The Leipzig Cone Applicator

The Leipzig cone applicator is a brachytherapy device that was first developed in 1987 by
the Leipzig University in Germany for the treatment of superficial lesions.1 It is a surface
applicator that is commonly used with an Iridium-192 radioactive source and a high dose rate
(HDR) remote afterloader. By using this applicator, a more conformal treatment can be
delivered, directing the radiation to the area of interest while limiting unnecessary exposure to
surrounding healthy tissues. Common sites that can be treated with the use of this device include
the oral cavity, the vaginal cuff, Karposi sarcomas, and various skin cancers.2,3
A set of six Leipzig cone applicators are available for use in treatment delivery. The
applicators are composed of a 92% tungsten and 8% steel alloy with a fixed geometry and short
source-to-skin distance (SSD) of 1.3-1.5 cm.1,4 These applicators are cup-shaped with a single
dwell position at the applicators vertex and are available in different diameters ranging from 1-3
cm to accommodate different target sizes (Figure 1).1 In addition, the Leipzig cone has two
different catheter orientation options: horizontal with the source parallel to the treatment surface
and vertical with the source perpendicular to the treatment surface (Figure 2). The catheter
orientation is dependent on the source applicator and each applicator has a 1 mm plastic
protective end cap. The end cap is placed on the end of the cone between the skin surface and
applicator to help absorb electron contamination and reduce the skin-surface dose (Figure 3).4
There are several advantages and disadvantages in using a Leipzig cone applicator for
treatment of superficial lesions. Some advantages include the applicators simplicity in design and
setup as well as the capability for sharp dose gradients at the edges of the treatment area. Sharper
dose gradients are obtained through the tungsten/steel shielding collimation and the shorter
source-to-skin distance used in treatment delivery. Due to the ability for sharper dose gradients,
lower doses to surrounding healthy tissues can be achieved.5 Another advantage for the use of
the Leipzig applicator is that it can be used as an alternative method to electron beam irradiation.
If treatment setup is difficult because of the limitations of bulky electron cone applicators,
brachytherapy may be used with a Leipzig applicator for treatment delivery. Disadvantages for
using the Leipzig applicators include the restriction of only being used to treat flat surfaces and
small lesions.4 The treatment areas should not exceed 3-4.5 cm in diameter and the planning
target volume (PTV) should not exceed a maximum depth of 4-5 mm.2,4 If the depth is greater, it
may result in a higher skin surface dose. Other disadvantages of the Leipzig applicator are that it
produces an inhomogeneous dose distribution since no flattening filter is used and it is limited to
using only one treatment SSD.5

Figures
Figure 1. A set of Leipzig cone applicators with varying diameters with option for horizontal
source loading or vertical source loading.1

Figure 2. Diagram showing source orientation for Leipzig applicators: horizontal source
orientation (left) and vertical source orientation (right).5
Figure 3. A Leipzig applicator applied to a patient’s skin surface for treatment.4

References
1. Pedraza R, Rojas EL, Mitsoura E. Dosimetric characterization of 192Ir source-Leipzig
applicators sets for surface cancer treatment with Monte Carlo code MCNP4C. Mex J
Biomed Eng. 2009;30(1):33-40. http://www.medigraphic.com/pdfs/inge/ib-
2009/ib091g.pdf. Accessed July 22, 2018.
2. Garcia-Martinez T, Chan J, Perez-Calatayud J, Ballester F. Dosimetric characteristics of
a new unit for electronic skin brachytherapy. J Contemp Brachytherapy. 2014;6(1):45-53.
http://dx.doi.org/10.5114/jcb.2014.40770.
3. Perez-Calatayud J, Granero D, Ballester F, et al. A dosimetric study of Leipzig
applicators. Int J Radiat Onc Biol Phys. 2005;62(2):579-584.
http://dx.doi.org/10.1016/j.ijrobp.2005.02.028.
4. Ouhib Z, Kasper M, Perez-Calatayud J, et al. Aspects of dosimetry and clinical practices
of skin brachytherapy: The American Brachytherapy Society working group report.
Brachytherapy. 2015:14(6):840-858. https://doi.org/10.1016/j.brachy.2015.06.005.
5. Sarudis, S. Dose distribution beneath the Leipzig skin applicator set. [master’s thesis].
Stockholm, Sweden: University of Stockholm.