The coupling efficiency of a "dry head" electromagnetic lithotripter (Dornier Compact Delta) was studied in vitro. A fiber-optic probe hydrophone (FOPH-500) was positioned in a test tank filled with degassed water. The tank was coupled through a semi-transparent latex membrane to the water-filled cushion of the lithotripter head, so that bubbles (air pockets) trapped between the two coupling surfaces could be easily observed and photographed. When gel was applied to both the latex membrane and the water cushion, numerous bubbles (some several millimeters in diameter) could be seen at the coupling interface. Hydrophone measurements in the geometric focus of the lithotripter showed that the acoustic pressure could be two times lower when bubbles were present than when they were manually removed. In our in vitro design, trapped bubbles could be easily observed and therefore removed from the acoustic path. However, during patient treatment with a dry-head lithotripter one cannot see whether bubbles are trapped against the skin. This study provides a demonstration of the dramatic effect that trapped bubbles can have on the amount of acoustic energy actually delivered for treatment.