Standardizing Excellence Across the ICON Oncology Network

“ClearCheck has reduced our planning second checks from 40–50 minutes per plan to approximately 10 minutes per patient… it really makes checking plans easier.” 

This month, we are excited to spotlight Icon Oncology, South Africa’s largest private oncology network, an organization treating more than 30,000 radiotherapy patients each year across 26 accredited clinics equipped with 31 linear accelerators. Their clinical community includes 145 radiation oncologists, 29 physicists, 15 dosimetrists and 136 radiographers working within a distributed but tightly coordinated network of predominantly single linac sites.

Their scale is impressive but what’s even more remarkable is their commitment to standardization, efficiency, and continuous improvement, which has shaped the way they adopt and integrate advanced technologies like Radformation’s clinical automation suite of tools.

This month’s feature brings together insights from the physicists, dosimetrists, and radiographers who drive Icon's innovation from the ground up.

Icon operates Elekta and Varian LINACs with both MOSAIQ and ARIA. All planning is centralised in Eclipse via Citrix. New technologies follow a staged process, beginning with trials at select units and expanding through phased, well-structured training. This foundation prepared Icon for a smooth network-wide rollout of Radformation tools.

Implementing Radformation Across the Network

Radformation products were introduced through clearly defined user groups. Physicists trained on ClearCalc, pre-planning units on AutoContour and planners on EZFluence, followed by a controlled implementation of ClearCheck. ARIA and MOSAIQ leads ensured alignment across EMRs, supported by a core team experienced in planning workflows.

Icon’s established standardized workflows made it easy to develop unified SOPs, record training sessions and assign product leads. Experienced internal champions provided ongoing support as teams adopted the new tools.

Training for AutoContour included duplicate sessions, recordings and RO-specific options to accommodate all staff. A clear transition deadline encouraged consistent adoption.

The switch from Limbus was driven by broader functionality and tighter integration with other Radformation products. Users report improved consistency in contours and fewer pre-planning edits. According to Rinette Koenig, “AutoContour is an intuitive and practical solution that was rapidly adopted due to its ease of use. It requires minimal post-processing, significantly reducing the time spent on manual contouring.”

EZFluence quickly became a central tool in Icon’s breast planning workflows. Training followed a structured, hands-on approach with phased content. Planners report significantly faster planning times, improved homogeneity and fewer hotspots.

This efficiency plays a major role in easing workload pressure in one of ICON’s busiest planning environments. As Judy Pols states, “With EZFluence there is a clear gain in efficiency, with planners able to achieve a homogenous plan within a matter of minutes.”

ClearCheck  is one of the tools that has delivered the largest measurable gains. Once templates were fully established, the time it took to do second checks dropped dramatically. It replaced many manual checks and consolidated documentation, improving both speed and confidence. Jaco van Staden explains, “ClearCheck has reduced our planning second checks from 40–50 minutes per plan to approximately 10 minutes per patient… it really makes checking plans easier.” Users note that the software improves confidence by presenting a consolidated view of all checks and allowing planners to resolve missed items independently before review. ClearCheck has also replaced printed plan protocols by generating a single comprehensive report.

ClearCalc plays an essential role in ICON’s secondary dose verification workflow and is used for all 3D and electron plans. The ability to evaluate multiple points increases the reliability of checks and improves confidence in treatment accuracy. The physics team is exploring the use of ClearCalc RadMonteCarlo for IMRT and VMAT plans and is also investigating log file analysis.

ClearCalc has streamlined many manual verification steps, shortened turnaround times between planning and approval and reduced the amount of repetitive QA work. Results are stored centrally in a consistent format so teams in every region can review calculations in a common, standardized manner. Mia Meyer summarizes the implementation impact as follows: “ClearCalc has taken over many of the manual verification steps that used to feel like QA déjà vu. It streamlined plan reviews, reduced calculation time, and improved the turnaround between planning and final approval. In short, fewer spreadsheets, fewer sighs, and faster patient starts - what’s not to love?”

ICON’s experience with the Radformation team has been positive throughout implementation and ongoing support. Users consistently report responsive communication, high-quality training and strong guidance during customization or troubleshooting. Juanita van Staden says that “the Radformation team consistently provided the guidance and training we needed, and whenever an answer wasn’t immediately available, they went out of their way to find a solution.”

Across the network, Radformation tools have increased efficiency, improved consistency and strengthened workflow clarity. These gains support ICON’s long-standing goal of delivering reliable, standardized radiotherapy regardless of location. Teams report reduced stress, time savings and greater confidence in their work.

Getting to Know the ICON Team

The ICON team brings the same warmth and authenticity to life outside the clinic as they do to their work. They are deeply connected to South Africa’s landscapes, whether setting off on rooftop-tent road trips, finding quiet in the Karoo, or enjoying the mountains-and-sea charm of Knysna and Struisbaai.

Weekends often mean a get-together, with food at the centre of it all. A traditional braai (BBQ) or a snoek fish braai, golden braaibroodjies toasted over the fire, warm roosterkoek straight off the coals, and perfectly seasoned biltong shared among family and friends are firm favourites.

Their interests span hiking, photography, pickleball, gardening, wine tasting across the Western Cape’s renowned wine farms, reading and gaming. Together, their stories reflect a team grounded in simple joys, food traditions, and the natural beauty that make South Africa home.