I previously worked in medical image processing/transcoding and you are correct, but most people probably don't know precisely how or why.
The knee jerk mindset that most people have in safety-critical design, is being ultra conservative.
In the fields of medical and space (and likely others), you have an asymmetrical risk-reward profile. Think about it this way, if an engineer takes a risk on refactoring some software logic, and it speeds the system up 3%, what is their reward? A raise? A promotion? Fat chance. If that refactor instead breaks 3% of the time; engines blow up, people die, customers yell at them, they get fired, perhaps in some situations they even get sued.
The engineers then converge to a local maxima by the means of: "If it ain't broke, don't fix it", and various other ultra conservative leanings. This mindset also will often get selected for in hiring, and rewarded.
Now take the limit of this as time goes to infinity, you have bloated, legacy software that is full of spaghetti code and can't take new features easily (if at all). In the case of NASA's space shuttle program, it was extremely expensive, and the cost wasn't falling significantly over time either.
One might view ultra conservatism as the problem, but the real issue is the asymmetrical risk-reward profile. Solving that takes a head-on approach with great leadership, deploying capital, state of the art testing/QA, great deployment pipelines, and more. Shield people from the risk, and intentionally reward people when they push the envelope.
Imagine if you had a software testing process and product specification that was 99.9999% effective (and no, yours is not even close to that), you could then move at a silicon valley "fail fast" pace and advance the technology and architecture rapidly.