In the 1960s, with the development of weak shock theory by Blackstock and other advances, nonlinear acoustics found growing importance and applications in the atmosphere and underwater. By comparison, during this time frame the field of medical ultrasound remained largely focused on linear mechanisms. Three major subfields within medical ultrasound eventually developed major nonlinear theory and applications: cavitation, lithotripsy, and imaging. Edwin Carstensen’s collaborative research and directorship of the Rochester Center for Biomedical Ultrasound played an important role in these developments. This talk focuses on the development of nonlinear acoustics to clinical imaging, tracing benchmark developments from the 1960s to the early 2000s, under the guiding influence of Ed Carstensen.