Leipzig cone applicators are designed to treat superficial skin lesions using

the HDR remote afterloader system. This application has multiple advantages over
alternative methods, such as electrons and orthovoltage x-ray machines.
Orthovoltage x-ray machines simply lack technical support and are not often utilized
due to more advanced technologies.1 Use of electron beams on linacs can be rather
difficult for treatment of small size and shallow depth tumors. Bolus is often
required to pull isodose lines closer to the surface and percent depth dose
significantly changes with field sizes smaller than practical range. The Leipzig cone
applicator is the treatment of choice for very small lesions with the added benefit of
excellent cosmetic results and without severe early/late complications.2

The Leipzig skin applicator consists of six different cone-shaped applicators

(1, 2, or 3cm) in either parallel or perpendicular orientation for varying size of
lesions and desired dose distribution.3 The source of iridium-192 travels from the
HDR afterloader through a single channel and is located at the focal point of the
cone. A 1-mm plactic cap is essential for the reduction of surface dose from
secondary electron contamination within the walls of the collimator. If this
protective cap is missing during treatment, surface dose can increase by a factor of
ten. Lesions treated with Leipzig should ideally be less than 25mm in diameter and
located where contact with the entire applicator surface is achievable.

Simplicity in design and set up are a major benefit of the Leipzig applicator.
A major advantage of this applicator is the tungsten alloy collimators that produce
sharp dose gradients at the edge of treatment area. The short source-to-skin
distance of 1.6cm results in faster dose fall off compared to 40cm for superficial
units and 100cm for electron beam linacs. Ease of planning and very short treatment
times are also key advantages. Disadvantages include the limitation of solely being
able to treat lesions smaller than the largest cone diameter of 3cm. Dose distribution
can be complex as iridium-192 has multiple photon energies and the general
complex geometry of the applicators as a whole. Dose is inhomogenous due to lack
of flattening filter as well.

Figure 1: Leipzig Applicator

Figure 2: Diagram showing horizontal applicator type (Left) and vertical applicator type (Right)

References:
1. Perez-Calatayud J, Granero D, Ballester F, et al. A dosimetric stud of Leipzig
applicators. Int J Radiat Oncol Biol Phys. 2005;62(2):579-
584. http://dx.doi.org/10.1016/j.ijrobp.2005.02.028
2. Buchauer, K., G. Henke, H. Schiefer, and L. Plasswilm. "Surface Dose
Characterisation of the Varian Ir-192 HDR Conical Surface Applicator Set
with a Vertically Orientated Source." Strahlentherapie Und Onkologie. U.S.
National Library of Medicine, Nov. 2014. Web. 27 July 2017. DOI.
10.1007/s00066-014-0713-2
3. Sarudis, S. (2006). Dose distribution beneath the Leipzig skin applicator set. M.S.
Thesis, University of Stockholm.
http://ki.se/sites/default/files/sebastian_sarudis_exjobb.pdf