Comparison of the results of sleeve gastrectomy, gastric pilication and liragulitide in obese rats.

Obesity, which is generally seen in adults, is a serious health problem. Diseases caused by obesity are among the leading causes of death worldwide. Liraglutide (LG) is an analogue of glucagon-like peptide-1, which slows gastrointestinal motility, resulting in decreased food consumption. Gastric plication (GP) and sleeve gastrectomy (SG) is the reduction of stomach volume by surgical means. We examined and compared the body mass index (BMI) changes, metabolic changes and changes in gastric histology in obese rats after LG injection with surgical methods such as SG and GP. In this research, 35 Wistar Albino female rats were used. Rats were divided into 5 groups with 7 rats in each group. Group (G) 1: The control group, fed with a normal calorie diet for 8 weeks. G 2: Sham group, G 3: SG group, G 4: GP group and G 5: LG group, fed with high-calorie feed for 4 weeks. At the end of the 4th week, the study was terminated by making appropriate interventions for the groups. When the blood glucose (BG) levels measured at the beginning, 4th week and 8th week of the experiment were evaluated, it was monitored that the BG level at the 8th week was the lowest in the LG group (p<0.05). It was observed that the preop Ghrelin and Leptin levels of the LG group were lower than those of the SG and GP groups (p<0.05). As a consequenc As a consequence of our metabolic investigations, we observed that the use of LG is at least as effective as SG.

Side specific differences of tumor budding on non-metastatic colon cancer.

OBJECTIVE: Recent literature suggests that tumor budding (TB) may have a significant clinical impact on colorectal cancers. Our study aims to reveal the effect of TB on the long-term outcomes of patients and to reveal whether there is a difference in tumor location and TB in colonic cancer. PATIENTS AND METHODS: A cohort of 100 patients with non-metastatic colon cancer was included in the study. The clinicopathological information of the patients was reviewed. Patients' preparations were re-evaluated to identify TB as: low, medium, and high and represent 0-4 buds, 5-9 buds, and 10 or more buds per 0.785 mm2, respectively. Long-term oncological outcomes of patients were analyzed. The recurrence, metastasis, and final status of the patients were determined during the follow-up period. RESULTS: Low TN was associated with <65 year (p = 0.048), absence of lymphatic metastasis (p = 0.003), and absence of perineural invasion (p = 0.023). High TB was associated with higher pT stage (p = 0.017) and tumor stage (p = 0.005). Additionally, right-sided tumors had a high TB score than left side (82.3% vs. 23.6%, p = 0.011). Patients with high TB had lower overall survival, but these were not statically significant. According to multiple regression analysis, mortality risk was associated with age (p = 0.046), pN status (p = 0.003) and TB (p = 0.040). CONCLUSIONS: High TB is associated with mortality in colon cancer and is more common in right colonic carcinoma.

Our surgical experience in traumatic and congenital diaphragmatic hernia: Single-center study.

Background and Aim: Diaphragmatic hernias can develop congenitally or secondary to trauma. Congenital diaphragmatic hernias occur with Bochdalek hernia and Morgagni hernia (MH). In this study, we aimed to present laparoscopic and open surgical treatment for traumatic and congenital diaphragmatic hernias, and complications and length of hospital stay in the light of the literature. Patients and Methods: Twenty-two patients who were diagnosed with diaphragmatic hernia between January 2013 and January 2020 in our clinic were examined retrospectively in terms of demographic features, clinical and radiological findings, and length of hospital stay. Results: The complaints of the patients diagnosed with diaphragmatic hernia were often abdominal pain, shortness of breath, early satiety, nausea, vomiting, and abdominal distention. The mean age of the patients was 54 (19-88) years. Sixteen patients were females and six were males. Two patients were operated due to stab injury, six patients were operated due to ileus, and the remaining fourteen patients were operated due to congenital diaphragmatic hernia. Eight patients were operated under emergency conditions. The remaining patients were operated under elective conditions. The average hospital stay was 6(3-15) days. The length of hospital stay of those who underwent laparoscopic surgery was 4 (3-5) days. No patient had an exitus. All patients were discharged with healing. This rare pathology should be remembered especially in patients presenting with acute abdominal complaints accompanied by respiratory complaints. Conclusion: We think that cases with MH detected incidentally should be operated laparoscopically before becoming complicated.

Comparison of local rosmarinic acid and topical dexpanthenol applications on wound healing in a rat experimental wound model.

BACKGROUND: The aim of the study was to compare the effects of rosmarinic acid and dexpanthenol in a rat experimental wound model. MATERIALS AND METHODS: Twenty-four Wistar albino rats weighing 200-250 g were randomly divided into three groups. After 2-cm full-thickness skin defects were created, the wounds were washed with sterile 0.9% NaCl solution. After washing, the control group was left untreated, the second group received 5% dexpanthenol cream, and the third group received 10% rosmarinic acid cream. Before excision, the skin was evaluated macroscopically by measuring the reduction in wound size; after excision, histological examination (epithelisation, inflammation, fibrosis, granulation) was performed. RESULTS: Macroscopic comparison of the wound sizes showed that group 3 showed a statistically significant difference in wound size reduction compared to the other two groups. Histopathological examination showed that there was no statistically significant difference between the groups. We found that the rosmarinic acid group had greater wound size reduction than the other two groups. However, epithelialisation was detected in fewer cases. CONCLUSIONS: We believe that rosmarinic acid can be used as a topical cream for wound healing, as it leads to significant reduction in wound size, resulting in fewer scars.

The use of the SPT-based seismic soil liquefaction triggering evaluation methodology in engineering hazard assessments.

Probabilistic and deterministic seismic soil liquefaction triggering methodologies are proposed in Cetin et al. [1]. This manuscript: i) presents the protocols, which need to be followed for the correct use of this methodology for forward engineering (design) assessments, ii) guides the engineers through the procedure, and iii) discusses the "tricks" alongside the protocol. An illustrative soil profile shaken by a scenario earthquake is presented, through which consistent estimations of representative SPT blow-counts along with fines content are discussed. Additionally, the estimation of CSR input parameters are illustrated. Last but not least the uncertainty estimations of these input parameters are presented along with the probability and factory of safety for the assessment of liquefaction triggering. •A simplified methodology and its use to assess liquefaction triggering hazard of a soil site under an earthquake scenario event.•The consistent and unbiased mean estimates of input parameters of SPT blow-counts( N 1,60 ), fines content ( F C ), vertical effective ( σ ' v ) and total ( σ v ) stresses, maximum ground acceleration ( a m a x ), stress reduction (or non-linear shear mass participation) factor ( r d ) and moment magnitude ( M w ) along with their uncertainties are discussed.•Outlined methodology enables engineers to estimate the probability of- and factor of safety against- seismic soil liquefaction triggering for design problems.

Dataset on SPT-based seismic soil liquefaction.

This data article provides a summary of seismic soil liquefaction triggering and non-triggering case histories, which were compiled, screened for data completeness and quality, and then processed for the development of triggering relationships proposed in "SPT-based probabilistic and deterministic assessment of seismic soil liquefaction triggering hazard" [1]. The database is composed of 113 liquefaction, 95 non-liquefaction, and 2 marginal liquefaction case histories, from seismic events with moment magnitude Mw values varying in the range of 5.9 to 8.3. A spreadsheet summary of these case histories are included along with a separate spreadsheet, by which maximum likelihood assessment was performed. These data transparently enable researchers to access case history input parameters and processing details, and to compare the case history processing protocols with the ones of different researchers (e.g.: "The influence of SPT procedures in soil liquefaction resistance evaluations." [2], "SPT-based liquefaction triggering procedures." [3]).

Comparison of the effects of face mask treatment started simultaneously and after the completion of the alternate rapid maxillary expansion and constriction procedure.

OBJECTIVE: To test the null hypothesis that there were significant differences for skeletal, dentoalveolar, and soft tissue changes induced by face mask (FM) started simultaneously and after an alternate rapid maxillary expansion and constriction (Alt-RAMEC) procedure. MATERIALS AND METHODS: Thirty-six patients with Class III malocclusion due to maxillary deficiency were randomly assigned to Group I (FM started after the completion of the Alt-RAMEC) and Group II (FM started simultaneously with the Alt-RAMEC). The screw of the RME appliance was alternately activated and deactivated twice daily (0.20 mm per turn) for 1 week over the course of 8 weeks. The changes observed in both groups were assessed using the cephalometric lateral films and statistically evaluated using the paired t-test and Student's t-test. RESULTS: Thirty patients completed the present prospective study. No significant differences were observed between the groups. Class III malocclusion and negative overjet were improved by means of skeletal changes in conjunction with upper incisor proclination in both groups. Skeletal contribution to overjet correction in Groups I and II was 91.70% and 86.10%, respectively. Maxilla showed a forward movement of 3.84 mm and 3.02 mm in Groups I and II, respectively. CONCLUSIONS: The null hypothesis was rejected. Both groups showed similar results, and, thus, waiting until completion of the Alt-RAMEC procedure for the FM treatment is not necessary.

The efficacy of an experimental single solution versus alternate use of multiple irrigants on root dentin microhardness.

OBJECTIVES: This study was carried-out to evaluate and compare the efficacy of various irrigants when used singly or in combination on the microhardness of root canal dentin. STUDY DESIGN: A total of 50 root-halves were randomly divided into 5 groups immediately after the initial baseline microhardness measurements and treated with: Group-1; 7.5%Ethylenediaminetetraaceticacid (EDTA) + 2.5%sodium hypochlorite (NaOCl), Group-2; 7.5%ethyleneglycol-bis[b-aminoethylether]-N,N,N0,N0-tetraaceticacid (EGTA) + 2.5%NaOCl, Group-3; 7.5%trans1,2diaminocyclohexane NNN',N'tetraaceticacid (CDTA) + 2.5% NaOCl, Group-4; 7.5%EDTA + 2.5% Ethylenediamine (EDA), and Group-5; 1/1 (v/v) EDTA-EDA mixture + 1/1 (v/v) EDTA-EDA mixture. Fifty mL of each solution was used for 1 minute. The reference and post-treatment microhardness values were measured with a Vickers indenter under 80-gram load, 15-second dwell time. Data were analyzed by two-way ANOVA and Bonferroni tests (p=0.05). RESULTS: All solutions decreased microhardness of dentin (p< 0.05). There was statistically significant difference between each group, except Group-1 and 4, after 1st solution application. While Group-2 resulted in a greater reduction of dentin hardness, Group-5 caused the least change in microhardness values, after 1st solution application (p< 0.05). No statistical difference was observed between Groups 1-4, after 2nd solution application. However, Group-5 showed a significant difference compared with all other groups, after 2nd solution application (p< 0.05). CONCLUSIONS: Under the experimental conditions, all tested solutions reduced the microhardness of the root canal dentin. EGTA was the most efficient chelating agent. EDTA-EDA single mixture has led to least change on the microhardness of root dentin. Key words:Microhardness, CDTA, EDTA, EGTA, Ethylenediamine.

The effect of surfactant addition to EDTA on microhardness of root dentin.

INTRODUCTION: The aim of this study was to investigate the effect of different concentrations of cetrimide with or without 5% EDTA solution on the microhardness of human root dentin in vitro. METHODS: Twenty-five recently extracted single-rooted human teeth were selected. The roots were split longitudinally into 2 parts. The specimens were randomly divided into the following 5 groups and were treated with 5% EDTA, 5% EDTA + 0.25% cetrimide, 5% EDTA + 0.50% cetrimide, 0.25% cetrimide, and 0.50% cetrimide immediately after the initial baseline microhardness measurements. A standardized volume of 50 mL of each solution was used for 1 minute. The reference microhardness values of untreated specimens were initially measured with a Vickers indenter under a 50-g load and a 10-second dwell time at the midroot level of the root dentin. Post-treatment microhardness values were obtained in the same manner as the initial ones. The decrease in microhardness was calculated as a percentage. Data were analyzed statistically by 1-way analysis of variance (P = .05) and the post hoc Tukey test for multiple comparisons at the same level of significance. RESULTS: All solutions significantly decreased the microhardness of root dentin (P < .05). Although there was no significant difference among the solutions (P > .05), the specimens in the EDTA + 0.50% cetrimide solution group showed the highest change in microhardness. The plain EDTA and plain 0.50% cetrimide groups had similar values. CONCLUSIONS: The use of surfactants higher than 0.25% in concentration is questionable for clinical conditions.

Effect of human platelet-derived growth factor-BB on attachment of periodontal ligament cells on root surfaces.

OBJECTIVE: To evaluate the effects of platelet-derived growth factor-BB (PDGF-BB) on the attachment of human periodontal ligament cells (HPLCs) on the root surfaces demineralized with different agents. METHODS: We performed this study at Ege University, Izmir, Turkey between 2005 and 2006. Eighty root slices were subjected to one of following treatments after root planing: 1) only root planing, 2) Platelet derived growth factor-BB (PDGF-BB), 3) citric acid demineralization, 4) citric acid demineralization + PDGF-BB, 5) tetracycline hydrochloric acid (T-HCl) demineralization, 6) T-HCl demineralization + PDGF-BB, 7) ethylenediamine tetra-acetic acid (EDTA) demineralization, and 8) EDTA demineralization + PDGF-BB. Human periodontal ligament cells were seeded on the root surfaces. Following the 2-hour incubation period, the number of cells was calculated by the colorimetric assay. Three slices from each group were processed for scanning electron microscopy. The number of attached cells was tested by analysis of variance (p=0.050). RESULTS: There were no significant differences among the groups with regard to the mean number of attached cells (p=0.843), which was highest in the fourth group, and lowest in the sixth group. CONCLUSION: Root planing is the most important treatment to make the diseased root surfaces biocompatible to HPLCs adherence. Application of PDGF-BB to root surfaces demineralized with citric acid may be advocated to enhance periodontal regeneration.

Effects of immobilization beds on the dose in the entrance and exit dose region for Co-60, 4, 6 and 15 MV photons.

PURPOSE: The aim of this study was to determine the effects of Styrofoam beds used for immobilization on build-up and exit dose regions for high energy photon beams. MATERIALS AND METHODS: Build-up dose and exit dose measurements in central axis of Co-60 and 4, 6 and 15 MV photons at various field sizes and source to phantom distances were made in a water equivalent solid phantom with 2, 5 and 10 cm thick uniform Styrofoam beds at the surface. A Markus type plane-parallel ion chamber with fixed separation between collecting electrodes was used to measure the percent depth doses. RESULTS: The surface dose increased almost linearly with field size for Co-60, 4, 6 and 15 MV X-ray beams. The effect of immobilization (Styrofoam beds) on the surface dose increased with the thickness and this effect was lower with higher energies. When a 2 cm thick Styrofoam bed was used for immobilization, the surface dose in a 10x10 cm field was higher (43.9, 36.8, 28.8 and 14.9% for Co-60, 4, 6 and 15 MV, respectively). CONCLUSION: As the Styrofoam bed was thicker, the maximum dose point moved closer to the surface of the phantom for all energies. The exit surface dose was also enhanced with the presence of Styrofoam beds and similar to the effects on the surface dose. This enhancement was the maximum 5% for high energy photon beams and 6% for Co-60 beam. The introduction of Styrofoam beds in the radiation beam for the immobilization of the patient increases surface and exit doses to a considerable extent.

The effect of osteogenic medium on the adhesion of rat bone marrow stromal cell to the hydroxyapatite.

OBJECTIVE: To investigate the adhesive properties of bone marrow stromal cell (BMSC) on the hydroxyapatite (HA) particles and analyze their behavior. METHODS: The study took place in the Department of the Histology and Embryology, Celal Bayar University, Manisa and in the Department of Bioengineering, Ege University, Izmir, Turkey between 2004 and 2005. We cultured BMSC from the mature rat tibia and differentiated to the osteoblasts by osteogenic medium. The BMSCs were subcultured and were taken to the HA substrate. We measured their proliferation capacity and viability with MTT assay using the spectrophotometric method. Furthermore, we identified the osteoblast-like cells by immunohistochemical staining of osteonectin and osteocalcin and we analyzed the behavior of the cells on different sized HA particles by SEM at the end of 3 days incubation. RESULTS: Osteogenic medium caused the proliferation capacity of BMSC to speed up and the effects appeared earlier. We confirmed the osteoblastic differentiation by staining of most cells with osteoblastic markers. Subcultured cells were similarly adhesive to the HA particles and the osteogenic medium did not alter this behavior. They spread on the substrate similarly. Most of the cells demonstrated the cytoplasmic protrusion. Morphology of the cells did not change much with or without osteogenic medium. Different sizes of HA particles did not affect the adhesive properties of these cells except HA gel. The spreading and attachment ratios of the cells on HA gel were more than the others CONCLUSION: We found that there was heterogeneity in BMSC on differentiation capacity to the osteoblast, which was a sign of a subpopulation. Adhesive cells showed similar morphology and behavior under the effect of osteogenic medium. The only difference was the spreading capacity on the HA gel where cell used this substrate more effectively for adhesion.

Determination of output factors for the Leksell gamma knife using ion chamber, thermoluminescence detectors and films.

PURPOSE: In stereotactic radiosurgery by the Leksell gamma knife, small fields of 4-18 mm in diameter are used. The difficulties associated with the dosimetry of small radiosurgical beams are well known. The output factors for small field sizes show a strong field size dependence, with rapidly decreasing output factors as the diameter of the field decreases. The main purpose of this study was to determine output factors of 18, 14, 8 and 4 mm collimators for Leksell gamma knife and to compare them with the values given by the manufacturer. MATERIALS AND METHODS: The relative output factors of the 18, 14 8 and 4 mm collimators for model B Leksell gamma knife were measured. The output factor measurements were prformed using a PTW 0.125 cc ion chamber, G200 thermoluminescence detectors (TLDs), KodakXV and Kodak ERD2 films. RESULTS: For 14 mm collimator, output measurements used with an ion chamber, TLD, Kodak XV film and Kodak ERD2 film were in agreement with the manufacturer's estimates within 1%. For 8 and 4 mm collimators, the best agreement with values given by the manufacturer were obtained by Kodak EDR2 films (2% and 5%, respectively). CONCLUSION: The measured output factors are in good agreement with the values recommended by the manufacturer for 18, 14 and 8 mm collimators. No good agreement was found for 4 mm collimator.

Fungi in endodontic infections.

Fungi are chemoorganotroph eukaryotic microorganisms that can take part in endodontic infections and thereby may participate in the etiology of periradicular diseases. They possess virulence attributes--including adaptability to a variety of environmental conditions, adhesion to a variety of surfaces, the production of hydrolytic enzymes, morphologic transition, biofilm formation, and evasion and immunomodulation of the host defense--that may play a role in the pathogenesis of periradicular diseases. Fungi have occasionally been found in primary root canal infections, but they seem to occur more often in the root canals of obturated teeth in which treatment has failed. Candida albicans is by far the fungal species most commonly isolated from infected root canals, and this species has been considered a dentinophilic microorganism because of its invasive affinity to dentin. C albicans has also been discovered to be resistant to some intracanal medicaments, such as calcium hydroxide. Its ability to invade dentinal tubules and resistance to commonly used intracanal medicaments may help to explain why C albicans has been associated with cases of persistent root canal infections. Some medicaments, such as chlorhexidine digluconate, calcium hydroxide combinations (with camphorated paramonochlorophenol or chlorhexidine), and EDTA, have the potential to be used as effective intracanal medications for patients in whom fungal infection is suspected.

The effect of asymmetric collimation on the dose distribution and verification of treatment planning system for asymmetric fields.

PURPOSE: This study reports the feasibility of the symmetric fields for the usage of asymmetric fields, and checks the accuracy of treatment planning system (TPS). MATERIALS AND METHODS: A GE Saturne-42 linear accelerator, which produces dual photon energies of 6 and 15 MV, and an ISIS-3D TPS were used in this study. Percent depth doses (PDDs), dose profiles, and isodose distributions for symmetric and asymmetric fields were generated in a water phantom and these data were compared to those calculated by the TPS. RESULTS: When the results were compared it was seen that the PDDs decreased with increasing off-axis distance and depth. The PDDs comparison demonstrated that for 15 MV, asymmetric and symmetric field PDDs can differ by as much as 4%, and the differences between the calculated by the TPS and the measured PDDs for asymmetric fields were less than 2%. It was also seen that the penumbra of symmetric and asymmetric fields were very close to each other and the difference between the calculated and the measured ones were less than 2 mm. The comparison between the measured and calculated isodose distributions for 6 and 15 MV photon beams for asymmetric field showed that a good agreement has been achieved in general, and the differences between the field edges and near the centre of the fields were found within 2 mm. CONCLUSION: This study shows that the measured and calculated data using water phantom and TPS (ISIS-3D), respectively, were in good agreement. Therefore TPS can be used safely for asymmetric fields in routine practice.

Do collimator angle setup errors cause dose inhomogeneity at the junction zone during craniospinal irradiation? A phantom study.

PURPOSE: Craniospinal irradiation (CSI) has some geometric uncertainties, especially at the junction zone. In this study we tried to evaluate how possible random setup errors of the collimator angle may contribute to these uncertainties. MATERIALS AND METHODS: Cranial and spinal fields were drawn on RW3 solid water phantom in accordance with the divergence matching technique (DMT). Field dimensions were 18x18 cm and 6x30 cm, respectively. We placed light-insulated Kodak X-Omat V films at the junction zone, then we irradiated the films with different collimator angles with both Co-60 and 4 MV conditions, and determined how the junction zone was affected from random setup errors in DMT. RESULTS: 10.6 degrees collimator angle was proper for 30 cm upper spinal field. For Co-60 machine the dose homogeneity of this angle was +4.5%. For the angles of 8, 9, 11 and 12 degrees the homogeneities were -13%, - 11%, +5% and +10 %, respectively. For 4 MV photon the dose homogeneity of the 10.6 degrees collimator angle was +3%. For the angles of 8, 9, 11 and 12 degrees the homogeneities were -17%, -14%, +6 % and +13%, respectively. CONCLUSION: As the CSI has some geometric uncertainties, serious dose inhomogeneities may occur at the junction zone. The collimator angle is of great importance and any random setup errors may not be tolerated.

Beam characteristics of kilovoltage radiotherapy unit.

PURPOSE: To present the beam characteristics of the Siemens II orthovoltage x-ray therapy machine. MATERIALS AND METHODS: x-ray beam qualities with the tube operating between 100 and 300 kV were determined. The field flatness, central axis depth dose, and relative output factors were measured for several applicator sizes for rectangular cones at 40 cm, and for circular cones at 30 cm focal skin distance (FSD). RESULTS: The central axis depth doses were selectively compared with values presented in the literature and found to agree to within -/+3 % shallow depths for two energy ranges. The field edges had 85-95 % isodose line. Relative output factors of all the available cones were different. CONCLUSION: The beam quality for all the stations should be determined and relative output factors should be measured for all the available cones.

Determination of dose distributions and dose rates in the gamma knife.

PURPOSE: To measure the dose parameters of the Leksell gamma knife unit and compare them with the treatment planning data. MATERIALS AND METHODS: The dose distributions taken from treatment planning computer were confirmed with film dosimetry using a spherical uniform density polystyrene phantom. The dose rate measurements were made by using a 0.125 cc ion chamber and the spherical phantom for 4, 8, 14 and 18 mm helmets. The dose rate measurements were compared with the estimates given by the manufacturer. RESULTS: The dose distributions obtained by film dosimetry were in agreement with those taken from the treatment planning computer only for the 70% and 50% isodose line. The results of dose rate measurement showed that the 0.125 cc ion chamber was suitable only for 18 and 14 mm helmets. Conversely, it was not suitable for 8 and 4 mm helmets. CONCLUSION: This study showed that both computergenerated treatment plans and film densitometry estimates provided similar dose distributions without special beam blocking.

Effect of field placement errors on dose at junction between divergence matching and half-beam block techniques in craniospinal irradiation.

PURPOSE: In craniospinal irradiation, both overlapping and gapping between the cranial and upper spinal field may occur due to patient's daily position (setup). This can cause dose inhomogeneities at the craniospinal junction. In this study we tried to find out possible dose changes at the craniospinal junction due to setup mistakes. MATERIALS AND METHODS: Both divergence matching technique (DMT) and half-beam block technique (HBBT) were used. At first step, a gap between cranial and spinal field borders was used, and at the second step overlapping between the fields for both techniques was applied. We irradiated films located in water equivalents solid phantoms with Co60 teletherapy machine. RESULTS: Dose homogeneity was 4% when no gap was used. When 2, 5, 8 and 10 mm gap were used, overlap occurred. Dose inhomogeneities were 6%, 17%, 27%,34% and 16%, 24%, 29%, 43%, respectively for DMT. Dose inhomogeneity was 5% with no gap used. With gaps of 2, 5, 8, and 10 mm, overlap occurred. Dose inhomogeneities were 8%, 12%, 36%, 51% and 17%, 29%, 35%, and 47%, respectively for HBBT. CONCLUSION: With no gap or with 2mm gap between the fields the dose homogeneity is in acceptable dose variation limits (10%) for both techniques (DMT and HBBT). Beyond this distance the setup mistakes are not tolerable.