Introduction: The simulator is the device that starts the whole process of preparing the
patient for radiation treatment. The conventional simulator showed the patient's structure in
two dimensions. It was followed by a computed tomography (CT) simulator, which allows
three-dimensional (3D) visualisation and thus more accurate radiation treatment planning. It
is still the first choice when preparing a patient for radiation therapy, as it gives us
information about the electron density of the tissues. For greater accuracy, a magnetic
resonance (MRI) simulator is now used in addition, with the main advantage of good soft
tissue visualisation. Purpose: The aim is to explore and describe the role, development and
characteristics of CT, MRI and conventional simulators through a systematic literature
review. The aim of the thesis is to compare the three main types of radiotherapy simulators,
to highlight their advantages and disadvantages, the milestones in the development of
radiation therapy preparation and the possible future directions for the development of
equipment and simulation protocols Methods: We used a descriptive method with a
systematic literature review to develop our thesis. The literature search was conducted from
20 November 2022 to 12 March 2023 on national and international databases, where we
found a total of 4201 scientific articles, which were screened with the Prisma method.
Results: The findings of the articles included in the systematic literature review are
presented in the table below. We focused on the development of different simulation
methods and new equipment, the advantages and disadvantages of each simulator, and
possible improvements to the simulation process as part of the preparation for irradiation.
Discussion and conclusion: Our literature review found that simulators are still being
developed, updated and upgraded. Their main task is to prepare the patient for radiation
treatment and to obtain all the information needed for further planning of the treatment. In
addition to new CT methods, the idea of an MRI-only way of preparing patients for radiation
therapy is gaining ground, potentially replacing the now classical combination of CT and
MRI simulator. Currently, CT simulators are still the leading choice for information on tissue
electron density, but synthetic CT (sCT) images derived from MRI scans are also
increasingly being used to read out Hounsfield units (HU) for radiation treatment planning.
PET/CT is also increasingly used in the radiation planning process.
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