While medical imaging using ultrasound is an established field, technical advances are enabling a range of new-use cases and associated new ultrasound imaging devices. Examples include catheters capable of providing real-time 3D images to guide minimally invasive interventions and wearable devices for new monitoring and diagnostic applications. In contrast with conventional probes, which contain little or no electronics, these new devices need to become “smart”: integrated circuits need to be integrated into the probe to interface in a pitch-matched fashion with the many transducer elements (typically 1000+) needed for real-time 3D imaging. This chapter discusses the challenges associated with the design of such pitch-matched integrated circuits, focusing on strategies for channel-count reduction, beamforming, and digitization. The chapter includes a case study of a state-of-the-art catheter-based design for high-frame-rate 3D intracardiac imaging.