The issue of quality and patient safety in radiation medicine was highlighted by errors reported in a series of articles in New York Times in 2010. Our increasing need to emphasize safety in the use of advanced technology requires a restructuring of quality management programs (QMP). QMPs should emphasize a proactive process improvement life cycle. Such an infrastructure analyzes clinical operations to determine quality initiatives, rather than waiting for an incident to uncover the necessary process changes. Case studies will demonstrate various safety engineering tools and techniques such as fault tree analysis, failure modes and effects analysis, process mapping, system monitoring, and data mining. A number of examples will highlight the quality and safety needs in radiotherapy planning and delivery. At the conclusion of this activity, the learner will be able to do the following: 1. Identify the characteristics of an effective quality management program. 2. Recognize quality and safety issues and opportunities in radiotherapy planning and delivery. 3. Describe the application of safety engineering tools and techniques in Radiation Oncology.