The interaction of ultrasound with tissue leads to radiation pressure, heat generation, and cavitation. These phenomena have been utilised for local gene delivery, transfection and control of expression. Specially designed nanocarriers or adapted ultrasound contrast agents can further enhance local delivery by: (1) increased permeability of cell membranes; (2) local release of genes. Biological carriers may also be used for local gene delivery. Stem cells and immune cells appear especially promising because of their homing capabilities to lesion sites. Imaging methods can be employed for pharmacodistribution and pharmacokinetics. MRI contrast agents can serve as non-invasive reporters on gene distribution when co-delivered with the gene. They can be used to label nanocarriers and cellular transport systems in gene therapy strategies such as those based on stem cells. Finally, ultrasound heating together with the use of a temperature sensitive promoter allows a local, physical, spatio-temporal control of transgene expression, in particular when combined with MRI temperature mapping for monitoring and even controlling ultrasound heating.