The optimized methodology and results of the new characterization in terms of dose and image quality of the X-ray system used in the main pediatric hemodynamics service in Chile are presented. In addition, scattered dose rate values at the operator’s eye level are reported for all acquisition modes available in different thicknesses of absorbent media and angiography. The characterization was performed according to the European DIMOND and SENTINEL protocols adapted to pediatric procedures. The air kerma at the entrance surface (ESAK) was measured and the image quality parameters signal-to-noise ratio (SNR) and a figure of merit (FOM) were calculated. The scattered dose rate was measured in personal dose equivalent units. The ESAK for fluoroscopic modes ranged from 0.2 to 35.6 μGy/image when passing from 4 to 20 cm of polymethyl methacrylate (PMMA). For the cine mode, these values ranged from 2.8 to 160.1 μGy/image. The values of the image quality parameters showed a correct system configuration, although abnormal values were observed in the medium fluoroscopic mode. As for the scattered dose rate at the level of the cardiologist’s eyes, the highest value is PMMA with a thickness of 20 cm, where the cine mode reached 9.41 mSv·h-1. The differences found from previous evaluations can be explained by the deterioration of the system and the change of one of the X-ray tubes.

Multiple myeloma (MM) is a hematologic cancer characterized by clonal proliferation of plasma cells within the bone marrow. It is the most serious form of plasma cell dyscrasias, whose complications—hypercalcemia, renal failure, anemia, and lytic bone lesions—are severe and justify the therapeutic management. Imaging of bone lesions is a cardinal element in the diagnosis, staging, study of response to therapy, and prognostic evaluation of patients with MM. Historically, the skeletal radiographic workup (SRW), covering the entire axial skeleton, has been used to detect bone lesions. Over time, new imaging techniques that are more powerful than SRW have been evaluated. Low-dose and whole-body computed tomography (CT) supplants SRW for the detection of bone involvement, but is of limited value in assessing therapeutic response. Bone marrow MRI, initially studying the axial pelvic-spinal skeleton and more recently the whole body, is an attractive alternative. Beyond its non-irradiating character, its sensitivity for the detection of marrow damage, its capacity to evaluate the therapeutic response and its prognostic value has been demonstrated. This well-established technique has been incorporated into disease staging systems by many health systems and scientific authorities. Along with positron emission tomography (PET)-18 fluorodeoxyglucose CT, it constitutes the current imaging of choice for MM. This article illustrates the progress of the MRI technique over the past three decades and situates its role in the management of patients with MM.

This paper provides a comparative perspective on infrastructure provision in developing Asia's three largest countries: China, India, and Indonesia. It discusses their achievements and shortfalls in providing network infrastructure (energy, transport, water, and telecommunications) over the past two decades. It documents how three quite distinct development paths—and very different levels of national saving and investment—were manifested in different trajectories of infrastructure provision. The paper then describes the institutional, economic, and policy factors that enabled or hindered progress in providing infrastructure. Here, contrasting levels of centralization of planning played a key role, as did countries’ differing abilities to mobilize infrastructure-related revenue streams such as user charges and land value capture. The paper then assesses future challenges for the three countries in providing infrastructure in a more integrated and sustainable way, and links these challenges with the global development agenda to which the three countries have committed. The concluding recommendations hope to provide a platform for further policy and research dialogue.

The paper lays out basic design options for infrastructure policy. It first sketches mechanisms to assess demand. Then it sets out a hierarchy of issues starting with choice of market structure followed by conduct regulation. Ownership options are largely a function of market structure choices. The implications for finance—the topic of much day-to-day discussion in infrastructure policy-making—follow from these various prior choices. The discussion naturally circumscribes the role for the so-called public-private partnerships, their uses and pitfalls.