{
  "source": "Cooked Index — occupational AI risk register",
  "page": "https://cookedindex.com/jobs/medical-dosimetrists/",
  "methodology": "https://cookedindex.com/methodology",
  "notice": "Verdicts are re-examined as evidence accumulates. Re-fetch before relying on this; the page above always carries the current score.",
  "scored_at": "2026-08-11",
  "model": "claude-opus-5",
  "occupation": {
    "title": "Medical Dosimetrists",
    "soc_code": "29-2036",
    "category": "Healthcare",
    "us_employment": 3410,
    "median_annual_wage": 147470
  },
  "verdict": "EXPOSED",
  "risk_resistance": 42,
  "contested": false,
  "near_boundary": false,
  "dimensions": {
    "task_resistance": 8,
    "embodiment": 7,
    "liability_shield": 9,
    "trust_premium": 6,
    "judgment_accountability": 12
  },
  "reasoning": {
    "task_resistance": "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.",
    "embodiment": "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.",
    "liability_shield": "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.",
    "trust_premium": "Patients almost never learn your name; the relationships that matter are internal ones — the oncologist who knows your judgment on cord tolerance, the physicist who trusts your second check — and those carry weight at a specific institution but are not the product being purchased, which caps this at 6.",
    "judgment_accountability": "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."
  },
  "rationale": "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.",
  "outlook": "By the mid-2030s expect fewer dosimetrists per linac with the remaining roles shifted toward plan auditing, complex-case planning, and physics-adjacent QA rather than hands-on optimization.",
  "what_would_raise_it": {
    "levers": [
      {
        "dimension": "liability_shield",
        "change": "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",
        "plausibility": "plausible",
        "would_add": 5
      },
      {
        "dimension": "liability_shield",
        "change": "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",
        "plausibility": "already happening",
        "would_add": 3
      },
      {
        "dimension": "judgment_accountability",
        "change": "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",
        "plausibility": "plausible",
        "would_add": 4
      },
      {
        "dimension": "task_resistance",
        "change": "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",
        "plausibility": "already happening",
        "would_add": 4
      },
      {
        "dimension": "embodiment",
        "change": "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",
        "plausibility": "already happening",
        "would_add": 4
      }
    ],
    "ceiling_note": "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."
  },
  "adjudication": null,
  "employment_history": {
    "points": [
      {
        "y": 2021,
        "emp": 2400,
        "wage": 127270
      },
      {
        "y": 2022,
        "emp": 3190,
        "wage": 128970
      },
      {
        "y": 2023,
        "emp": 3900,
        "wage": 132880
      },
      {
        "y": 2024,
        "emp": 3970,
        "wage": 138110
      },
      {
        "y": 2025,
        "emp": 3410,
        "wage": 147470
      }
    ],
    "from": 2021,
    "to": 2025,
    "change_pct": 42.1,
    "comparable_from": 2021,
    "spans_soc_revision": false
  },
  "pivots": [],
  "license": "https://cookedindex.com/terms"
}