Radiation oncology at crossroads: Rise of AI and managing the unexpected.

Integrating artificial intelligence (AI) into radiation oncology has revolutionized clinical workflows, enhancing efficiency, safety, and quality. However, this transformation comes with a price of increased complexity and the emergence of unpredictable events. This letter proposes a framework based on high reliability organization (HRO) principles for managing real-time, unforeseen events. The framework emphasizes proactive risk assessment, adaptive teamwork at the situation assessment point, and reactive learning through incident analysis by placing human-centered decision-making at the core. Integrating cognitive diversity, psychological safety, and emotional intelligence fosters collective intelligence, enabling teams to navigate AI-driven complexities while safeguarding patient safety.