High-intensity focused ultrasound is used in many therapeutic applications such as drug activation/drug delivery, hyperthermia, cancer therapy, ultrasound surgery and myocardial ablation. Various ultrasonic systems have been proposed for these therapeutic applications. While many applicators produce adequate power levels, multiple element ultrasound phased arrays adjust for phase aberrations, focus around obstructions such as bone and/or air spaces (lungs), and follow, in real time, a moving target. Since large aperture arrays with several hundred elements are required, design compromises keep the element count and fabrication cost at a reasonable level. These trade-offs, which optimize the array aperture with respect to element count, often result in a non-ideal aspect ratio (element width to thickness), leading to lateral mode vibrations which reduce the electrical to acoustical efficiency to about 10 - 20%. These vibrations are easily observed with a laser interferometer system. Piezo composite technology, which eliminates the non-ideal aspect ratio by dividing the individual array elements into long, thin rods, provides a solution to this problem. The spaces between the rods are filled with a polymer to provide structural support and allow deposition of electrode layers to interconnect individual rods and to outline array elements. Several piezo composite transducers have been tested, and initial results show a greatly improved beam pattern and increased efficiency. Power handling capability of composites has recently improved allowing outputs in excess of 10 watts/cm2 with efficiencies greater than 60%. This is sufficient for many therapeutic applications.