High reliability industries ensure safety amidst high-risk work environments and rapidly changing conditions. The authors explored the relationship between risk culture in three fields that require high standards of reliability and execution – radiation oncology, aviation, and nuclear power. A bibliographic coupling analysis found that the radiation oncology field has been slow to adopt and disseminate state-of-the-art risk management tools, frameworks, and best practices that have led to high reliability in aviation and nuclear power and that could mitigate or eliminate patient safety risks.