A dual-mode ultrasound system provides real-time imaging and therapy delivery using the same transducer elements of a transducer array. The system may use a multi-channel driver to drive the elements of the array. The system uses a real-time monitoring and feedback image control of the therapy based on imaging data acquired using the dual-mode ultrasound array (DMUA) of transducer elements. Further, for example, multi-modal coded excitation may be used in both imaging and therapy modes. Still further, for example, adaptive, real-time refocusing for improved imaging and therapy can be achieved using, for example, array directivity vectors obtained from DMUA pulse-echo data.