An integrated system employing real-time ultrasound thermography and strain imaging in monitoring tissue response to phased-array heating patterns has been developed. The imaging system is implemented on a commercially available scanner (SonixRP) at frame rates > 500 fps with limited frame sizes covering the vicinity of the HIFU focal spot. These frame rates are sufficient to capture tissue motion and deformation even in the vicinity of large arteries. With the high temporal and spatial resolution of our strain imaging system, we are able to capture and separate tissue strains due to natural motion (breathing and pulsation) from HIFU induced strains (thermal and mechanical). We have collected in vivo strain imaging during sub-therapeutic and therapeutic HIFU exposure in swine and rat model. A 3.5-MHz phased array was used to generate sinusoidally-modulated pHIFU beams at different intensity levels and durations near blood vessels of different sizes (e.g. femoral in the swine and rat models). The results show that our approach is capable of characterizing the thermal and mechanical tissue response to sub-therapeutic pHIFU beam. For therapeutic pHIFU beams, the approach is still capable of localizing the therapeutic beam, but the results at the focal spot are complicated by bubble generation.