This paper presents an ultrasound transceiver ASIC designed for 3-D ultrasonic imaging of the carotid artery. This application calls for an array of thousands of ultrasonic transducer elements, far exceeding the number of channels of conventional imaging systems. The 3.6 × 6.8 mm 2 ASIC interfaces a piezo-electric transducer array of 24 × 40 elements, directly integrated on top of the ASIC, to an imaging system using only 24 transmit and receive channels. Multiple ASICs can be tiled together to form an even bigger array. The ASIC, implemented in a 0.18 μm high-voltage BCDMOS process, consists of a reconfigurable switch matrix and row-level receive circuits. Each element is associated with a compact bootstrapped high-voltage transmit switch, an isolation switch for the receive circuits and programmable logic that enables a variety of imaging modes. Electrical and acoustic experiments successfully demonstrate the functionality of the ASIC. In addition, the ASIC has been successfully used in a 3-D imaging experiment.