Heather Tlougan

Brachytherapy Class
Topic: Surface Applicators
April 23, 2014
Freiburg Flap
The Freiburg Flap is a flexible mesh style surface mold for skin radiation or intra-
operative surface treatments. The flexible applicator can easily be shaped to fit curved
surfaces. It is ideally suited for large lesions or surface lesions that are difficult to cover,
such as the skull or face.

It is made of silicone rubber material. The catheters that you see in the pictures are 1 cm
apart. There is a 5mm distance between catheter plane and skin. It can easily be cut to
size to fit lesion and conforms to the curvature of the skin quite easily. It is
recommended to go beyond target by 2cm. A few other advantages are that the HVL for
IR-192 is 3mm Pb, allowing easy shielding of selected areas within the treatment field. It
also treats more superficially than electrons and has a faster dose fall off than superficial
X-rays.

I was actually very lucky to follow a patient at my clinical site from simulation to the
calculation of this HDR technique. Unfortunately, it was not treated. I was able to help
with the aquaplast mask and actually sewing the flap to the mask. Here are some
pictures that show the procedure below. This patient had an angiosarcoma on his scalp.





This is a picture of the outline of the CTV and PTV. Next a CT wire is placed on this
outline and an aquaplast mask is made for immobilization.




Here is a picture after the aquaplast mask is made. Then the physician outlines the
area where the wire is under the mask so the Freiburg flap can be cut to fit the area.
Next, the patient takes off the mask and relaxes while the flap is sewn to the mask.
Then copper catheters are inserted into the channels so that the CT scan can be
done for planning. After the scan, the mask is put back on the patient and the after
loading catheters are inserted. Notice how the flap conforms so nicely to the
contour of the scalp.



Here are pictures of the treatment planning. Notice the placement of the catheters
and the IR-192.



Here is a picture of the dose distribution. This patient was treated with 10 fractions,
with a dose of 400 cGy per fraction for a total dose of 4000 cGy.


References:

1. Khan F. The Physics of Radiation Therapy. 4
th
ed. Baltimore, MD: Lippincott
Williams & Wilkins; 2010.
2. Devlin P. Brachytherapy Applications and Techniques. Philadelphia, PA:
Lippincott Williams & Wilkins; 2007.