From 1 to 4 September 2025, the Discipline of Radiation Therapy at Trinity College Dublin (Ireland) hosted the Radiation Oncology Safety Course as part of the Radiation Oncology Safety Education and Information System (ROSEIS). This comprehensive, four-day programme brought together a group of international radiotherapy professionals to discuss and learn about safety and quality in modern radiotherapy practice.

The course combined expert faculty presentations with hands-on, scenario-based workshops, ensuring participants could translate theoretical knowledge from past incidents into practical improvements for their local clinical environments. The ROSEIS platform (https://roseis.estro.org/) is a valuable instrument in incident reporting and management. It is an initiative of the Radiation Oncology Safety and Quality Committee (ROSQC) that is intended to standardise learning from events and to establish a shared database for safety improvement across radiotherapy centres worldwide.

Course structure and key learning areas

The programme was built around three pillars of radiation safety and quality, each designed to address current and emerging challenges: incident learning and just (fair) culture, cyberattack preparedness, and the integration and ethics of artificial intelligence (AI).

Regarding the first focus area, incident learning and just culture, the faculty guided participants through foundational risk management concepts while examining landmark cases that have shaped modern radiotherapy safety. Mixed international working groups compared their local reporting and learning systems, and revealed significant differences in escalation procedures, feedback mechanisms, and measurement of corrective actions.

This structured comparison approach helped departments identify critical gaps in their safety systems and develop strategies to embed just cultures that promoted transparent communication without fear of blame.

The section on the second pillar, cyberattack preparedness, included sessions that addressed the full spectrum of cyber-risk management: prevention, detection, response, and recovery. Through a combination of hands-on simulation exercises and practical recommendations, the speakers emphasised that cyberattacks are a matter of "when", not "if" for modern radiotherapy departments. Specifically, they paid attention to balancing internal security strengthening measures, such as network security, system segmentation, and downtime procedure rehearsals, with external validation through independent audits. These discussions directly supported ongoing ROSQC initiatives to develop comprehensive guidance on cyberattack preparedness and management in radiotherapy.

In the third area, AI integration and ethics, speakers examined current and emerging AI applications in contouring and treatment planning. There were critical discussions on appropriate quality assurance procedures in AI-enabled clinical environments.

The use of case studies demonstrated that traditional safety analysis methods, including prospective safety and root-cause analyses, must be adapted for AI-integrated workflows. In sessions on ethics, we examined the balance between human oversight and automation, and addressed professional responsibility, patient protection, and the importance of maintaining appropriate quality assurance that matched the level of clinical risk.

Practical takeaways for departments

Three key implementation strategies were emphasised that departments could adopt immediately. First, incident learning should be made measurable by establishing the first contact when problems occur, setting specific deadlines for feedback, and creating concrete ways to verify that implemented safety improvements are effective in practice. Second, cyber-risk should be treated as inevitable, and comprehensive contingency plans should be developed, offline backup workflows maintained, and mutual support agreements established with other centres. Regular tests should be conducted. Third, AI technologies should be implemented responsibly: roles and responsibilities must be clearly defined and all system assumptions documented; it should be ensured that quality assurance matches the potential clinical impact of failures, and ethics reviews must be incorporated throughout the deployment process.

The ROSEIS course was successful due to the outstanding faculty: Mary Coffey, Geoff P. Delaney, Todd Pawlicki, Dirk Verellen, and Aileen Flavin. Their expertise, combined with active participation from all attendees, created engaging discussions and collaborative learning that will no doubt benefit radiotherapy safety practices.

Dr. Daniela-Lidia Sandu

Radiation oncologist

University of Medicine and Pharmacy "Victor Babeș" 
Timișoara, Romania

OncoHelp Cancer Centre
Timișoara, Romania