ABSTRACT
Background: In recent years, Radiation Therapy (RT) has undergone many developments and provided progress in the field of cancer treatment. However, dose optimisation each treatment session puts the patient at risk of successive X-Ray exposure from Computed Tomography CT scans since this imaging modality is the reference for dose planning. Add to this difficulties related to contour propagation. Thus, approaches are focusing on the use of MRI as the only modality in RT. In this paper, we review methods for creating pseudo-CT images from MRI data for MRI-alone RT. Each class of methods is explained and underlying works are presented in detail with performance results. We discuss the advantages and limitations of each class. Methods: We classified recent works in deriving a pseudo-CT from MR images into four classes: segmentation-based, intensity-based, atlas-based and hybrid methods and the classification was based on considering the general technique applied. Results: Most research focused on the brain and the pelvic regions. The mean absolute error ranged from 80 to 137 HU and from 36.4 to 74 HU for the brain and pelvis, respectively. In addition, an interest in the Dixon MR sequence is increasing since it has the advantage of producing multiple contrast images with a single acquisition. Conclusion: Radiation therapy is emerging towards the generalisation of MRI-only RT thanks to the advances in techniques for generation of pseudo-CT images and the development of specialised MR sequences favouring bone visualisation. However, a benchmark needs to be established to set in common performance metrics to assess the quality of the generated pseudo-CT and judge on the efficiency of a certain method