MR fluoroscopy in vascular and cardiac interventions (review)

Vascular and cardiac disease remains a leading cause of morbidity and mortality in developed and emerging countries. Vascular and cardiac interventions require extensive fluoroscopic guidance to navigate endovascular catheters. X-ray fluoroscopy is considered the current modality for real time imaging. It provides excellent spatial and temporal resolution, but is limited by exposure of patients and staff to ionizing radiation, poor soft tissue characterization and lack of quantitative physiologic information. MR fluoroscopy has been introduced with substantial progress during the last decade. Clinical and experimental studies performed under MR fluoroscopy have indicated the suitability of this modality for: delivery of ASD closure, aortic valves, and endovascular stents (aortic, carotid, iliac, renal arteries, inferior vena cava). It aids in performing ablation, creation of hepatic shunts and local delivery of therapies. Development of more MR compatible equipment and devices will widen the applications of MR-guided procedures. At post-intervention, MR imaging aids in assessing the efficacy of therapies, success of interventions. It also provides information on vascular flow and cardiac morphology, function, perfusion and viability. MR fluoroscopy has the potential to form the basis for minimally invasive image–guided surgeries that offer improved patient management and cost effectiveness

Risk margin estimation through the cost of capital approach: some conceptual issues

The Solvency II directive requires that insurance liabilities are valued using a best estimate plus a risk margin. The risk margin should be estimated using the cost of capital approach,that is the cost of the solvency capital requirement\u2014which is computed through a value at risk measure\u2014needed to support the insurance obligation until settlement. The unitary cost of capital applied to the future capital requirement should be fixed. This paper deals with conceptual issues relating to the risk margin estimate through the cost of capital approach. It shows that the Solvency II specification of the methodology is consistent with financial economics. However, the theoretical framework required (a frictionless and normally distributed world) is too far-fetched to be acceptable. Even if these conditions were satisfied, a variable unitary cost of capital must be used