1 Chris Karteczka DOS 425 There are three types of brachytherapy: surface applicators or mold brachytherapy (in which

superficial tumors are treated using sealed sources placed close to the skin), interstitial brachytherapy (in which radiation sources are inserted into the tissue itself), and intracavity brachytherapy (in which sources of radiation are placed inside a body cavity).1 Surface molds or plaques are usually employed in cases of superficial lesions, wherein the radioactive sources are arranged on the external surface of the patient, displaced slightly from the lesion. The source is designed to provide a more constant and reproducible geometry for source positioning. It is mounted on a wax or plastic piece to fill in the space between the source and the lesion. The advantage of this treatment is the rapid fall off of dose thereby saving the sensitive normal tissue below, if present. The most common use of surface applicators is in the treatment of ocular tumors, skin carcinomas of the face and head, and various cancers of nasal cavity, oral cavity, external auditory canal, and hard plate.2 The picture below shows a surface applicator to treat a lip cancer.

Surface applicators can be custom made (to fit any body surface) or in the form of a generic, reusable surface mold (which can be applied to different patients on different anatomical parts). Generic surface applicators do not provide an exact fit and often it is required to tape the mold to the skin to ensure contact with the patient surface. Custom molds are fabricated to closely conform to the surface of the patient to decrease the possibility of movement of the surface applicator. The use of brachytherapy with custom-made external molds permits to obtain a uniform dose distribution with a sharp gradient in the edges of the applicator. The custom-made molds are easily used and permit a highly accurate daily treatment reproduction. They provide excellent local control with minimum treatment-related complications. Given the excellent results, HDR brachytherapy with external custom-made molds is a reasonable alternative to other radiation therapy techniques for the treatment of skin carcinomas.2 Strotium-90, Ruthenium-160, Iodine-125, and Palladium-103 have been used for surface applicators, particularly ophthalmic applicators where the beta particles provide the required surface dose with rapid fall-off beneath. More information on Strotium-90

2 eye applicator can be found at: http://www.aapm.org/meetings/05SS/program/pterygium072005_chiu.pdf. References: 1. Bentel GC. Radiation Therapy Planning. 2nd ed. The McGraw-Hill Companies; 1996. 2. Rachana KB, et al. A Customized Mould Brachytherapy Appliance. International Journal of Dental Clinic. 2011. 3(1):113-114. Available at: http://www.intjdc.com/intjdc/article/download/221/pdf. Accessed April 14, 2012.

Ania, The Leipzig skin applicator set is used for treatment of small superficial lesions (with diameters < 25 mm) together with an Ir-192 HDR source. Did you know that the Leipzig applicator set consists of six different cone-shaped applicators with different sizes and dosimetric characteristics? As you mentioned, each applicator is constructed from a tungsten/steel alloy and consists of the cone-shaped collimator and a plastic protective cap that absorbs the secondary electrons that are emitted from the collimator walls as primary radiation interacts. Issac, A custom made brachy surface applicators show various advantages over generic surface applicators. Custom applicators are fabricated to closely conform to the surface of the patient to decrease the possibility of movement; they can fit to any surface to obtain a uniform dose distribution.