Purpose:To examine the abilities of a traditional failure mode and effects analysis (FMEA) and modified healthcare FMEA (m‐HFMEA) scoring methods by comparing the degree of congruence in identifying high risk failures.Methods:The authors applied two prospective methods of the quality management to surface image guided, linac‐based radiosurgery (SIG‐RS). For the traditional FMEA, decisions on how to improve an operation were based on the risk priority number (RPN). The RPN is a product of three indices: occurrence, severity, and detectability. The m‐HFMEA approach utilized two indices, severity and frequency. A risk inventory matrix was divided into four categories: very low, low, high, and very high. For high risk events, an additional evaluation was performed. Based upon the criticality of the process, it was decided if additional safety measures were needed and what they comprise.Results:The two methods were independently compared to determine if the results and rated risks matched. The authors’ results showed an agreement of 85% between FMEA and m‐HFMEA approaches for top 20 risks of SIG‐RS‐specific failure modes. The main differences between the two approaches were the distribution of the values and the observation that failure modes (52, 54, 154) with high m‐HFMEA scores do not necessarily have high FMEA‐RPN scores. In the m‐HFMEA analysis, when the risk score is determined, the basis of the established HFMEA Decision Tree™ or the failure mode should be more thoroughly investigated.Conclusions:m‐HFMEA is inductive because it requires the identification of the consequences from causes, and semi‐quantitative since it allows the prioritization of high risks and mitigation measures. It is therefore a useful tool for the prospective risk analysis method to radiotherapy.