We present results from a real-time ultrasound-guided focused ultrasound platform designed to monitor and control bubble activity. A single element transducer is used in a dual-mode fashion to interleave HIFU therapy with imaging pulses. Use of the same element for both therapy and monitoring creates an inherent alignment between the imaging focus and the therapy focus. Field programmable gate arrays (FPGA) control the signal generation and echo reception enabling real-time data processing to detect and control bubble activity with microsecond latency. Results are presented from in vitro experiments in swine liver and bovine cardiac tissue demonstrating the ability to detect bubble activity and control lesion growth at intensities up to 15 kW/m2.