Key Points
- Sonographers operate ultrasound equipment to capture diagnostic images, while respiratory therapists administer treatments like ventilation, oxygen therapy, and breathing assessments for patients with cardiopulmonary disorders.
- BLS reports a median annual wage of $89,340 for sonographers and $80,450 for respiratory therapists (May 2024), with sonographers earning roughly $8,890 more per year on average.
- Both careers project employment growth faster than the average for all occupations through 2034, sonography at 13% and respiratory therapy at 12%.
- Respiratory therapists require a state license in 49 of 50 states plus a CRT or RRT credential through the National Board for Respiratory Care, while sonographers generally rely on ARDMS or ARRT certification with state licensure required in only New Hampshire, New Mexico, North Dakota, and Oregon.
- Most accredited associate programs in either field run two years, with bachelor's tracks running four years and clinical hours that determine credential eligibility.
What Is a Diagnostic Medical Sonographer?
A diagnostic medical sonographer operates ultrasound equipment to create real-time images of organs, blood vessels, tissues, and developing fetuses that physicians use to diagnose medical conditions. Sonographers position patients, capture images, analyze them for technical quality, and provide preliminary findings to the interpreting physician. Most work in hospitals, outpatient imaging centers, and physician offices.
Day-to-day duties include:
- Preparing patients and explaining procedures before the exam.
- Operating ultrasound equipment to capture images of the requested anatomy.
- Adjusting angles, frequencies, and gain settings to produce diagnostic-quality images.
- Recognizing abnormal findings and flagging them for physician review.
- Maintaining equipment, documenting procedures, and following imaging safety protocols.
Sonographers often specialize. The major recognized specialties are abdominal, breast, cardiac (echocardiography), musculoskeletal, obstetric and gynecologic, pediatric, and vascular sonography. Specialization is typically pursued through additional training and the corresponding ARDMS or CCI specialty exam.
What Is a Respiratory Therapist?
A respiratory therapist evaluates, treats, and manages patients with breathing or cardiopulmonary disorders, working with patients from premature infants to elderly patients living with COPD. Respiratory therapists perform diagnostic tests, administer oxygen and aerosolized medications, set up and manage mechanical ventilators, and respond to respiratory emergencies. Most work in hospitals, though long-term care, home healthcare, and sleep labs are common settings.
Day-to-day duties include:
- Assessing respiratory status, lung function, and oxygenation.
- Performing tests like spirometry, pulse oximetry, and arterial blood gas analysis.
- Administering bronchodilators, oxygen, and other respiratory medications.
- Setting up, monitoring, and adjusting mechanical ventilators for critically ill patients.
- Educating patients with chronic conditions like asthma, COPD, and cystic fibrosis on inhaler technique, breathing exercises, and home equipment.
Respiratory therapists work in higher-acuity environments than most allied health roles. ICU, neonatal ICU, and emergency department assignments are part of the standard career path.
Training and Certification Requirements
Both careers require an associate's degree as the entry-level credential, though bachelor's pathways exist and are increasingly preferred in some hospital systems. Each path requires a national certification through a recognized credentialing body before practice begins.
Diagnostic Medical Sonography Training
Entry-level sonography training typically takes two years through an associate's degree program, with four-year bachelor's tracks also available. Programs combine classroom instruction in anatomy, physiology, sonographic physics, and patient care with extensive clinical hours in working imaging environments. Programs accredited by the Commission on Accreditation of Allied Health Education Programs (CAAHEP) or the Accrediting Bureau of Health Education Schools (ABHES) meet the eligibility requirements set by ARDMS and ARRT for credentialing exams.
After completing an accredited program, graduates sit for a certifying exam. The three principal credentialing pathways are:
- American Registry for Diagnostic Medical Sonography (ARDMS): the most widely recognized sonography credentialing body. ARDMS issues specialty credentials including Registered Diagnostic Medical Sonographer (RDMS) and Registered Vascular Technologist (RVT).
- American Registry of Radiologic Technologists (ARRT): offers a sonography credential (ARRT(S)) often pursued by professionals who already hold ARRT(R) in radiography.
- Cardiovascular Credentialing International (CCI): issues credentials specific to cardiac sonography, including Registered Cardiac Sonographer (RCS) and Registered Vascular Specialist (RVS).
State licensure for sonographers exists in only four states: New Hampshire, New Mexico, North Dakota, and Oregon. In the other 46 states, sonographers practice based on national certification and the employer's credentialing requirements.
Respiratory Therapy Training
Respiratory therapy training typically takes two years through a CoARC-accredited associate's degree program, the standard entry-level credential. Coursework covers cardiopulmonary anatomy and physiology, pharmacology, pathophysiology, ventilation management, and emergency care. Clinical rotations place students in hospital, ICU, NICU, and emergency settings.
After completing a CoARC-accredited program, graduates sit for National Board for Respiratory Care (NBRC) exams to earn credentials:
- Certified Respiratory Therapist (CRT): the entry-level NBRC credential. Required to practice as a respiratory therapist in most states.
- Registered Respiratory Therapist (RRT): the advanced practitioner credential. Most hospitals prefer or require the RRT for new hires, especially for ICU, NICU, and emergency department assignments.
After NBRC credentialing, the respiratory therapist applies to the state's medical board or health department for a state license. State licensure is required to practice in 49 of 50 states (Alaska is the only state without a respiratory therapy practice act), and most states require an active NBRC credential as the basis for licensure.
Salary and Job Outlook
Sonographers earn more than respiratory therapists on a national median basis, and both careers project employment growth well above the cross-occupation average through 2034.
Diagnostic Medical Sonographer
BLS reports a median annual wage of $89,340 for diagnostic medical sonographers (May 2024). Wages vary by employer setting: sonographers in outpatient care centers tend to earn higher median wages than those in hospitals or physician offices. Employment is projected to grow 13% from 2024 to 2034, much faster than the average for all occupations, driven by an aging population that requires more diagnostic imaging.
Respiratory Therapist
BLS reports a median annual wage of $80,450 for respiratory therapists (May 2024). Hospital-based respiratory therapists typically earn higher median wages than those in long-term care, home healthcare, or physician offices. Employment is projected to grow 12% from 2024 to 2034, much faster than the average for all occupations, reflecting rising rates of chronic respiratory conditions and an aging population.
If either field's pay matches your goals, compare diagnostic medical sonography and respiratory therapy programs on Dreambound to see what training options are available in your area.
State Licensing and Scope of Practice
The state licensing reality is the single biggest difference in how these two credentials travel. Respiratory therapy is a licensed profession in 49 of 50 states. Alaska is the only state without a respiratory therapy practice act. A respiratory therapist moving from Texas to Florida must apply for a Florida license even with active NBRC credentials and a current Texas license, and licensure typically requires verification of NBRC credentials, a state application fee, and in some states a jurisprudence exam.
Diagnostic medical sonography is licensed in only four states: New Hampshire, New Mexico, North Dakota, and Oregon. In the other 46, sonographers practice under their national certification (ARDMS, ARRT(S), or CCI) and the employer's credentialing requirements. A sonographer with ARDMS credentials can typically move between states without state-level paperwork, though hospital and imaging center credentialing applications still apply.
Beyond licensure, the scope of practice differs sharply:
- Sonographers do not administer treatments. The work ends with capturing the image and providing preliminary findings to the interpreting physician.
- Respiratory therapists deliver hands-on treatment. They adjust ventilators, administer medications, respond to code situations, and intubate in some states under physician protocols.
The trade-off is direct: sonography offers higher pay and more credential portability between states, while respiratory therapy involves more direct intervention with critically ill patients and more state-by-state administrative steps when relocating.
Which Path Is the Right Fit for You?
Sonography may be the stronger fit if:
- You prefer visual, technical work that emphasizes precision and pattern recognition.
- You want flexibility to move between states without restarting state licensure each time.
- You're drawn to outpatient or imaging center settings with more predictable hours.
- You're considering specialization in obstetric, cardiac, vascular, or musculoskeletal sonography.
- The pay difference matters to your decision, with sonography earning about $8,890 more per year at the national median.
Respiratory therapy may be the stronger fit if:
- You want direct, hands-on patient care with critically ill or chronically ill patients.
- You're comfortable working in ICU, NICU, and emergency department settings.
- You want a faster path into supervised clinical decision-making during a shift.
- You prefer 12-hour hospital shifts over 8-hour outpatient schedules.
- You're prepared for state-by-state licensure if you relocate during your career.
Sonography and Respiratory Therapy Programs on Dreambound
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Diagnostic Medical Sonography Programs
