Governance structures in radiotherapy are central to ensuring patient safety, yet significant variation exists in how errors are reported, analysed and mitigated globally. This literature review evaluates current international approaches to radiotherapy error governance, highlighting barriers to consistent reporting and opportunities for system-wide improvement.

A structured search of peer-reviewed literature and policy documents was undertaken using a Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology. The search yielded 42 relevant articles, reviewed for themes relating to governance frameworks, safety culture, incident reporting systems and technology’s role in error reduction.

Findings reveal inconsistent adoption of Safety I and Safety II models, underreporting due to blame culture, and limited integration of artificial intelligence (AI) into governance frameworks. Successful strategies included pre-treatment peer review, multidisciplinary safety boards and AI-assisted risk management tools. Despite advancements, gaps persist in standardising incident definitions, fostering transparency and promoting a just culture.

The review suggests the need for international alignment on governance practices, wider integration of AI and proactive learning from near misses. Radiographers and radiation oncology teams are urged to engage in shaping safety governance through open reporting, system design and education. Implications for practice: Improved governance not only reduces harm but also supports continuous quality improvement in radiotherapy services.