Week 3 discussion: Freiburg Flap Applicator

Brachytherapy is designed to deliver radiation to surface, interstitial, or intracavitary

areas at a short distance through low dose rate (LDR), medium dose rate (MDR), or high dose
rate (HDR).1 External surface applicator is used to treat superficial skin lesions. It is also known
as mold which can be modified to conform radioactive sources to any body sites or organ
surface. Freiburg flap applicator is one type of high dose rate (HDL) surface applicators, but can
also be used with the microSelectron-LDR/MDR.2
The design of the Freiburg flap applicator promotes brachytherapy highly effective for
skin lesions. It is considered as an excellent alternative for electron or external photon in skin
cancer treatments.3 It is a noninvasive easy implanted technique. The mat-like Freiburg flap
applicator is composed by many small silicone-spheres and evenly arranged holes in between.
The thermoplastic molds are thin and flexible which can be applied to any uneven or irregular
skin surface. It is reusable for cost effective treatments. The short distance from the plane of the
source to skin surface (0.5 to 1.0 cm) distributes hotter skin dose with better sparing of deeper
organs at risk (OAR). The equal distance of the holes created by the silicone-spheres provides
precise separation of radioactive sources carried in catheters. Thus, it improves the conformality
and precision of dose distribution in target area.
The Freeburg flap applicator is a user-friendly technique. Besides its flexibility and
applicable to various surface, it also can be attached to the aquaplast mask for better
immobilization such as the treatment of skin keloid over breast area.4 It can be customized to
certain shapes and sizes depending on the target area, which makes a better control of radioactive
sources. It can carry up to 36 channels and deliver radiation at 5 mm source to surface distance
and 24 cm x 24 cm field size.2 It is applicable for up to 28 days implantation. It is also suitable
for intraoperative treatment.
The images about Freiburg flap applicators are below.

Figure1: An example of Freiburg flap applicator4

Figure 2: Flap attached to aquaplast mask for bilateral breast skin keloids treatment4

Figure 3: Dose distribution of HDR vs. Electron plans in color wash view.4

References:
1. Khan FM, Gibbons JP. The Physics of Radiation Therapy. 5th ed. Philadelphia, PA:
Lippincott Williams & Wilkins; 2014: 309.
2. Clinical Solutions. Nucletron: MicroSelectron-HDR & PDR Selectron-LDR Applicators.
MD: Nucletron Corporation.
3. Schmidt K. Brachytherapy implants: Surface applicators. [SolfChalk]. La Crosse, WI:
UW-L Medical Dosimetry Program; 2016.
4. Dou K, Li B, Laser B, Jacobs M, Lerma F, and Sarfaraz M. High dose rate Freiburg flap
applicator for skin lesion treatment-Alternative to electron or photon? MedStar Health
RadAmerica Mercy Medical Center Radiation Oncology.
http://macaapm.org/fall2014/wp-content/uploads/sites/5/2014/10/Session-3.2-KaiDou.pdf. Accessed April 20, 2016.