# General Aspects of Identification, Prevention, and Protection From Medical Errors in Radiation Oncology

## TL;DR

This paper reviews how medical errors occur in radiation oncology and proposes system-based solutions to improve patient safety and clinician well-being.

## Contribution

A novel multidimensional safety framework that shifts focus from blaming individuals to preventing errors through system-level improvements in radiation oncology.

## Key findings

- Medical errors in radiation oncology are often underreported due to fear and legal frameworks focused on individual blame.
- A safety framework integrating non-punitive reporting and AI-assisted quality assurance can enhance patient safety and clinician support.
- High workload and poor reporting systems in developing countries like Serbia hinder transparency and learning from errors.

## Abstract

Medical errors represent an inherent risk in all areas of medicine, but in radiation oncology, they are of particular concern due to the complexity of treatment pathways and the potential severity of consequences. While legal systems often equate medical error with negligent treatment, clinicians typically view medical error as an unintended deviation occurring despite adherence to accepted standards of care. This conceptual discrepancy contributes to fear-driven practice, underreporting of adverse events, and missed opportunities for system-level learning. In this in-depth review, we synthesize current evidence on the definitions, mechanisms, and classification of medical errors, with a specific focus on radiation oncology. We critically analyze error patterns across pre-treatment, treatment, and post-treatment phases, emphasizing the interplay between human factors, system vulnerabilities, and technological complexity. Beyond technical considerations, this review provides a novel integrative perspective by linking guideline-based practice, incident learning systems, safety culture, communication strategies, and emerging artificial intelligence-assisted quality assurance approaches. Using Serbia as an illustrative example of a developing country, we highlight how legal frameworks centered predominantly on criminal liability, combined with high clinical workload and limited national reporting systems, may inadvertently discourage transparency and learning from errors. We propose a multidimensional safety framework that integrates protocol harmonization, non-punitive reporting, structured error disclosure, clinician support mechanisms, and advanced technological solutions. By shifting the focus from individual blame to system-based prevention and resolution, this review offers transferable insights for improving patient safety, enhancing clinician well-being and strengthening safety culture in radiation oncology across diverse healthcare settings.