Aubrie Rice

SupaFirefly Assignment

At my clinical site, it is common to treat esophagus patients with a VMAT plan using 2-3 half arcs
depending on the size of the PTV volume. For this assignment, I used a patient dataset that was
previously treated with this technique but I planned to create my own VMAT plan as well as SupaFirefly
plan for comparison. For both plans, I started with optimization objectives that mimicked the physicians
constraints and then pushed harder on the organs at risk (OAR) as needed to minimize dose while still
achieving optimal coverage. For the VMAT plan, I used 3 half arcs from G340-179.9, G179-341, and
G340-179.9. This arc arrangement can be seen in Figure 1 which shows fields 1 and 2.

Figure 1. Arc arrangement for fields 1 (left) and 2 (right) of VMAT plan.

For the SupaFirefly plan, I used the beam arrangement outlined in the assignment instructions
and this arrangement can be seen in Figure 2.

Figure 2. SupaFirefly beam arrangement used.

Aubrie Rice
SupaFirefly Assignment

After completing optimization, both plans were normalized so that 100% of the dose covered
95% of the target volume. In terms of isodose distribution, both plans achieved a very tight (to the
target) high dose distribution (Figure 3a-3b).

Figure 3a. SupaFirefly isodose distribution in axial plane showing conformity of high dose.

Figure 3b. VMAT isodose distribution in axial plane showing conformity of high dose.
Aubrie Rice
SupaFirefly Assignment

As you can also see in Figures 3a-3b, the VMAT plan was able to achieve a more conformal lower
isodose distribution (specifically the 50% isodose line in red) compared to the SupaFirefly technique
which is expected in comparing VMAT to static IMRT. This was even more prevalent on more superior
slices where the heart was in the field (Figure 4a-4b).

Figure 4a. SupaFirefly dose distribution in axial plane near heart showing non-conformity of lower
isodose levels.

Figure 4b. VMAT dose distribution in axial plane near heart showing conformity of lower isodose levels.
Aubrie Rice
SupaFirefly Assignment

The bulging of isodose lines on the IMRT plan in the axial planes that include the heart give an
idea of which beam angles were optimal in treating the target and sparing the heart. The SupaFirefly
plans superior capability to spare the heart can also be seen by comparing the 2 DVHs (Figure 5).

Figure 5. DVH comparing the SupaFirefly (triangles) and VMAT (squares) plans.

Both were acceptable plans in terms of meeting the physicians planning objectives (Figures 6a-
6b). The SupaFirefly plan though, was optimal for limiting heart dose (Figures 6a-6b). This technique also
achieved slightly lower lung doses, as well.

Figure 6a. SupaFirefly planning objectives outlining the mean heart dose and lung constraints in red.
Aubrie Rice
SupaFirefly Assignment

Figure 6a. VMAT planning objectives outlining the mean heart dose and lung constraints in red.

Overall, I believe that both techniques were comparable in terms of their ability to achieve
optimal plans. The SupaFirefly technique was definitely superior when it came to limiting the mean
heart dose compared to the VMAT technique. For me, learning and implementing the SupaFirefly
technique was extremely helpful. My center does not do a whole lot of static IMRT and tends to focus
more on VMAT planning. It was neat to see the difference in the 2 plans and how the SupaFireflys beam
angles worked to spare organs at risk.