location of maximal energy deposition during short duration high intensity focused ultrasound irradiation of in vitro tissue was examined. It was found that the theoretical model did not predict the size and shape of the experimental lesions. To correctly predict lesion size and shape much higher values of attenuation and absorption were required than can be accounted for by thermal coagulation of the tissue alone. The values used suggest that for intensities greater than 3030 W/cm2 the effective local attenuation/absorption in the focal region increased by a factor of 10–20. It is finally shown that temperature dependent tissue changes should be incorporated in thermal models to avoid underestimation of the induced temperature distributions during high intensity focused ultrasound therapy.