EXPOSED
The core of the job — building and optimizing radiation treatment plans on a TPS workstation — is exactly the target of knowledge-based planning, auto-contouring, and vendor auto-planning tools that already produce clinically usable plans in minutes for prostate, breast, and standard head-and-neck cases. What persists is plan evaluation under competing constraints (organ-at-risk tradeoffs in re-irradiation, unusual anatomy, brachytherapy and SBRT cases), second-check QA, and being the person in the room with the physicist and radiation oncologist when a plan is deviated from. The occupation isn't licensed at the state level in most places — CMD certification plus physician sign-off is the shield — so protection comes from institutional QA culture more than statute.
Headcount grew steadily across the period.
This line is counted by the Bureau of Labor Statistics — the one figure on this page that isn't a judgement of ours. Headcount moves on demand, offshoring, demographics and the business cycle, and automation is one term among several, often not the loudest.
So a falling line is not evidence that AI did it, and a rising one is not evidence that it won't. Both happen in this register: some occupations resist automation and shrink anyway, others are highly automatable and keep growing.
BLS projection, 2024–2034
+3.5%
Percentage only. The projection counts a different population from the 3,410 above — it includes self-employed workers, which for this occupation is most of them, so the two headcounts are not comparable.
Exposed, but growing
AI can already do a lot of these tasks, and the BLS still expects +3.5% more of these jobs by 2034. Demand for the output is growing faster than the work is being automated away — the mechanism BLS gives for software developers, and the combination people most often misread as an error.
Different clocks. The score is what current AI could do to this work today. The projection is how many of these jobs will exist in 2034. Everything between the two — how fast employers actually adopt, whether demand grows in the meantime — is why they can point opposite ways without either being wrong.
~200 openings a year on average, including replacing people who leave.
DosimetristMedical PhysicistMedical DosimetristRadiation DosimetristMedical Radiation DosimetristCMD (Certified Medical Dosimetrist)Radiation Oncology Medical PhysicistRadiation Therapy Dosimetrist (RT Dosimetrist)
Holding it up: judgment & accountability . Weakest point: trust premium .
Mixed — a routine tier and a judgment tier Beam angle selection, MLC segmentation, dose-volume optimization loops, and DVH review are all keystroke work inside Eclipse/RayStation/Monaco that vendor auto-planning and knowledge-based planning already reproduce for the standard prostate, whole-breast, and 3D palliative cases that fill most queues — the 8 reflects that the surviving irreducible work is narrower: fusing a re-irradiation case against prior dose, HDR applicator reconstruction, and catching a contour error the model propagated silently.
Some physical or field component You are physically present for CT/MR sim on complex cases, in the vault for HDR applicator geometry and catheter reconstruction, and doing hands-on ion chamber/film measurements for patient-specific QA on some setups — but that is a fraction of a week otherwise spent seated at dual monitors, which is why this sits at 7 rather than up with therapists who position patients daily.
Certification preferred, not legally required MDCB certification is the credential most employers require and Texas is nearly alone in licensing dosimetrists, so when a plan error reaches a patient the medical event report under 10 CFR 35.3045 lands on the authorized user physician and the medical physicist who signed the plan check — a 9 credits the real barrier that no hospital lets an uncertified person plan, without pretending you hold personal statutory liability.
Meaningful discretion Choosing which OAR constraint to break when the PTV abuts brainstem, deciding whether a 2 mm shift on a fused prior plan is acceptable cumulative dose, and flagging a plan you believe is unsafe are genuinely ambiguous calls you make first — the 12 rather than higher is because the physician's signature and the physics plan check both sit downstream of every decision you make.
The verdict above describes this occupation as a whole. Almost nobody does the typical version of a job — tick what's actually in your week and see how your own mix sits.
Your task mix speaks to task resistance (8/20 here) — how much of the day's work current AI already does. That is the dimension the boxes above are about.
It cannot move the other three. Liability shield (9/20) is whether the law requires a licensed human to sign. Trust premium (6/20) is whether buyers specifically pay for a person. Judgment and accountability (12/20) is whether the role exists to own consequential calls. Those are facts about the occupation's standing, not about which tasks are in your week — a paralegal who does only trial exhibits still holds no licence. Together they are 27 of this occupation's 42 points (64%).
Embodiment (7/20) is also a property of the work rather than the worker, but we don't tag individual tasks as physical or not, so the picker can't tell you anything about it. That's a limit of this tool, not a claim.
Did we get the list right? Tell us what's missing — the tasks are written from the outside, and you're reading this from the inside.
No occupation passed every test: close enough to medical dosimetrists on skills and subject matter, at least 10 points more resistant, no big jump in training, no new licence, no pay cut, and not shrinking on its own. That happens for 223 of the 654 occupations here that aren't SAFE, and it is worth stating plainly rather than leaving the section off.
The usual reason is that exposure travels with the skill profile. The jobs most similar to yours tend to be exposed for the same reasons yours is, so the near neighbours don't clear the gap — and the ones that do are a different kind of work, not a transfer of what you already know. Read that as a limit of this method, not a verdict that you're stuck: it only compares whole occupations, and it cannot see specialisation, industry, or anything you'd bring that isn't in a federal skill survey.
Here is that claim on your own job rather than in the abstract. These are the three occupations closest to this one by skill and subject matter — the places the work would most naturally transfer — with what the register scores them:
That is the whole problem in three lines. The nearest work is not meaningfully safer, so there is no move here that trades a similar skill set for a better verdict. This is not us running out of ideas — it is what the neighbourhood looks like.
The moves above are yours to make. This is the other half: what would have to change in the world for the occupation itself to score higher. None of it is in any one person's gift, but it is where the floor actually comes from. Scores here are not a one-way ratchet. Only two of the five dimensions — task resistance and embodiment — track what machines can do. The other three track law, what buyers will pay for, and who is answerable, and those move in both directions, often in response to the same pressure AI creates. If every lever below landed, this occupation would score around 62/100, still EXPOSED.
Genuine two-tier structure: if vendor auto-planning absorbs standard prostate/breast/H&N, the residual day is re-irradiation dose accumulation, deformable registration QA, brachytherapy and SBRT planning, adaptive online replanning at the console under time pressure, and proton/particle cases — work current tools do not close. Watch for the case-mix shift in department workload logs rather than any new rule
Growth of online adaptive radiotherapy (Varian Ethos, MR-Linac) requiring a dosimetrist physically at the console during the fraction to re-optimize while the patient is on the table; if adaptive fractions become a large share of treatments, presence becomes non-substitutable
AAPM/ASTRO practice guidelines (e.g., MPPG-style documents and ASTRO's Safety Is No Accident) being written so that any auto-generated or knowledge-based plan requires documented independent review by a CMD before physicist second-check — and accreditation bodies (ACR/ASTRO APEx, ACRO) auditing for that specific attestation
State-level licensure of medical dosimetrists — Texas already licenses them (HB 1889, in effect since 2012) and Florida requires registration; if additional states adopt licensure acts naming the CMD as the person who must sign the treatment plan record, and NRC/state radiation control programs write dosimetrist sign-off into Part 35-style medical event reporting, the shield becomes statutory rather than institutional
Formalizing the dosimetrist as the named owner of the AI-plan override decision in the electronic chart — a discrete 'auto-plan accepted/rejected with rationale' field in ARIA/MOSAIQ that is discoverable in litigation and reviewed at morbidity conference
The limit. Trust premium has no realistic route: patients do not select or know their dosimetrist, and there is no consumer-facing market to pay a premium into. Total headcount is small enough that even full licensure protects a shrinking number of seats if per-plan time collapses.
| New York-Newark-Jersey City, NY-NJ | 280 | $176,030 +19% |
| Houston-Pasadena-The Woodlands, TX | 130 | $133,240 -10% |
| Chicago-Naperville-Elgin, IL-IN | 110 | $165,620 +12% |
| Dallas-Fort Worth-Arlington, TX | 90 | $159,570 +8% |
| Atlanta-Sandy Springs-Roswell, GA | 80 | $156,040 +6% |
| Washington-Arlington-Alexandria, DC-VA-MD-WV | 80 | $156,290 +6% |
| Detroit-Warren-Dearborn, MI | 70 | $139,210 -6% |
| Philadelphia-Camden-Wilmington, PA-NJ-DE-MD | 60 | $156,090 +6% |
| Seattle-Tacoma-Bellevue, WA | 40 | $204,840 +39% |
| Tampa-St. Petersburg-Clearwater, FL | 40 | $177,250 +20% |
| New York-Newark-Jersey City, NY-NJ | 280 | $176,030 +19% |
We have no reported case of a named organisation automating this occupation. Not one deployment, not one announcement.
That is worth saying out loud next to a score of 42. The verdict above is about what the work exposes — what current AI could do to these tasks. It is not a claim that anyone has done it. For this occupation those two things have come apart completely: the capability argument is on this page, and the evidence column is empty.
Has AI actually changed your work? One tap, anonymous, and the running tally is public. Nothing else is asked of you.
Rather than check back: get the digest and we'll tell you what changed — or watch a single occupation from its own page.