A Guide to Your First 5 Years in Radiation Therapy

Man laying at scanning machine with text "words of wisdom for beginning radiation therapists"

Written by: Ron DiGiaimo, MBA, FACHE, Cheryl Turner, EdD., R.T., (R)(T), and Ben Adams

Welcome to Radiation Therapy

You made it! Years of education, training, memorization and hands-on work have led you into the world of radiation therapy. You are at the intersection of direct connection and care for patients and constantly growing technological advancement.  

Now that you are at the start of your first five years, you may be wondering, what’s next? Seasoned industry leaders Ron DiGiaimo, MBA, FACHE, and Cheryl Turner, EdD., R.T., (R)(T) have provided a roadmap of experienced wisdom and guidance as your journey begins, providing an opportunity to understand the complexities of the Radiation Oncology sector and what it takes to succeed and thrive within this industry. Emerging technologies, clinical and administrative hurdles, and maintaining a productive, patient-first perspective are key areas that will elevate your first five years as you refine your experience, gain confidence and grow as a radiation therapist. 

Ron DiGiaimo and Dr. Cheryl Turner are both tenured leaders in healthcare, with over 30 years of experience crossing into education, healthcare finance, and operational development, as well as clinical and administrative roles.  However, like you, their decades-long careers started as entry level radiation therapists, being drawn to help and provide care to others. 

“Be the person who volunteers for extra assignments,” DiGiaimo begins. “Creating and taking opportunities for yourself by learning the most complex setups, shadow and assist the doctor while they do brachytherapy implants (HDR and LDR), be positive and willing to participate in every aspect of operations from patient care, to supply ordering, charge capture, compliance and expense management.” He often refers to this approach as “being paid to learn and build a career.” Exposure and experience today prepare you for success in the future and attitude matters.

Going the extra mile by volunteering is certainly a good step to get ahead and start building professional relationships with colleagues and others in your department, (and in the small world of radiation therapy, those connections will count tenfold throughout your career!) Being a sponge and learning every detail of complex patient set ups (Dx, Scheduling, Organs at risk, etc.) will grow your understanding of the “Why, When and How” of your role in relation to your peers in other modalities. Small steps like these go a long way in positively impacting your communication and collaboration skills both professionally and personally. 

Invest in Yourself and Your Network

Hitachi Proton Therapy Gantry
Image Provided Courtesy of Hitachi

According to Dr. Turner, starting off and growing in radiation therapy is fundamentally dependent on the communication and cooperation of all professionals involved in oncology care. Radiation therapy heavily emphasizes communication inside the department and with outside colleagues in imaging, nuclear medicine, and chemotherapy units. Being friends with the nuclear medicine people, the sonographers, and other specialists does not just boost your LinkedIn. It also develops your potential in helping crossover issues and making you more comfortable within a complex, fast-paced system.

One of the best-kept secrets in radiation therapy is the ability for career pivoting and development. Some Radiation Therapists (RTT) can feel trapped by their niche expertise if they allow it, but the truth is that the ability to grow has never been more accessible with continued education and networking abilities for this specialty. Creating a teamwork connection, going the extra mile in your department as an overachiever, and continuous learning all open doors for both horizontal and vertical career growth, as you find your way within the industry.

As both DiGiaimo and Dr. Turner look back at their careers, these three areas remain prominent as the keys for their career growth and recommended to be at the top of your mind from Day 1 in your new department.

  • Volunteer and go the extra mile on your assignments. Understand everything there is to know about not only your role but everyone else’s from receptionist to Physician.
  • Invest in yourself. Research new technology, network with potential mentors, and leave no stone unturned, for the sake of your long-term growth.
  • Never lose empathy for the patient which will translate to quality work performance.

The Therapy-Technology Relationship

From the perspective of long-time radiation therapists, technology within the field is moving at lightning speed. New technologies across every modality have allowed for radiation therapy to get faster, more efficient, and more precise. These developments have all allowed for better care for the patients… Mostly. 


One of the “side effects” of consistently explosive growth in technology is that while our abilities speed up, our overall understanding of WHYs and WHAT’s  of the process of care can slow down on going learning if you allow it to happen. While automating away the basics is a tempting shortcut, always keep the WHAT and WHY top of mind with regard to patient set ups and reproducibility. Refusing to take shortcuts and compromise care will benefit you and your experience but more importantly, it benefits your patient. 


“Don’t allow an overdependence on technology to occur!” DiGiaimo urges, “Don’t simply move a patient to clear a fault. Make sure that you’re eyeballing the patient and looking at the anatomy first and foremost, especially after they relax their position.” 

Patient > Record & Verify Prompt

Doctor with patient at scan
Image Provided Courtesy of Mevion

The crux of this perspective comes down to what every healthcare worker knows: Patient Care comes first, always! For laser precision is critical when analyzing patients, reproducibility is needed within the millimeter, and understanding the what and why is the stopgap that separates serving the patient and “serving” the computer screen. It can be frustrating, time consuming and wreak havoc on a daily schedule causing some to say “that’s good enough” but in reality, “good enough” is what prevents perfect care for patients and the ONLY “good enough” is a perfect set up. 


If technology changes so quickly that you don’t have the education and training or mentorship for your staff, how can you be assured that everything is being done as safely as possible? Central to the idea of understanding and using technology is education and training. Dr. Turner credits exceptional mentors and the desire for learning as valuable foundations for her career. Comprehensive training programs and mentorship make the difference when acclimating to the continuous changes in technology and best practices. 


The resources you need to keep up with technology are there. Online training, seminars, and even the teammate across the hall are all available to you in reaching the goal of the highest importance: Providing perfect care to patients. And it all starts with investing in yourself. 

Protect Your Patient

Balancing safe patient care efforts with operational expectations can oftentimes be a challenge. None know that more than Dr. Turner and DiGiaimo, who have spent a large portion of their careers focusing and researching the effects of busy workplace conditions on patient care in radiation therapy and how patient flow, efficiencies, operations and finance all merge in cancer center management.


Seeking a balance between increased numbers of patients, rapidly changing technologies, and providing safe patient care is the ultimate goal of radiation therapists. Patient and procedure numbers are vital to business operations; but the ability of a radiation therapist to manage these numbers and ensure safety and quality is essential.


“Overwork and understaffing are by-products of chaotic workplace environments,” Dr. Turner emphasizes, as “the business perspective often leads to doing more with less.” The clash of provider and business perspectives will certainly occur, and the best advice is to protect the patient.

Keeping Your Work Patient-First

If there is anything that radiation therapists need to know before they step through the doors on the first day, it is to keep the patient first. Throughout this guide, is the fundamental reason behind every piece of advice. When dealing with anxious or sick patients, this ranges from approaching every question and request with empathy to spending the extra minute to an hour making sure the tiniest, most precise details are correct for their treatment and positioning image-guided radiation therapy imaging and associated treatment also commonly known as IGRT.  

Unfortunately, the patient-first philosophy can cause interpersonal disputes, frustrations, and conflict in other areas of your work. Some will not want to take the extra time to ensure the most accurate precision. Nor will they view patients as more than tasks to accomplish and virtual checkmarks.

However, learning how to communicate and work with these personalities while keeping the “patient-first” mindset for the sake of the department is essential.  DiGiaimo urges to “never compromise patient care for a personal relationship with a coworker.” Disagreements can be worked through later, but in the treatment room, the patient comes first. And “good enough” is never good enough until it is. 

When DiGiaimo and Turner started their careers treating patients’ common treatments today such as: Intensity-modulated radiation therapy (IMRT), Stereotactic radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT) were not widespread or even available in most facilities.  At the time, intra-operative (IORT) was state of the art and DiGiaimo was at the first treatment in Texas as a new grad working on a veri-flex record and verify system.  All the technology was new, and faults were new, positioning was the same and proved to be critical, even more so than the technology at the time, and should be the case today as well for consistent reproducibility.  

In terms of your career journey, being patient-first means being knowledgeable as much as possible, which includes knowing more than just the acronyms, but also knowing the science and rationale behind the acronym and the true meaning and goal for the patient outcome. Continued learning is your key to success. Technology and best practices change over time, and so should you; ask yourself if you would be comfortable treating a patient without access to a verification system and if not, why not?  What can you do to overcome that concern, then do it, adding a verification system on top of that treatment confidence will help make you among the best in your field! 

Paving a Path for Continued Success in Radiation Therapy

To conclude, congratulations on entering the world of radiation therapy!!!!  You did it and you should be very proud! The journey does not stop after graduating and getting the job. You will make mistakes, hopefully not many. Taking accountability and recognizing them as chances to learn and grow is what will define your career and allow you to both respect yourself and gain the respect, trust and confidence of your peers, physicians and ultimately the patient. Stay active, open to learning, and ready to work as you enter your first five years! 

Ron DiGiaimo, MBA, FACHE, has over 30 years of experience in oncology management, clinical experience, and financial management.  Ron is a proven strategist in practice building, coding, and documentation for both Part A and Part B reimbursement, and broad experience with marketing, operations, compliance, development, and public relations with strong ethics and integrity. Currently, he directs several oncology-specific and broad healthcare consulting companies to facilitate clients reaching their desired goals. Ron DiGiaimo serves as a national government expert witness regarding oncology fraud and abuse of Medicare spending. 

Dr. Cheryl Turner has been a radiation therapist for 30 years and an educator for 15 of those years. Cheryl founded and developed Rad-Cast, the CE Podcast for Radiation Sciences Professionals. She believes that the foundation of solid clinical practice lies in effective and applicable education and training. Additionally, she has extensive involvement in professional societies including the American Registry of Radiologic Technologists, the American Society of Radiologic Sciences, and the Latin American Radiology Outreach organization. Cheryl completed her doctorate degree from Liberty University in 2016 with a focus on education in radiation oncology settings.