This presentation will focus on a novel quality care paradigm developed for the radiation oncology services within Veterans Health Affairs (VHA) network. The VHA Radiation Oncology Quality and Safety Initiative (ROQSI) utilizes quality processes, checklists, audits, and electronic peer-review, incident reporting and outcome tracking systems to assess quality and safety of radiation treatment delivery and determine disease site-specific outcomes. The VHA-ROQSI can easily serve as a model for the radiation oncology community at large.