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How to Become a Radiation Therapist

What is a radiation therapist?

A radiation therapist typically works as part of an oncology team that consists of radiation oncologists, oncology nurses, and medical physicists to treat patients with cancer and other diseases by administering radiation treatments. Radiation therapy is used to treat cancer by shrinking or removing cancer or tumors. Radiation therapists work with patients of all ages, from infants to the elderly. 

Radiation therapists work under the direction of a radiation oncologist, administering prescribed radiation treatments to patients. They operate highly advanced radiation machines called linear accelerators or LINAC. With the machines, radiation therapists can treat any area of a patient’s body by delivering high-energy X-rays or electrons to tumors and cancer cells. The treatment is designed to shrink or eliminate the tumor or cancerous cells over time.

Radiation therapists review and administer treatment plans designed by radiation oncologists and medical physicists. They explain treatment plans and processes to patients and put them at ease before, during, and after the treatment. Radiation therapists use exact settings on LINAC machines to limit healthy cells in the body from exposure to radiation. They maintain the LINAC machines and ensure they are in good working order and up to standards. Radiation therapists record all treatments and keep track of patient progress. They observe patients after treatments for any adverse or unusual reactions to treatments. 

A radiation therapist plays a key role in helping patients in their battles against cancer and other serious diseases. They help patients improve their quality of life, not only by treating them but also by comforting and taking care of them throughout the treatment process.

Qualifications and eligibility

Radiation therapists will need to complete either an associate’s or bachelor’s degree, typically in radiation therapy or radiography. Their education includes biology, anatomy, physics, math, dentistry, and medical knowledge. They need an in-depth understanding of the types of illnesses treated by radiation therapy as well. 

Radiation therapists have to complete a certification program that specializes in radiation therapy or be licensed by the state in which they live and work. Requirements to obtain licensure or certification vary by state, however, most employers prefer to hire certified radiation therapists. In most states, individuals must pass a national certification exam before seeking employment as a radiation therapist. The prerequisites needed to qualify to take the national certification exam include completing an accredited training program or having 2 years of experience in the field. The exam is administered by the American Registry of Radiologic Technologists (ARRT). Certification must be renewed annually.

Some of the top places to receive your radiation therapist certificate are:

  • Mayo Clinic: This one year program is offered by the well-known Mayo Clinic in Minnesota. This is a small program with just 8-10 students per class. For the last 35 years, this program has had a 100% passing rate.
  • Washburn University: This year-long program is perfect for you if you already have an associate’s degree in radiology. This certificate includes your unpaid clinical hours and virtual instruction Monday through Friday. The course runs from July through to the following July.
  • Texas State University: This is a bachelor’s degree program with a 100% employment rate after graduating. Though this may take longer than a technical school, Texas State University is known for its high standards in radiology. The degree will include all of your clinical hours and prepare you to sit for the certification exam.

Work environment

Radiation therapists work in a variety of healthcare facilities, including hospitals, doctors’ offices, universities, and outpatient centers. They spend most of their time on their feet, working closely with patients. They may have to lift or turn patients during treatments, which can be physically demanding at times.

Typical work hours

Most radiation therapists work full time, Monday through Friday, during regular business hours. However, they can be on call in case of emergencies, which can happen at any time day or night.  

Types of radiation therapists

There are two main types of radiation therapy that radiation therapists perform. These are external beams and internal.

External Beam Radiation Therapy

Therapists performing external beam radiation therapy operate a machine called a linear accelerator, that aims high-energy X-rays directly at specific cancer cells in a patient’s body to shrink or remove them. The machine moves around the patients, directing radiation to a specific part of the body from many directions. External beam radiation therapy is the most common type of therapy and is used to treat a specific part of the patient’s body. 

Internal Radiation Therapy

For internal radiation therapy treatments, the source of radiation is put inside the patient’s body. The source might be solid or liquid. 

Brachytherapy

This type of internal radiation therapy involves a solid radiation source, which might be pellets, seeds, ribbons, wires, needles, capsules, balloons, or tubes. The solid is surgically placed in the patient’s body, either in or near the tumor. Brachytherapy is a local treatment that focuses on a specific part of the body, much as external beam radiation therapy does. Brachytherapy typically is used to treat prostate, breast, brain, cervical, eye, gallbladder, head and neck, lung, prostate, and other cancers. The three types of brachytherapy are:

  • Low-dose rate (LDR) – LDR implants emit low doses of radiation for one to seven days. 
  • High-dose rate (HDR) – HDR implants discharge high doses of radiation for 10 to 20 minutes. Typically they are administered twice a day for up to five days or once a week for up to five weeks.
  • Permanent – permanent implants emit radiation continuously until there’s no radiation left in them. The implants, about the size of a grain of rice, remain in your body. 

Systemic therapy

This type of internal radiation therapy uses a liquid radiation source. It’s called systemic because the treatment travels in the blood to tissues throughout the patient’s body, where it seeks out and kills cancer cells. Systemic radiation therapy can be administered by mouth, through a vein via an IV line, or by injection. Systemic therapy is used to treat thyroid, bone, prostate, and other cancers. Two common types of systemic therapy are:

  • Radioimmunotherapy – combines a small amount of radioactive material with a special drug called a monoclonal antibody that finds and attaches to cancer cells, allowing the monoclonal antibody to be delivered directly to the cells.
  • Peptide receptor radionuclide therapy (PRRT) – uses radioactive material with a special protein called a peptide to make a radiopeptide, which finds and attaches to certain types of cancer cells and delivers a high dose of radiation directly to the cells.

Income potential

The earning potential for a radiation therapist can vary greatly depending on geographic location, education, experience, and acquired skills.  

  • According to the U.S. Bureau of Labor Statistics, the median annual wage for radiation therapists was $82,790 in May 2021. The lowest 10% earned less than $61,030, and the highest 10% earned more than $128,550. In May 2021, the top industries for radiation therapists were:
    • Outpatient care centers – $121,140
    • Offices of physicians – $82,540
    • Hospitals; state, local, and private – $81,050
  • The average salary for a radiation therapist II (those with 4-7 years of experience) was $91,500. 
  • Salaries range as high as $137,500 and as low as $33,000. The 5 states with the highest annual pay are listed as:
    • New York – $102,404
    • New Hampshire – $96,920
    • Vermont – $94,710
    • Maine – $93,068
    • New Jersey – $90,643
  • The bottom 3 states are:
    • Texas – $71,362
    • Louisiana – $68,754
    • North Carolina – $65,209

Position trends

The U.S. Bureau of Labor Statistics predicts that the jobs for radiation therapists are projected to grow 9% from 2020 to 2030, about as fast as the average for all occupations. Approximately 1,100 openings for radiation therapists are projected each year over the decade. As the population ages and the incidence of cancer increases, the demand for radiation therapists may increase. Demand may also result from continued advancements in the detection of cancer and the development of more sophisticated treatment techniques.

Career path

There are a wide variety of career pathways available to radiation therapists. Most start their careers in radiography but can advance into other areas of radiation therapy. Some opportunities available for radiation therapists include:

  • Magnetic Resonance Technologists
  • Nuclear Medicine Technologists 
  • Palliative Radiation therapists
  • Radiographers
  • Sonography (Ultrasound) Technicians
  • Vascular Sonographers
  • Bone Densitometry Technologists
  • Breast Sonographers 
  • Cardiac Interventional Technologists 
  • Computed Tomography Technicians
  • Mammographers
  • Vascular Interventional Technologists

Career advancement roles for radiation therapists include:

  • Dosimetrists – Dosimetrists work closely with oncologists to develop treatment plans for a patient’s cancer. They balance the amount of radiation required with maintaining the patient’s healthy organs. A certification program in dosimetry and passing a national exam are required.
  • Oncologists – Oncologists are physicians who specialize in the treatment of cancer. They use radiation, chemotherapy, or surgery to treat patients. To become an oncologist, you will need to attend medical school and complete a residency in oncology. 
  • Medical Physicists – Medical physicists develop safer and more accurate radiation and imaging equipment. They work closely with physicians regarding radiation output. A master’s degree or doctorate is required.
  • Health Services Managers – health services managers recruit and train employees. They know and follow laws and regulations concerning healthcare and ensure their facility is following them. This position typically required a master’s degree.

Steps to becoming a radiation therapist

Here are the typical steps to becoming a radiation therapist:

1. Get a high school diploma or GED

The first step in your path to becoming a radiation therapist is to get your high school diploma or a GED. While in school, focus on biology, physics, chemistry, and mathematics classes. 

2. Do volunteer work

Consider volunteering in a hospital radiation therapy department where you can see firsthand what radiation therapists do. Some undergraduate programs in radiation therapy prefer applicants with volunteer experience.   

3. Earn your degree

You can choose to pursue an associate’s or bachelor’s degree in radiation therapy or a related major. The minimum formal educational requirement to become a certified, registered radiation therapist is an associate’s degree. However, many employers look for candidates who have a bachelor’s degree. Look for programs that are accredited by the American Registry of Radiologic Technologists (ARRT)

4. Gain clinical experience

As part of your undergraduate studies, you will be required to complete certain clinical requirements to obtain your degree. The number of hours can vary, depending on the program, but typically, you’ll need 15 or more credit hours working with a registered radiation therapist in a clinical setting.

5. Become certified and/or licensed

The American Registry of Radiologic Technologists (ARRT) offers primary credentials for radiation therapy in 6 different pathways. These include:

  • Magnetic Resonance Imaging – shows your ability to operate MRI machines to help diagnose diseases and injuries. 
  • Nuclear Medicine Technology – proves your knowledge and competency in detecting cancer and heart disease by preparing and injecting radiopharmaceutical agents into patients and using a scanner or camera to capture images. 
  • Radiation Therapy – proves your ability to operate specialized equipment to treat patients with cancer or other serious diseases. 
  • Radiography – demonstrates your ability to capture images of patients’ internal organs, soft tissues, and bones using X-ray equipment to help diagnose and treat patients who have a range of diseases and injuries.
  • Sonography – shows your competency in operating specialized ultrasound equipment to create images of a patient’s internal organs and tissues for creating images of an unborn child and other reasons.  
  • Vascular Sonography – Proves your knowledge and understanding of the use of ultrasound machines to produce images of patients’ veins and arteries using high-frequency sound waves. 

Requirements to earn one or more of these credentials include earning an associate’s degree or higher, completing an ARRT-approved educational program in the same discipline as the credential you are pursuing, meeting the ethical standards, and passing an exam. Earning one or more of these credentials demonstrates your qualifications to perform the role of a radiation therapist. Candidates can attempt the exam three times within three years. Once you pass the exam, you can apply for ARRT certification. Some states require radiation therapists to earn a state license in place of or in addition to ARRT certification. Check with your state’s licensing entity for state requirements.

6. Find employment as a radiation therapist

Once you have your degree and are certified, you are eligible to work as a radiation therapist. You can typically find work in hospitals, cancer centers, and educational institutions.   

7. Maintain your certification and or license

Certified radiation therapists typically need to renew their certification by completing a certain number of continuing education requirements every two years and continuing qualifications requirements every ten years. The requirements can vary by state.

8. Earn additional certifications

ARRT offers post-primary certifications for radiation therapists who have earned a primary certification and are looking to pursue additional credentials. You must be ARRT certified and registered in an appropriate supporting category before pursuing an additional credential. In some cases, you can be certified by other organizations, such as the Nuclear Medicine Technology Certification Board (NMTCB) or the American Registry for Diagnostic Medical Sonography (ARDMS). You also will need to meet the clinical experience and ethical requirements and pass an exam. The specialized certifications you can earn are:

  • Bone Densitometry – demonstrates your competency in assisting doctors to diagnose issues with bone health by using specialized X-ray equipment. You’ll need an ARRT certification in Radiography, Nuclear Medicine Technology, or Radiation Therapy to qualify for this credential.
  • Breast Sonography – proves your ability to use a transducer on the patient’s breast to produce ultrasound images. Credentials in Radiography and Mammography, or a certification in Sonography are required for this credential.
  • Cardiac Interventional Radiography – gives you the skills and experience to assist physicians with minimally invasive, image-guided procedures to help diagnose and treat heart and blood vessel diseases without surgery. Certification in Radiography is required.
  • Computed Tomography – demonstrates your knowledge and skills in performing scans of patients’ bodies to help doctors diagnose a disease or an acute condition. To qualify, you’ll need ARRT certification in either Radiography, Nuclear Medicine Technology, or Radiation Therapy.
  • Mammography – this credential qualifies you to perform routine screenings or screenings for suspected lumps or other signs of breast cancer using specialized equipment to help physicians detect breast cancer and other breast diseases. Obtaining a credential in Radiography is a prerequisite. 
  • Vascular Interventional Radiography – shows your knowledge and competency in assisting physicians with minimally invasive, image-guided vascular procedures, including angioplasty, stenting, thrombolysis, and more. A credential in Radiography is required.

Additional information on certification opportunities for radiation therapists can be found at the Nuclear Medicine Technology Certification Board and the American Registry for Diagnostic Medical Sonography.

Tips for becoming a radiation therapist

If you are planning to become a radiation therapist, there are a few things you can do to put you ahead of the game. Here are some tips for becoming a radiation therapist:

  • Make sure you are a good fit for the job. You’ll need to enjoy working with people and technology, be detail oriented, and have the ability to stand on your feet for long periods. Working with sick patients every day can also be emotionally and mentally draining, so you should be able to handle that type of stress.   
  • Assess whether you have the technical skills to learn how to operate medical machinery
  • Have compassion and empathy toward patients with serious illnesses and a desire to help them. 
  • Develop good interpersonal skills as radiation therapists work closely with patients who are often emotional and under physical stress. 
  • Be an effective communicator. Radiation therapists work as part of an oncology team and must be able to communicate with doctors, nurses, and medical physicists.  
  • Think about what level of education you want to achieve. Completing an associate’s degree is quicker, but a bachelor’s degree may offer more opportunities. 
  • Volunteer at a local hospital where you can talk to radiation therapists and get advice and insight into a career as a radiation therapist.
  • Find out which type of radiation therapy interests you the most so you can tailor your studies and training to that area.

Radiation therapist interview questions to expect

  1. Why do you believe it’s important to wear PPE when handling each patient?
  2. There will be hard days. How do you manage the emotional toll being a radiation therapist has on you?
  3. How do you ensure that you’re targeting the exact body part you’re supposed to be targeting?
  4. Are you familiar with systemic therapy machines? When have you worked with them?
  5. Which of the 15 disciplines from ARRT are you most familiar with?

Radiation therapist FAQs