High-intensity therapeutic ultrasound (HITU) is a minimally invasive and non-ionizing medical procedure used to combat cancers. Faithful characterization of HITU fields is fundamental to ensure patient safety and clinical efficiency. However, standardized quality assurance protocols have not yet been established for HITU, which is a prerequisite for the wide acceptance of HITU as a therapeutic modality. This review discusses the challenges in the acoustic output characterization of HITU and the solutions that have been proposed to overcome this issue. The purpose of this review is to discuss the state of art of the metrological techniques, and invoke new ideas to prompt further development of HITU usage and characterization techniques, to ensure the safe and effective usage of therapeutic ultrasound.