Rapid-onset disasters pose a particular challenge to oncology services, especially radiation oncology, which is highly technical and dependent on complex equipment and digital infrastructure. Thoughtful preparation can anticipate vulnerabilities and improve disaster response; however, recommendations are still emerging and individual clinics are largely left to develop and activate their own disaster preparedness plans. A principled conceptual framework for system design is therefore needed. In this article, we discuss such a framework, mapping disaster preparedness considerations onto the widely-used Donabedian model of healthcare quality, which evaluates care across 3 interdependent domains: Structure, Process, and Outcome. We draw on examples from outside oncology—including humanitarian surgical programs and institutional pandemic responses—that have applied this model at the clinical and operational level. We demonstrate that previously reported experience of disaster response in radiation oncology maps coherently onto this framework, and we present specific design principles and practical approaches that organizations can employ. Current guidance from professional societies and accreditation bodies is reviewed, and future directions—including formal risk assessment and commercial disaster-recovery solutions—are discussed. When thoughtfully applied, these principles of system design can help oncology programs build meaningful resilience before the next disaster arrives.
Radiation oncology departments are uniquely vulnerable to disruptions such as cyberattacks, pandemics, and natural disasters, which can result in unacceptable treatment delays. Using the National Academy of Medicine Crisis Standards of Care framework and lessons learned from the University of Vermont Medical Center cyberattack, an ethical framework is proposed to guide decision making in radiation oncology during a crisis.
Radiation oncology incident reporting requires consideration of several parallel authorities and systems: Federal authorities governed through NRC Code of Federal Regulations, Agreement State regulations, additional state laws and regulations, voluntary reporting through incident learning systems such as the Radiation Oncology Incident Learning System (RO-ILS), and hospital enterprise safety platforms. Each system serves a distinct purpose and addresses a different audience. A single serious incident can activate multiple platforms simultaneously. Forty states have assumed Agreement State status with the NRC, and their reporting thresholds, timelines, and procedural requirements can differ substantially from the federal baseline. Many states have their own additional laws, regulations, and licensing requirements. Most hospital safety reporting systems were designed to capture and describe general medical incidents rather than radiation therapy incidents. As such, RO-ILS is a specialty-specific online safety tool administered through the Clarity Patient Safety Organization (PSO), with accompanying confidentiality and privilege protections outlined in the federal Patient Safety Act. The current goals of PSOs and incident learning systems are to reduce errors, improve quality, and promote safety. We describe the institutional model developed at UCLA, centered around the Quality and Safety Oversight Committee (QSOC) and a Medical Event Determination Committee (MEDC), which serves as an authoritative triage body for incident reportability determinations. The MEDC convenes within 24 hours of incident discovery, makes reportability determinations, and works with the institutional radiation safety officer to produce the necessary documents for reporting. This framework is replicable and adaptable to programs of any size.
Magnetic resonance imaging (MRI) is increasingly integrated into radiation oncology through dedicated MRI simulators and MR guided radiotherapy systems, improving target delineation and enabling adaptive treatment strategies. However, MRI introduces a distinct set of safety risks compared with conventional radiotherapy equipment, including hazards related to static magnetic fields, radiofrequency energy deposition, gradient switching, and cryogenic systems. Despite the growing adoption of MRI in radiation oncology, most reported safety incidents and lessons learned originate from radiology settings. While prior work has described implementation considerations for MRI and MR guided radiotherapy programs, there remains limited literature connecting potential disaster scenarios with their consequences within radiation oncology workflows. This review focuses on evidence primarily reported in radiology, together with clinical experience, to contextualize potential disaster scenarios, their consequences, and mitigation strategies within radiation oncology environments. Key disaster scenarios are examined, including projectile incidents, thermal injuries, cryogen related events, fires, and medical emergencies, with representative cases illustrating the impact of failures in screening, access control, and operational protocols. The manuscript further outlines essential infrastructure considerations, emergency response strategies, and governance frameworks required for safe implementation. Risk mitigation strategies are discussed with emphasis on structured safety programs, staff training, patient screening, incident reporting, and simulation based preparedness. MRI safety in radiation oncology requires a coordinated, multidisciplinary approach to prevent rare but potentially catastrophic events and to support the safe expansion of MRI integrated treatment technologies.
The COVID-19 pandemic dramatically impacted radiation oncology departments as efforts were made to maintain high-quality, timely oncologic care in the setting of multiple competing factors. By close collaborations with public health organizations, institutions, and within individual departments, innovative workflows and strategies were created to evolve the field with sustainable programs impacting all aspects of radiation oncology. This manuscript details the response of radiation oncology in a pandemic, the transformation of current radiation oncology practice and education, and the generation of preparedness for a future pandemic.
