{ "source": "Cooked Index — occupational AI risk register", "page": "https://cookedindex.com/jobs/radiation-therapists/", "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": "Radiation Therapists", "soc_code": "29-1124", "category": "Healthcare", "us_employment": 17070, "median_annual_wage": 105310 }, "verdict": "SAFE", "risk_resistance": 67, "contested": false, "near_boundary": true, "dimensions": { "task_resistance": 13, "embodiment": 17, "liability_shield": 13, "trust_premium": 14, "judgment_accountability": 10 }, "reasoning": { "task_resistance": "At 13 the manual setup — immobilization masks, tattoo/surface-mark alignment, couch shifts from CBCT match, and daily side-effect checks — stays human, but a real share of the shift (record-and-verify checks, IGRT auto-registration, chart QA, ARIA/Mosaiq documentation, appointment sequencing) is already being handed to software, which is what keeps it out of the 14+ band.", "embodiment": "17 reflects that the work happens with hands on a semi-clothed, sometimes nauseated or intubated patient in a vault, lifting and rolling them onto an index bar, seating a thermoplastic mask, and clearing a 6 MV gantry's collision path — variable bodies and variable rooms, though the machine and the vault itself are fixed and controlled, which is why it isn't 19.", "liability_shield": "13 fits ARRT(T) certification plus state licensure in most states, with the therapist personally signing the daily treatment record and the wrong-site/wrong-dose misadministration reportable under state radiation control regs — but the prescription, dose, and plan approval belong to the radiation oncologist and medical physicist, so the deepest liability sits above you.", "trust_premium": "14 is earned by 25-40 consecutive weekday appointments where you are the one who notices the skin breakdown, the weight loss loosening the mask fit, and the patient who stopped talking — continuity no one else on the care team has — while the referral and the trust in the treatment itself still route through the oncologist.", "judgment_accountability": "10 is right because the prescription, fractionation, and tolerances are written for you and out-of-tolerance shifts get escalated to physics or the physician, but you decide in real time whether today's match is good enough to treat, whether a shift needs a re-sim, and whether to stop the beam — genuine calls made alone in the console, inside a defined envelope." }, "rationale": "The job is physically positioning frightened, often frail patients to sub-millimeter tolerance on a linear accelerator, verifying setup against imaging, and running the beam — none of which current robotics can do in an uncontrolled clinical room. AI is already absorbing the adjacent screen work (treatment plan checks, auto-contouring, image registration, dose record documentation, scheduling), so the informatics side of the role thins while the daily hands-on delivery persists. Patients see the same therapist every weekday for six weeks, which makes the relationship, not the button-press, the durable part.", "outlook": "Headcount stays roughly flat to slightly up with cancer incidence; AI takes the planning and documentation hours, so the surviving job is more patient-side and more precision-setup than it is today.", "what_would_raise_it": { "levers": [ { "dimension": "liability_shield", "change": "State radiologic technologist licensure laws (e.g. the long-pending federal CARE Act, plus states like Idaho/Missouri that still lack RT licensure) extending mandatory licensure to all radiation therapists, combined with ARRT/ASRT-backed rules requiring a licensed therapist to personally attest to daily setup verification and any AI-suggested shift before beam-on — making the attestation individually, not institutionally, liable", "plausibility": "plausible", "would_add": 3 }, { "dimension": "liability_shield", "change": "NRC/state radiation-control 'medical event' reporting rules or a Joint Commission element of performance naming a credentialed therapist as the required human check on AI-generated online adaptive replans (as on Varian Ethos / Elekta Unity workflows), so an autonomous adaptive plan cannot be delivered unsigned", "plausibility": "already happening", "would_add": 2 }, { "dimension": "task_resistance", "change": "Task-mix shift as auto-contouring, plan QA and dose documentation are absorbed: the residual day becomes adaptive-therapy decision support, immobilization problem-solving on frail/pediatric/claustrophobic patients, and toxicity triage — the tier machines can't reach. Genuine two-tier occupation, and the routine tier is the one already going", "plausibility": "already happening", "would_add": 2 }, { "dimension": "judgment_accountability", "change": "Formal adoption of online adaptive radiotherapy at scale, where the therapist at console owns the accept/reject call on a daily AI-recontoured plan under time pressure with the patient on the table — ASTRO/AAPM guidance (e.g. AAPM TG-report work on adaptive QA) codifying that authority rather than routing it to a physicist", "plausibility": "plausible", "would_add": 4 }, { "dimension": "trust_premium", "change": "Limited route. Patients do not select their therapist and payment is bundled per-fraction under Medicare's radiation oncology payment structures, so there is no consumer-side price signal for a human. The only realistic lift is proton/pediatric/SBRT centers marketing named continuity-of-care teams, which is marginal", "plausibility": "unlikely", "would_add": 1 } ], "ceiling_note": "Embodiment is near its practical maximum at 17 and cannot rise much; the honest risk is not displacement but headcount compression per linac as adaptive automation lets one therapist cover more fractions, which the register's dimensions don't capture." }, "adjudication": { "method": "two independent runs agreed on the verdict", "outcome": "corroborated", "run_totals": [ 67, 70 ], "run_verdicts": [ "SAFE", "SAFE" ] }, "employment_history": { "points": [ { "y": 2017, "emp": 17250, "wage": 80570 }, { "y": 2018, "emp": 18260, "wage": 82330 }, { "y": 2019, "emp": 17860, "wage": 85560 }, { "y": 2020, "emp": 17390, "wage": 86850 }, { "y": 2021, "emp": 16050, "wage": 82790 }, { "y": 2022, "emp": 15510, "wage": 89530 }, { "y": 2023, "emp": 16640, "wage": 98300 }, { "y": 2024, "emp": 18700, "wage": 101990 }, { "y": 2025, "emp": 17070, "wage": 105310 } ], "from": 2017, "to": 2025, "change_pct": -1, "comparable_from": 2019, "spans_soc_revision": true }, "pivots": [], "license": "https://cookedindex.com/terms" }