Surface Applicators

Brachytherapy (short distance radiation therapy using radioactive isotopes) can be delivered
in many different ways. It can be delivered interstitially, interluminally, intercavitarily and even
directly on the surface of the patient.

Additionally, all these methods can use either High Dose
Radiation (HDR), Medium Dose Radiation (MDR) or Low Dose Radiation (LDR) sources.
1
In
fact, the dose rate can be so small or the isotope decay life so short that the sources are implanted
permanently into the patient and allowed to decay fully. For areas to be treated on the surface,
surface applicators are used and the radiation dose is generally delivered using HDR and a
remote afterloader.
There are different applicators used for the various surfaces that can be treated with
brachytherapy. For example, the vertex of the scalp can be easily treated by modifying an
Aquaplast face mask and using the Freiburg Flap, manufactured by Elekta. It is a flexible
sheet impregnated with multiple catheters that can be molded to any surface shape.
2
Refer to
the Devlin textbook,
3
Chapter 3 Case 1 for an example with photos. Similar products are
available from various vendors. See figure below for an example of a similar product being used
to treat the skin on a hand.


For smaller lesions, the Valencia skin applicator (also by Elekta) can be used.
2
See below for a
photo of one such applicator.

Another area which uses brachytherapy surface applicators is in the mouth. For small, shallow
lesions, this method can be used as a boost after treatment with external beam radiation
therapy. The device would be anchored in place using denture adhesive.
4
Finally, there are
several conditions of the eye that are treated with brachytherapy surface applicators called eye
plaques. These plaques are installed under local anesthesia and sutured directly to the eye (see
below).

A new surface applicator I found especially interesting is the isotope-free Xoft S700Axxent. It is
electronic brachytherapy and generates its own low kV energy x-rays at a dose rate comparable
to 7Ci Ir-192 source.


Below are some links I found helpful:
www.tcrt.org/HDR-Brachytherapy-with-Surface-Applicators-technical-considerations-and-
Dosimetry-p-259-268-p12349.html
PubMed (the NCBI Resources website): www.ncbi.nlm.nih.gov/pubmed
Applicators that are on the market: Varian GammaMed Plus and Nucletron microSelectron
HDR system with Leipizg and Valencia surface applicators.

References:
1. Lenards N. Surface applicators [SoftChalk]. LaCrosse, WI: University of Wisconsin
Medical Dosimetry Program; 2014.
2. Elekta. Elekta. www.elekta.com/healthcare-professionals/products/elekta-
brachytherapy/applicators/skin/freiburg-flap.html
3. Devlin PM. Brachytherapy Applications and Techniques. Philadelphia, PA: Lippencott
Wilkins & Williams; 2007.
4. Bentel GC. Radiation Therapy Planning, 2
nd
edition. New York, NY: McGraw-Hill;
1996.