The State of Medical Dosimetry:

As the professional society for medical dosimetrists, the American Association of Medical Dosimetrists (AAMD) supports the education and training of medical dosimetrists while highlighting the critical importance of teamwork among radiation oncologists, medical physicists, radiation therapists and medical dosimetrists. Each of these roles can have a meaningful impact on the state of medical dosimetry. Some timely topics in the medical dosimetry profession include staffing shortages, limited resources for educational programs and creating balanced staffing models.

The shortage of medical dosimetrists

There is currently a growing shortage of medical dosimetrists. In fact, the 2020 AAMD Medical Dosimetry Workforce Study determined that by 2035 there would be an annual shortage of 50 medical dosimetrists in the United States, which is an increase compared to the undersupply of 10 per year as seen in 2021.¹ It is expected that the peak percentage rate of medical dosimetrist retirement will be between 2025 and 2030, further increasing the demand for medical dosimetrists. This data does not account for any changes in cancer incidence, number of medical dosimetry graduates, or medical dosimetrist workload.¹

While artificial intelligence (AI) has aided in automating certain aspects of contouring and treatment planning, all work completed by AI should be assessed by a medical dosimetrist. The 2020 AAMD Medical Dosimetry Workforce Study data indicated that with AI, the work of the medical dosimetrist has “not decreased but shifted to more review of the AI and collaboration with the physician on how to adapt, modify or optimize the outcome.²

Additional changes to the profession regarding education and certification have also contributed to the shortage. With the elimination of on-the-job training in 2017 as a route to certification, individuals are now required to hold a baccalaureate degree and complete a medical dosimetry education program accredited by the Joint Review Committee on Education in Radiologic Technology (JRCERT) to be eligible for certification by the Medical Dosimetrist Certification Board (MDCB). An MDCB candidate must pass a test with “performance-based questions” in order to verify that applicants are able to “apply learned skills and knowledge.”^4a Certified medical dosimetrists are life-long learners and must complete “50 continuing education credits in each five-year cycle” to maintain certification.^4b

A focus on education and training

To address the shortage, concerted efforts are needed to expand education and training programs for aspiring medical dosimetrists. The 17 JRCERT-accredited medical dosimetry programs are limited in their enrollment capacity by the number of clinical sites available. We urge institutions to become clinical sites for medical dosimetry programs, providing necessary hands-on experience. Radiation oncology professionals can pass on knowledge from their practice to set students up for success. Additionally, career fair participation and school outreach are needed to bring awareness to the profession and attract aspiring medical dosimetrists.

It is imperative to invest in the development of an educational curriculum that equips students with the knowledge and skills needed to excel in their roles. In 2023, the AAMD awarded $170,000 in grants to JRCERT-accredited medical dosimetry education programs. The grants are being utilized to add more software, training and resources to better prepare graduates for their clinical roles.

Furthermore, ongoing professional development opportunities are essential for medical dosimetrists to stay abreast of emerging trends and techniques in radiation oncology. The AAMD assists medical dosimetrists with their continuing education to maintain certification and network through different avenues. The online Continuing Education Center is a resource for those unable to travel due to shrinking budgets. Annual and regional meetings help dosimetrists to network in person and gain valuable information to take back to their radiation oncology departments. Learning from each other is priceless and drives the profession forward!

Staffing models in the wake of COVID-19

The COVID-19 pandemic brought about unprecedented challenges for health care professionals, including medical dosimetrists. Many transitioned to remote or hybrid work models to ensure continuity of care. According to the latest data from the 2023 AAMD Salary Survey, there was a 6% increase in fully remote medical dosimetrists when compared to data from the 2021 AAMD Salary Survey.² The AAMD MedDos Infinity Task Group further stated, “Each radiation oncology work environment should collaboratively determine the scope of what work is able to be addressed remotely and what needs to be done on site in the support of patient care based on the unique role and responsibilities of the Medical Dosimetrists.³

Staffing models have become a hot topic in radiation oncology, specifically medical dosimetry. This is because hybrid work can be helpful where teams have evaluated and figured out what works well for the team. Conversely, some departments may find hybrid work a hindrance if they haven’t figured out the right balance or how to leverage technology tools. It is highly important to assess and reassess what’s working within the department. Remote work should be acknowledged as a resource for some rural areas or high cost of living segments of the country which may struggle to attract dosimetry talent. A hybrid model can help create work-life balance for those with long commutes, while keeping a physical presence to maintain interdepartmental team building. The best practice is to continue to keep an open dialogue between all departments and administration to determine the proper balance for the radiation oncology department’s staffing solution.

The value of medical dosimetrists

Tenured medical dosimetrists who appreciate their institution’s nuances can increase operational efficiencies and bridge the gap between many departments. For example, the medical dosimetrist may assist in the insurance authorization processes by creating comparison plans to indicate the need for advanced treatment techniques.

With the advancement of AI and workplace philosophies of doing more with less, it’s more important than ever to keep constant vigilance to promote patient safety. As radiation therapists are the final check before beam on, medical dosimetrists can be an ally in cross-checking patient information too. For example, a well-trained medical dosimetrist can keep an eye out for abnormalities upon fusion or question and confirm unusual contours. Medical dosimetrists can also assist in verifying prescriptions in the record and verify systems are consistent with the doctor’s directives/contour names. Good catches happen when employees feel safe to speak up no matter what level they are at within the organization.⁵

Additionally, as patients live longer and re-treatment and cases of prior radiation rise, communication is vital to deliver treatments safely. A communicative department can help foster great collaborations between physicists, physicians and medical dosimetrists to determine the best approach for challenging case presentations. Building strong interdepartmental teams helps reduce the risk of miscommunications and inefficiencies.

Adapting to the future of medical dosimetry

With continued challenges related to radiation oncology staffing models and advancements in technology, medical dosimetrists will remain steadfast in our commitment to teamwork, innovation and patient-centered care.

As an example, adaptive radiotherapy is an evolving modality that has started to become more commonplace. This new approach to treatment comes with a lot of logistical decisions to be made. The duties involved with adaptive radiotherapy don’t always align within the scope of practice each radiation oncology profession historically has outlined. The workflow of adaptive radiotherapy has made it imperative for all radiation oncology professions to work together to delineate who is serving each role in the process of an adaptive treatment. In a point/counterpoint paper published in the Journal of Applied Clinical Medical Physics, both viewpoints on adaptive radiotherapy highlighted the need for medical dosimetrists to be involved in the planning process. They said, “Both Physicists and Dosimetrists contribute distinct perspectives and strengths to patient care” and “by focusing on training Dosimetrists instead of taking over their responsibility, Medical Physicists create a synergistic environment where multiple disciplines work together to leverage the benefits of new technologies.”⁶ This further reinforces our viewpoint that adaptive radiotherapy is a team effort that needs to include all radiation oncology specialties. Together, we can overcome challenges, drive progress and continue to make a meaningful difference in the lives of the patients we serve.