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Transcranial transmission of ultrasound is increasingly used in a variety of clinical and research applications, including high intensity ablation, opening the blood brain barrier, and neural stimulation. Numerical simulations of ultrasound propagation in the head are used to enable effective transcranial focusing and predict intracranial fields. Such simulations require maps of the acoustic properties of the head, which can be derived from clinical CT images. However, the spatial resolution of these images is typically coarser than the scale of heterogeneities within the skull bone, which are known to exert a major influence on ultrasound propagation. In the present work, the impact of image related homogenisation on transcranial transmission from a single element transducer is examined using a dataset of co-registered clinical resolution CT and micro-CT images of skull sections. Reference acoustic property maps are derived from micro-CT images of cortical bone tissue. The influence of imaging resolution is examined by progressively downsampling the segmented acoustic property maps, and through comparison with maps derived from co-registered clinical CT images. The influence of different methods of segmenting the bone volume from the clinical CT images, and for resampling the clinical and micro-CT data are also examined. Image related homogenisation is demonstrated to have a substantial effect on the transcranial transmission of ultrasound, resulting in underestimations of simulated transmission loss and time-of flight. Effects on time-of flight are due to the loss of the internal scattering microstructure of the skull, while changes in transmitted ultrasound amplitude are due to both loss of microstructure and other smoothing effects. Inflating the simulated attenuation coefficient of the skull layer reduces the error in transmitted pressure amplitude to around 40%, however this is unable to correct fully for errors in time of flight and the pressure distribution of the transmitted field. [ABSTRACT FROM AUTHOR]