BackTable Vascular & Interventional (BackTable)

In this episode, Dr. Aron Chary provides an in-depth look into endovascular and minimally invasive treatments for pain management, specifically focusing on cryoneurolysis. He shares his experience of implementing the technology for both benign and malignant conditions in an independent private practice setting. --- CHECK OUT OUR SPONSOR Boston Scientific Visual ICE Cryoablation System https://www.bostonscientific.com/en-US/products/cryoablation/visual-ice.html --- SYNPOSIS The discussion covers various aspects, including collaboration with Boston Scientific for the VISUAL ICE cryoablation system, Dr. Chary’s personal journey from academics at Emory to private practice in Memphis, the effectiveness of cryoneurolysis in different areas such as genicular nerve and palliative care, and the operational dynamics between hospital and outpatient settings. The doctors delve into the procedural specifics, patient response, and outcomes with cryoneurolysis, including Dr. Chary’s efforts to navigate insurance and reimbursement challenges. --- TIMESTAMPS 00:00 - Introduction 07:04 - Evolution of Pain Intervention Techniques 11:08 - Building a Pain Intervention Service 16:16 - Versatility of Cryoablation in Pain Management 23:54 - Expectations and the Future of Pain Management Research 31:41 - Cryoneurolysis Insights and Patient Management 42:10 - Techniques in Celiac Cryoneurolysis 52:33 - Pain Management in the Outpatient Setting --- RESOURCES Percutaneous CT-Guided Cryoablation of the Celiac Plexus: A Retrospective Cohort Comparison with Ethanol: https://www.jvir.org/article/S1051-0443(20)30349-3/abstract BT VI Episode 199 - Advanced Minimally Invasive Pain Interventions with Dr. David Prologo: https://www.backtable.com/shows/vi/podcasts/199/advanced-minimally-invasive-pain-interventions BT VI Episode 433 - Kyphoplasty Evolution: Steering Toward Targeted Therapy with Dr. David Prologo: https://www.backtable.com/shows/vi/podcasts/433/kyphoplasty-evolution-steering-toward-targeted-therapy Boston Scientific, VISUAL ICE: https://www.bostonscientific.com/en-US/products/cryoablation/visual-ice.html

In this episode of the BackTable Podcast, host Dr. Aaron Fritts interviews guest Dr. Ilan Rzadkowolsky-Raoli about his experience of being diagnosed with a large saddle embolus and subsequently being treated by his best friend, Dr. Ripal Gandhi. Dr. Rzadkowolsky-Raoli is an interventional radiologist at Palmetto General Hospital in Miami, Florida. Dr. Rzadkowolsky-Raoli discusses the impact of his diagnosis on his practice, how it has changed the way he approaches and speaks to his patients, and his advice for clinicians. --- CHECK OUT OUR SPONSORS Varian, a Siemens Healthineers company https://www.varian.com/products/interventional-solutions/embolization-solutions Medtronic ClosureFast https://www.medtronic.com/closurefast6f --- SHOW NOTES 00:00 - Introduction 06:18 - Dr. Rzadkowolsky-Raoli’s Personal Journey 09:41 - Diagnosis and Treatment Process 12:18 - Post-Treatment Recovery and Reflections 24:18 - Impact on Practice and Patient Care 31:45 - Final Thoughts and Appreciation --- RESOURCES Pulmonary Embolism Response Team (PERT) Consortium: https://pertconsortium.org/ Inari FlowTriever: https://www.inarimedical.com/flowtriever/

En este episodio de BackTable Español, Dra. Gina Landinez entrevista a Dr. Miguel Montero-Baker sobre la enfermidad arterial periférica y salvamento de extremidades en la comunidad latinoamericana. In this episode of BackTable Español, Dr. Gina Landinez interviews Dr. Miguel Montero about peripheral arterial disease and limb salvage in the Latin American community. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/nKsjxN --- SHOW NOTES Los dos doctores discuten el camino de Dr. Montero-Baker a convirtirse en un Cirujano vascular enfocado en el salvamento de extremidades, su experiencia de construir un centro de preservación, y diferencias culturales entre los pacientes latinoamericanos y estadounidenses. Además Dr. Montero-Baker comparte sus consejos sobre sus técnicas, su equipo preferido, y como superó los retos institucionales para empezar un programa del salvamento extremidad. Finalmente, él enfatiza la importancia de la prevención y la educación del paciente sobre la enfermedad arterial periférica. The two doctors discuss Dr. Montero's path to becoming an interventional radiologist focused on limb salvage, his experience building a preservation center, and cultural differences between Latin American and US patients. Additionally, Dr. Montero shares his advice on his techniques, his preferred equipment, and how he overcame institutional challenges to start a limb salvage program. Finally, he emphasizes the importance of prevention and patient education about peripheral arterial disease.

In this episode, host Dr. Ally Baheti interviews Dr. Deepak Sudheendra about obstacles that he has faced while practicing medicine, including dealing with a career-threatening injury, redefining boundaries between clinical and home responsibilities, and navigating a transition from a surgical to radiology residency. --- CHECK OUT OUR SPONSORS Medtronic Ellipsys Vascular Access System https://www.medtronic.com/ellipsys RADPAD® Radiation Protection https://www.radpad.com/ --- SHOW NOTES Dr. Sudheendra has recently returned to his clinical IR practice. He had taken one year off to recover from a traumatic fall that resulted in multiple fractures and loss of function in his left hand and arm. The recovery process was physically arduous, requiring intensive physical and occupational therapy multiple times a week to re-learn basic functions. As an IR that was 100% procedural, Dr. Sudheendra faced a lot of uncertainty about whether he would ever be able to return to performing complex procedures. Additionally, he faced the stress of battling with insurance companies for his rightful disability insurance payments. The paperwork process required him to submit case logs and attestations from co-workers to prove his prior case volume. Through this experience, Dr. Sudheendra is able to give disability insurance advice for young physicians and graduating trainees. Buying an insurance plan before residency or fellowship ends will allow the trainee to pay a lower premium than if they were attendings. It is important to read the fine print in the contracts that are offered and consider buying both short-term and long-term insurance, since there is no way to predict the timing and severity of a future injury. Additionally, buying into multiple plans can lower the total annual premium, but it comes with the added stress of having to deal with multiple companies when an injury does occur. As Dr. Sudheendra returned to clinical practice, he started with locums in community hospitals. He found that easing back into simple IR procedures allowed him to not only gain his confidence back, but also invest more time into his family. His next endeavor is opening his own office-based lab (OBL) focused on vascular interventions. To end the episode, we discuss Dr. Sundheendra’s perspective on navigating his career. He originally started in a cardiothoracic surgery residency, but decided to leave the field to pursue interventional radiology. This switch was not simple, and it required years of researching and advocating for himself to different residency programs. On this journey, he was able to attain his diagnostic radiology residency and interventional radiology fellowship positions through persistence and networking. Overall, Dr. Sudheendra advises procedurally-oriented medical students and early trainees to expose themselves to all related subspecialty areas, think about new developments in those fields, and imagine how the field might change in the course of their careers. --- RESOURCES Dr. Deepak Sudheendra Website: https://www.gethealthyveins.com/ Dr. Deepak Sudheendra Twitter: https://twitter.com/Dr_Sudi/with_replies Physician Moms Group on Facebook: https://www.facebook.com/groups/PhysicianMomsGroup/

We talk with Dr. Reza Rajebi and Dr. Kavi Devulapalli about what constitutes a good job in interventional radiology, how to spot red flags when you're job searching, and when to pivot in your career. --- CHECK OUT OUR SPONSOR Laurel Road for Doctors https://www.laurelroad.com/healthcare-banking/ --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/gTvtfF --- SHOW NOTES In this episode, host Dr. Aaron Fritts interviews interventional radiologists Drs. Reza Rajebi and Kavi Devulapalli about what constitutes a good job versus a bad job in interventional radiology including red flags to look for, the importance of mentorship and when to pivot in your career. The three begin by discussing their training and various jobs they have held. Dr. Devulapalli took the first job he got out of residency, then worked with an interventional cardiologist building a multidisciplinary OBL. Now he does locums and teleradiology from home. Dr. Rajebi started in academics, then transitioned to private practice at a traditional IR and DR group. He is now at an OBL, now doing a mix of locums. Dr. Fritts currently does locums and DR in Dallas. They discuss what makes an ideal IR job, as well as what leads to job dissatisfaction. They agree that the people you work with are the most important aspect of a good job. Supportive colleagues who share your vision and a pathway for professional growth are also key requirements. Job dissatisfaction in IR is often due to lack of autonomy, inability to build your practice, private equity buyouts such as paths to partnership, and politics such as hospital contracts. They discuss how to spot red flags when job hunting. Dr. Rajebi advises to be aware of false promises, to do robust research, and to ask like minded people what they think of the position. They end by discussing when to pivot in a job you are unhappy with. Dr. Rajebi says not to pivot until you are sure you will get 3 out of 4 things that make an ideal job: location, salary, job satisfaction, and work life balance. Dr. Devulapalli shares his experience with job dissatisfaction and advice on mentorship, noting that you should not pivot too early or too often. He says that the moment you start having negative feelings about your job is when mentorship really matters. He advises to give it a year and use that time to reflect in order to pivot and find a better opportunity. --- RESOURCES Dr. Kavi Devulapalli’s blog: https://linemonkeymd.com/ Dr. Reza Rajebi’s paper on issues for the early career IR: https://pubmed.ncbi.nlm.nih.gov/33726963/

In this episode, Dr. Ally Baheti interviews interventional radiologist Dr. Lorenzo Patrone about his recent multidisciplinary editorial entitled "The 'Woundosome' Concept and Its Impact on Procedural Outcomes in Patients With Chronic Limb-Threatening Ischemia.” --- CHECK OUT OUR SPONSOR Reflow Medical https://www.reflowmedical.com/ --- SYNPOSIS Dr. Patrone explains his interest in critical limb ischemia (CLI) and describes how he reached out to colleagues around the world with the intention of drafting a paper that summarizes research in below-the-ankle interventions and increases awareness of the woundosome concept. He explains the woundosome concept, which aims to understand how each patient’s foot vasculature influences the effectiveness of below-the-ankle interventions and tissue healing. Understanding each patient’s anatomy, having adequate imaging of the foot, obtaining pedal acceleration times, and using micro-oxygen sensors are strategies to assess wound perfusion, which is integral for treatment planning and prognosis. He illustrates these techniques in a case study of a non-healing wound. Finally, Dr. Patrone shares some technical tips for below-the-ankle interventions, including the benefits of ipsilateral antegrade access, sheath selection, and strategic contrast administration. --- TIMESTAMPS 00:00 - Introduction 02:25 - Multidisciplinary and Global Collaboration 05:59 - Explaining the Woundosome Concept 07:51 - Understanding Wound Perfusion 10:20 - Assessing the Effectiveness of Revascularization 20:09 - Case Example with Pictures 28:07 - Technical Tips for CLI Interventions --- RESOURCES Find Your Algorithm (FYA): https://fya-congress.com/ The "Woundosome" Concept and Its Impact on Procedural Outcomes in Patients With Chronic Limb-Threatening Ischemia: https://journals.sagepub.com/doi/10.1177/15266028241231745?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed Vascular imaging of the foot: the first step toward endovascular recanalization (Manzi): https://pubmed.ncbi.nlm.nih.gov/21997985/ BASIL-2 Trial: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)00462-2/fulltext BackTable VI Ep. 90- Pedal Acceleration Time for Limb Salvage with Jill Sommerset and Dr. Mary Constantino: https://www.backtable.com/shows/vi/podcasts/90/pedal-acceleration-time-for-limb-salvage The First-in-Man "Si Se Puede" Study for the use of micro-oxygen sensors (Montero-Baker): https://pubmed.ncbi.nlm.nih.gov/26004327/ PEDRA Perfusion Monitoring: https://www.pedratech.com/ Armada XT Balloon: https://www.cardiovascular.abbott/us/en/hcp/products/peripheral-intervention/peripheral-dilatation-catheters/armada-14.html

In this episode of the BackTable Podcast, vascular surgeon Dr. Nicolas Mouawad and interventional radiologist Dr. Raja Ramaswamy share their insights on the changing landscape of deep vein thrombosis (DVT) management, steps of mechanical thrombectomy, and current research on DVT interventions. --- CHECK OUT OUR SPONSOR Inari Medical https://www.inarimedical.com/ --- SYNPOSIS The guests start by describing their typical referral patterns, noting that most cases come through the emergency department. In terms of workup, it is important to distinguish between acute and chronic DVTs and classify the thrombosis location as either proximal (femoral vein or higher) or distal. Anticoagulation, usually with direct oral anticoagulants, is always started, with efficacy largely determined by patient compliance. Regarding endovascular intervention, thrombolysis may be an effective adjunctive treatment if the clot occurred within a two-week timespan, but it carries a bleeding risk and requires ICU monitoring. On the other hand, mechanical thrombectomy is an option for both acute and chronic clots, allows for intervention in patients with high bleeding risk, and does not require post-procedural hospitalization. Both physicians emphasize that interventions should be employed if there are long-term benefits of avoiding post-thrombotic syndrome and pulmonary embolism. The physicians walk through a typical mechanical thrombectomy procedure, which involves the thrombectomy device, venogram, intravascular ultrasound, and possible stent placement. Finally, they discuss recent data, including the ATTRACT Trial for thrombolytics and the CLOUT Registry and Trial for ClotTriever use. Notably, they mention the DEFIANCE Trial as a current prospective randomized clinical trial for ClotTriever use in the iliofemoral region. --- TIMESTAMPS 00:00 - Introduction 03:48 - DVT Referral Patterns and Treatment Algorithms 08:55 - Choosing an Anticoagulation Regimen 11:01 - DVT Interventions 13:54 - Patient Scenarios and Treatment Decisions 22:29 - Post-Thrombotic Syndrome 26:16 - Mechanical Thrombectomy Technique 35:45 - Postoperative Care 39:09 - The Evolution of Mechanical Thrombectomy 43:38 - ATTRACT Trial 46:20 - CLOUT Trial --- RESOURCES Inari ClotTriever System: https://www.inarimedical.com/clottriever-system ATTRACT Trial: https://www.nejm.org/doi/full/10.1056/NEJMoa1615066 CLOUT Trial: https://pubmed.ncbi.nlm.nih.gov/35218955/ DEFIANCE Trial: https://evtoday.com/news/inari-medical-begins-defiance-randomized-clinical-trial-of-clottriever-system-in-dvt

In this episode of the Backtable Podcast, host Dr. Chris Beck interviews guests Dr. Omar Chohan and Dr. Harris Chengazi about dialysis fistula declot procedures and their own experiences with various devices and strategies, including usage of pre-procedure ultrasound, heparinization, and closure techniques. Both Dr. Chohan and Dr. Chengazi are interventional radiologists at Great Lakes Medical Imaging in Buffalo, New York. The doctors dive into treatment of anastomosis stenosis, stressing the importance of technique refinement, physical examination, and thoughtful pre-procedure planning. The discussion concludes with an invitation for listeners to share their experiences with the ‘bottle-cap’ hemostasis trick. --- CHECK OUT OUR SPONSOR Argon Cleaner Rotational Thrombectomy System https://www.argonmedical.com/cleaner --- SHOW NOTES 00:00 - Introduction 05:59 - Importance of Problem Solving in Declot Procedures 07:27 - Role of Pre-Procedure Ultrasound 12:00 - Process of Declot Procedures 28:27 - Moving to the Arterial Side: Access and Treatment 32:37 - Wire Management and the Risk of Rupture 41:59 - Art of Closure: Techniques and Considerations 45:53 - When to Quit: Evaluating the Need for Revision or Alternative Treatment 50:24 - Experience and Planning in Successful Fistula Treatment --- RESOURCES BackTable Declot Guide: https://www.backtable.com/shows/vi/topics/procedure/declot BackTable VI Episode #25 - Declots with the Argon Cleaner Device with Dr. Sabeen Dhand: https://www.backtable.com/shows/vi/podcasts/25/declots-with-the-argon-cleaner-device BackTable VI Episode #117 - Successful (and Quick!) Declots for AV Access with Dr. Neghae Mawla: https://www.backtable.com/shows/vi/podcasts/117/successful-quick-declots-for-av-access BackTable VI Episode #139 - AV Fistula & Graft Maintenance with Dr. Ari Kramer: https://www.backtable.com/shows/vi/podcasts/139/av-fistula-graft-maintenance BackTable VI Episode #141 - DEB vs. Balloon Angioplasty Alone for Dysfunctional Hemodialysis Access with Dr. Eric Therasse: https://www.backtable.com/shows/vi/podcasts/141/deb-vs-balloon-angioplasty-alone-for-dysfunctional-hemodialysis-access BackTable VI Episode #292 - Dialysis Interventions with Drug-Coated Balloons, Covered Stents and More Dr. Ari Kramer: https://www.backtable.com/shows/vi/podcasts/292/dialysis-interventions-with-drug-coated-balloons-covered-stents-more

In this episode, host Dr. Sabeen Dhand interviews Dr. Charles Bailey about Limb Alert, a hospital protocol devised to expedite the diagnosis and treatment of patients presenting with acute limb ischemia. Dr. Bailey is a vascular surgeon and the Director of Peripheral Artery Disease (PAD) and Limb Salvage at the University of South Florida. Dr. Bailey explains how the Limb Alert program standardizes the care pathway, rapidly alerts necessary personnel, initiates labs, and prepares the Penumbra Lightning Bolt 7 System for endovascular thrombectomy. The incorporated protocol significantly streamlines patient management, resulting in encouraging survival rates. Dr. Bailey further emphasizes the necessity for modern endovascular trials in acute limb ischemia and proposes a multicenter randomized trial to provide evidence for endovascular treatment. --- CHECK OUT OUR SPONSOR Penumbra Lightning Flash https://www.penumbrainc.com/products/lightning-flash/ --- SHOW NOTES 00:00 - Introduction 02:43 - Dr. Bailey’s Journey to Florida and His Practice 06:43 - Importance of Timely Intervention in Acute Limb Ischemia 21:29 - Role of Debulking in Acute Limb Ischemia 28:20 - Tips and Tricks for Successful Outcomes 31:17 - Impact of the Limb Alert Program 41:19 - Future of Acute Limb Ischemia Treatment 47:40 - The Need for New Randomized Trials --- RESOURCES Acute Limb Ischemia: An Update on Diagnosis and Management: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6723825/ Safety and efficacy of mechanical aspiration thrombectomy at 30 days for patients with lower extremity acute limb ischemia - STRIDE Study: https://www.jvascsurg.org/article/S0741-5214(23)02196-1/fulltext

How can interventional radiologists help patients with long COVID? Today we hear directly from Jillian Angeline, a long COVID survivor that benefited tremendously from minimally invasive interventional care. Jillian sits down with host Dr. Eric Keller, and shares how interventional radiologist Dr. Brooke Spencer helped get her life back by turning the tide against her long-haul COVID symptoms which had been ongoing for multiple years. --- This podcast was developed in collaboration with: Interventional Initiative https://theii.org/ --- SYNPOSIS Jillian shares her challenging journey from being an extremely active individual to barely being able to walk, due to persistent inflammation following COVID-19 infection. After seeing numerous physicians across various states and experiencing dismissal and misdiagnosis, Jillian was finally referred to Dr. Spencer at the MIPS Center in Colorado where she underwent a series of venous interventions that significantly helped her. This episode aims to raise awareness about possible life-changing IR options for patients suffering from long COVID, the importance of patient advocacy, and underscores multidisciplinary collaboration amongst medical professionals. --- TIMESTAMPS 00:00 - Introduction 02:33 - Jillian’s Journey 05:11 - Finding Interventional Radiologist, Dr. Brooke Spencer 08:39 - Venous Interventions 16:03 - Road to Healing 32:21 - Advice for Long COVID Patients --- RESOURCES Dr. Brooke Spencer, MD, FSIR Practice: https://mipscenter.com/about-us/dr-e-brooke-spencer-md-fsir/ The Interventional Initiative: https://theii.org/

In this episode, host Dr. Chris Beck continues the discussion on managing hepatocellular carcinoma (HCC) with Dr. Tyler Sandow and Dr. Juan Gimenez, interventional radiologists at Ochsner Health in New Orleans, Louisiana. --- CHECK OUT OUR SPONSOR Boston Scientific TheraSphere https://www.bostonscientific.com/therasphere --- SHOW NOTES We continue the conversation where we left off in Part 1. Tyler and Juan share their thoughts on lobar treatment vs. radiation segmentectomy, selection strategies, and their preferred combination of ablation and Y-90. Tyler also reviews the core tenets of Y-90 treatment and references a handful of major landmark trials and studies. Juan highlights more studies that guide their approach to preoperative mapping and intraoperative delivery of Y-90. Juan emphasizes cone-beam CT and how this technique has significantly evolved over the years. We cover dosimetry software, navigation software, and the calculation of treated tumor volumes. Additionally, Tyler and Juan discuss their change in treatment approach for especially complex cases, which can involve factors such as extrahepatic feeders and difficult treatment locations. We also discuss the redistribution of flow and how underlying liver disease may affect treatment plans. We wrap up Part 2 of our discussion by highlighting the doctors’ current research pursuits. Tyler tells us about exciting new developments in the tumor marker arena, the emerging role of albumin in HCC, and the rising popularity of radiation segmentectomy in metastatic disease. Juan shares a few closing thoughts on the extrahepatic applications of Y-90 and the advantages of using AI in interventional radiology. --- RESOURCES LEGACY Trial: https://www.bostonscientific.com/en-US/medical-specialties/interventional-radiology/interventional-oncology/therasphere/clinical-data/legacy-study.html RASER Trial: https://pubmed.ncbi.nlm.nih.gov/35617978/ DOSISPHERE Trial: https://www.bostonscientific.com/en-US/medical-specialties/interventional-radiology/interventional-oncology/therasphere/clinical-data/dosisphere-01.html TARGET Study: https://www.bostonscientific.com/en-US/medical-specialties/interventional-radiology/interventional-oncology/therasphere/clinical-data/target-study.html Radiation Lobectomy: Preliminary Findings of Hepatic Volumetric Response to Lobar Yttrium-90 Radioembolization: https://link.springer.com/article/10.1245/s10434-009-0454-0 Radiation lobectomy: Time-dependent analysis of future liver remnant volume in unresectable liver cancer as a bridge to resection: https://www.sciencedirect.com/science/article/abs/pii/S0168827813004315 ACR–ABS–ACNM–ASTRO–SIR–SNMMI PRACTICE PARAMETER FOR SELECTIVE INTERNAL RADIATION THERAPY (SIRT) OR RADIOEMBOLIZATION FOR TREATMENT OF LIVER MALIGNANCIES: https://www.acr.org/-/media/ACR/Files/Practice-Parameters/rmbd.pdf Clinical, dosimetric, and reporting considerations for Y-90 glass microspheres in hepatocellular carcinoma: updated 2022 recommendations from an international multidisciplinary working group: https://pubmed.ncbi.nlm.nih.gov/36114872/ “Simplicit90y” Boston Scientific Dosimetry Software: https://www.bostonscientific.com/en-US/medical-specialties/interventional-radiology/interventional-oncology/therasphere/dosage-and-administration.html

In this episode, host Dr. Aaron Fritts interviews Jason Newton - an attorney with 14 years of private practice defense experience and current General Counsel at Curi - about cybersecurity in medicine and healthcare. --- SHOW NOTES Jason begins by introducing how he became an expert in cybersecurity law. Dr. Fritts and Jason then segue to the present day threats of ransomware in healthcare, beginning with a birds eye view and progressively getting more granular. They cover the topics of staffing shortage, how threat-actors are akin to present-day pirates, and the chief risk of ransomware. We learn that healthcare is the most common target of ransomware from threat-actors and how “big fish” are not only the main targets, meaning many smaller health entities are also under real threat. Jason explains well documented reports which detail the intense interest in health information of several US targets such as government leaders, military personnel, celebrities, and popular athletes. Dr. Fritts and Jason underscore how money is the central driving force behind ransomware attacks on healthcare. Jason also takes a deep dive into how threat-actors engage in social engineering to ensure their success. Troubling enough, Jason also shares how threat-actors (on average) have already infiltrated health systems 66 days prior to the day the breach has been discovered. Essentially health systems will only see threat-actors when these hackers want to be seen and demand ransom. ChatGPT, AI, and deep-fake technology is also discussed and how it can be used by threat-actors to bolster their ransomware attacks on healthcare. Jason also mentions the need for health systems to invest in cybersecurity insurance and the inverse relation between “secure” and “easy”. Health systems’ responsibility to secure their data is paramount to mitigating and avoiding ransomware. Jason highlights the necessity of training, the fact that people can be the weakest link in security, and how it is critical for everyone to approach their email inbox with a “no-trust” policy. Anti-phishing software can also be a very helpful addition to health systems looking to bolster their cybersecurity. Mr. Newton supplies some helpful training, consultation, and investigation resources from the Cybersecurity and Infrastructure Security Agency. While we hope this discussion may be helpful, there are no guarantees that the information and resources shared will prevent and/or mitigate bad outcomes, and no guarantees or endorsements are made. Although Jason is an attorney, he cannot and does not offer legal advice to external parties and an attorney-client relationship is not established with listeners of this podcast. Please contact your personal or corporate attorney if you require legal advice. --- RESOURCES Cybersecurity and Infrastructure Security Agency website: https://www.cisa.gov/resources-tools

In this episode, guest host Dr. Steven Raman interviews a founding father of percutaneous tumor ablation, Dr. Luigi Solbiati about the development of this revolutionary treatment, new therapies that have stemmed from it, and his vision for the future of interventional oncology. --- CHECK OUT OUR SPONSOR Varian, a Siemens Healthineers company https://www.varian.com/ --- SHOW NOTES Dr. Solbiati was a radiologist at the General Hospital of Busto Arsizio when he developed an interest in cancer in the 1980s. He traveled to the UK to learn about CT and ultrasound imaging. Upon his return to Italy, he combined this knowledge with his hospital’s department of pathology to obtain the first liver and abdominal ultrasound-guided biopsies for non-palpable lesions. Dr. Solbiati notes that in most of the world, ultrasound is personally performed by medical doctors, and it is an important skill to have. Next, we discover how Dr. Solbiati came to treat the first parathyroid adenoma using percutaneous ethanol injection. After Dr. Solbiati had performed a parathyroid tumor biopsy, the treatment team realized that her serum PTH levels had completely normalized due to compression of the overactive parenchyma. Inspired by this result, Dr. Solbiati researched past literature and saw the success of ethanol injection to cause sclerosis of liver and renal cysts. Since the patient was not a surgical candidate, she was willing to undergo ethanol injection, which was eventually successful. Dr. Solbiati explains that parathyroid tumors are hypervasculated and encapsulated, so they are able to contain ethanol and prevent diffusion. Additionally, the use of ultrasound made it possible for operators to visualize the amount of liquid ethanol entering a solid tumor. Overtime, Dr. Solbiati began to work with Dr. Tito Livraghi to inject ethanol and chemotherapeutics for hepatocellular carcinoma lesions. The outcomes from their initial studies are still used as benchmarks for locoregional therapies today. Their research gained publicity from scientific and non-scientific media, which came with both positive and negative reactions. Dr. Solbiati emphasizes the importance of collaboration with surgeons and other interventionalists to combine surgical, intravascular, and percutaneous therapies. Additionally, he also played a key role in the testing of cool-tip radiofrequency ablation. Dr. Solbiati highlights the significance of percutaneous ablation in advancing health equity. Ethanol and radiofrequency ablation are relatively cost-efficient and safe, which allows for higher quality of cancer treatment in resource-limited settings. He looks toward the future of interventional oncology as the “fourth pillar” of cancer care (in addition to medical, surgical, and radiation oncological treatments), the growing use of augmented reality for percutaneous procedures, and the increasing rate of combination therapy with immunologic agents. --- RESOURCES Percutaneous ethanol injection of parathyroid tumors under US guidance: treatment for secondary hyperparathyroidism (Radiology, 1985): https://pubmed.ncbi.nlm.nih.gov/3889999/ Hepatic metastases: percutaneous radio-frequency ablation with cooled-tip electrodes (RSNA, 1997): https://pubs.rsna.org/doi/10.1148/radiology.205.2.9356616

Looking to enhance your interventional oncology practice with renal tumor ablation? In this episode, host Dr. Don Garbett is joined by Dr. AJ Gunn to discuss the current landscape of renal tumor ablation and Dr. Gunn’s procedural tips for successful outcomes. Dr. Gunn is an interventional radiologist at the University of Alabama at Birmingham, with extensive experience in building service lines, including renal tumor management. --- This podcast is supported by: RADPAD® Radiation Protection https://www.radpad.com/ --- SYNPOSIS The doctors review various scoring systems to predict the risks associated with renal ablation. Dr. Gunn emphasizes that tumor size is the most consistent predictor of procedural complications, local recurrence, and metastasis. He also discusses ablation techniques and proactive steps to avoid complications, such as hydrodissection and the selection of appropriate ablation technology. He employs cryoablation for central renal tumors and large tumors to minimize damage to the collecting system, while using microwave ablation for smaller peripheral lesions. Additionally, prior literature and his personal experience suggest that preoperative embolization may be beneficial for larger hypervascular tumors. Finally, Dr. Gunn speaks about the ongoing Embolization Before Ablation of Renal Cell Carcinoma (EMBARC) study and the importance of sharing knowledge and experiences within the interventional oncology community. --- TIMESTAMPS 00:00 - Introduction 04:24 - Practice Building Philosophy 09:29 - Importance of Clinical Follow Up 12:17 - Predictive Factors of Ablation Success 23:30 - Renal Ablation Technique 31:41 - Embolization Before Ablation 44:13 - The Future of Renal Tumor Treatments --- RESOURCES Percutaneous Cryoablation of Stage T1b Renal Cell Carcinoma: Safety, Technical Results, and Clinical Outcomes (Gunn et al, 2019): https://pmc.ncbi.nlm.nih.gov/articles/PMC8983093/ Should Renal Mass Biopsy Be Performed prior to or Concomitantly with Thermal Ablation? (Chung et al, 2018): https://pubmed.ncbi.nlm.nih.gov/30075976/ EMBARC Trial: https://med.stanford.edu/ir/clinical-trials/embarc.html Society for Interventional Oncology (SIO) Conference: https://www.sio-central.org/Events/Annual-Scientific-Meeting

In this episode, host Dr. Aaron Fritts interviews Dr. Rehan Quadri about the impact of intra-procedural arterial monitoring via sheath technology. Dr. Quadri is a practicing interventional radiologist at UT Southwestern in Dallas, Texas. --- CHECK OUT OUR SPONSOR Endophys https://endophys.com/ --- SHOW NOTES Dr. Quadri begins by telling us about a new arterial sheath, the EndoPhys Pressure Sense Arterial Sheath, which enables real-time blood pressure monitoring in a number of different cases and advantages that it offers over arterial lines and cuff monitors. We also discuss specific indications for utilizing this technology, such as trauma, GI bleeds, stroke, fistulas, and other emergent arterial interventions requiring minute-to-minute monitoring. We also breakdown the specs of the sheath, including its setup, calibration, placement, recorded measurements, and the accuracy of the read-outs when compared to those of past technologies. Dr. Quadri speaks on the cost and the overall value of the EndoPhys sheath. He concludes the episode by discussing new advancements in the technology such as improved device warmup times and a radial-specific sheath. --- RESOURCES Endophys Pressure Sense Arterial Sheath: https://endophys.com/

In this episode, host Dr. Chris Beck interviews Dr. Nima Kokabi about renal trauma embolizations, including imaging workup, embolization technique, and a warning on renal biopsies. --- CHECK OUT OUR SPONSOR Boston Scientific Embold Fibered Coils https://www.bostonscientific.com/en-US/products/embolization/embold-detachable-coil-system.html --- SHOW NOTES Dr. Kokabi was born in Iran, then moved to Canada where he grew up. He attended medical school in Australia due to the shortage of English speaking medical schools in Canada. After his medical training, he was interested in IR, and came to Yale for a fellowship. He then joined Emory as an attending, where he serves one of the largest trauma hospitals in the country. IR and trauma surgery have a close relationship at Emory, and Dr. Kokabi notes they rely more and more on IR for trauma management, even for things such as penetrating trauma, which is traditionally handled by surgery. Most IR consults for kidney injury are iatrogenic from non-target renal biopsies in a nephrology office. The rules for getting access to a kidney that IRs are trained in are generally not followed by nephrology, and only some have ultrasound guidance for their biopsies. Other consults for bleeding from kidney injury are post-op from a partial nephrectomy or from blunt trauma. To work it up, he gets a 2 phase arterial and venous CT. All kidney injuries are evaluated and reported using the American Association for the Surgery of Trauma (AAST) grading scale. If there is an active bleed, they will go to IR for embolization. If the injury is severe, and there is no parenchymal enhancement, this indicates either the artery or both the artery and vein were transected, and this patient requires surgery. In cases where there is only a small pseudo-aneurysm or a perinephric hematoma, these patients can be monitored with repeat imaging. For the embolization, Dr. Kokabi uses radial access. For his microcatheter, he likes the True Select. He always uses coils in the kidney, while in the liver, he uses gel foam. Some of his colleagues use glue for the kidney. He prefers detachable Embold coils, which are fiber coils with a nitinol pusher, so they don’t kink when being pushed very fast, and can be adjusted if positioning is unsatisfactory. When he is finished, he injects first through the microcatheter and then again through the base catheter to ensure he hasn’t missed any bleeding. He generally follows patients in the hospital for 1-2 days, before signing off. His parting advice to trainees and anyone doing kidney biopsies is to exercise caution, because although it is just a biopsy, it can cause life-threatening bleeding. --- RESOURCES AAST Kidney Injury Scale: https://radiopaedia.org/articles/aast-kidney-injury-scale

In this episode, guest host Dr. Venu Vadlamudi interviews Dr. Martin Radvany about where neurointerventional training stands in 2022, including stroke training for residents, barriers that IRs face in finding training after residency, and future directions of stroke care. --- CHECK OUT OUR SPONSOR RapidAI http://rapidai.com/?utm_campaign=Evergreen&utm_source=Online&utm_medium=podcast&utm_term=Backtable&utm_content=Sponsor --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/s3zGTV --- SHOW NOTES We begin by discussing stroke training in neurointerventional radiology. The Society of Interventional Radiology (SIR) has been prioritizing stroke training for IRs for years, with their former Clots Course and current Stroke Course, with Dr. Vadlamudi and Dr. Radvany as the directors of the course. This course occurs at the annual SIR meetings. Courses such as these are necessary because many residents aren’t trained in neurointervention but when they get out in the community the need is there and their employers often expect them to be able to provide stroke care. Dr. Vadlamudi hopes to grow the stroke course and eventually break away from the annual SIR meeting into it’s own free-standing course, such as has been done with the Y90 course. Next, we cover some of the barriers to IRs getting involved in stroke care. Often, practitioners with years of experience want or need to start performing neuroendovascular interventions but didn’t get a lot of experience in their training. Industry support is an important area that requires some growth to be able to support this pathway for IRs already in practice. Simulators are also a key aspect in training, and we discuss the possibilities of leveraging this for stroke training. By bringing patient specific anatomy into the simulator, anyone could use this to train in stroke thrombectomy and be able to practice with a patient's unique anatomy before performing the actual case. Finally, we discuss what trainees should expect going forward in IR residency and neuro fellowship. Interventional radiology is becoming very clinical, and it is important for trainees to focus on this. Spend the time in the ICU and on the floor. Knowing how to take care of your patients is essential in IR; we need to do more than just master the procedures. There are many ways to get training in stroke intervention. Mentorship at all levels is important and encouraged to push the field forward. --- RESOURCES Outcomes of Stroke Thrombectomy Performed by Interventional Radiologists versus Neurointerventional Physicians: https://pubmed.ncbi.nlm.nih.gov/35150837/

In this episode, host Christopher Beck discusses the current landscape of IR training with Dr. Neil Jain, a fourth-year IR/DR resident at Georgetown University. Neil, who attended medical school in New Jersey, discusses his early desire for a diverse medical career encompassing clinical work, innovation, and mentorship. --- CHECK OUT OUR SPONSOR RADPAD® Radiation Protection https://www.radpad.com/ --- SHOW NOTES To start the episode off, Neil offers valuable advice on when to decide on interventional radiology as a career path. He emphasizes that the ideal timing varies based on one's portfolio, but he personally found his passion for IR during his first year of medical school, which facilitated building meaningful connections early on. The conversation then explores the different pathways to entering the field of interventional radiology, including integrated, ESIR, and classic routes. Neil provides insights into the pros and cons of each pathway, shedding light on the evolving landscape of residency applications. We then delve into the changing dynamics of application processes, as Neil discusses the nuances of the recent changes and how students can strategically navigate them. He introduces the concept of "signaling" features, gold and silver star preferences, and the importance of proper program selection when applying to IR residency. Neil also offers guidance on away rotations, emphasizing their significance for students aspiring to match into competitive IR programs. He underscores the dedication to IR as a crucial factor in securing a match. Another key factor is mentorship, and Neil highlights how peer and attending mentors as well as the resources provided by the Society of Interventional Radiology (SIR) can play an enormous role in matching into IR. The discussion then shifts to the virtual residency application process, with Neil offering valuable do's and don'ts for applicants. He underscores the importance of creating a proper environment and engaging in hobbies during virtual interviews. He also provides valuable advice on preparing for common interview questions, encouraging applicants to build compelling stories that showcase their clinical understanding. As the field of interventional radiology continues to evolve, Neil emphasizes the importance of staying informed and maintaining close connections with mentors and resources like SIR.

In this episode, guest host Dr. Peder Horner interviews Dr. Harold Coons about the history of IR, his contributions to the field, where the field is headed, and his advice for trainees and early career IRs. --- CHECK OUT OUR SPONSORS BD Advance Clinical Training & Education Program https://page.bd.com/Advance-Training-Program_Homepage.html Philips SymphonySuite https://www.philips.com/symphonysuite --- SHOW NOTES Dr. Coons attended Pomona College, where he studied math. He then realized he didn’t want to be a nuclear scientist in the Sputnik era, which was where most opportunities were at the time. He decided to attend medical school at UCLA instead. As a medical student, he saw how happy the radiologists were, so he decided to choose it as a specialty. He had the opportunity to do a carotid arteriogram one day when everyone else was busy. He considered himself a maverick and someone who was always ready to take on a challenge. He then experienced a moment that changed his life, when Czech radiologist Josef Rösch came to UCLA to visit from the University of Oregon where he was working with Charles Dotter. Dr. Coons saw Dr. Rösch direct puncture the spleen for a spleen portogram, and it took him only 15 seconds. This was incredible to him, and after that, Dr. Coons followed him around whenever he did procedures. They teamed up, Dr. Coons volunteering to be the nurse, because no nurses liked working with Rösch. Coons shaped catheters for him at a steam kettle, watched him do the first TIPS on a dog, and did the first arterial embolization with clotted venous blood under the direction of Dr. Rösch. After his stint in the Airforce at a hospital in San Antonio, where he honed his embolization skills, he returned to San Diego. He was then working in private practice as the only IR in San Diego. One year, he heard about a meeting at Massachusetts General, so he submitted 6 papers on things he had been doing recently. All his papers were accepted, so he went to the meeting. At his first presentation, the leader of the meeting announced to the audience that he had accepted these papers to expose Coons as a fraud, because these techniques were nothing any academic had ever heard of. He did his presentation, and everyone in the audience, including the meeting leader, believed what he was doing was indeed real. He apologized to Coons and invited him to the speakers dinner, where he sat next to Kurt Amplatz and Plinio Rossi. Rossi convinced him to start publishing his ideas to get the credit he deserved, and to have something to show his children. Dr. Coons was forced to retire early in 1996 due to radiation exposure, but has been an avid innovator, educator, and international speaker since then. His passion for IR and excitement for the future of the field is contagious to all who have the pleasure of hearing him speak.

Interventional treatment for pulmonary embolism (PE) has significantly evolved in recent years, largely due to advancements in techniques, knowledge, and device technology. Dr. Zarina Sharalaya (interventional and structural cardiologist) and Dr. Ripal Gandhi (interventional radiologist) join host Dr. Chris Beck to discuss the evolving landscape of PE treatment, comparing large-bore mechanical thrombectomy with catheter-directed thrombolysis and exploring outcomes from the PEERLESS randomized control trial. --- This podcast is supported by: Inari Medical https://cwa.inarimedical.com/inari-learn --- SYNPOSIS Dr. Sharalaya and Dr. Gandhi begin by covering risk stratification and treatment algorithms for their patients with PE. The doctors then go onto discuss the procedure in detail, and best practices and techniques for mechanical thrombectomy. The conversation also focuses on the PEERLESS trial, highlighting how the study showed significant benefits of mechanical thrombectomy, including faster symptom improvement, decreased ICU stay, and reduced readmission rates. Dr. Sharalaya and Dr. Gandhi conclude the episode with a series of case presentations. --- TIMESTAMPS 00:00 - Introduction 08:01 - Pulmonary Embolism Risk Stratification and Treatment Algorithms 14:49 - Procedure Overview 24:25 - Best Practices and Techniques in Thrombectomy 34:31 - Peerless Study Overview and Findings 46:50 - Gender Differences in PE Treatment 47:49 - Future of PE Treatment and Advice 51:55 - Case Presentations and Clinical Insights --- RESOURCES 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS): https://pubmed.ncbi.nlm.nih.gov/31504429/ PEERLESS II: A Randomized Controlled Trial of Large-Bore Thrombectomy Versus Anticoagulation in Intermediate-Risk Pulmonary Embolism: https://www.jscai.org/article/S2772-9303(24)01053-6/fulltext Large-bore Mechanical Thrombectomy Versus Catheter-directed Thrombolysis in the Management of Intermediate-risk Pulmonary Embolism: Primary Results of the PEERLESS Randomized Controlled Trial: https://pubmed.ncbi.nlm.nih.gov/39470698/

In this episode of the BackTable Podcast, guest host Dr. Krishna Amuluru interviews Dr. Fawaz Al-Mufti about recent trials on large core strokes and how they may impact practice. Dr. Al-Mufti is a practicing neurointerventionalist and serves as the Associate Chair of Neurology for Research at New York Medical College. Dr. Al-Mufti examines the cost-effectiveness and socioeconomic implications of successful treatment of patients with large core strokes. The doctors highlight various stroke thrombectomy trials including the RESCUE-Japan, SELECT2 Trial, and TENSION trials. The discussion also covers how these findings affect thrombectomy expansion in lower resource settings and the future outlook of endovascular thrombectomy procedures. --- CHECK OUT OUR SPONSOR RADPAD® Radiation Protection https://www.radpad.com/ --- SHOW NOTES 00:00 - Introduction 02:53 - Large Ischemic Core Infarcts 06:06 - The Importance of ASPECTS 11:59 - Large Ischemic Core Trials 23:37 - Socioeconomic Implications of Thrombectomy 38:08 - The Future of Thrombectomy --- RESOURCES Mission Thrombectomy: https://missionthrombectomy.org/ The Alberta Stroke Program Early CT score (ASPECTS): A predictor of mortality in acute ischemic stroke: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8515558/ Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomized trials (HERMES Study): https://doi.org/10.1016/S0140-6736(16)00163-X Thrombectomy for Stroke at 6 to 16 Hours with Selection by Perfusion Imaging (DEFUSE III Trial): https://www.nejm.org/doi/full/10.1056/nejmoa1713973 Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct (DAWN Trial): https://www.nejm.org/doi/full/10.1056/nejmoa1706442 Endovascular Therapy for Acute Stroke with a Large Ischemic Region (RESCUE-Japan Trial): https://www.nejm.org/doi/full/10.1056/nejmoa2118191 Trial of Endovascular Thrombectomy for Large Ischemic Strokes (SELECT2 Trial): https://www.nejm.org/doi/full/10.1056/NEJMoa2214403 TESLA Trial: Rationale, Protocol, and Design: https://www.ahajournals.org/doi/10.1161/SVIN.122.000787 Endovascular thrombectomy for acute ischaemic stroke with established large infarct: multicentre, open-label, randomized trial (TENSION Trial): https://www.sciencedirect.com/science/article/pii/S0140673623020329 Evaluation of acute mechanical revascularization in large stroke (ASPECTS ⩽5) and large vessel occlusion within 7 h of last-seen-well: The LASTE multicenter, randomized, clinical trial protocol: https://pubmed.ncbi.nlm.nih.gov/37462028/ Trial of Endovascular Therapy for Acute Ischemic Stroke with Large Infarct (ANGEL-ASPECT Trial): https://www.nejm.org/doi/full/10.1056/NEJMoa2213379 Acute endovascular stroke therapy (Dr. Mike Chen Review): https://pubmed.ncbi.nlm.nih.gov/20535000/ Mechanical thrombectomy is cost-effective versus medical management alone around Europe in patients with low ASPECTS (European Cost Effectiveness Study): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10313965/ Mechanical Thrombectomy Global Access For Stroke (MT-GLASS): A Mission Thrombectomy (MT-2020 Plus) Study: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10313965/ Noncontrast Computed Tomography vs Computed Tomography Perfusion or Magnetic Resonance Imaging Selection in Late Presentation of Stroke With Large-Vessel Occlusion: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8576630/

We talk with Dr. Mary Costantino and Dr. Goke Akinwande about their experiences and advice on making equipment purchase decisions for OBLs and outpatient centers, including pitfalls to avoid. --- CHECK OUT OUR SPONSOR Siemens Healthineers https://www.siemens-healthineers.com/ --- SHOW NOTES In this episode, interventional radiologists Dr. Mary Constantino, Dr. Goke Akinwande, and Dr. Aaron Fritts discuss the process of choosing and financing equipment for office-based labs (OBLs). This episode focuses on three major types of equipment: C-arms or fixed units, disposables, and ultrasound machines. First, the doctors discuss the fundamental differences between mobile C-arms and fixed units. Drs. Constantino and Akinwande agree that while the fixed unit is more ergonomically advantageous, it carries significantly more cost. While a fixed unit must be incorporated into the architectural planning of the OBL, a C-arm can be adapted to an existing space. Both doctors emphasize the importance of vendor support and knowing that they have quick access to technicians in the area. Dr. Constantino provides her perspective on disposables and device partnerships, noting that an IR’s priority should be obtaining the equipment that allows them to operate to the best of their abilities. Dr. Akinwande obtains most of his disposables through consignment inventory in order to minimize waste. Finally, the doctors talk about ultrasound technology and situations where different types may be more appropriate than others. Overall, they emphasize that while the OBL model grants autonomy to IRs, this pursuit introduces a large financial risk that should be carefully considered. --- RESOURCES Midwest Institute for Non-Surgical Therapy: https://www.mintstl.com/ Advanced Vascular Centers: https://www.advancedvascularcenters.com/

Host Aparna Baheti interviews Barbara Hamilton and Aarti Luhar about navigating training and early career during a pregnancy. They discuss factors to consider such as scheduling, parental leave policies, radiation exposure risks, and childcare. --- CHECK OUT OUR SPONSORS Athletic Greens https://www.athleticgreens.com/backtablevi Medtronic Abre Venous Stent https://www.medtronic.com/abrevenous --- SHOW NOTES Our guests start by sharing their paths to motherhood. Dr. Luhar was pregnant as a diagnostic radiology trainee, while Dr. Hamilton was pregnant as an attending. We talk about the benefits of being part of a large department or group during maternity leave, due to more flexibility of scheduling changes and availability of coverage. Both of our guests recommend that IRs reach out to their HR departments as soon as they feel comfortable sharing their pregnancy news. Establishing contact with the department is a helpful way to clarify parental leave policies, specifically if one qualifies for parental leave and how long the leave can be. Additionally, Dr. Luhar encourages listeners to reach out to colleagues who have been pregnant before, since they can be a valuable resource for insights on the granular details of practicing IR while pregnant. In terms of radiation as an occupational exposure, Dr. Hamilton did not change her caseload during pregnancy. She shares her preference to wear extra radiation protection around her waist. Dr. Luhar reached out to her hospital’s radiation physicist for guidance. She received the advice to use standard radiation protection and follow the principle of ALARA (as low as reasonably achievable). Additionally, we discuss the risks of pathogen exposure and needle sticks. Both doctors agree that having supportive staff and colleagues can make the pregnancy process more manageable. Additionally, we discuss unexpected challenges during pregnancy. Dr. Hamilton describes her experience with the risk of premature labor and bedrest. Dr. Luhar recounts the struggle of scheduling prenatal appointments and dealing with pregnancy complications while working a full caseload. We close the episode by giving advice for evaluating the culture of your work environment, relying on support systems that are in place, and not being afraid to ask important questions. --- RESOURCES Dr. Barbara Hamilton Twitter: @TSuperheroine Dr. Barbara Hamilton Instagram: @TiredSuperheroine SIR Pregnancy Toolkit: https://www.sirweb.org/practice-resources/toolkits/pregnancy-toolkit/

How can we make life-changing treatments like uterine fibroid embolization (UFE) more globally accessible? To help answer this question, Dr. Janice Newsome and Dr. Azza Naif share what they’re doing in Tanzania to make UFE a standard option in fibroid care. Dr. Newsome is a Professor at Emory University and Dr. Naif is an IR attending physician at Muhimbili University of Health and Allied Sciences (MUHAS) and a member of the first generation of Tanzanian IR trainees. --- This podcast is supported by: Varian, a Siemens Healthineers company https://www.varian.com/products/interventional-solutions/embolization-solutions --- SYNPOSIS The doctors focus on patient education, overcoming cultural barriers, training of IR specialists, and the economic aspects of UFE. The discussion highlights the importance of making women’s health treatments accessible worldwide and adapting procedures to fit local resources while maintaining high standards of care. --- TIMESTAMPS 00:00 - Introduction 05:25 - Patient Care in Tanzania 16:28 - Challenges in UFE Adoption 21:38 - Equipment and Techniques for UFE 34:26 - Post-Procedure Follow-Up Care 41:16 - Cost and Accessibility of UFE 47:01 - Future Goals for Fibroid Care --- RESOURCES BackTable VI Podcast Episode #318 - Back on the Road2IR with Dr. Janice Newsome, Dr. Judy Gichoya and Dr. Fabian Laage Gaupp: https://www.backtable.com/shows/vi/podcasts/318/back-on-the-road2ir BackTable VI Podcast Episode #104 - Bringing IR to East Africa: The Road2IR Story with Dr. Fabian Laage Gaupp: https://www.backtable.com/shows/vi/podcasts/104/bringing-ir-to-east-africa-the-road2ir-story Road2IR: https://www.road2ir.org/

In this episode, Dr. Jos van den Berg discusses the benefits of joining the Critical Limb Ischemia (CLI) Global Society, including discounts on Amputation Prevention Symposium (AMP) meetings, access to a specialized journal, and participation in Multidisciplinary CLI Network (MCLIN) discussion boards. Dr. van den Berg is an interventional radiologist at University of Bern in Switzerland and Europe Office Chairman and Member of Board of Directors for CLI Global Society. Dr. van den Berg also serves as a reviewer and editorial board member of multiple high-impact scientific journals. With members across the globe, the CLI Global Society emphasizes a multidisciplinary approach to combat CLI, aiming to prevent amputation and death through education, patient advocacy, and awareness about CLI. Dr. van den Berg also sheds light on the complexity of CLI management in Europe due to varied reimbursement systems among countries and the society’s efforts to tackle these challenges. The episode also touches on the society’s future goals, including expanding its global presence and continuing to offer extensive resources and networking opportunities to its members. --- CHECK OUT OUR SPONSORS BD Advance Clinical Training & Education Program https://page.bd.com/Advance-Training-Program_Homepage.html Reflow Medical https://www.reflowmedical.com/ --- SHOW NOTES 00:00 - Introduction 02:08 - Meet Our Guest: Dr. Jos van den Berg 05:42 - Deep Dive into CLI Global Society 07:53 - Exploring the Impact and Initiatives of CLI Global Society 14:42 - Challenges and Differences of CLI Management in Europe 21:08 - Innovations and Future Endeavors in CLI Treatment 23:45 - Closing Thoughts and the Importance of Membership --- RESOURCES CLI Global Society: https://www.cliglobalsociety.org/ Multidisciplinary CLI Network (MCLIN) Global CLI LIVE Meeting (every 2nd Friday of the month, 7am EST): https://www.cliglobalsociety.org/education/mclin/#myaccount AMP CLI Meeting: https://www.hmpglobalevents.com/amptheclimeeting

In this episode, host Dr. Jacob Fleming interviews Dr. Dana Dunleavy about spinal tumor ablation and vertebral augmentation. Dana is an interventional radiologist and Director of Windsong Interventional & Vascular Services. --- CHECK OUT OUR SPONSOR Stryker Interventional Spine https://www.strykerivs.com --- SHOW NOTES Dana begins the discussion by reflecting on his upbringing in a small country town. His parents, his mother a midwife and his father a contractor, shaped his early experiences. His exposure to medicine began through his mother, particularly in witnessing childbirths. As he navigated his way through medical school, he contemplated various specialties, including orthopedic surgery, interventional radiology, and neurosurgery. He discovered incredible mentors in radiology and ultimately found his place in the field of interventional radiology. During his residency at Johns Hopkins, he sought externships in interventional spine and had the opportunity to immerse himself in this field for one month. He underscores the significance of participating in tumor boards and being a valuable contributor to the team in terms of diagnosis and treatment. He also emphasizes the value of calling consults when performing biopsies and the importance of meeting with the patient face-to-face and engaging in a thorough discussion of the treatment plan. Next, Dana delves deeper into the topics of bone tumor ablation and mechanical augmentation. He notes the importance of having a comprehensive understanding of the patient's anatomy and being well-versed in interventional tools. Cement extravasation is a feared complication of vertebral augmentation, so Dana discusses the role of implants as a means to establish structural support and mitigate the risk of cement leakage. In addition, he talks about his approach in combining ablation with mechanical augmentation so that the augmentation provides a structure after the ablation. Lastly, he discusses the use of advanced technology such as cone beam CT in trajectory planning. He shares his hybrid approach to performing bone biopsies, utilizing fluoroscopy during access and cone beam CT to ascertain accurate trajectory.

Dr. Aparna Baheti talks with Dr. Timothy Huber about performing thyroid nodule ablation procedures, including patient selection, technique pearls and pitfalls, and how to incorporate the procedure into your practice. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/QZ9TpA --- SHOW NOTES In this episode, interventional radiologist Dr. Tim Huber and our host Dr. Ally Baheti discuss the process of thyroid nodule radiofrequency ablation, including patient selection, workup, procedural technique, and follow up. Dr. Huber describes the most common indication for ablation, which is the presence of benign thyroid nodules that cause compressive symptoms. These can affect quality of life when they restrict a patient’s ability to swallow, breathe, and speak. He recommends ablation for symptomatic nodules that are over 2 cm in diameter. Dr. Huber also mentions functional nodules as more challenging cases, but still treatable with ablation. Though ablation for thyroid malignancies is rare, it is a field of active and growing research. In his workup, Dr. Huber uses ultrasound to assess nodular composition, vasculature, size, and nearby enlarged lymph nodes. Next, he obtains two benign fine needle aspiration samples and checks TSH levels before proceeding with ablation. During the procedure, he anesthetizes the skin of the neck with lidocaine, and periodically checks in with patients about pain level. Dr. Huber describes his “trans-isthmic approach” that keeps the needle as stable as possible. He exercises caution when ablating near the “danger triangle” containing the recurrent laryngeal nerve which innervates the vocal cords. While ablating posterior to anterior, Dr. Huber tracks echogenic changes on ultrasound. After the procedure, patients are monitored for one hour and then followed up in one month, and then three months over the next year. Dr. Huber warns interventionalists that post-ablation zones may look disfigured on ultrasound, but this will revert back to normal within 3-6 months. --- RESOURCES European Thyroid Association Guidelines: https://www.eurothyroid.com/guidelines/eta_guidelines.html Korean Society of Thyroid Radiology Guidelines: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6005940/

In this episode of the Back Table Innovation Podcast, host Dr. Diana Velazquez-Pimentel, a radiologist and biomedical engineer, chats with Dr. Alim Mitha about the novel idea of biodegradable flow diverters and the future of interventional neuroradiology. Dr. Mitha is a cerebrovascular, endovascular, and skull base neurosurgeon and biomedical engineer at the University of Calgary. During his neurosurgery residency, Dr. Mitha also completed a master’s degree in biomedical engineering. Afterwards, he pursued additional fellowships in cerebrovascular and skull base surgery, as well as endovascular neurosurgery. Since then, he has started a research lab focused on tissue engineering and biomedical device development. He explains the role of flow diverters and how they are used to guide blood flow away from the intracranial aneurysms. While flow diverters have been applied to treatment of many different types of aneurysms, Dr. Mitha notes that these devices carry thrombogenic risks. During his training, he saw that it was not preferable to deploy a flow diverter in a young patient who would have to remain on antiplatelet therapy for the rest of their life. As a result, Dr. Mitha began to develop a polymer-based biodegradable flow diverter that could be absorbed by the body after the aneurysm had been occluded, in addition to being visible on non-invasive imaging. He explains the process of building a prototype, incorporating a company, joining a start-up incubator, and now performing first in-human-clinical trials. --- CHECK OUT OUR SPONSOR RADPAD® Radiation Protection https://www.radpad.com/ --- SHOW NOTES 00:00 Introduction 03:05 Understanding the Role of Flow Diverters 08:17 The Conception of a Biodegradable Flow Diverter 11:35 The Challenges and Successes in Prototyping 13:53 A Path Towards Commercialization 16:10 Considerations for Clinical Adoption 24:00 Developing Skills for Engineering and Entrepreneurship 27:29 First-In-Human Trials and Early Feedback 30:36 Innovating Within the University of Calgary --- RESOURCES University of Calgary Creative Destruction Lab: https://creativedestructionlab.com/locations/calgary/ The Brain Conferences: https://www.fens.org/meetings/the-brain-conferences

In this episode, host Dr. Aparna Baheti interviews Dr. Fritz Angle about adrenal vein sampling, including indications, workup, and his technique for accessing the right adrenal vein. --- CHECK OUT OUR SPONSOR RADPAD® Radiation Protection https://www.radpad.com/ --- SHOW NOTES Dr. Fritz Angle is the Director of Interventional Radiology at the University of Virginia. He frequently performs adrenal vein sampling for primary hyperaldosteronism, and has developed a specific technique. The patient is usually referred from an endocrinologist or primary care doctor. The IR should review the labs to verify the aldosterone-to-renin ratio is greater than 20. Additionally, it is important to review medications and stop all potassium sparing diuretics at least two weeks before the procedure. If they haven’t had a CT scan, the IR should order one to assess the position of the right adrenal vein, the hardest to access due to its variable anatomy.  The morning of the procedure, Dr. Angle always checks a potassium level to know whether to give potassium supplements. He gets dual femoral access, so that he can obtain both non-stimulated and ACTH-stimulated samples. He obtains the sample from the left adrenal vein first. For the right side, he starts with a C2 catheter, to which he adds side holes using a biopsy needle. The left adrenal vein is almost always one vertebral body above the right renal vein, so he begins here, with the catheter pointing directly posterior. He searches around the entire back wall of the IVC by puffing contrast and rotating the catheter. He moves up and down by half a vertebral level. If he still cannot locate it, he begins looking to the left and right. When injecting, it is important to be gentle. To do this, he inserts an 014 wire through his catheter, then does a dry scan to see if the vein is pointing toward the liver or the right adrenal gland. If the vein is injected too hard, it can cause a venous infarct and adrenal insufficiency. The right adrenal vein forms an upside down Y shape. Dr. Angle draws two sets each from the right and left adrenal veins and two peripheral samples.  To interpret results, look for a cortisol of 2-3x greater (3-4x greater in stimulated samples) compared to the peripheral blood to confirm correct placement in the adrenal veins. Once you correct aldosterone levels to cortisol levels, the aldosterone-to-cortisol ratio should be about 5x greater on one side (compared to the other side) to confirm the diagnosis and lateralize the hyperaldosteronism to one side. About 2 ⁄ 3 cases lateralize, but Dr. Angle has found many patients’ symptoms are actually due to bilateral adrenal hyperplasia. Finally, Dr. Angle emphasizes that this is an easy, safe procedure that all IRs should offer.

In this episode, host Dr. Aaron Fritts interviews FLOW Medical cofounders Dr. Osman Ahmed and Dr. Jonathan Paul about how they built a company with the goal of designing a data-driven thrombolytic device that can deliver personalized care for patients with pulmonary embolism. --- CHECK OUT OUR SPONSOR RapidAI http://rapidai.com/?utm_campaign=Evergreen&utm_source=Online&utm_medium=podcast&utm_term=Backtable&utm_content=Sponsor --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/KikSeM --- SHOW NOTES Dr. Paul, interventional cardiologist, begins by explaining how he and Dr. Ahmed, interventional radiologist, came to work together. Dr. Ahmed came to the University of Chicago shortly after Dr. Paul started a pulmonary embolism response team (PERT) program. Dr. Ahmed, through his IR training, had experience with PE/VTE. They met and decided to combine their knowledge to build the program together. They both saw a need for new catheter directed thrombolytic (CDT) devices in their respective fields. The landscape of thrombectomy device innovation was booming, but they did not see the same innovation happening for CDT. After they both received the COVID vaccine, they were eating at Panera and drew out the idea for their device on a napkin. Neither of them had prior engineering experience and didn’t know how to proceed after this, so they relied on the University of Chicago’s entrepreneurial programs as a starting place. They then did market research and used their own internal research funding to subcontract with an engineering firm. They have been working on the design prototype since, and are conducting animal studies to trial the device. Once they reach design freeze, they will start the regulatory process and NIH 510(k) submission. They also have an NIH SBIR grant for small businesses doing innovative research. They plan to have the device on market in mid 2024. The goal for their device is to make it a catheter that can provide real-time feedback to minimize the complications of both too little or too much thrombolytic therapy. They are installing a sensor on the device that displays how much of the clot is lysed and allows for personalized PE treatment. They hope to incorporate AI into their data management, which they will use to tailor treatment in future patients. --- RESOURCES FLOW Medical: https://www.flowmedical.co

In this episode, Dr. Blake Parsons talks through the role of spinal cord stimulation in treating vascular issues and diabetic neuropathy. He also discusses the growing presence of vascular specialists in clinics, the transition from procedural work to clinical involvement, and the significance of building a strong patient-doctor relationship. The doctors highlight the effectiveness of Nevro 10 kHz therapy in providing long-term pain relief and sensory improvements for patients struggling with painful diabetic neuropathy, even after conventional treatments fail. Additionally, they touch upon reimbursement updates, the rise of outpatient care, and the future of spinal cord stimulation - emphasizing its potential beyond just pain relief to include improvements in patients’ overall quality of life, reducing risks related to diabetic foot wounds, and incidental falls. The need for a multidisciplinary approach in treating vascular and neuropathic conditions is also discussed, along with the role of interventional radiologists in managing these complex cases. --- CHECK OUT OUR SPONSOR Nevro HFX Spinal Cord Stimulator https://www.hfxforpdn.com --- SHOW NOTES 00:00 - Introduction 06:00 - Demystifying Spinal Cord Stimulation for Pain Management 17:11 - Optimizing Patient Care: Trials, Techniques, and Insurance 26:03 - Leveraging Telehealth and Support Teams for Patient Success 30:22 - Challenges and Solutions in Managing Peripheral Neuropathy 35:19 - Collaboration and Referral Dynamics in Vascular and Interventional Radiology 39:19 - Exploring the Future of Neuropathy Treatment and Quality of Life Improvements 43:46 - Addressing the Challenges of Permanent Implant Procedures 48:46 - Role of Technology and AI in Patient Management 56:31 - Concluding Thoughts on Neuropathy Treatment and Practice Dynamics --- RESOURCES Nevro 10 kHz Therapy: https://nevro.com/English/en/providers/HFX-Advanced-Therapies/default.aspx Effect of High-frequency (10-kHz) Spinal Cord Stimulation in Patients With Painful Diabetic Neuropathy: A Randomized Clinical Trial (JAMA Neurology RCT 2021): https://pubmed.ncbi.nlm.nih.gov/33818600/ Long-term efficacy of high-frequency (10 kHz) spinal cord stimulation for the treatment of painful diabetic neuropathy: 24-Month results of a randomized controlled trial (SENZA-PDN RCT 2023): https://pubmed.ncbi.nlm.nih.gov/37536514/ Electrical spinal-cord stimulation for painful diabetic peripheral neuropathy (Lancet RCT 1996): https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(96)02467-1/abstract

Urologist Dr. Claus Roehrborn and Interventional Radiologist Dr. Sandeep Bagla discuss the pros and cons of Prostate Artery Embolization (PAE) compared to other Minimally Invasive Surgical Treatments (MISTS) for Benign Prostate Hyperplasia (BPH). They also discuss the importance of a collaborative, multidisciplinary approach when offering these treatment options, including agreeing on the best treatment for the patient. --- CHECK OUT OUR SPONSOR RADPAD® Radiation Protection https://www.radpad.com/ --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/Daw1w2 --- SHOW NOTES In this episode, urologist Dr. Claus Roehrborn and interventional radiologist Dr. Sandeep Bagla discuss benign prostatic hyperplasia (BPH) and prostate artery embolization (PAE) in the context of counseling patients and cross-specialty collaboration. Dr. Roehrborn starts by reviewing the history of BPH treatment, from medications like alpha-blockers and anticholinergics, to minimally invasive options like UroLift, Rezum, and PAE. He emphasizes that the latter options are growing in popularity, since they provide treatment alternatives for patients who are concerned about side effects from medications, or have not experienced symptom relief from medications. Dr. Sandeep Bagla describes Prostate Cancer USA’s philosophy on IR/Urology partnership and how it can ultimately benefit patients. This model provides the patient with both an IR suite for the PAE procedure and a urology clinic for diagnostic assessment, determination of PAE candidacy, and follow-up assessment. Both doctors describe ideal patients for PAE. These are usually patients with a gland size above 60 g, confirmed bladder function, and a desire to preserve ejaculation function. Contraindications include urinary retention, chronic prostatitis, and heavily calcified glands. Finally, they describe how they manage minor short-term complications such as frequency and dysuria with medication. They track symptom relief using the International Prostate Symptom Score (IPSS), Dr. Bagla notes that the largest drop in IPSS usually occurs about 4-5 weeks post-procedure.

In this episode of the BackTable Podcast, host Dr. Ally Baheti discusses the relationship between pelvic venous disease and physical therapy with Ingrid Harm-Ernandes, a pelvic floor physical therapist, mentor for Duke University’s Women’s Health Physical Therapy Residency Program, and author of The Musculoskeletal Mystery: How to Solve Your Pelvic Floor Symptoms. Ingrid gives a detailed walkthrough of a physical therapy session, highlighting the importance of holistic and interdisciplinary treatment approaches, as well as patient communication. She shares perspectives on the need for earlier interventions of physical therapy, misconceptions around the pelvic therapy issues, and the significant role of interventional radiologists as part of the treatment team. She also discusses her book which aims to demystify pelvic floor issues and empower both patients and practitioners in treating them. --- CHECK OUT OUR SPONSORS BD Advance Clinical Training & Education Program https://page.bd.com/Advance-Training-Program_Homepage.html RADPAD® Radiation Protection https://www.radpad.com/ --- SHOW NOTES 00:00 - Introduction 02:25 - Discussion on Pelvic Venous Disease and Physical Therapy 02:36 - Exploring the Role of Physical Therapy in Treating Pelvic Pain 04:41 - Understanding the Challenges in Treating Pelvic Pain 06:51 - Identifying Symptoms of Pelvic Venous Disease 10:06 - The Role of Pelvic PT in Treating Pelvic Venous Disease 15:49 - Finding a Qualified Pelvic PT 22:13 - Improving Synergy between Interventional Radiologists and Pelvic PT 28:39 - Understanding the Musculoskeletal Mystery in Pelvic Floor Symptoms 33:48 - Final Thoughts and Advice for Treating Patients with Pelvic Venous Disease --- RESOURCES The Musculoskeletal Mystery: How to Solve Your Pelvic Floor Symptoms: https://www.pelvicpain.org/resources/marketplace/books/the-musculoskeletal-mystery

Cone Beam CT has become a cornerstone of modern interventional practice. Are you utilizing it to its fullest potential? Dr. Michael Miller joins host Dr. Chris Beck to discuss Cone Beam CT, sharing advanced techniques and clinical pearls. Dr. Miller is an interventional radiologist and Associate Professor of Radiology at Atrium Health, Wake Forest Baptist Hospital, North Carolina. --- This podcast is supported by: GE Healthcare Allia Image Guided Systems https://www.gehealthcare.com/products/interventional-image-guided-systems/allia --- SYNPOSIS Dr. Miller explains the importance of fundamental training and how fundamentals can be scaled across various procedures to improve outcomes, including vascular malformations and endoleaks. Dr. Miller then speaks to best practices that he has learned firsthand through his years of using Cone Beam CT. The doctors also touch on tips for setting up the IR suite and collaborating with anesthesia. --- TIMESTAMPS 00:00 - Introduction 07:22 - Advanced Uses of Cone Beam CT 15:04 - Setup and Best Practices 22:34 - Vascular Malformations 23:32 - Understanding Sclerosant Distribution 26:53 - Trajectory Guidance in Complex Cases 32:45 - Contrast Bolus Timing and Spin Techniques 40:16 - Advice for New Angio Suites --- RESOURCES BackTable VI Podcast Episode #51 - Cone Beam CT Techniques with Dr. Austin Bourgeois: https://www.backtable.com/shows/vi/podcasts/51/cone-beam-ct-techniques Shujaat, S., Alfadley, A., Morgan, N., Jamleh, A., Riaz, M., Aboalela, A.A., Jacobs, R., 2024. Emergence of artificial intelligence for automating cone-beam computed tomography-derived maxillary sinus imaging tasks. A systematic review. Clin Implant Dent Relat Res 26, 899–912. https://doi.org/10.1111/cid.13352 Orth, R.C., Wallace, M.J., Kuo, M.D., Technology Assessment Committee of the Society of Interventional Radiology, 2009. C-arm cone-beam CT: general principles and technical considerations for use in interventional radiology. J Vasc Interv Radiol 20, S538-544. https://doi.org/10.1016/j.jvir.2009.04.026 Bapst, B., Lagadec, M., Breguet, R., Vilgrain, V., Ronot, M., 2016. Cone Beam Computed Tomography (CBCT) in the Field of Interventional Oncology of the Liver. Cardiovasc Intervent Radiol 39, 8–20. https://doi.org/10.1007/s00270-015-1180-6 Wallace, M.J., Kuo, M.D., Glaiberman, C., Binkert, C.A., Orth, R.C., Soulez, G., Technology Assessment Committee of the Society of Interventional Radiology, 2008. Three-dimensional C-arm cone-beam CT: applications in the interventional suite. J Vasc Interv Radiol 19, 799–813. https://doi.org/10.1016/j.jvir.2008.02.018 Bm, K., Sm, T., Mj, S., 2023. Cone-Beam CT With Enhanced Needle Guidance and Augmented Fluoroscopy Overlay: Applications in Interventional Radiology. AJR. American journal of roentgenology 221. https://doi.org/10.2214/AJR.22.28712 Kwok, Y.M., Irani, F.G., Tay, K.H., Yang, C.C., Padre, C.G., Tan, B.S., 2013. Effective dose estimates for cone beam computed tomography in interventional radiology. Eur Radiol 23, 3197–3204. https://doi.org/10.1007/s00330-013-2934-7

In this episode, host Dr. Dana Dunleavy engages in a thought-provoking discussion about independent interventional radiology practice with two esteemed IRs, Dr. Kavi Devulapalli and Dr. Ian Wilson. Together, they discuss the complexities and opportunities in the ever-evolving landscape of IR. --- CHECK OUT OUR SPONSOR Philips SymphonySuite https://www.philips.com/symphonysuite --- SHOW NOTES We start off the discussion with Kavi expanding on early experiences in working a standard DR / IR split that most IRs tend to work in. He elaborates on how this split was not what he, as well as most IRs, intended to practice in when they entered the field. Thus, he then shifted over to the OBL space, a gratifying journey, but one he notes was difficult to navigate due to the intricacies. As Kavi finally transitioned to locum tenens work, he reflects on its appeal, despite the scarcity of opportunities. He notes that locum tenens work is usually in areas with an extreme dearth of IRs, such as rural areas. This conversation also explores the topic of exclusive contracts. Their impact on independent IR practices' access to hospital privileges is also explored, shedding light on the challenges faced by IRs seeking to expand their reach. Ian then notes that his locum tenens work was also in a rural setting, and how he had served this location for an extended period of time due to their lack of retention of IRs. The discussion then reveals a growing trend among physicians, as more and more are turning to locum work due to its exclusive focus on the IR aspect of the job that initially attracted them to this field. It's a mutual demand, as physicians seeking to specialize in IR find locum work to be a well-suited avenue, while areas of healthcare dearth are equally eager to tap into the expertise of these specialists. Both guests emphasize the urgent need for sustainable solutions to address this growing public health crisis in rural areas. This is precisely where organizations like Travelier come into play. Travelier was established by IRs, one of whom is Kavi, with a mission to bridge this critical gap by offering world-class IR services to communities with unmet needs. Their approach involves assembling dedicated physician teams and creating interventional radiology practices that generate revenue while providing viable work solutions for radiologists. This discussion is a testament to the adaptability and innovation that drive the field of IR, characterized by the commitment to improving healthcare access in areas where it is needed the most. It's also a testament to the increasing mutual demand for specialized IR services and the unique opportunities that come with it. --- RESOURCES Travelier: https://travelierir.com

In this episode, guest host Dr. Jacob Fleming interviews Dr. Jason Cox about musculoskeletal interventions and how he uses ultrasound for diagnosis and intervention in his full spectrum musculoskeletal practice. --- CHECK OUT OUR SPONSOR Laurel Road for Doctors https://www.laurelroad.com/healthcare-banking/ --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/ZHCWxF --- SHOW NOTES We begin by discussing Dr. Cox’s path to MSK intervention. During his interventional training at University of Missouri, the musculoskeletal radiology program was rebuilt, and ultrasound was incorporated heavily. He used his ultrasound skills from vascular intervention in IR to learn musculoskeletal anatomy on ultrasound. He was drawn to MSK radiology due to the mechanical aspect of MSK work and the integration of visual spatial awareness and hand eye coordination involved in MSK ultrasound. He started out by learning steroid injections for sports injuries, commonly rotator cuff injuries. He now does around 20 diagnostic or interventional ultrasound procedures each day in his clinic. He opened his clinic with a partner, and did it slowly while still working at his prior job. He started working at his new clinic on his vacation days until he could build up the clientele to leave his prior job. One of the biggest challenges in opening his MSK radiology clinic was finding a sonographer able to do the complex MSK cases he was doing. The most common procedure Dr. Cox does at his clinic is ultrasound guided carpal tunnel release. He also does tendon barbotage for hydroxyapatite deposition disease for the rotator cuff tendons. His practice has grown largely due to the number of patients that are referred because they cannot get an MRI. He reads his ultrasound exams like an MRI report, with a high level of detail, differential diagnosis and recommendations. --- RESOURCES Institute for Advanced Medical Education: https://www.iame.com Linked In: https://www.linkedin.com/in/jasoncoxmd Ultrasound First Clinic: https://ultrasound-first.com European Society of Musculoskeletal Radiology: https://www.essr.org

In this episode, host Dr. Aaron Fritts is joined by Dr. Pranav Moudgil, a new IR graduate who has just completed his first IR job search. Today’s discussion revolves around the job landscape for recent interventional radiology graduates. --- CHECK OUT OUR SPONSOR Philips Image Guided Therapy Devices Academy https://resource.philipseliiteacademy.com --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/rhaY4i --- SHOW NOTES The episode begins by introducing Pranav, who hails from Michigan and has recently completed his IR training at Beaumont. His discussion on today’s podcast was influenced by the recurring question he faced during his job hunt: “What do candidates like him seek in their careers?” Pranav's job search began in January of his PGY-5 year, 18 months before his graduation. When compared to his initial expectations of a robust job market, reality both did and did not meet these expectations. Pranav found that while there were a lot of job postings online, he was aware that there were just as many, if not more, word-of-mouth job opportunities. During his early training years, Pranav initially thought that he wanted a 100% IR role, but after getting more exposure to DR, he later realized that he wanted a balanced mix of DR and IR. When searching for jobs, Pranav found that many of his interviews came from listings on the ACR job board. However, after seeing the jobs his peers ended up taking, Pranav realized that personal connections played a significant role in job placement for him and his peers. As we delve into the core aspects of Pranav's job search strategy, he emphasizes the importance of being aware of which factors you value most in a job. Pranav also encourages new grads to evaluate job offers in terms of technical staff support and long-term job satisfaction. He advises job seekers to be vigilant for red flags during negotiations and emphasizes the importance of clear communication. The topic of locums tenens work also gets brought up during this discussion, as a means to explore diverse job opportunities before committing to a permanent position. Overalll, for a new IR graduate, Pranav recommends engaging in candid discussions about pay and structural aspects with mentors, understanding personal priorities, and evaluating job offers with a discerning perspective. --- RESOURCES ACR Job Listings: https://jobs.acr.org/

In this episode, host Dr. Jacob Fleming interviews one of his attendings Dr. Bhavya Shah about the remarkable features of focused ultrasound technology and its applications. They discuss its dynamic nature, allowing for a wide range of applications. --- SHOW NOTES Dr. Bhavya Shah is a neuroradiologist at UT Southwestern in Dallas, TX and the director of their transcranial-focused ultrasound lab. While in residency at Boston MIT, he studied the radiology applications for nerve regeneration and expanded his scope of practice during his fellowship at Stanford. Dr. Bhavya Shah explains the use of low intensity focused ultrasound (LIFU) and high intensity focused ultrasound (HIFU), particularly in the context of movement disorders including essential tremor and Parkinson’s disease. LIFU is used to identify the appropriate targets in the brain in relation to the disease and may be used to alter how neurons behave. In contrast, high intensity focused ultrasound (HIFU) is utilized to ablate and destroy tissues typically after the localization of the intended treatment area. Dr. Shah developed a way to identify targets in the brain for treatment with focused ultrasound with the use of four-tract tractography in cadavers. Using this technology, the brain can be thinly sliced into sections which could then be registered off an MRI back to the path using block face photography, allowing the identification of white matter tracts that enter and leave the thalamus. With these tracts identified, neuroradiologists can first stimulate the localized area with LIFU to confirm the location, then ablate using HIFU. The procedure lasts approximately 30-45 minutes as the patient remains awake. Remarkably, patients with essential tremor usually experience benefit immediately following the procedure as patients with Parkinson’s have symptom improvement within days to weeks. After two hours of observation, patients are discharged assuming no side effects. Side effects are uncommon but can include numbness and tingling around the mouth or fingertips as well as muscle weakness. Beyond its use for movement disorders, the adaptable nature of focused ultrasound technology shows promise for a broad range of applications, particularly for the use of neuropsychiatric conditions. Dr. Shah offers the potential for the use of HIFU as a wearable device that delivers constant stimulation modulated by biofeedback, potentially eliminating the need for MRI for the procedure. Dr. Shah and Dr. Fleming end the discussion with how radiology has evolved over the years and the importance of keeping an open mind working in a multidisciplinary team. They emphasize the gravity of patient engagement and the central goal of medicine and improving the standard of care should always be aimed at benefiting the patient. --- RESOURCES MRI–Guided Focused Ultrasound Thalamotomy for Essential Tremor: https://thejns.org/view/journals/j-neurosurg/138/4/article-p1028.xml Trial of Globus Pallidus Focused Ultrasound Ablation in Parkinson’s Disease: https://www.nejm.org/doi/10.1056/NEJMoa2202721 Long-term effects of bilateral subthalamic nucleus deep brain stimulation on gait disorders in Parkinson's disease: a clinical-instrumental study https://pubmed.ncbi.nlm.nih.gov/37208527/ Magnetic Resonance Image Guided Focused Ultrasound Thalamotomy. A Single Center Experience With 160 Procedures: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8894664/

In this episode, guest host Dr. Isabel Newton interviews Dr. Richard Saxon about his innovative approach of using stent grafts for transjugular intrahepatic portosystemic shunting (TIPS), the creation of the Viatorr endoprosthesis, and medical ethics of experimental technology. --- CHECK OUT OUR SPONSORS Philips Image Guided Therapy Devices Academy https://resource.philipseliiteacademy.com Boston Scientific Nextlab https://www.bostonscientific.com/en-US/nextlab.html?utm_source=oth_site&utm_medium=native&utm_campaign=pi-at-us-nextlab-hci&utm_content=n-backtable-n-backtable_site_nextlab_1_2023&cid=n10013202 --- SHOW NOTES As an IR fellow, Dr. Saxon was surrounded by constant innovation at the Dotter Institute. He saw the takeoff of TIPS as a last treatment option for patients with liver failure, who were suffering from major variceal bleeding. He recounts the early days of TIPS as extremely technically challenging and arduous, since the methods and devices had not yet been refined. Dr. Saxon spent a significant amount of time performing TIPS revision procedures, which led him to explore the underlying pathology of biliary duct injury and subsequent stent thrombosis. These experiences led him to develop a stent graft for TIPS, which was first tested in swine models and eventually became the Viatorr endoprosthesis. Dr. Saxon highlights the supportive people and environment at the Dotter Institute as a major factor in fueling TIPS improvement. Additionally, during this era, innovative ideas were able to flourish with less influence of medical-legal or intellectual property disputes. In today’s clinical setting, TIPS has become a good option for patients with intractable variceal bleeding, but it is no longer the only option. Dr. Newton emphasizes that patient selection is a crucial part of ensuring that IRs continue to practice safely and effectively. The doctors discuss hepatic encephalopathy, another complication of TIPS that requires careful patient screening, adequate follow up, and collaboration with the medicine side of liver disease treatment. Finally, Dr. Saxon reflects on his career in translational research. A large part of his success has come from recognizing where his passions lie, what his current work environment can support, and maintaining a constant drive to improve procedures and clinical care. --- RESOURCES Gore Viatorr TIPS Endoprosthesis: https://www.goremedical.com/products/viatorr/resource-library Stent-Grafts for Revision of TIPS Stenoses and Occlusions: A Clinical Pilot Study: https://www.jvir.org/article/S1051-0443(97)70606-7/fulltext Barry Uchida on the BackTable Podcast: https://www.backtable.com/shows/vi/podcasts/122/history-of-the-tips-procedure-an-interview-with-barry-uchida

Dr. Shamit Desai talks with Dr. Kavi Devulapalli and Dr. Vishal Kadakia about Locums work, including the current market and opportunities, different practice models, navigating finances and taxes, and how to organize your life around this unique practice style. Meet the locums chameleon! --- CHECK OUT OUR SPONSOR Medtronic Abre Venous Stent https://www.medtronic.com/abrevenous --- SHOW NOTES To start off, we discuss what locums means for each of these clinicians, including inpatient vs outpatient work. Most locums opportunities are in mid-sized cities and smaller cities, due to increased demand in these areas. Locums work is a way for IRs to take control of their practices, making it a very appealing work model. The ratio of IR to DR for each of these clinicians ranges from 70:30 up to 90:10. Employers need locums to prevent burnout of their FTE employees, and to reduce call in areas where IRs are overworked. Employers also look to locums to build service lines and bring in procedures that aren’t currently being done at their institutions. It is a rewarding opportunity for both employer and employee. Next, we review job expectations and the difference between inpatient and outpatient locums work. There are generally two types of clients, one needing someone to fill the role of a person who works at FTE, and another where the IR department is made up of a roster of rotating locums providers. Being in locums, you get exposure to so many different people, and practices and you get to expand your network. This opens up many opportunities that you would not get at one location. Some of the downsides are the need to constantly adapt, use equipment you are not as familiar with, and work with staff who do not know your preferences or even glove size. However, you get to build your schedule, and you have the power to work where you want when you want. Finally, we discuss some of the contracts, reimbursement, and insurance details. The three discuss the differences between being a W2 employee versus a 1099 employee, comparing what happens with health insurance and retirement. They also discuss the pros and cons of a 1099 versus owning an LLC versus starting an S corporation. All three physicians highly recommend researching these and speaking to a lawyer about your best options until you fully understand these concepts. They discuss licensure, credentialing and malpractice insurance, as well as whether they recommend using an agency for these as a locums. Lastly, they discuss reimbursement, including models such as a flat rate for a week versus a deconstructed model that consists of a daily rate, a call rate, and an overtime rate. --- RESOURCES Kavi Devulapalli Profiles Twitter: @linemonkeymd Blog: https://linemonkeymd.com Vishal Kadakia Profiles LinkedIn: https://www.linkedin.com/in/theirdoc

In this episode, host Dr. Ally Baheti interviews interventional radiologist Dr. Luke Wilkins about his approach to the subintimal arterial flossing with antegrade-retrograde intervention (SAFARI) technique for crossing challenging chronic total occlusions (CTO) in critical limb ischemia (CLI) patients. --- CHECK OUT OUR SPONSORS Reflow Medical https://www.reflowmedical.com/ BD Rotarex Atherectomy System https://www.bd.com/rotarex --- SHOW NOTES Dr. WIlkins gives us the basic indication for the procedure, which is when the lesion is unable to be crossed from a purely antegrade approach and other re-entry devices have failed. Dr. Wilkins will always attempt to use an Outback wire and an Enteer balloon before performing the SAFARI technique. There are multiple factors that influence the decision to use SAFARI, such as lesion location, level of calcification, and size of the true lumen at the re-entry point. Next, Dr. Wilkins walks us through a typical SAFARI. He normally establishes retrograde access in the dorsalis pedis or posterior tibial artery using a 4 cm micropuncture needle and an exchange length Nitrex wire. He uses telescoping catheters from the antegrade direction. When the antegrade and retrograde approaches enter the same subintimal plane, the 2 devices can connect and the lesion can be crossed. If it is challenging to achieve the same intimal plane for both devices, the gunsight approach of overlapping snares can be utilized. After the lesion is crossed, normal angioplasty and stenting can occur. Dr. Wilkins gives advice on how to make the procedure efficient. In occlusions that are longer than 1 cm, he always makes sure that the foot is prepped before the case starts. He also emphasizes the importance of knowing when to try a different technique and notes that this intuition comes from experience. Finally, we discuss patency rates for SAFARI patients, which have been relatively high. This technique has made a large impact on limb salvage in a patient population that previously had no other non-surgical options. --- RESOURCES Rotarex Atherectomy System: https://www.bd.com/en-us/products-and-solutions/products/product-families/rotarex-rotational-excisional-atherectomy-system Outback Re-Entry Catheter: https://cordis.com/na/products/cross/endovascular/outback-elite-re-entry-catheter Enteer Re-Entry Catheter/Balloon: https://www.medtronic.com/us-en/healthcare-professionals/products/cardiovascular/chronic-total-occlusion-devices/enteer/indications-safety-warnings.html Nitrex Wire: https://www.medtronic.com/us-en/healthcare-professionals/products/cardiovascular/guidewires/nitrex.html CXI Catheter: https://www.cookmedical.com/products/di_cxi_webds/ Outcome and Distal Access Patency in Subintimal Arterial Flossing with Antegrade-Retrograde Intervention for Chronic Total Occlusions in Lower Extremity Critical Limb Ischemia: https://www.jvir.org/article/S1051-0443(19)31033-4/fulltext

In this episode of the BackTable Podcast, host Dr. Chris Beck interviews guest Dr. Andrew Sholl, who demystifies the ins and outs of percutaneous biopsies and their impact on diagnoses. Dr. Scholl is a pathologist at LCMC Health in New Orleans, Louisiana. Dr. Sholl emphasizes the importance of understanding substantial clinical history, as well as obtaining adequate and correctly processed samples. The doctors discuss the varying scenarios faced in pathology, such as instances when larger samples are beneficial and the nuances of differentiating malignancies in certain organs. They also cover detailed tips for conducting biopsies and the process of how pathologists assess patient samples. The overarching message is the importance of communication and collaboration between interventional radiologists and pathologists to ensure the best patient outcomes. --- CHECK OUT OUR SPONSOR Argon BioPince Ultra https://www.argonmedical.com/product/biopince-ultra-full-core-biopsy-instrument/ --- SHOW NOTES 00:00 - Introduction 02:38 - Understanding Pathology Training and Practice 06:07 - Role of Pathology in Medical Diagnosis 18:57 - Importance of Sample Size and Quality in Pathology 26:34 - Next Gen Sequencing and Molecular Markers 29:44 - Biopsy Devices and Their Impact on Diagnosis 37:21 - Using Clinical History in Pathology 43:16 - Challenges and Considerations in Diagnosing Renal and Hepatic Tumors 50:25 - Importance of Communication Between Pathologists and Interventional Radiologists

Vascular Surgeon Krishna Mannava and Vive Vascular VP of Operations Kristin Longwell give advice on staffing the OBL/ASC based on their experiences over the last few years, including the essentials positions to start with, whether or not to use consulting firms, and sourcing your staff. --- CHECK OUT OUR SPONSOR Boston Scientific Nextlab https://www.bostonscientific.com/en-US/nextlab.html?utm_source=oth_site&utm_medium=native&utm_campaign=pi-at-us-nextlab-hci&utm_content=n-backtable-n-backtable_site_nextlab_1&cid=n10008040 --- SHOW NOTES In this episode, host Dr. Aaron Fritts interviews vascular surgeon Dr. Krishna Mannava and Kristin Longwell, vascular technologist and VP of operations and from Vive Vascular. They discuss staffing in the office based lab, cultivating company culture, and how to recruit and retain good employees. We begin by discussing where to start with staffing when building your office based lab (OBL). First, you must determine what needs to be in house and what will be outsourced. They had help from a consulting firm that helped with hiring, the interview process, and establishing human resources policies. They began with two registered nurses (RNs), two radiologic technologists (RTs), one ultrasound technologist and one front desk operator. Dr. Mannava says he needs one RN to run a room and one for pre and post op. Similarly, he needs one RT to run the C-arm, and one helping tableside. Out of house needs are extensive and include billing, legal, IT, housekeeping, web development, and purchasing. Next, they discuss some challenges of running an OBL. They approached growth by maintaining open communication with their employees. All employees are hourly and have concrete schedules. Many are willing to work outside of their job definition to help out wherever needed during a day. Every afternoon, they have one RN and one RT work late, and they rotate through this schedule so everyone can maintain work life balance. Finally, they discuss company culture. Dr. Mannava explains that one year into their venture, they had a company retreat to revamp their mission which helped personalize it and was empowering for the employees. He believes that employees are customers, and he wants his employees to feel valued and excited about work. This helps with retention and ultimately saves money by avoiding high turnover. Kristen implemented a daily huddle, weekly updates, monthly operational meetings and annual retreats to keep employees engaged and ensure staff are all on the same page. Dr. Mannava ends by saying that he tries to instill a sense of gratitude at his workplace and he believes that it is his job to promote the work culture he wants in a top down fashion. --- RESOURCES VIVE Vascular https://www.vivevascular.com Outpatient Endovascular and Interventional Society (OEIS) 2022: https://oeisociety.com/meetings/2022-annual-meeting/

Vascular Surgeon Dr. Mazin Foteh and our host Dr. Sabeen Dhand consider various factors that can influence the choice of treatment methods for calcified common femoral artery (CFA) disease, including discussing the pros and cons of an endovascular vs surgical approach. --- CHECK OUT OUR SPONSOR Shockwave Medical https://shockwavemedical.com/?utm_source=CFA-Backtable-Podcast&utm_campaign=Backtable-Podcast --- SHOW NOTES In this episode, vascular surgeon Dr. Mazin Foteh and our host Dr. Sabeen Dhand consider various factors that can influence the choice of treatment methods for common femoral artery (CFA) disease. To start, Dr. Foteh describes risk factors of common femoral disease, such as smoking, renal failure, and diabetes. He notes that CFA lesions are usually calcified and homogenous because they are composed of layers of calcium, lipid, and platelets deposited in fibrin sheaths. He further distinguishes between partially occluded and fully occluded CFA lesions. Dr. Foteh reviews key tips to minimize complications during an open endarterectomy. To maximize exposure, he recommends making a longitudinal incision rather than a medial groin incision. Before closing, he also ensures that he checks 3-4 cm proximal and distal to the CFA and stents the external iliac artery if needed. Dr. Foteh opts for general anesthesia over local anesthesia, in case of unforeseen complications. With an endovascular approach, Dr. Foteh finds that shock wave lithotripsy has been most effective at cracking calcium, changing vessel compliance, and ultimately increasing luminal gain. He uses this technique first, examines the results, and then uses a drug-coated balloon or stent as needed. --- RESOURCES Clinical Trial Investigating the Efficacy of the Supera Peripheral Stent System for the Treatment of the Common Femoral Artery: https://clinicaltrials.gov/ct2/show/NCT02804113

Genicular artery embolization (GAE) is quickly emerging as a treatment option for knee osteoarthritis when other therapies have failed. In this episode of the BackTable Podcast, Dr. Osman Ahmed discusses the origins of GAE and how he employs it in his practice. --- This podcast is supported by an educational grant from: Guerbet https://www.guerbet-us.com --- SYNPOSIS Dr. Ahmed, an interventional radiologist at the University of Chicago, shares details about the procedure, his journey in adopting it, and his thoughts on the current landscape of GAE. Topics include procedural techniques, patient selection, anatomical considerations, potential complications, and the importance of ongoing research in this field. --- TIMESTAMPS 00:00 - Introduction 04:43 - Knee Osteoarthritis and Current Treatments 07:54 - Building a GAE Practice 13:23 - Tools and Procedure: Step-by-Step 25:05 - Post-Procedure Care and Complications 30:26 - Future of GAE and Other Applications 34:03 - Conclusion and Contact Information --- RESOURCES BackTable INN Ep. 46- New Innovations in Treatment of PE: The Flow Medical Story with Founders Dr. Osman Ahmed and Dr. Jonathan Paul: https://www.backtable.com/shows/innovation/podcasts/46/new-innovations-in-treatment-of-pe-the-flow-medical-story BackTable VI Ep. 429- Tackling Upper GI Bleeds: Techniques and Tools with Dr. Osman Ahmed: https://www.backtable.com/shows/vi/podcasts/429/tackling-upper-gi-bleeds-techniques-tools BackTable VI Ep. 447- Exploring GAE: Clinical Insights & Outcomes with Dr. Mark Little: https://www.backtable.com/shows/vi/podcasts/447/exploring-gae-clinical-insights-outcomes GEST MSK Conference 2025 (Paris): https://www.gestmsk.com/ Okuno Y et al. Transcatheter arterial embolization as a treatment for medial knee pain in patients with mild to moderate osteoarthritis (2014): https://pubmed.ncbi.nlm.nih.gov/24993956/ Little MW et al. Genicular artEry embolizatioN in patiEnts with oSteoarthrItiS of the Knee (GENESIS 1) Using Permanent Microspheres: Interim Analysis (2021): https://pubmed.ncbi.nlm.nih.gov/33474601/ Little MW et al. Genicular Artery Embolisation in Patients with Osteoarthritis of the Knee (GENESIS 2): Protocol for a Double-Blind Randomised Sham-Controlled Trial (2023): https://pubmed.ncbi.nlm.nih.gov/37337060/ Correa MP et al.GAUCHO - Trial Genicular Artery Embolization Using Imipenem/Cilastatin vs. Microsphere for Knee Osteoarthritis: A Randomized Controlled Trial (2022): https://pubmed.ncbi.nlm.nih.gov/35304614/ Sapoval M et al. Genicular artery embolization for knee osteoarthritis: Results of the LipioJoint-1 trial (2024): https://pubmed.ncbi.nlm.nih.gov/38102013/

In this episode, host Dr. Aaron Fritts and Dr. Krishna Mannava engage in a discussion with Dr. Bret Wiechmann about a concerning trend in the field—insurance denials for critical limb ischemia (CLI) interventions. --- CHECK OUT OUR SPONSOR Philips SymphonySuite https://www.philips.com/symphonysuite --- SHOW NOTES Bret is an IR in Gainesville, Florida with over 26 years of experience and is one of the founders of the Outpatient Endovascular & Interventional Society (OEIS). OEIS was started 10 years ago to advocate for the viability of non-hospital IR services. We start the episode with Bret sharing his staff’s firsthand encounters with pre-authorization challenges for atherectomy procedures.The panel discusses how the recent inflammatory NY Times article regarding the use of atherectomy to treat peripheral artery disease has exacerbated these challenges. The doctors delve into the perplexing use of non-scientific articles as evidence by insurance companies, which are often influenced by third-party recommendations. The disconnect between insurance decisions and patients' actual needs becomes evident, as peer-to-peer reviews usually involve physicians unfamiliar with the specific medical speciality. Next, we explore strategies for navigating the intricacies of insurance approvals, a particularly challenging task as each insurance company has its unique set of requirements for procedure coverage. Evaluating these requirements for each patient not only limits the capabilities of the physician, but also decreases the quality of the patient's care. One strategy that is discussed is compiling a list of different payers and their specific requirements for each procedure, but this takes away valuable time away from a patient’s care. Another strategy includes the intriguing notion of physicians noting the names of insurance companies and peer reviewers on medical records as reasons for denying certain procedures. While promising, the effectiveness of this approach remains uncertain. Furthermore, the episode contemplates the possibility of refusing to work with insurance companies that consistently denying coverage— a bold strategy that warrants careful consideration as it may drop patient volumes. To combat the rising tide of insurance denials, the discussion emphasizes the pivotal role played by organizations like OEIS. It highlights the importance of involving referring physicians in various specialties, patients themselves as well as industry stakeholders manufacturing relevant devices to bring about meaningful change in the insurance approval process. --- RESOURCES New York Times Article: https://www.nytimes.com/2023/07/15/health/atherectomy-peripheral-artery-disease.html OEIS: https://oeisweb.com

In this episode, guest host Dr. Shamit Desai interviews Dr. Keerthi Prasad about his path to starting an IR practice alongside interventional pain specialists. --- CHECK OUT OUR SPONSORS Medtronic VenaSeal https://www.medtronic.com/venaseal Boston Scientific Lab Agent https://www.bostonscientific.com/en-US/customer-service/ordering/lab-agent.html --- SHOW NOTES This unique collaboration started after Dr. Prasad finished fellowship. He describes the support and investment that his anesthesiologist partners provided in helping him launch IR service lines in their existing practice. On the pain management side, he primarily performs vertebral augmentation, DRG stimulation, and nerve blocks. He has also expanded his services into vein care, since venous disease is often concomitant with PAD, wound care, and pain. Dr. Prasad emphasizes the value of focusing on specific procedures and disease states in order to provide the best and most up to date clinical care possible. This can also set you apart from other competitors and help patients identify you as their vascular specialist. Dr. Prasad delves into the infrastructure of their centers. Their high volume of patients requires close coordination of all office and medical staff. To retain highly trained medical staff, he recommends investing in their training, minimizing office politics, and granting sufficient autonomy. Since 2016, the Centers for Pain Control and Vein Care has expanded to multiple locations in northwest Indiana. Dr. Prasad closes the episode by speaking about practice marketing and forming new referral networks. He emphasizes the importance of identifying if there is a true clinical need to perform each procedure and following up with patients and referring doctors. --- RESOURCES Centers for Pain Control and Vein Care: https://www.discover-cpc.com/

In this episode, Dr. Ally Baheti interviews interventional radiologist Dr. Judy Gichoya about her recent paper on artificial intelligence (AI) and the use of a deep learning model to recognize patients’ self-described racial identity, based on radiology images. --- CHECK OUT OUR SPONSORS Medtronic Concerto https://mobile.twitter.com/mdtvascular Viz.ai https://www.viz.ai/ --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/XIPsKR --- SHOW NOTES Dr. Gichoya had started by tackling the original problem of bias in diagnoses for chest X-rays, since it has always been difficult to tell whether something is a real diagnosis, or simply just a finding. Her team built a deep learning model; however, they saw that it did not work well for black patients. With further investigation, they discovered that their model had learned signals that correlated with self-identified race. Intrigued by this finding, Dr. Gichoya and her team sought to identify the factors that the model used when making its race determination. Because AI is black box in nature, the methods by which the algorithm learns remains largely unknown. When tested in other imaging modalities (mammogram, chest CT, spine imaging), the model still showed high accuracy. Additionally, the model retained accuracy when different information was eliminated from the images (ex. age, disease distributions, bone densities). The model was also able to predict race in healthy patients, showing that it did not rely on patterns of disease prevalence in specific ethnic groups. Next, we spoke about the implications of this research in developing risk scores. Deep learning models are able to look at factors that humans are not trained or able to see. Dr. Gichoya highlights the model’s potential effectiveness in predicting osteoarthritis risk in black patients. We also look at applications in opportunistic screening and information about social determinants of health. For example, most patients presenting with chest pain often get chest CTs. Dr. Gichoya thinks that these images can be used by the model to learn about patients’ environmental exposures, like pollution. We finish the episode with a discussion on the changing landscape of IR and how AI can be used as an assistive technology. Interventional cardiologists are already using AI to dictate their procedural reports in real-time. In the interventional oncology space, AI could help integrate imaging and pathology findings to determine personalized treatment courses. All of these applications depend on researchers’ ability to market their findings to peers and the public, Dr. Gichoya gives tips on how to do this. --- RESOURCES AI recognition of patient race in medical imaging: a modelling study: https://www.thelancet.com/journals/landig/article/PIIS2589-7500(22)00063-2/fulltext

In this episode, Dr. Aaron Fritts interviews Dr. Nisha Mehta, a radiologist and founder of the Physician Side Gigs online community. --- CHECK OUT OUR SPONSORS Medtronic AV DCB https://www.medtronic.com/avdata Reflow Medical https://www.reflowmedical.com/ --- SHOW NOTES Dr. Mehta traces her journey from being a radiologist between jobs to managing and advocating for one of the largest grassroots physician communities, with more than 162,000 online members. She started Physician Side Gigs as a private Facebook group with a few doctors to get advice on managing finances for her paid writing and speaking engagements. Overtime, the size and scope of the group grew so much that there was a branch point where a separate group, Physician Community, formed. Both groups remain active today– while Physician Side Gig still centers around business and personal finance education, Physician Community is more free flowing and fosters a variety of conversations about the healthcare environment, clinical practice, and physician advocacy. This advocacy really came into the spotlight during the peak of COVID-19, when members of the online community collaborated to create a list of physician demands for the federal government and were successful in securing $70 billion for physicians in a stimulus package. Dr. Mehta cites the lack of bureaucracy in the group as factors that helped contribute to this outcome. The groups’ goals are to provide members with peer support and bridge them to opportunities to pursue other interests and revenue streams. We also discuss Dr. Mehta’s personal career trajectory and how her priorities shifted throughout the years. In the beginning stages of Physician Side Gigs, she was able to balance a full time clinical practice and manage the online group in her free time. However, as the group grew in audience and partnerships, she re-evaluated her priorities and saw that fostering the community gave her more energy and allowed her to make more impact than her clinical practice did. She now practices radiology on a per diem basis and devotes most of her time to Physician Side Gigs and physician advocacy. She has also hired staff members to help moderate the group and ensure that it remains a safe and supportive environment. Finally, Dr. Mehta speaks about physician autonomy. The decision to pursue a side gig is not always based on revenue maximization. Instead, side gigs can be a way for physicians to dedicate time to pursuing their non-clinical interests and prevent burnout. Her biggest advice for doctors is to be intentional about what they want their lives to look like, and to not get caught up in others’ expectations for them. In the long run, having career autonomy can extend career longevity and allow physicians to navigate their lives on their own terms. --- RESOURCES Physician Side Gigs Website: https://www.physiciansidegigs.com/ Ep. 194 (VI)- Financial Basics with the White Coat Investor: https://www.backtable.com/shows/vi/podcasts/194/financial-basics-from-the-white-coat-investor Ep. 277 (VI)- Private Equity and the Radiology Job Environment with Ben White: https://www.backtable.com/shows/vi/podcasts/277/private-equity-the-radiology-job-environment Ep. 27 (INN)- Physician Underdog with LOUD Capital Founder Navin Goyal: https://www.backtable.com/shows/innovation/podcasts/27/physician-underdog

In this multidisciplinary episode, guest host and vascular surgeon Dr. Krishna Mannava interviews interventional cardiologist Dr. John Phillips about when and how he treats dissections after balloon angioplasty in peripheral vasculature. --- CHECK OUT OUR SPONSORS Philips Image Guided Therapy Devices Academy https://resource.philipseliiteacademy.com Philips SymphonySuite https://www.philips.com/symphonysuite --- SHOW NOTES Since arterial dissection is a known and common complication of balloon inflation, Dr. Phillips emphasizes the importance of distinguishing between dissections that are flow-limiting and need to be treated, and those that are not flow-limiting. The dissection can be evaluated by measuring pressure gradients and intravascular ultrasound (IVUS). If the dissection flap arc is greater than 180 degrees, Dr. Phillips generally considers it to be flow-limiting. Next, he will determine plaque composition in the area of the dissection. If it is calcified or long, he will deploy a woven nitinol stent. If he needs to target a more specific area that is not calcified, he will use the Tack Endovascular System. The doctors discuss more details about the Tack system. It is a scaffold system that was created specifically for use in dissections after balloon angioplasty in narrowed vessels. The deployment of multiple small devices contributes to an overall lower metal burden than a stent would introduce. The system also has an adaptive and overlapping sizing platform to address dissection in different vessels in the same procedure. Since the Tacks are only meant to scaffold the dissection flap, they do not exert as much radial force as a stent does. This is the reason why Dr. Phillips generally avoids using it in heavily calcified areas. Dr. Phillips also answers submitted audience questions regarding the indications, technique, billing, and education opportunities for the Tack system. Overall, he encourages practitioners to get in touch with their local sales representatives for more information, and brings up the possibility of remote proctoring in the future. In terms of follow up care after balloon angioplasty and Tack placement, Dr. Phillips prescribes dual antiplatelet therapy for three months and possible switches to monotherapy afterwards. This is the same regimen as he prescribes for patients with stents. Additionally, surveillance duplex appears similar in patients with Tacks and stents. --- RESOURCES Tack Dissection Repair Device: https://www.usa.philips.com/healthcare/product/HCIGTDTCKESYSTM/tack-endovascular-system-dissection-repair-device Dr. John Phillips Twitter: https://twitter.com/midohiovascular

Interventional Radiologist Dr. Jonathan Gross and host Dr. Aaron Fritts discuss the results from his recent JVIR Media article on the quantifiable environmental impact of operating an interventional radiology practice for one week. Guess how many road trips around the world it equates to!? --- CHECK OUT OUR SPONSOR RADPAD® Radiation Protection https://www.radpad.com/ --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/Wg2OuX --- SHOW NOTES In this episode, interventional radiologist Dr. Jonathan Gross and our host Dr. Aaron Fritts discuss the results from Dr. Gross’s recent JVIR article on the quantifiable environmental impact of operating an IR practice for one week. Dr. Gross begins by describing his lifelong interest in environmental sustainability. He developed the idea for this study because he recognized the discordance between his conscientious practices at home and his less sustainable practices in the IR suite. Dr. Gross acclimates us to vocabulary that is used in the article and defines the measurements of “life cycle assessment” and “volume of greenhouse gases.” Many listeners will be surprised to find out that material waste makes up less than 2% of all greenhouse gas emissions in an IR suite. The majority of emissions is actually produced by air conditioning and air exchange systems, which frequently and unnecessarily run when IR suites are not being used. Finally, Dr. Gross shares ways to reduce the environmental impacts of IR, such as installing motion-sensor lights, using re-processed equipment instead of single-use equipment, and streamlining procedure packs. --- RESOURCES The Environmental Impact of Interventional Radiology: An Evaluation of Greenhouse Gas Emissions from an Academic Interventional Radiology Practice: https://pubmed.ncbi.nlm.nih.gov/33794372/ Environmental Impacts of Abdominal Imaging: A Pilot Investigation: https://pubmed.ncbi.nlm.nih.gov/30158086/

In this episode, host Dr. Chris Beck interviews Dr. Alexander Ushinsky about his standard workup and treatment when performing arterial thrombectomy in acute limb ischemia (ALI). --- CHECK OUT OUR SPONSOR AngioDynamics Auryon System https://www.auryon-system.com/ --- SHOW NOTES In the past three years, Dr. Ushinksy has focused on building up peripheral vasculature service lines at the Mallinckrodt Institute of Radiology at Washington University in St. Louis. He has acquired skills not only in treatment of ALI, but also in building referral bases and collaborating with vascular surgeons and cardiologists. To begin, we review important aspects of a focused history and physical exam. It is crucial to assess whether the patient has underlying peripheral arterial disease (PAD), other thromboembolic diseases, or underlying coagulopathies. Different etiologies of thrombus could require additional consultation with hematologists and cardiologists. Additionally, timing of symptom onset is important to consider when planning interventions in an on-call setting. Dr. Ushinsky relies on extremity pulse exams using bedside doppler and the Rutherford Classification System for ALI to ascertain whether intervention can be helpful. In cases of Rutherford class 1-2a, intervention is usually warranted. Cases that fall into class 2b may or may not require intervention, and cases in class 3 and beyond usually do not gain benefit from intervention since lower extremity paralysis and clot burden is so severe. With regards to types of interventions, Dr. Ushinsky highlights two common IR procedures– lysis catheter placement and endovascular thrombectomy. In the past, lysis catheters were the only available endovascular treatment. We walk through catheter placement, noting that in order to gain maximum benefit, the catheter should be placed across the entirety of the thrombus, with holes proximal and distal to the lesion, so that tPA can be infused throughout the clot and have appropriate inflow and outflow tracts. Good candidates for lysis catheter placement include patients who have extensive clot burden in small vessels and those who have underlying CLI that can be definitively addressed in a later procedure. A major difference between lytic catheter placement and thrombectomy is that patients receiving lytic therapy require admission to the ICU for close monitoring and frequent neurovascular checks. Next, we pivot to discussion about newer thrombectomy devices. Dr. Ushinsky describes pros and cons of common devices that are used in his practice and types of cases that would benefit from each one. Thrombectomy is useful if there is a low clot burden that can be addressed in a single session. Additionally, this procedure is more appropriate than lysis catheter placement if the patient is elderly, has had recent surgery, or is otherwise a poor candidate for systemic tPA. Dr. Ushinsky always performs a diagnostic angiogram at the beginning of the case and a completion angiogram to confirm that the lesion has been fully treated. Overall, he believes that the best intervention for a patient is the one that the practitioner feels the most adept at and can safely perform. --- RESOURCES Rutherford Acute Limb Ischemia Classification System: https://www.jvascsurg.org/article/S0741-5214(97)70045-4/fulltext#secd69653256e1488 Boston Scientific AngioJet Thrombectomy System: https://www.bostonscientific.com/en-US/products/thrombectomy-systems/angiojet-thrombectomy-system.html Penumbra Indigo Thrombectomy System: https://www.penumbrainc.com/peripheral-device/indigo-system/ AngioDynamics Auryon Thrombectomy System: https://www.angiodynamics.com/product/auryon/ Rotarex Excisional Atherectomy System: https://www.bd.com/en-us/products-and-solutions/products/product-families/rotarex-rotational-excisional-atherectomy-system Pounce Thrombectomy System: https://pouncesystem.com/ Find this episode on BackTable.com to see the full list of resources.

In this episode, our guest host Dr. Vishal Kumar interviews medical anthropologist and social scientist Dr. Kelly Knight of UCSF. They discuss the meaning of structural competency, methods for incorporating this concept into medical education, and how it can be applied to alleviate physician burnout. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/4GAyUy --- SHOW NOTES Dr. Knight starts by defining structural competency as the recognition of the underlying policies, systems, and hierarchies that produce social determinants of health. While these structures may sometimes be invisible, they have a large impact on health outcomes. Examination of these factors allows us to think about interventions that can make healthcare more equitable. Next, we highlight effective ways to integrate structural competency into medical education. Dr. Knight shares information about national shared curricula that are designed with the flexibility for each institution to modify the content according to their community’s needs. Finally, we examine redlining as an example of structural violence, signifying intentional disinvestment in marginalized communities. Dr. Knight believes that change starts with an initial acknowledgement and recognition of policies that make populations vulnerable to illness. She also encourages individual healthcare providers to take action by developing interpersonal communication skills, strategizing ways to make the clinical space more focused on healing, and working with elected individuals to create equity at a policy level. All of these efforts may allow for healthcare providers to reconnect with their original motivation to help patients and have a protective effect against burnout. --- RESOURCES Structural Competency Working Group: https://www.structcomp.org/ Teaching Structure: A Qualitative Evaluation of a Structural Competency Training for Resident Physicians: https://pubmed.ncbi.nlm.nih.gov/27896692/ Mountains Beyond Mountains: The Quest of Dr. Paul Farmer: https://www.amazon.com/Mountains-Beyond-Tracy-Kidder/dp/0812973011 The REPAIR Project: https://repair.ucsf.edu/home Do No Harm Coalition: https://www.donoharmcoalition.org/ UCSF Health Equity Collaborative: https://thecollaborative.ucsf.edu/training-health-equity-collaborative

In this episode, host Dr. Aaron Fritts interviews interventional radiologists Dr. Kumar Madassery and Dr. Shelly Bhanot about catheter shapes and when to use each type in basic and challenging cases. --- CHECK OUT OUR SPONSOR Cook Medical https://www.cookmedical.com/vascularaccessbacktable --- SHOW NOTES Kumar serves as an Associate Professor and Director of Peripheral Vascular Interventions/Critical Limb Ischemia and Shelly is a PGY-6 IR resident at Rush University Medical Center in Chicago, IL. Kumar and Shelly walk us through a number of different catheters and techniques, along with tips that they have learned from their experiences in the cath lab. They pair complex and challenging anatomy with catheter types, and they describe their reasoning behind different approaches. After going through case-based examples, both Kumar and Shelly share advice on how trainees can become more familiar with tools on the back table. These include observing supply shelves, asking questions, and learning from IR techs and device representatives. We conclude the episode by emphasizing the power of teaching and how experience is a big factor in becoming more and more familiar with all the catheters that are available to our specialty. Disclaimer: The content, information, opinions and viewpoints contained in this presentation are for educational purposes only. Some opinions expressed may represent those of the speaker and are based on their own clinical experience in their practice. This information is not meant or intended to serve as a substitute for a healthcare professional’s clinical training, experience or judgment. Guest speakers are paid consultants of Cook Medical. Always refer to the Instructions for Use for complete prescribing information including indications for use, warnings, precautions, adverse events and deployment/use instructions.

In this episode, host Dr. Mary Costantino interviews Dr. Kathy Krol, interventional radiologist and former SIR president about the evolution of interventional radiology, her various leadership roles, and the growth of women in IR. --- CHECK OUT OUR SPONSOR Inari Medical https://www.inarimedical.com/ --- SHOW NOTES We begin by discussing how Dr. Krol entered the field of radiology and subsequently became involved in special procedures in radiology, before the beginning of interventional radiology. At the time, there was only a 7 French stiff wire, a J wire, or a straight wire. She recalls how the introduction of two key instruments, the glide wire, and the stent, changed the entire practice and scope of the types of interventions radiologists could do. Next, Dr. Krol talks about her involvement with SIR (Society of Interventional Radiology). She first joined a meeting at a hotel in San Francisco, where she was the only woman in the room, and repeatedly mistaken for a nurse. At the time, the society had recently allowed women to join, and since joining, she has never missed a SIR annual business meeting. During her time as the president of SIR, in 2006, some of the main issues were preserving IR as its own field among vascular surgery and interventional cardiology, forming an independent IR residency, and forming the idea of the outpatient-based lab (OBL) as a new space for IRs to work in. Dr. Krol shares stories of her struggles as a woman in IR as well as in leadership positions. She began in radiology, where she had to work hard to learn procedures, and then even harder to prove to colleagues that she was capable. She was often mistaken for a tech or a nurse and resorted to wearing suits instead of dresses while in the IR suite performing procedures. She often had to take whatever role was given, but she used this to her advantage. One such instance is when she wanted to volunteer for SIR, they put her in coding and billing which was not her interest. She turned this around and became so invested in it that she has now helped create nearly all the CPT codes that exist for IR today.

In this episode of the BackTable Podcast, host Dr. Ally Baheti interviews Dr. Deepak Sudheendra and Laurie Bouzarelos about the complexities of navigating insurance for procedures performed in vascular and interventional radiology outpatient-based labs (OBLs). Dr. Sudheendra is an interventional radiologist at 360 Vascular Solutions in Dublin, Ohio and Laurie Bouzarelos is the founder and owner of Provider Solutions, a small business which focuses on coaching private practice and business-owning physicians on payor contracting. The conversation illuminates common challenges faced by physicians when negotiating insurance contracts, and it emphasizes the lack of awareness among insurance companies about the roles of IRs and the significance of OBLs. Laurie Bouzarelos shares her expertise on insurance contracting, highlighting the importance of education, strategy, and patient-focused care in achieving favorable contract terms. The episode delves into tactics for contract negotiation, leveraging data for better rates, and the critical role of in-house billing for financial transparency and control. Dr. Sudheendra shares his personal journey and the tenacity required to educate insurance providers about IR and OBLs. He underscores the broader need for healthcare professionals to advocate vigorously for their both patient care standards and their financial interests. The episode also includes practical insights for setting up a fee schedule, understanding market dynamics, and the potential pitfalls in standard contracts. --- CHECK OUT OUR SPONSORS Varian, a Siemens Healthineers company https://www.siemens-healthineers.com/ Reflow Medical https://www.reflowmedical.com/ --- SHOW NOTES 00:00 - Introduction 03:14 - Journey of Insurance Contracting: From Confusion to Clarity 10:08 - Art of Negotiation: Laurie’s Unique Coaching Model 19:53 - Leveraging Data for Effective Insurance Negotiations 25:17 - Power of Negotiation: Changing the Game in Insurance Contracting 28:09 - Exploring the Challenges of Physician Negotiations with Insurance Companies 31:54 - Power of Personal Advocacy and Site Visits in Negotiations 36:45 - Navigating Contract Renegotiations and Understanding Fee Schedules 40:56 - Importance of In-House Billing and Vigilant Fee Management 52:16 - Final Advice: The Importance of Negotiation and Understanding Your Business --- RESOURCES Provider Solutions (Laurie Bouzarelos’ company): https://www.providersolutionsconsulting.com/about

In this episode, Dr. Vishal Kumar interviews Dr. Mark Wilson, vice chair and professor of radiology and biomedical imaging at UCSF, and chief of diagnostic and interventional radiology at the Zuckerberg San Francisco General Hospital and Trauma Center about the evolution of trauma care in interventional radiology, translational research, and the impact of mentorship and student outreach. --- CHECK OUT OUR SPONSOR RADPAD® Radiation Protection https://www.radpad.com/ --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/0RPqzN --- SHOW NOTES We begin by discussing how Dr. Wilson discovered radiology, and how he has come to be a leader in IR. He started out with an interest in psychiatry, and became involved in research on psychiatric brain imaging. As he delved deeper into biomedical imaging, his fascination grew. With help from his mentor, he began publishing, which motivated him to further pursue his passion for research. He learned about IR, and then got into UCSF for his radiology residency. Being at the frontier of innovations, Dr. Wilson has been involved in research on MR guided interventions, remote navigation, and percutaneous venous chemo filters. He says these projects have reinforced that radiology and research isn’t done in a vacuum. He depends on his collaborators in material science, chemistry, and other fields to successfully innovate. One thing he loves about the research lab is the student involvement, and getting to see high school and college students get their name on a paper. This is one area of student outreach that has an incredible impact and shapes future leaders in radiology and medicine. Finally, we discuss how Dr. Wilson spearheaded the role of radiology within the hospital infrastructure when they created the new SF General Hospital, the Zuckerberg San Francisco General Hospital and Trauma Center. He collaborated with hospital leadership and architects, as well as emergency medicine, surgery, anesthesia and nursing to build a state of the art trauma care center to serve the people of San Francisco. It fulfills its goal of bringing the services to the patient to deliver better and more efficient care. From CT scanners in the ED, to a hybrid trauma OR, this new center is one of the leading IR and trauma centers in the world. --- RESOURCES The History of the Zuckerberg San Francisco General Hospital and Trauma Center: https://zuckerbergsanfranciscogeneral.org/about-us/our-history/

In this episode, BackTable is on location in Barcelona for CIRSE 2022! Dr. Aaron Fritts conducts a live video interview with interventional radiologist Dr. Lorenzo Patrone. They discuss their experiences with balancing clinical, academic, and family responsibilities, as well as differences in the American and European physician work environments and the use of social media in medicine. --- CHECK OUT OUR SPONSORS Reflow Medical https://www.reflowmedical.com/ Medtronic Chocolate PTA Balloon https://www.medtronic.com/peripheral --- SHOW NOTES Dr. Patrone recounts his entry into the European IR speaking circuit. Through networking, he continues to meet speakers, learn from their experiences, and gain effective communication and presentation skills. He speaks about normalizing the feeling of imposter syndrome, especially when being invited to speak among IR founders and luminaries. He emphasizes personal growth and identifying where your passion and talent overlaps with lecture content. Dr. Patrone highlights the fact that the field of IR revolves around three different aspects: First, the pioneering phase to innovate new procedures, then the research/evidence phase to demonstrate reproducible results, and finally, the education phase to disseminate knowledge and inspire new generations of IRs. It is common for IRs to feel overwhelmed when trying to commit to all of these fields. Instead of trying to master all aspects of the job, Dr. Patrone recommends that clinicians find different angles of their jobs and hone in the aspects that make them enthusiastic to come to work. Personally, he prioritizes clinical care and teaching. We discuss how time is the ultimate luxury, and how to avoid over-commitment and burnout. We also consider societal gender roles and talk about unjust extra pressures faced by female physicians. Then, we look at some key differences between a physician career in the US, versus one in Europe. Dr. Patrone comments on the pay gap, training pathway, and overall philosophy of the Italian and British healthcare systems. Finally, we discuss benefits and misuses of social media within the medical community. Dr. Patrone emphasizes that social media should be used as a tool to teach and inspire, rather than a platform to criticize individuals or specialties. Regarding case-based posts and feedback, he highlights the point that every clinician could have a different but valid approach to each case, based on the practice setting and operator skill. He also encourages other posters to talk about case complications, which can provide enormous educational value for learners.

In this episode, Interventional Radiologist Sabeen Dhand talks with Interventional Cardiologist S. Jay Mathews about novel techniques for arterial thrombectomy, including a discussion on using large bore devices, a variety of technique tips and tricks, and what's on the horizon for new devices/techniques. --- CHECK OUT OUR SPONSOR Boston Scientific Eluvia Drug-Eluting Stent https://www.bostonscientific.com/en-US/medical-specialties/vascular-surgery/drug-eluting-therapies/eluvia/eluvia-clinical-trials.html?utm_source=oth_site&utm_medium=native&utm_campaign=pi-at-us-de_portfolio-hci&utm_content=n-backtable-n-backtable_site_eluvia_1&cid=n10008043 --- SHOW NOTES In this episode, interventional cardiologist Dr. S. Jay Mathews and our host Dr. Sabeen Dhand discuss various devices used in arterial thrombectomy, including large bore aspiration catheters, the preclose system, separators, and stentrievers. Dr. Mathews clarifies the definition of “large bore” as a catheter that is 8 Fr or larger. He notes these devices face some resistance in the interventional community, due the belief that arteries may be size prohibitive. However, he notes that the pre-close systems make arterial closure very feasible. Large bore catheters are able to achieve higher aspiration force compared to smaller catheters. Dr. Mathews prefers to use the Lightning 7 or 12 systems from Penumbra because of their angled/atraumatic catheter tips and their flexibility in navigation. In cases of highly organized thrombus, Dr. Mathews may use separators to break up the clot into smaller and more manageable parts. He also speaks about using filters to capture the clot, but always in conjunction with aspiration, to prevent distal embolization. The doctors also discuss the role of thrombolysis. Although thrombolysis procedure time is shorter than that of thrombectomy, patients remain ischemic for longer, leading to more reperfusion symptoms. Before placing a lysis catheter, Dr. Mathews recommends re-establishing some flow and creating a channel for more effective delivery of tPA. Finally, we talk about new research in thrombus morphology and how this will affect future innovation in ultrasonic energy and nano-magnetic particles. --- RESOURCES Penumbra Lightning Catheter: https://www.penumbrainc.com/indigo-lightning/ Noninvasive thrombectomy of graft by nano-magnetic ablating particles: https://www.nature.com/articles/s41598-021-86291-2

In this episode, co-hosts Drs. Ally Baheti and Mike Barraza interview diagnostic radiologist and blogger Dr. Ben White, who speaks about private equity (PE) ownership of radiology practices, the nationwide radiologist shortage, and advice for navigating job offers. The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/D3g0nd --- SHOW NOTES Dr. White starts the episode by sharing his passion for writing, especially regarding topics that have affected his journey in medicine. His blog features topics that are useful for both trainees and physicians. His current practice structure is an independent diagnostic radiology practice, which is fully owned by physician partners. He thinks that this “priva-demics” job is well-suited to his interest in teaching residents and medical students. He also enjoys the autonomy that the practice has in staffing– it can remain non-bureaucratic and flexible to address patient care. Next, Dr. White explains the factors driving the rise of PE buyouts of radiology practices, including the pros and cons of becoming a PE-owned practice. During a buyout, radiologists are offered more cash and stocks upfront in exchange for a loss of practice autonomy and a cap on future salaries. While PE firms usually advertise buyout as an opportunity to strengthen the practice with more resources, obtain help with debt payment, and eliminate inefficiencies, these benefits may not come to fruition in the long term. Additionally, radiologists may leave practices if they are not satisfied with PE management and priorities, which result in staffing shortages. Buyouts also affect independent radiology practices, since PE-owned practices are able to offer higher salaries for less work, which artificially inflate salaries across the radiology market. Dr. White fears that smaller practices and hospitals will lose their radiology workforces and will be forced to shed low-paying contracts and cease to provide imaging services for patient populations who need medical care the most. Additionally, there is unavoidable friction that arises when third party employers come between the patient-physician relationship. Finally, Dr. White gives advice to radiologists about approaching each job prospect with a holistic perspective, including job factors that cannot be measured. He encourages early career radiologists to identify their values and ask themselves if they view their next job as simply a short term stop, or if they want to set up roots for the long term. This distinction can help guide them in making career decisions. --- RESOURCES American Radiology Associates: https://www.americanrad.com/ Dr. Ben White’s Blog: https://www.benwhite.com/ Strategic Radiology: https://www.strategicradiology.org/

Welcome to the first episode of BackTable Tumor Board, and our first recording session at our new in-person studio! Guest host Dr. Tyler Sandow (interventional radiologist) leads a multidisciplinary discussion about patient care coordination in hepatocellular carcinoma (HCC) diagnosis and treatment, with insights from his colleagues at Ochsner Health– Dr. Steven Young (hepatologist), Dr. Jonathan Mizrahi (medical oncologist), and Deondra Bonds-Adams (patient navigator). Physicians, nurses, nurse practitioners, and physician assistants can follow this link to earn CME / CE credits for completing an accredited learning activity related to this discussion: https://www.cmeuniversity.com/course/take/125735 --- This podcast is supported by an educational grant from: AstraZeneca https://www.astrazeneca.com/our-therapy-areas/oncology.html With additional support from: Boston Scientific https://www.bostonscientific.com/en-US/medical-specialties/interventional-radiology/interventional-oncology.html --- SYNPOSIS The team speaks on the value of having multiple specialties weigh in on treatment conversations that are tailored to each patient’s medical history and risk factors, such as underlying cirrhosis and portal hypertension. Deondra highlights the importance of assessing the patient’s understanding of their disease and the role of physician extenders and schedulers in patient education. Dr. Young discusses the value of outreach clinics and streamlining the transplant evaluation process. Finally, Dr. Mizrahi gives advice on building referral networks and establishing early contact with transplant centers. --- TIMESTAMPS 00:00 - Introduction 00:46 - Multidisciplinary Tumor Board 06:00 - Patient Experience in Treatment Pathways 10:10 - Barriers to Treatment 16:03 - Benefits of IR Clinic 19:33 - HCC Screening and Risk Factors 24:08 - Building Referral Networks 30:34 - Strategies for Effective Scheduling 35:43 - The Future of HCC Treatment

Welcome to the first episode of BackTable Tumor Board, and our first recording session at our new in-person studio! Guest host Dr. Tyler Sandow (interventional radiologist) leads a multidisciplinary discussion about patient care coordination in hepatocellular carcinoma (HCC) diagnosis and treatment, with insights from his colleagues at Ochsner Health– Dr. Steven Young (hepatologist), Dr. Jonathan Mizrahi (medical oncologist), and Deondra Bonds-Adams (patient navigator). --- This podcast is supported by an educational grant from: AstraZeneca https://www.astrazeneca.com/our-therapy-areas/oncology.html With additional support from: Boston Scientific https://www.bostonscientific.com/en-US/medical-specialties/interventional-radiology/interventional-oncology.html --- SYNPOSIS The team speaks on the value of having multiple specialties weigh in on treatment conversations that are tailored to each patient’s medical history and risk factors, such as underlying cirrhosis and portal hypertension. Deondra highlights the importance of assessing the patient’s understanding of their disease and the role of physician extenders and schedulers in patient education. Dr. Young discusses the value of outreach clinics and streamlining the transplant evaluation process. Finally, Dr. Mizrahi gives advice on building referral networks and establishing early contact with transplant centers. --- TIMESTAMPS 00:00 - Introduction 00:46 - Multidisciplinary Tumor Board 06:00 - Patient Experience in Treatment Pathways 10:10 - Barriers to Treatment 16:03 - Benefits of IR Clinic 19:33 - HCC Screening and Risk Factors 24:08 - Building Referral Networks 30:34 - Strategies for Effective Scheduling 35:43 - The Future of HCC Treatment

In this episode, host Dr. Aparna Baheti interviews interventional nephrologist Dr. Satyaki Banerjee about peritoneal dialysis, including indications, placement technique, and tips for preventing complications. The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/Sc3ac2 --- SHOW NOTES Dr. Banerjee is an interventional nephrologist at a private practice OBL in Albuquerque, NM. He has completed around 750 PD catheter placements to date. Indications for PD include patients with renal failure and a glomerular filtration rate (GFR) less than 15%. Regardless of the etiology of renal failure (i.e. hypertension, diabetes), or symptoms (i.e. uremia, volume overload), PD, like hemodialysis (HD), is an option. PD is becoming increasingly popular due to patients’ ability to do it from home rather than at a dialysis clinic 3 days per week. It also empowers patients to manage their own health. Though obesity used to be a contraindication for PD, it no longer is, and Dr. Banerjee frequently places PDs in patients with a BMI of 40. The only contraindication is an abdominal wall with extensive scarring that prevents the location of a clear window. Next, Dr. Banerjee overviews his PD workup. He does a consultation that includes an ultrasound of the abdominal wall (to verify the absence of a hernia or diastasis recti), discussion of risks, and review of post-procedure instructions. The night before, he gives his patients 60mL of lactulose after a liquid diet that evening. Before the procedure, he ensures his patients' bowel and bladder are empty, and places a foley catheter if there is concern for bladder obstruction. He holds Coumadin and Eliquis for 2 days prior to the procedure, and Aspirin and Plavix the day of. His goal for INR is less than 1.5. If they are hyperkalemic, he gives Lokelma, a new powder medication, which he prefers over Kayexalate. He measures the patient's beltline, and where they wear their pants, and always asks if they would prefer the catheter on their right or left. Dr. Banerjee discusses his method for placing PD catheters. He uses a triple prep of chlorhexidine, iodine, and ChloraPrep. He starts by doing a scout x-ray to mark the pelvic rim. He accesses the peritoneum from a paraumbilical approach, just lateral to the spine, and always goes through the rectus muscle. He injects lidocaine until he reaches the posterior rectus sheath, where he switches to contrast. He likes to see a spider web dissipation of contrast to confirm he is intraperitoneal. He prefers a stiff glide for his wire, and an 18 French peel away. After introducing the wire, if it forms the classic loop around the pelvis, then he proceeds to serial dilation. PD catheters are different than PleurX catheters because they have a swan neck and a double cuff. The deep cuff must be in or on the rectus muscle, and the swan neck should be hanging over the rectus. He uses a Vicryl purse-string suture to anchor the deep cuff. He tunnels about 2 inches away from the deep cuff, with the superficial cuff ending in the subcutaneous fascia. He infuses antibiotics through the catheter, usually vancomycin and cefepime. His PD patients can start dialysis the day after the procedure. He then sees his patients one week later for a dressing change and 2 weeks later for a second dressing change and to review home instructions with the PD nurse.

In this episode of the BackTable Podcast, host Dr. Aaron Fritts interviews Dr. Osman Ahmed about treatment algorithms and new technologies for upper gastrointestinal (GI) bleed embolization. Dr. Ahmed is an interventional radiologist at the University of Chicago. The doctors dive into various embolization techniques, microcatheters, and embolic materials that are ideal for managing upper GI bleeds. Dr. Ahmed highlights the importance of understanding the etiology of bleeding, differences between arterial vs. venous bleeding, and first-line therapies such as endoscopy. Dr. Ahmed also discusses the utilization of new embolic materials like Obsidio Embolic, which is designed specifically for peripheral use, and its advantages in achieving rapid and complete vessel occlusion. Additionally, the doctors cover pre-procedural imaging, procedural techniques, and operator preferences for microcatheters and embolic devices. They emphasize the procedural nuances, operator comfort, and evolving technologies in the management of GI bleeds. --- CHECK OUT OUR SPONSOR Boston Scientific Obsidio Embolics https://www.bostonscientific.com/obsidio --- SHOW NOTES 00:00 - Introduction 03:29 - Discussion on Upper GI Bleeds 06:35 - Pre-Procedure Imaging for Upper GI Bleeds 11:16 - Procedure Walkthrough for Upper GI Embolization 19:51 - Understanding Mesenteric Anatomy 22:50 - Embolization Devices: Coils and More 25:31 - Exploring Obsidio: A New Embolic 32:55 - Post-Procedure Care 34:17 - Case Discussions and Final Thoughts --- RESOURCES Navigating Early Cases with the Obsidio™ Conformable Embolic - GEST 2023 Webinar with Dr. Ahmed: https://thegestgroup.com/webinar-featuring-obsidio/ BackTable VI Episode #179 - Happiness is a Warm Coil: Treating GI Bleeds with Dr. Donald Garbett: https://www.backtable.com/shows/vi/podcasts/179/happiness-is-a-warm-coil-treating-gi-bleeds BackTable VI Episode #216 - Stick It: Glue Embo with Dr. Ziv Haskal: https://www.backtable.com/shows/vi/podcasts/216/stick-it-glue-embo BackTable VI Episode #321 - New Innovations in Lower GI Bleed Embolization with Dr. Kevin Henseler: https://www.backtable.com/shows/vi/podcasts/321/new-innovations-in-lower-gi-bleed-embolization Obsidio - Conformable Embolic: https://www.bostonscientific.com/obsidio

In this episode, host Dr. Michael Barraza interviews interventional radiologist Dr. David Johnson about practice building in an IR/DR group, including factors that make a good job, and how he formed one of the largest PAE practices in the Southeast. --- CHECK OUT OUR SPONSOR Viz.ai https://www.viz.ai/ --- SHOW NOTES Dr. Johnson found his current job, his first out of fellowship, via a job board. His wife, an ER physician, was looking for a job at the same time, which complicated their search slightly. They ultimately found their current positions by being flexible and understanding that no job is perfect. Dr. Johnson believes that when searching for a job, “you can't let the best be the enemy of the good.” What he was looking for in a job was a practice where he could do a lot of IR in a situation where he could build the IR practice that he wanted. He notes that this is something you should try to find out beforehand during the job search because, at some practices, it’s very difficult to change the way things work and the types of procedures they do. One of the most important things to consider and something he recommends to anyone looking for an IR job is the potential for growth. He cautions that this is a long game you must be ready to play. You can't expect to come in and change or build a practice in 2-3 years. After he found his footing and established himself in his new job, he began to grow his practice by finding out what the need was in his community. He started by marketing multiple service lines and seeing which would stick. He did this so that he could feel things out and see which physicians ended up referring to him, and which didn’t. It can be hard to balance practice building while in a combined DR/IR practice due to your DR responsibilities, due to quotas and RVUs. He says that you need to keep your mind on the long game in this situation. He did this by talking to at least one clinician every day about a patient he could help in some way. He figured that if he did this for two years, he would slowly get his name out and build a referral base. Most of these calls were low yield, but it paid dividends for him in the long run. About 1-2 years in, he began getting calls from physicians that he had talked to asking if he could do something for a patient. Finally, Dr. Johnson speaks on how he approached prostate artery embolization (PAE), a procedure that previously didn’t exist in Fort Myers, FL, and used it to turn his practice into one of the biggest PAE centers in the Southeast. He thought of the procedure as a challenge, which he was looking for, and he knew there was a need in the community, so it was something he realized could grow. He didn’t know how to do PAE, but he turned to the STREAM Meeting to learn the technique. He stresses that this was not a fast process. It took 18 months from when he attended STREAM to when he got his first patient on the table. His first patients were self-referred. He built referrals by doing the procedure well and garnering good outcomes. Importantly, he provided good consults and follow-ups, always making sure to include a follow-up with their urologist to whom they reported the good results. To help his clinic run successfully, he had to hold himself accountable to ensure things got done. He relies heavily on digital reminders as well as a great medical assistant who does most of his scheduling. For his PAE patients, who often experience post-PAE syndrome, it is important to him to be available for them; he doesn't want them to feel abandoned. He gives them his cell phone and tells them to call him day or night. It is important to him to be more than just the technician. He wants to be there for them, to be the first person they call, to be their physician. He also believes closing the loop with referring providers is crucial to maintain rapport and a strong stream of new referrals. --- RESOURCES STREAM Meeting: https://www.thestreammeeting.com

CLI fighters Dr. Bryan Fisher and Dr. Sabeen Dhand discuss their approach to treating calcified arteries above the knee, including looking at newer technologies and choosing the appropriate device to effect real durable change to the calcified wall. --- CHECK OUT OUR SPONSOR Shockwave Medical https://shockwavemedical.com/?utm_source=ATK-Backtable-Podcast&utm_campaign=Backtable-Podcast --- SHOW NOTES In this episode, vascular surgeon Dr. Bryan Fisher and our host Dr. Sabeen Dhand discuss treatments, intravascular ultrasound (IVUS), and device selection for calcified lesions above the knee. First, Dr. Fisher discusses common risk factors for above the knee calcifications, including diabetes, end-stage renal disease, and smoking. In his diagnostic workup, he highlights the benefits of using CT for showing atherosclerotic disease, as well as IVUS for viewing intimal and medial calcifications. With intimal calcifications, Dr. Fisher prefers to use an atherectomy device. For severely stenotic regions, he notes that orbital atherectomy can clear the way for other devices to pass through. After atherectomy, he usually performs IVUS to identify the luminal gain and assess the degree of plaque modification. The doctors talk about new frontiers in technology such as intravascular lithotripsy, a technique that has been modified from urological treatment. The intermittent delivery of focal energy cracks calcium deposits and minimizes the risk of vessel rupture. Additionally, they discuss optical coherence tomography and how it can assist in visualizing the results of lithotripsy. Overall, Dr. Fisher believes that angioplasties will likely cause injury to intimal walls, but these effects can be minimized by knowledge of vessel architecture and proper device selection. --- RESOURCES The Surgical Clinic: https://thesurgicalclinics.com/ Shockwave Intravascular Lithotripsy: https://shockwavemedical.com/clinicians/international/peripheral/

In this episode, host Dr. Sabeen Dhand interviews Dr. John Rundback, interventional radiologist, about distal femoropopliteal disease, including the unique pathophysiology of this area, which stents work best at the adductor canal and the trifurcation, and tips for early operators. --- CHECK OUT OUR SPONSOR Veryan BioMimics 3D® Vascular Stent System https://www.veryanmed.com/usa/products/biomimics-3d-vascular-stent-system/ --- SHOW NOTES In this episode, host Dr. Sabeen Dhand interviews Dr. John Rundback, interventional radiologist, about distal femoropopliteal disease, including the unique pathophysiology of this area, which stents work best at the adductor canal and the trifurcation, and tips for early operators. We begin by discussing peripheral arterial disease (PAD) pathophysiology, specifically in the challenging areas around the adductor canal (Hunter’s canal). Dr. Rundback describes how the femoral artery has twists and turns around this area and that it can experience compressive forces up to 15-20% during motions such as flexion of the knee. Due to this being the most dynamic location of the femoral artery, this is often where plaque rupture will happen, resulting in critical limb ischemia (CLI) and requiring urgent intervention. The two discuss how traditional rigid stents do not work well in this area due to the dynamic nature of the region and the fact that the artery is tortuous and can cause rigid stents to fracture or cause intimal hyperplasia due to turbulent flow. Drug coated balloon (DCB) angioplasty generally does not work for this region due to poor durability. They discuss the utility of the Tack device, a scaffold with minimal metal which is better suited for focal dissections. Dr. Rundback emphasizes the importance of intravascular ultrasound (IVUS) during all distal femoropopliteal cases due to the complexity of the region and patient-to-patient variation. He uses IVUS to choose which device and what size to use because measuring on angiography is not accurate in these cases. Finally, they discuss the Supera and BioMimics stents, including the indications, benefits, and ease of deployment of each. Dr. Rundback says that Supera, a woven nitinol stent, gives it the benefit of thermal memory. The difficulty with this stent is the need for aggressive vessel preparation and plaque modification, generally requiring lengthy angioplasty and possibly atherectomy. The BioMimics stent can rotate, curve, and shorten, which is optimal for this region to maintain swirling or helical blood flow rather than causing turbulent flow. The BioMimics stent is also very easy to deploy, and Dr. Rundback generally chooses this stent in locations where he can’t adequately prep the vessel. --- RESOURCES BioMimics 3D stent: https://www.veryanmed.com/international/products/biomimics-3d-vascular-stent-system/ Supera™ Stent: https://www.cardiovascular.abbott/int/en/hcp/products/peripheral-intervention/supera-stent-system/overview.html Tack device: https://www.usa.philips.com/healthcare/product/HCIGTDTCKESYSTM/tack-endovascular-system-dissection-repair-device

In this episode of the BackTable Podcast, host Dr. Michael Barraza interviews guest Dr. Marcelo Guimaraes about the advantages and implementation of radial access in interventional radiology. Dr. Guimaraes is a vascular and interventional radiologist from the Medical University of South Carolina (MUSC). Dr. Guimaraes shares insights on the adoption of radial access over femoral access, emphasizing its simplicity, safety, and the clear benefits recognized by younger interventionalists. He elaborates on the importance of education, partnership with the industry, and following a standard protocol to build a successful radial access program. The doctors also cover specific topics like the RAVI Registry outcomes, patient preferences for radial access based on a study, the cost-benefit analysis, and handling various challenges such as artery spasms and loops. Dr. Guimaraes advocates for radial access as the default method for embolization therapies, highlighting its efficacy across a range of procedures and patient conditions. --- CHECK OUT OUR SPONSOR Medtronic Concerto https://mobile.twitter.com/mdtvascular --- SHOW NOTES 00:00 - Introduction 02:56 - Insights into MUSC’s Interventional Radiology Program 04:44 - Emergence of Radial Access in Interventional Procedures 07:04 - Challenges and Solutions in Setting Up a Radial Access Program 10:14 - Essential Equipment for Radial Access 22:20 - Addressing Spasm Challenges in Radial Access 30:11 - Patient Preference: Radial vs Femoral Access 32:46 - Safety and Efficacy of Radial Access: The Data 41:11 - Post-procedure Hemostasis Protocol 43:51 - Optimal Radial Artery Access Point and Best Practices --- RESOURCES How To Do The Barbeau Test - BackTable Demo: https://www.backtable.com/shows/vi/demos/how-to-do-the-barbeau-test Comparison of transradial coronary procedures via right radial versus left radial artery approach: A meta-analysis: https://pubmed.ncbi.nlm.nih.gov/27037544/ Transradial Versus Transfemoral Arterial Access in Liver Cancer Embolization: Randomized Trial to Assess Patient Satisfaction (Dr. Guimaraes paper): https://pubmed.ncbi.nlm.nih.gov/29150395/ An Update on Radial Artery Access and Best Practices for Transradial Coronary Angiography and Intervention in Acute Coronary Syndrome: A Scientific Statement From the American Heart Association: https://www.ahajournals.org/doi/full/10.1161/HCV.0000000000000035 The RAVI registry: prospective, multicenter study of radial access in embolization procedures – 30 days follow up: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10828405/

In this episode, Dr. Chris Beck interviews Interventional Radiologist Dr. Josh Kuban about his liver tumor ablation practice at MD Anderson Cancer Center, including how it's evolved over time with newer technologies. They also discuss patient workup for liver tumors, treatment with microwave ablation, and post-procedure follow up. Dr. Kuban shares why he uses microwave ablation technology, and the advantages of ablation confirmation software for these procedures. --- CHECK OUT OUR SPONSOR NeuWave Microwave Ablation Systems https://www.jnjmedtech.com/en-US/product-family/neuwave-microwave-ablation-systems --- SHOW NOTES We begin by discussing how Dr. Kuban started to get involved in interventional oncology and tumor ablation. He started off doing a broad base of vascular procedures. When he came to MD Anderson, he began building close relationships with oncologists which led him to become focused on ablation, primarily of liver and lung lesions. For liver tumors, Dr. Kuban primarily uses microwave ablation, while in the lung, he does cryoablation. The benefits of microwave ablation are the efficiency of the procedure compared to the time it takes to perform cryoablation. He generally does multiprobe ablations, which allows him to treat the tumor more aggressively from the beginning. He is able to do this confidently by taking advantage of ablation confirmation (AC) software. He always starts with a pre-procedure CT which he uploads to the AC software. He then compares his pre-image to his probe image which helps target the lesion intraoperatively. After ablating, he does another scan that has arterial and venous phases to look for bleeding. The AC software then takes the pre-scan and post-scan and merges them to show the ablation zone. Lastly, we discuss the impact that AC software has had on Dr. Kuban’s practice. When Dr. Kuban approaches a liver ablation case, his goal is to get the entire tumor in a single procedure, and he believes that he has to be able to see the margins in order to effectively ablate them. The software allows him to see the treatment effect in real time and provide more complete treatment the first time. After using this software, his recurrence rates have been very low, and he is confident that if a recurrence does happen, it is not due to incomplete ablation. He also emphasizes the effects that AC software has had on practice building. Because of this software, he is able to show images of cases to referring providers. --- DISCLAIMER Dr. Josh Kuban is presenting on behalf of Ethicon. The presentation reflects the opinions of the individual presenter, and the steps described may not encompass the complete steps of the procedure. Additionally, other surgeons may prefer different techniques, approaches, etc., as individual surgeon experience in his/her clinical practice, as well as patient needs, may dictate variation in procedure steps. Accordingly, results from any case studies reported in this presentation may not be predictive of results in other cases. Before using any medical device, review all labeling, including without limitation; the Instructions For Use (IFU), and relevant package inserts with particular attention to indications, contradindications, warnings and precautions, and steps for use of the device(s). Dr. Josh Kuban is compensated by and presenting on behalf of Ethicon and must present information in accordance with applicable regulatory requirements. The NeuWave™ Ablation System and Accessories are indicated for the ablation (coagulation) of soft tissue in percutaneous, open surgical and in conjunction with laparoscopic surgical settings, including the partial or complete ablation of non-resectable liver tumors. The NeuWave™ Microwave Ablation System and Accessories are not indicated for use in cardiac procedures. The system is designed for facility use and should only be used under the orders of a clinician.

Are you interested in starting an ASC or converting your OBL into an ASC, but aren’t sure where to start? We’ve got you covered with this comprehensive overview. Attorney Jason Greis joins guest host and ASC founder Dr. Krishna Mannava to explore the operational, financial, and legal intricacies of starting an ASC. Jason is a Partner of Benesch, Friedlander, Coplan & Aronoff LLP, outside co-counsel to the Renal Physicians Association and OEIS Society, and recognized faculty member of SIR Business Institute. --- CHECK OUT OUR SPONSOR RADPAD® Radiation Protection https://www.radpad.com/ --- SYNPOSIS Jason and Dr. Mannava discuss crucial factors such as structural modifications, financial considerations, legal requirements, Certificate of Need (CON) states, and credentialing processes. The conversation also delves into strategic partnerships with hospitals, the role of ASC management companies, and the involvement of non-physician owners. Additionally, they explain the implications of non-compete clauses, operational challenges, investment structures, and exit strategies. --- TIMESTAMPS 00:00 - Introduction 03:11 - OBL to ASC Conversion 06:08 - Financial and Regulatory Aspects 15:35 - Ownership and Investment Strategies 29:41 - Non-Competes and Legal Risks 34:21 - Specialized Legal Advice and Conclusion --- RESOURCES Vive Vascular: https://www.vivevascular.com/ SIR Business Center: https://irbc.sirweb.org/

Varicoceles embolization is the least invasive treatment option for varicoceles, making it the favored option for most patients and a staple in the interventional radiologist’s procedural repertoire. Dr. John Matson joins host Dr. Ally Baheti to give us an essential guide to varicocele embolization, serving as an introduction for junior IRs and refresher for the more experienced. Dr. Matson is an Assistant Professor of Interventional Radiology at University of Virginia. --- RADPAD® Radiation Protection https://www.radpad.com/ --- SYNPOSIS Dr. Mattson covers the indications, procedural setup, technique variations, and post-procedure follow-up for treating varicoceles, with specific attention to the different embolic materials used in clinical practice. He also delves into the importance of pre-procedure evaluations, imaging requirements, and managing potential complications. --- TIMESTAMPS 00:00 - Introduction 02:05 - Indications for Varicocele Embolization 06:05 - Procedure Setup and Execution 12:57 - Coil Sizing and Embolic Materials 17:36 - Managing Complications 20:25 - Post-Procedure Care and Follow-Up

Tumor embolization is a versatile procedure that can provide symptomatic and long-term benefits for patients. In this episode of BackTable MSK, host Dr. Michael Barraza discusses musculoskeletal tumor embolizations with Dr. Gina Landinez from the Miami Cardiac and Vascular Institute, where she is helping to grow the MSK interventions program. --- This podcast is supported by: Accountable Physician Advisors http://www.accountablephysicianadvisors.com/ --- SYNPOSIS Dr. Landinez explains that the main indications for embolization are preoperative tumor shrinkage and pain palliation. Embolization decreases hemorrhagic risk and procedure time during surgical resection and leads to better surgical margins. Pain palliation can also be achieved due to tumor size reduction and decreased pressure on surrounding nerves and tissue. Dr. Landinez explains that lesions well-suited embolization are hypervascular, large, not sensitive to radiation, and painful. She also describes the risks of off-target skin and muscle embolization and the importance of exercising caution with vertebral tumors. Finally, Dr. Landinez shares valuable practice-building tips about developing relationships with orthopedic surgeons and providing adequate follow up care. --- TIMESTAMPS 00:00 - Introduction 03:51 - Indications for Embolization 08:08 - Building Referral Networks 13:45 - Preoperative Planning 18:34 - Technical Aspects of Embolization 27:25 - Challenges and Considerations 31:23 - Importance of Outpatient Follow Up

In this episode, Dr. Bagrodia discusses cultivating a healthy culture inside and outside of the operating room with Dr. Chris Kane, Dean of Clinical Affairs at UCSD and CEO of the UCSD Physician Group. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/rVQG40 --- SHOW NOTES First, the doctors discuss the definition of culture, which Dr. Kane defines as the norms of behavior and relationships within an organization. Culture can include dress code, meeting rules, and punctuality. Most of the time, institutional culture is established in an unspoken way. Dr. Kane emphasizes the importance of having a conscious strategy to create a healthy culture and reiterates that trust is a crucial foundation for motivating cultural changes. Next, the doctors discuss helping team members find meaning in their work. Dr. Kane recommends that surgeons share patient gratitude with their other colleagues who are not frontline medical workers. He acknowledges his staff’s contributions during meetings and expresses his gratitude through written notes. He also recommends communication training for everybody on his team. Then, he shares tips for assessing organizational culture. He believes that it is most important to ask team members what they think the overarching goal of the institution is and to assess the attrition rate through exit surveys. He emphasizes that behavioral norms matter most, as department leaders often lead by example. One detrimental practice is favoritism, which Dr. Kane regards as disrespectful to other team members. Additionally, he shares his personal experiences with changing cultures at different institutions and utilizing change management theories. Finally, Dr. Kane shares general leadership advice. He highlights the importance of creating a patient-centered environment, leading by influence rather than authority, and the power of positivity.

In this episode, host Dr. Aaron Fritts interviews Dr. Jim Melton and Amanda Stanley about intravascular lithotripsy in the ASC, including reimbursement trends, patient selection and the future of the device. --- CHECK OUT OUR SPONSOR Shockwave Medical https://shockwavemedical.com/?utm_source=Backtable-Podcast&utm_campaign=Backtable-Podcast --- SHOW NOTES We begin by discussing Amanda’s role in the practice. She is an ex OR nurse and has been clinical director for their original hybrid ASC/OBL in Oklahoma City for 8 years. She has taken on many roles over the years, the most recent being COO. Some of her functions under this title include clinical revenue cycle management (RCM), payer negotiation, credentialing and accreditation. Since partnering with a private equity firm, she has also been collaborating with others in ASCs they have acquired around the country. Dr. Melton states that intravascular lithotripsy (IVL) reimburses very well in the outpatient space, but that this is only true in the ambulatory surgery center (ASC) and does not translate to outpatient based labs (OBLs). Medicare pays for all associated Shockwave intravascular lithotripsy CPT codes, commercial insurance does not. They found in their practice that by using the Medicare fee schedule, they could prove to their local commercial insurance providers that it was worth paying for, and they are now getting it approved via both parties. Specifically, C9765, which is for IVL, percutaneous transluminal angioplasty (PTA) and stenting, pays $5000 more than the code that is just for PTA and stenting. Lastly, we go over sizing and patient selection. In the ASC, he most commonly uses the 5.5, 6 and 7, which all go through a 5-6 Fr slender sheath in the foot. If you use an 8 then you’ll need a 7 Fr sheath, and if you use a size 9, 10, or 12, you’ll need an 8 Fr sheath. Dr. Melton emphasizes the importance of selecting the right patients for the ASC and hospital. In those with significant comorbidities or a femoral artery that will need a size 9, 10 or 12 balloon, he tends to do these in the hospital. He finds that he places a stent more often than not after IVL and PTA because of what he sees using intravascular ultrasound (IVUS). He shares a tip for using the current IVL balloon. Because it emits the strongest sonic pressure impulse at the center of the balloon, he uses IVUS to mark the most calcified segment, then targets this area with the center of the balloon. He remarks that the newer version, coming out soon, has a shorter balloon and emits the same strength across its entire length, allowing you to skip this step. --- RESOURCES Ep. 287 OBL/ASC Reimbursement Update January 2023 https://www.backtable.com/shows/vi/podcasts/287/obl-asc-reimbursement-update-jan-2023

In this episode, host Dr. Sabeen Dhand interviews Dr. Jihad Mustapha, interventional cardiologist, about new technology for treating CLI, including CTOP classification, CTO crossing techniques, and reentry devices. --- CHECK OUT OUR SPONSOR Reflow Medical https://www.reflowmedical.com/ --- SHOW NOTES Dr. Jihad Mustapha is an interventional cardiologist who practices at Advanced Cardiovascular in Grand Rapids, MI. He used to perform the entire scope of interventional cardiology, until finding his passion in critical limb ischemia and dedicating his career to treating this complex disease. Advanced Cardiovascular has grown, and now includes a dedicated interventional cardiology department and a PAD/CLI specific department. The basic principle for treating chronic total occlusions is to approach them from the best direction. This generally starts with an up and over technique to do the initial planning angiography. Dr. Mustapha then uses the wire and catheter technique, but limits his efforts to 5 minutes. If he can’t cross, he tries a new method. If he can cross but can’t reenter distally, then there are multiple methods to turn to, including reentry devices like the Outback and Pioneer. He emphasizes that when using reentry devices, you must measure the CTO and enter just after it ends, allowing no more than 1-2 mm of space between the cap and your reentry point. If it is impossible to reenter at that level, you should not use a reentry device and should turn to another method. The Chronic Total Occlusion crossing approach based on Plaque cap morphology (CTOP) classification is helpful when deciding how to safely approach a CTO or which technique to turn to, and Dr. Mustapha uses it in all his cases. Next, we discuss pedal access. Dr. Mustapha acknowledges he hasn’t used reentry devices for years now, due to the fact that pedal access is so much quicker and works just as well. If a CTO has a complex CTOP classification, he doesn’t even try anterograde first, he just goes directly to pedal access and crosses retrograde. When he uses the retrograde approach to cross the CTO cap, he often finds the occlusion is not as long as he expects it to be, and also that he is intraluminal much more often than he initially anticipates. For long chronic total occlusions (CTOs), he starts with pedal access, crosses the CTO plaque cap, and continues through the occlusion, stopping just before the reentry point. If it pops through the cap, he then uses the tibiopedal artery minimally invasive retrograde revascularization (TAMI) technique, but if it does not, he comes anterograde and uses the flossing technique. Finally, we discuss how to use the Wingman device, as well as tips for using the Jenali and modified Schmidt techniques. Finally, we discuss new devices coming soon in the CLI arena. Dr. Mustapha is excited about companies that are creating a 2-in-1 device that allows you to cross the CTO and then use it as a reentry device. Dr. Mustapha parts by telling listeners that CTOs are never friendly, whether long, short, calcified, or non-calcified, but as long as you anticipate this and go into a case expecting surprises, you’ll do well. --- RESOURCES Ep. 60: Building a Limb Salvage Program https://www.backtable.com/shows/vi/podcasts/60/building-a-limb-salvage-program CTOP Paper: https://capbuster.com/wp-content/uploads/2021/03/Chronic-Total-Occlusion-Crossing-Approach-Based-on-Plaque-Cap-Morphology-The-CTOP-Classification.pdf Tibial Pedal Access Paper: https://www.openaccessjournals.com/articles/tibialpedal-arterial-access--retrograde-interventions-for-advanced-peripheral-arterial-disease--critical-limb-ischemia.html Jenali Scoring System: https://evtoday.com/pdfs/et0910_Feature_mustapha.pdf Find this episode on backtable.com to view the full list of resources mentioned in this episode.

En este episodio del podcast, el Dr. Iñigo Insausti Gorbea y la Dra. Sara Lojo Lendoiro, se centraron en la técnica de embolización prostática como alternativa mínimamente invasiva para el tratamiento de la hiperplasia benigna de próstata. Se detallaron los criterios de inclusión del paciente para poder realizar este procedimiento, las tasas de éxito y los riesgos potenciales. Además, se destaca la importancia de educar a los urólogos y médicos de atención primaria sobre este procedimiento, abogando por una mayor participación clínica de los intervencionistas en la atención al paciente. El Dr. Insausti también abordó la necesidad de que los radiólogos intervencionistas cuenten con consultas y camas propias, para los pacientes. Por último, en el episodio se habla sobre el futuro potencial de la embolización de próstata, incluida la introducción de materiales de embolización alternativos y la tasa de retratamiento de pacientes a largo plazo, en comparación con las opciones quirúrgicas. --- SHOW NOTES 00:00 - Introducción 01:43 - Comprender la hipertrofia prostática benigna 03:42 - Impacto en la calidad de vida de los pacientes 04:31 - Introducción a la embolización de la próstata. 06:25 - Candidatura del paciente para la embolización 07:29 - Comparación de embolización y cirugía. 11:08 - Riesgos asociados con la embolización de la próstata 14:51 - Tasas de éxito de la embolización de la próstata 24:17 - El futuro de la embolización de la próstata 45:01 - Conclusión y pensamientos finales

On this episode, BackTable VI host Dr. Christopher Beck shares the mic with two Maternal Fetal Medicine (MFM) specialists, Drs. Roxane Rampersad at Washington University and Tony Shanks at Indiana University, to discuss cross-specialty management of postpartum hemorrhage (PPH) between OBGYN and interventional radiology (IR). The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/ASxPdP

In this episode, Dr. Chris Beck interviews vascular access surgeon Dr. Ari Kramer about his management of arteriovenous (AV) access for dialysis patients. We cover his preferred imaging for identifying and deciding to treat stenoses, the protracted angioplasty technique, and the evolution of research in drug coated balloons (DCB) and stent grafts. --- CHECK OUT OUR SPONSORS Medtronic Chocolate PTA Balloon https://www.medtronic.com/peripheral BD Rotarex Atherectomy System https://www.bd.com/rotarex --- SHOW NOTES Dr. Kramer starts by describing his vascular access practice. He is the sole operator within a hospital-based practice where he creates and maintains AV access. When evaluating a patient for possible intervention, duplex ultrasound, physical exam findings, patient history, and information from the dialysis center all play roles in determining whether the patient is eligible for a fistulagram. Dr. Kramer offers fistulagram tips: he obtains access above the arterial anastomosis in order to avoid occlusion of outflow, and he first shoots contrast into the venous tract first and works his way up to the arterial system. Depending on the findings of the fistulagram, stenotic lesions in the venous outflow tract can be treated. Dr. Kramer generally treats the lesion if the stenosis limits flow by more than 50%. Additionally, he treats any lesion resulting in a luminal diameter of 2mm or less. In an AV fistula circuit, Dr. Kramer describes his procedure, which is largely informed by the most current clinical trials. He first employs the FLEX Vessel Prep system to reduce circumferential fibromuscular tension. Next, he performs protracted plain old balloon angioplasty (POBA) for 90 seconds. This helps Then, he re-images the vessel to ensure there was no injury and utilizes a DCB to deliver paclitaxel. We discuss the clinical trials outcomes of the two current DCBs that have been approved for use in AV management, IN.PACT and Lutonix. Dr. Kramer also notes the significant cost of DCBs and lack of access to treatment for the most at-risk patients. He encourages clinicians to unite to advocate for increased reimbursement for this treatment that has been proven to show the highest standard of care. Additionally, we address treatment of non-autogenous AV circuits with stent grafts. Dr. Kramer prefers self-expanding covered stents, such as Viabahn or Covera, since they are conformable and resistant to kinks. Overall, Dr. Kramer emphasizes the importance of the operator staying up to date on clinical trials that show data for diverse tools with various indications, knowing their own skill and comfort, and incorporating the best treatments based on their patient and practice context. --- RESOURCES Ep. 139 AV Fistula Graft Management: https://www.backtable.com/shows/vi/podcasts/139/av-fistula-graft-maintenance FLEX Vessel Prep System: https://www.venturemedgroup.com/ KDOQI Clinical Practice Guideline for Vascular Access, 2019 Update: https://www.ajkd.org/article/S0272-6386(19)31137-0/fulltext Fahrtash, F., Kairaitis, L., Gruenewald, S., Spicer, T., Sidrak, H., Fletcher, J., Allen, R., & Swinnen, J. (2011). Defining a significant stenosis in an autologous radio-cephalic arteriovenous fistula for hemodialysis. Seminars in dialysis, 24(2), 231–238. Haskal, Z. J., et al. (2010). "Stent graft versus balloon angioplasty for failing dialysis-access grafts." New England Journal of Medicine 362(6): 494-503. Bard Peripheral Vascular. Covera vascular covered stent instructions for use. Rev.4 / 08-18. http://www.bardpv.com/eifu/uploads/BAWB05872R4-Covera-Vascular-Covered-Stent-IFU.pdf. The Fight Doctors: https://thefightdoctors.com/about/ Find this episode on BackTable.com for all resources mentioned in this podcast, including references to journal articles.

In this episode, host Dr. Chris Beck interviews chest and interventional radiologist Dr. Robert Suh about his lung biopsy technique, including how he approaches pain management, and his take on the best way to seal the biopsy tract to prevent air leaks. --- CHECK OUT OUR SPONSOR AngioDynamics BioSentry https://www.angiodynamics.com/product/biosentry-tract-sealant-system/ --- SHOW NOTES Dr. Suh begins by telling us about his background and current practice at UCLA. He was trained in interventional radiology but did a second fellowship in chest radiology due to the job market at the time. At UCLA they have a very organ-specific practice, and Dr. Suh has spent his whole career on chest and lung imaging and procedures. He splits his time between procedures, triage and planning, clinic and administrative days. Before a lung biopsy, Dr. Suh sees the patient when they arrive and reviews their procedure. He ends the patient meeting by putting the ball back into their court by coaching them on their breathing. He tells them to take a small breath in and hold it. He has them concentrate on this while on the table which gives them more control in an unfamiliar environment. He uses mild or moderate sedation, and feels that the most important part of pain management is properly numbing the parietal pleura as it is somatically innervated. To do this, he brings a 19 gauge coaxial needle up to the extrapleural space, which looks like a black band of fat, and administers at least 10cc of lidocaine or bupivacaine. Once the parietal pleura is numb, the procedure goes much better because the needle is not tugging on the pleura with each breath. For subpleural lesions, he prefers a tangential approach, which crosses more lung parenchyma but yields a better sample than the shorter perpendicular approach. If a target is inaccessible, he first tries to reposition the patient and does not hesitate to consult interventional pulmonology to discuss alternative approaches. Dr. Suh discusses how he previously used blood patches at the end of the biopsy to seal the tract, and why he changed his technique. He now exclusively uses BioSentry, a hydrogel polymer that functions similarly to a blood patch. After deploying the BioSentry through the introducer needle he waits 3-5 minutes, checks for pneumothorax development, and if there is no pneumothorax he sends patients home within 30 minutes without doing a post-biopsy chest x-ray. --- RESOURCES MD Anderson Study: https://pubmed.ncbi.nlm.nih.gov/15673500/ Memorial Sloan Study: https://pubmed.ncbi.nlm.nih.gov/30480487/ AngioDynamics BioSentry: https://www.angiodynamics.com/product/biosentry-tract-sealant-system/

In this episode, host Dr. Ally Baheti interviews interventional radiologist Dr. Brooke Spencer about management of pelvic venous disease, endovascular therapies for pelvic varices, and important considerations for treating patients with complex and chronic pain. --- CHECK OUT OUR SPONSOR Boston Scientific Drug Elution https://www.bostonscientific.com/en-US/medical-specialties/vascular-surgery/drug-eluting-therapies.html?utm_source=oth_site&utm_medium=native&utm_campaign=pi-at-us-de_portfolio-hci&utm_content=n-backtable-n-backtable_site_portfolio_1_2023&cid=n10012334 --- SHOW NOTES Dr. Spencer serves as the CEO and medical director of Minimally Invasive Procedure Specialists in Denver, CO. Her patients commonly get referred from OB/GYNs for chronic pelvic pain that is refractory to laparoscopic surgery and undiagnosed. She notes that collaborative relationships with women's health specialists and pelvic pain physical therapists are necessary for adequate patient outreach. Classifying cases by the location and nature of the vessel abnormality (i.e. compressive, obstructive, varicose, reflux, congenital) allows her to think about the best treatment for each patient. Targeting proximal veins can improve back and groin pain, dyspareunia, and heavy periods. Iliac vein stenting can improve compressive symptoms 50% of the time. On the other hand, isolated labial pain is best treated by directly targeting labial varices. Perineal ultrasound is a helpful way to locate some varicosities, but Dr. Spencer prefers MRI and digital subtraction venography to get a comprehensive venous picture and correlate symptoms with imaging. Next, the doctors discuss embolization and foam sclerotherapy. Through her experience, Dr. Spencer has seen sclerotherapy work better in varices with slower outflow and coil embolization work better for varices with more rapid flow. She prefers oversized floppy coils to minimize the risk of migration. With both treatments, there can be significant insurance barriers. It is important to utilize preauthorization specialists and be aware of what the patient’s insurance will cover, in order to better frame a conversation about treatment options. After the procedure, maximal pain relief can be achieved anywhere between 3 to 6 months. During this period, it is important to counsel patients over adjunct therapies such as pelvic floor therapy, steroids, and puncture aspiration to remove trapped blood. Overall, Dr. Spencer wants IRs to keep in mind that the chronic pain population has faced many misdiagnoses and insurance barriers, so they might harbor mistrust of the healthcare system. It is crucial to acknowledge their feelings and understand their anatomy in order to manage their expectations. --- RESOURCES Pelvic Guru: https://pelvicguru.com/ Efficacy of Endovascular Treatment for Pelvic Congestion Syndrome: https://pubmed.ncbi.nlm.nih.gov/27318059/ International Pelvic Pain Society: https://www.pelvicpain.org/ “The Way Out” book: https://www.amazon.com/Way-Out-Revolutionary-Scientifically-Approach/dp/059308683X

In this episode, host Dr. Michael Barraza interviews Dr. Stephen Hunt about building a pain practice, including his nerve ablation technique, how to obtain referrals, and why it is one of the most rewarding procedures that he does. --- SHOW NOTES We begin by discussing what caused Dr. Hunt to start building a pain service. He was treating many patients with lung cancer, and he saw so many patients toward the end of their life. What they wanted was to reduce their suffering due to pain. He saw what was being offered for them, which was opioids, but this caused them to be disconnected from their families at such an important time in their life. He knew he could offer nerve blocks and ablation, so he began educating himself. As he learned about different blocks, he adapted them to create his own technique. Pretty soon, word got out that he was doing this, and he started getting referrals from oncologists. Soon after this, thoracic surgeons and breast surgeons began referring to him for post-thoracotomy and post-mastectomy pain. Next, radiation oncologists referred their patients with radiation necrosis of the ribs, and orthopedic surgeons referred patients to him for pain from musculoskeletal metastases. For his technique, he often starts with a test block using bupivacaine and triamcinolone, which prolongs the effect of the bupivacaine and provides relief for around two weeks. For the ablation, he does the block in the same way, waits 15 minutes, and then injects ethanol to ablate the nerve. Some tips he has learned for celiac ablation are to ablate the retrocrural splanchnic nerves, because they feed into the celiac, and you will get a better result. Other areas he commonly ablates are intercostal nerves. For these, to avoid devastating paralysis from damage to the spinal cord, he always orients his needle lateral and stays at least two inches away from the spine. He advises those new in pain interventions to remember your anatomy. In radiology, we learn it all, and if you remember these nerves, you will be able to help a lot of people with their pain and decrease their suffering, making an enormous impact on someone’s quality of life. --- RESOURCES PIGI Lab: https://www.med.upenn.edu/pigilab/ Twitter: @PigiLab @md_rogue

In this episode of BackTable, Dr. Bagrodia interviews Dr. William Flanary, a physician-comedian popularly known as Dr. Glaucomflecken, about lessons he has learned as a two-time testicular cancer survivor and the importance of humor in medicine. --- CHECK OUT OUR SPONSOR RADPAD® Radiation Protection https://www.radpad.com/ --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/VJvXZx --- SHOW NOTES First, Dr. Glaucomflecken shares about his first diagnosis of testicular cancer. During his third year of medical school he felt a lump in his testicle, which led to a quick workup, diagnosis, and a full orchiectomy. The diagnosis was emotionally difficult, as he was in his mid-twenties and healthy. He returned to comedy, a skill he had developed in high school and college, to cope with his diagnosis. This time, however, he started to practice medical-based comedy with his new experiences as a medical student. He recounts other discussions he had about his cancer, such as fertility, the possibility of chemotherapy, and active surveillance. Four years after his first orchiectomy, he received his second diagnosis of testicular cancer during his last year of residency. He recounts feeling distraught and overwhelmed, as questions about fertility, hormone replacement, medical expenses, and postponing residency became more serious. He decided to have a full orchiectomy and testosterone replacement therapy, which solved his issues with fatigue and irritability. Additionally, his wife got him involved in testicular cancer support groups and foundations, including one called First Descents, an organization that encourages young adults with cancer to explore the outdoors. He notes that young patients are often overlooked in cancer support groups and encourages cancer patients to find their support networks outside of friends and family as well. Then, Dr. Flanary discusses his experience with suffering from cardiac arrest in 2020, which led to his wife doing ten minutes of chest compressions to keep him alive. He reflects on this event and concludes that it taught him how to be a better physician to his patients by making sure he involves patients’ families and encouraging him to address medical insurance issues directly. Finally, Dr. Flanary discusses how he uses humor to advocate and educate patients on social media. He notes that comedy can stimulate conversation and debate and encourages physicians to have social media presence. --- RESOURCES Knock Knock Hi Podcast https://podcasts.apple.com/us/podcast/knock-knock-hi-with-the-glaucomfleckens/id1659572053 First Descents https://firstdescents.org/

In this episode, host Dr. Michael Barraza interviews Dr. Zola N’Dandu, an interventional cardiologist at Ochsner Medical Center in Louisiana, about building a successful critical limb ischemia (CLI) program. --- CHECK OUT OUR SPONSORS Boston Scientific Lab Agent https://www.bostonscientific.com/en-US/customer-service/ordering/lab-agent/contact.html?utm_source=oth_site&utm_medium=native&utm_campaign=pi-at-us-labagent-hci&utm_content=n-backtable-n-backtable_site_labagent_1_2023&cid=n10013205 Reflow Medical https://www.reflowmedical.com/ --- SHOW NOTES Dr. N’Dandu’s current practice is about 65% peripheral artery disease, with a focus on critical limb ischemia. He discusses how he developed his current CLI focus by traveling and attending conferences, after his formal training. It was during one of these conferences that Dr. N’Dandu was inspired to further get involved with the patients in the wound care center at Ochsner. This interest led to the start of his CLI team. The episode then shifts towards Dr. N’Dandu’s process of building his CLI team. His commitment to this endeavor helped bring more like-minded people to his team. Having a centralized and committed team has helped Dr. N’Dandu streamline his patient visits, reduce the number of appointments needed for each patient, and greatly decrease the burden on the patients. Dr. N’Dandu then discusses the evolution of CLI in the last decade and how there are now more medications, therapies, and data available to support patient care. Procedural advancements have also been immensely helpful. Things like radial-to-pedal, 3rd and 4th generation stents, proliferative therapy with stents, drug-coated balloons, and bio-absorbable stents are all advancements in CLI treatment. Additionally, obtaining more data on each therapy will help refine the treatment algorithm for CLI. As the conversation shifts towards aspects that still need to evolve in CLI treatment, Dr. N’Dandu emphasizes that our treatment of no-option-CLI patients needs to change. One of the treatments that he uses for these patients is deep vein arterialization, a technique that was first discovered in 1912 but still has more potential for growth. DVA involves shunting arterial blood to the veins, which works for CLI, as studies show that it increases angiogenesis and perfusion of the tissue. As Dr. N’Dandu discusses the specifics of his DVA technique, he emphasizes that new advancements are being made every day, so it is crucial to have a cohesive team that can follow up with patients.

In this episode, Dr. Aaron Fritts interviews Dr. Chris Grilli of Christiana Health about his treatment algorithms and procedural tips for splenic embolization as a treatment for splenic trauma, hypersplenism, and splenic artery aneurysm. --- CHECK OUT OUR SPONSOR Boston Scientific Embold Fibered Coils https://www.bostonscientific.com/en-US/products/embolization/embold-detachable-coil-system.html --- SHOW NOTES Dr. Grilli explains that the most common indication for splenic embolization is trauma. He walks us through different trauma guidelines for grading splenic trauma. At his institution, if only a small portion of parenchyma is involved, the patient is monitored. If significant trauma and vascular injury is present and the patient is mostly stable, the patient gets referred to IR. Dr. Grilli notes that the decision to refer to IR or trauma surgery is also institutionally dependent. Across most institutions, it is more common to monitor pediatric splenic trauma rather than intervene. Next. Dr. Grilli walks us through an embolization for splenic trauma. He will most often opt for femoral access, unless there is underlying pathology or very large body habitus. He uses a 5Fr sheath and then navigates to the splenic artery with a C2 angiographic catheter. Then, he performs angiography to visualize the bleed, decide if he wants to embolize proximally or distally, and chooses his embolic agent. The doctors discuss pros and cons of using plugs, coils, and liquid embolics. Coils can induce stasis more quickly than a plug can. There are also coils with different materials and mechanisms of deployment. Dr. Grilli notes that an angiographic run at the end of an ideal case would show that the embolic device has obstructed flow in the main artery and the spleen is now being perfused by collaterals. Finally, we address non-traumatic indications for splenic embolization. In hypersplenism, oncologists will refer patients to IR to address platelet sequestration. Dr. Grilli says that these cases require embolization of segmental branches of the splenic artery, in the effort to kill off 40-70% of the spleen. This procedure could introduce significant adverse effects that must be discussed with the patient beforehand. In embolization of splenic artery aneurysms, Dr. Grilli prefers to use long packing coils or covered stents. --- RESOURCES ChristianaCare IR Residency: https://residency.christianacare.org/vascular-interventional-radiology AAST Spleen Injury Scale: https://www.aast.org/resources-detail/injury-scoring-scale#spleen WSES Classification and Guidelines for Splenic Trauma: https://pubmed.ncbi.nlm.nih.gov/28828034/ Cobra 2 (C2) Catheter: https://meritoem.com/product-category/catheters-extrusions/diagnostic-peripheral/performa-impress/cobra-2/ Sarah Catheter: https://www.terumois.com/products/catheters/optitorque.html Penumbra Pod Device: https://www.penumbrainc.com/peripheral-device/pod/ Embold Fibered Coil: https://www.bostonscientific.com/en-US/products/embolization/embold-detachable-coil-system.html Interlock Coil: https://www.bostonscientific.com/en-US/products/embolization/interlock-and-idc-detachable-embolization-coils.html Management of Hypersplenism by Partial Splenic Embolization With Ethylene Vinyl Alcohol Copolymer (Onyx): https://www.ajronline.org/doi/full/10.2214/AJR.10.4401?mobileUi=0 MYNXGRIP Closure Device: https://cordis.com/na/products/close/endovascular/mynxgrip-vascular-closure-device AngioSeal Closure Device: https://www.terumois.com/products/closure/angio-seal-vascular-closure-devices/angio-seal.html CELT Closure Device: https://www.veryanmed.com/usa/products/celt-acd-vascular-closure-device/

Trigger warning: This episode contains discussions about suicide. In this episode of the BackTable podcast, interventional radiologist Dr. Jenanan Vairavamurthy shares about the tragic loss of his physician brother to suicide and discusses his own mental health journey. He highlights the immense pressures and challenges that medical training and practice impose on providers. --- SYNPOSIS The discussion emphasizes the need for mental health awareness and the importance of creating supportive environments within the medical community. He advocates for open conversations about mental health struggles and urges those in leadership positions to prioritize the well-being of colleagues and trainees. This powerful conversation aims to destigmatize mental health issues in the medical field and encourages medical providers to seek and provide support for each other. --- TIMESTAMPS 00:00 Introduction 04:11 Assessing Personal Mental Health 06:31 Personal Tragedy and Mindset Shift 11:49 The Realities of Wellness in Medicine 21:59 Creating Supportive Environments Within Medicine 25:58 Navigating Personal and Professional Challenges 35:15 Building and Leading Supportive Networks --- RESOURCES Physician Supp​​ort Line: https://www.physiciansupportline.com/

In this episode, guest host Dr. Dana Dunleavy and guest Dr. Douglas Beall delve into the transformative potential of neuromodulation in the treatment of chronic pain, particularly for painful diabetic neuropathy (PDN). Dr. Beall is an interventional musculoskeletal radiologist practicing at Oklahoma Spine in Edmond, Oklahoma. Dr. Beall recounts his journey, from his beginnings in the military to his experiences with navigating institutional resistance to his clinical practice, and finally the process of moving to private practice. He discusses the positive impact of spinal cord stimulation on patients with PDN and reflects on its effectiveness in reducing pain and improving neurologic function. He underscores the crucial role of interventional radiologists in managing PDN, while also advocating for the integration of these specialists in pain management clinics. Dr. Beall argues that interventional radiologists possess unique skill sets adept for neuromodulation, which opens up new treatment possibilities in the process. He shares insights on the evolution of spinal cord stimulation technology, reimbursement considerations, and the importance of clinical trials in refining treatment approaches. The episode ends with an invitation for interested physicians to participate in professional forums and learn more about this burgeoning field. --- CHECK OUT OUR SPONSOR Nevro HFX Spinal Cord Stimulator https://www.hfxforpdn.com --- SHOW NOTES 00:00 - Introduction 02:30 - Challenges and Triumphs of a Solo Practice 14:44 - Evolution of Neuromodulation in Practice 17:05 - Impact of Neuromodulation on Painful Diabetic Neuropathy 31:53 - Unique Mechanism of High Frequency Neuromodulation 46:02 - Role of Interventional Radiologists in Neuromodulation 54:11 - Future of Neuromodulation in Interventional Radiology --- RESOURCES Douglas Beall, MD Research Gate Profile: https://www.researchgate.net/scientific-contributions/Douglas-P-Beall-39583252 Long-term efficacy of high-frequency (10 kHz) spinal cord stimulation for the treatment of painful diabetic neuropathy: 24-Month results of a randomized controlled trial: https://pubmed.ncbi.nlm.nih.gov/37536514/ High-Frequency 10-kHz Spinal Cord Stimulation Improves Health-Related Quality of Life in Patients With Refractory Painful Diabetic Neuropathy: 12-Month Results From a Randomized Controlled Trial: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9256824/ Neuromodulation Interventions for the Treatment of Painful Diabetic Neuropathy: a Systematic Review: https://link.springer.com/article/10.1007/s11916-022-01035-9 High-frequency spinal cord stimulation at 10 kHz for the treatment of painful diabetic neuropathy: design of a multicenter, randomized controlled trial (SENZA-PDN): https://link.springer.com/article/10.1186/s13063-019-4007-y

In this episode, Dr. Tyler Sandow (Ochsner Health) interviews interventional radiologists Dr. Edward Kim (Mount Sinai) and Dr. Terence Gade (University of Pennsylvania) about the future directions of hepatocellular carcinoma (HCC) treatments, specifically focusing on the adoption of precision medicine and multidisciplinary approaches. They delve into various HCC treatments, such as locoregional therapies like transarterial chemoembolization (TACE) and transarterial radioembolization (TARE), as well as the roles of systemic immunotherapies and checkpoint inhibitors. They highlight the importance of sequential order and timing of treatments and the use of imaging biomarkers for individualized cancer care. Throughout the discussion, influential clinical trials in HCC treatment are discussed and summarized. The doctors unanimously agree that as the sphere of interventional oncology is rapidly evolving, the focus should be centered on providing the most effective and patient-specific care with a deep understanding of combination therapies. --- CHECK OUT OUR SPONSOR AstraZeneca https://www.astrazeneca-us.com/ --- SHOW NOTES 00:00 - Introduction 05:45 - The Beginnings of Systemic Therapy for HCC 08:28 - The Role of Immunotherapy in HCC Treatment 11:09 - Multidisciplinary Clinics and Tumor Boards 20:21 - The Society of Interventional Oncology and Treatment Guidelines 24.59 - Choosing Between Locoregional and Combination Therapies 39:17 - The Use of Immunotherapy in Early Stage Patients 42:08 - Current Safety Data for Immunotherapy 48.56 - TACE Drug Choice 53:16 - How to Approach Treatment of Multifocal or Large Tumors 01:00 - Timeline for Imaging to Assess Treatment Response 01:03 - The Future of Immunotherapy and Interventional Oncology --- RESOURCES Society of Interventional Oncology (SIO): https://www.sio-central.org/ Sorafenib in Advanced Hepatocellular Carcinoma (SHARP Trial) https://www.nejm.org/doi/full/10.1056/nejmoa0708857 Efficacy and Safety of Sorafenib in Patients in the Asia-Pacific region with Advanced Hepatocellular Carcinoma: https://pubmed.ncbi.nlm.nih.gov/19095497/ Efficacy and Safety of Nivolumab Plus Ipilimumab in Patients With Advanced Hepatocellular Carcinoma Previously Treated With Sorafenib (CheckMate 040 Trial): https://jamanetwork.com/journals/jamaoncology/fullarticle/2771012 Tremelimumab and Durvalumab as First-line Therapy in Patients with Unresectable Hepatocellular Carcinoma (HIMALAYA Trial): https://ascopubs.org/doi/10.1200/JCO.2022.40.4_suppl.379 Atezolizumab plus Bevacizumab in Unresectable Hepatocellular Carcinoma (IMbrave 150 Trial): https://www.nejm.org/doi/full/10.1056/nejmoa1915745 Lenvatinib Combined With Transarterial Chemoembolization as First-Line Treatment for Advanced Hepatocellular Carcinoma (LAUNCH Trial): https://ascopubs.org/doi/abs/10.1200/JCO.22.00392 Randomised, Multicentre Prospective Trial of Transarterial Chemoembolisation Plus Sorafenib as Compared with TACE Alone in Patients with Hepatocellular Carcinoma (TACTICS Trial): https://pubmed.ncbi.nlm.nih.gov/31801872/ Uncoupling Immune Trajectories of Response and Adverse Events from Anti-PD-1 Immunotherapy in Hepatocellular Carcinoma: https://pubmed.ncbi.nlm.nih.gov/35430299/ Personalised Versus Standard Dosimetry Approach of Selective Internal Radiation Therapy in Patients with Locally Advanced Hepatocellular Carcinoma (DOSISPHERE-01 Trial): https://pubmed.ncbi.nlm.nih.gov/33166497/ Radiation Segmentectomy for Curative Intent of Unresectable Very Early to Early Stage Hepatocellular Carcinoma (RASER Trial): https://www.thelancet.com/journals/langas/article/PIIS2468-1253(22)00091-7/fulltext Immunotherapy and Transarterial Radioembolization Combination Treatment for Advanced Hepatocellular Carcinoma: https://journals.lww.com/ajg/abstract/2023/12000/immunotherapy_and_transarterial_radioembolization.23.aspx Find this episode on BackTable.com to see additional resources.

In this episode Dr. Kumar and Dr. Bennett discuss various levels of racism found in healthcare, and share allegories of racism as outlined by Dr. Camara P. Jones, including the gardeners tale. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/Y1eaX6 --- SHOW NOTES In this episode, guest host Dr. Vishal Kumar interviews Dr. Ayanna Bennett about how to train ourselves to recognize perpetuated health disparities within the medical system and how we can actively work to dismantle them. The doctors first talk about understanding racism on an institutional level, which results in a “machine” that selectively delivers better and worse aspects of healthcare to different populations. Dr. Bennett emphasizes that every disease process shows race disparities not because of inherent biological differences in racial groups, but because of unequal frequencies and quality of contact with healthcare systems. Throughout the episode, they reference the allegories of Dr. Camara Jones, a physician-epidemiologist and civil rights activist. These allegories provide a framework for discussing nature vs. nurture for health outcomes and also privilege defined as the lack of barriers to entry. In terms of actionable steps that providers can take toward reducing health inequity, Dr. Bennett encourages us to learn and engage with the communities that they serve. She advises us to be “counter-stereotypical” and show interest in patients’ lives outside of the healthcare setting. Finally, she calls us to analyze the impact that our institutions have on maintaining the health of the community as a whole, rather than solely focusing on individual patients. --- RESOURCES The Gardener’s Tale Allegory by Dr. Camara Jones: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1446334/ Tedx Talk by Dr. Camara Jones: https://www.youtube.com/watch?v=GNhcY6fTyBM

In this episode, host Dr. Ally Baheti interviews interventional radiologist Dr. Saher Sabri and vascular surgeon Dr. Frank Arko about their perspectives on a July 2023 New York Times article about the ethics of peripheral arterial disease (PAD) treatment in outpatient based labs (OBLs) and ambulatory surgery centers (ASCs). --- SHOW NOTES Dr. Arko emphasizes the importance of approaching articles as an unbiased reader. He acknowledges that sensationalism in the news is common, and while bad actors do exist, he personally knows talented OBL/ASC practitioners. He also notes that the article fails to mention that the majority of these practitioners follow society guidelines to provide appropriate and effective treatment for their patients, rather than prioritizing financial gain. He believes that most non-surgical specialists have the clinical insight to know when patients would be better candidates for open bypasses as opposed to endovascular interventions. Dr. Arko describes the split response to the article within vascular surgeons on social media, based on their personal philosophies of open versus endovascular interventions for PAD. Dr. Sabri believes that PAD and critical limb-threatening ischemia (CLTI) are not very well known by the general public, this article was a missed opportunity to bring attention to these conditions and disparities in treatments depending on patients’ geographic locations and ethnicities. The article may have the effect of scaring patients away from seeking treatment for PAD and CLTI, as well as receiving care at OBLs, which were originally founded to make interventions more efficient and patient-friendly. Additionally, the article could foster divisiveness between vascular surgeons, interventional radiologists, and interventional cardiologists and as a result, increase barriers to collaboration. It is important to differentiate between PAD and CLTI and the stage at which patients present to medical care. Limb salvage rates and decisions to intervene and/or amputate are multifactorial and are not as straightforward as the article may imply. Both doctors agree that specialty societies share the responsibility of monitoring their members for overuse of interventions. In terms of rebates and volume discounts from device companies, the doctors discuss the ethics of cost savings that benefit a hospital system versus savings that benefit a physician-owned OBL. Dr. Arko recognizes that financing an OBL with device company partnerships can be a smart business decision if devices are used appropriately and only when indicated. He speaks about the need for societies to support more randomized control trials that compare the effectiveness of each atherectomy device. We also discuss implications for insurance coverage of PAD/CLTI interventions. Dr. Sabri believes that it is unfortunate when insurance companies become the decision-maker of patient treatments. --- RESOURCES “They Lost Their Legs. Doctors and Health Giants Profited” (NY Times, July 2023 article): https://www.nytimes.com/2023/07/15/health/atherectomy-peripheral-artery-disease.html BEST-CLI: https://www.bestcli.com/ “Blocked Artery in Your Leg? Here’s What You Should Know” (ProPublica, June 2023 article) https://www.propublica.org/article/what-to-know-about-peripheral-artery-disease Outpatient Endovascular Interventional Society (OEIS): https://oeisweb.com/ Society of Vascular Surgery (SVS) Position Statement: https://vascular.org/news-advocacy/articles-press-releases/svs-response-new-york-times-article-overuse-interventions

In this episode of the Backtable Podcast, guest host Dr. Paul Bhogal, a consultant interventional neuroradiologist at Royal London Hospital in the UK, and guests Dr. Piotr Walczak and Dr. Prakash Ambady discuss the potential of intra-arterial treatments combined with blood brain barrier (BBB) manipulation in treating various neurological conditions and tumors. The trio of doctors discuss methods such as the use of hyperosmolar mannitol and focused ultrasound to breach the BBB and deliver drugs directly to the brain tissue. Dr. Walczak and Dr. Ambady also highlight their individual research areas, including therapies involving cell delivery and engineered cells. The conversation also covers potential risks and new perspectives in comparison to current techniques such as whole-brain radiation. --- CHECK OUT OUR SPONSOR RADPAD® Radiation Protection https://www.radpad.com/ --- SHOW NOTES 00:00 - Introduction 05:44 - Challenges of Treating Glioblastoma Multiforme 12:52 - Understanding the Blood Brain Barrier 18:30 - Strategies to Negate the Blood Brain Barrier 20:52 - Blood Brain Barrier Disruption Using Intra-Arterial Mannitol 26:35 - Infusion Rates and Magnetic Resonance Guidance 33:47 - Role of Radiolabel Studies in Drug Delivery 36:31 - Future of Therapeutic Agents Design 47:54 - Potential of Focused Ultrasound in Drug Delivery 56:10 - Exploring the Use of Cells in Drug Delivery 58:44 - Future of Intra-Arterial Interventions --- RESOURCES Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma: https://pubmed.ncbi.nlm.nih.gov/15758009/ Effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomized phase III study: 5-year analysis of the EORTC-NCIC trial: https://pubmed.ncbi.nlm.nih.gov/19269895/ REMOVAL OF RIGHT CEREBRAL HEMISPHERE FOR CERTAIN TUMORS WITH HEMIPLEGIA - PRELIMINARY REPORT: https://jamanetwork.com/journals/jama/article-abstract/254927 Real-Time MRI Guidance for Reproducible Hyperosmolar Opening of the Blood-Brain Barrier in Mice: https://www.researchgate.net/publication/328537972_Real-Time_MRI_Guidance_for_Reproducible_Hyperosmolar_Opening_of_the_Blood-Brain_Barrier_in_Mice Dr. Piotr Walczak ResearchGate Profile: https://www.researchgate.net/profile/Piotr-Walczak-6 Dr. Prakash Ambday ResearchGate Profile: https://www.researchgate.net/profile/Prakash-Ambady Maculopathy Associated With Osmotic Blood- Brain Barrier Disruption and Chemotherapy in Patients With Primary CNS Lymphoma: https://pubmed.ncbi.nlm.nih.gov/32484895/ PET imaging of intra-arterial 89 Zr bevacizumab in mice with and without osmotic opening of the blood-brain barrier: distinct advantage of intra-arterial delivery: 10.2967/jnumed.118.218792 Safety of intra-arterial chemotherapy with or without osmotic blood–brain barrier disruption for the treatment of patients with brain tumors: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9307096/ Delivery of chemotherapeutics across the blood-brain barrier: challenges and advances: https://pubmed.ncbi.nlm.nih.gov/25307218/

In this episode, cohosts Dr. Aparna Baheti and Dr. Aaron Fritts interview interventional radiologist Dr. Sandeep Bagla about “The Halo Effect”, including how to recognize when you are being subjected to bias, and how to critically evaluate bad outcomes to improve your practice and enhance patient safety. The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/FSZCxF --- CHECK OUT OUR SPONSORS Accountable Physician Advisors http://www.accountablephysicianadvisors.com/ Accountable Revenue Cycle Solutions https://www.accountablerevcycle.com/ --- SHOW NOTES Dr. Bagla begins by describing the halo effect. The halo effect describes the tendency for people to overestimate the value of individual positive attributes when evaluating the whole. Thiis can happen when we form our opinions of people, techniques, and even medical devices. The opposite is also true, named the horn effect, where we tend to overestimate negative attributes. They are both forms of bias. In interventional radiology, the halo effect can impact case outcomes by contributing to operator tunnel vision and the reluctance to waver from the desired way of executing a procedure. For Dr. Bagla, the idea of the halo effect came about while working with new colleagues, many of whom do things differently than he did. He realized that in IR, physicians do things a certain way because that’s how they learned in training, whether it really is the safest and best way, or just the most familiar. He also sees the horn effect occur often when people start using a new device. If the device doesn’t work well for them the first time, many often refuse to use it in the future based on that first experience. He summarizes by noting that in IR, there are so many opportunities to become biased, whether through the halo effect or the horn effect. Lastly, Dr. Bagla reviews how he works to avoid these inherent biases. The first step in overcoming this bias is to understand its presence. Next, you must stop and realize that what you are doing is not working, whether due to the procedural approach, the device, or the way you are using the device. Dr. Bagla believes we must be critical of ourselves and try to think outside of our preferred wire, catheter, or device. In order to do this, you must go through the steps and review your checklist in order to determine which step the problem occurred at. Only by doing this can you avoid falling victim to these biases that are so prevalent in medicine. --- RESOURCES BackTable Episode 195: Disclosures of Conflicts of Interest https://www.backtable.com/shows/vi/podcasts/195/disclosures-of-conflicts-of-interest

Is your microwave ablation technique up to date? Dr. Ed Kim sits down with guest-host Dr. Kavi Krishnasamy to explore cutting-edge techniques in tumor ablation, with a focus on hepatocellular carcinoma (HCC) treatment with microwave. Dr. Ed Kim is the Director of Interventional Oncology and Professor of Radiology and Surgery in the Division of Vascular and Interventional Radiology at the Mount Sinai Medical Center. --- This podcast is supported by an educational grant from: Varian, a Siemens Healthineers company https://www.varian.com/ --- SYNPOSIS The doctors discuss microwave ablation, radiation segmentectomy, and the decision-making algorithms for choosing appropriate procedures based on lesion characteristics. Dr. Kim touches on the complexities of ablation near the diaphragm and subcapsular lesions, emphasizing the impact of practitioner skill and experience on outcomes. Recent advancements in ablation technologies, software, and device-specific versus device-agnostic applications are also highlighted, along with the importance of post-contrast scans and ultrasound skills. Dr. Kim also delves into emerging technologies such as HistoSonics, augmented reality/virtual reality, and immunotherapy synergies. The doctors underscore the need for a multidisciplinary approach for optimizing patient outcomes and pushing the field toward future innovations. --- TIMESTAMPS 00:00 - Introduction 04:28 - Standardizing Ablation Algorithms 07:51 - Suboptimal Lesion Locations 13:06 - Device Selection and Properties 22:49 - Ablation Planning Software 32:53 - Real-Time Visualization 44:48 - Biopsy and Ablation Techniques 52:14 - Future of Ablation Technology --- RESOURCES Dr. Ed Kim’s Publications: https://scholars.mssm.edu/en/persons/edward-kim ACCLAIM Trial: https://www.sio-central.org/ACCLAIM-Trial A multicenter randomized controlled trial to evaluate the efficacy of surgery versus radiofrequency ablation for small hepatocellular carcinoma (SURF trial): Analysis of overall survival: https://ascopubs.org/doi/10.1200/JCO.2021.39.15_suppl.4093 Surgery versus thermal ablation for small-size colorectal liver metastases (COLLISION): An international, multicenter, phase III randomized controlled trial. https://ascopubs.org/doi/10.1200/JCO.2024.42.17_suppl.LBA3501 SIR welcomes results of COLLISION Trial, presented at the 2024 ASCO Annual Meeting: https://www.sirweb.org/media-and-pubs/media/news-release-archive/collision-trial-06032024/ HistoSonics: https://histosonics.com/

In this episode, host Dr. Christopher Beck interviews Dr. Peter Soukas about his algorithm for below the knee (BTK) critical limb ischemia (CLI) interventions as well as his implementation of new evidence-based guidance. --- CHECK OUT OUR SPONSOR Medtronic HawkOne Directional Atherectomy System https://www.medtronic.com/hawkone --- SHOW NOTES Dr. Soukas serves as the director of vascular medicine, the interventional peripheral vascular lab, and the endovascular medicine fellowship at Brown University in Providence, RI. In addition, he holds the position of associate professor of medicine at The Warren Alpert Medical School at Brown University. Dr. Soukas began his career as an interventional cardiologist. Over the course of his 13-year tenure in Providence, he has dedicated his career to the treatment of CLI and BTK disease. Prior to any interventional work, Dr. Soukas follows a comprehensive work-up including an ankle-brachial index (ABI), arterial duplex, and evaluating kidney function for safe administration of contrast. For a majority of cases, he uses the common femoral artery as the access point, but prefers to prep multiple access sites in the event of needing both anterograde and retrograde, or pedal, access. He discusses the use of the chronic total occlusion crossing approach based on plaque cap morphology (CTOP) classification on angiogram in determining the need for a retrograde approach. The type I morphology is characterized by the convexity of the plaque pointing away and is often treated successfully by an anterograde approach alone, as CTOP types II, III, and IV benefited from the addition of retrograde tibiopedal access. Once access is gained and the plaque morphology is evaluated using angiography, it becomes crucial to address any issues with the inflow to the affected vessel. This step ensures proper blood flow and provides a stable foundation for further interventions. Intravascular ultrasound is then used to assess the size and extent of the plaque, and then depending on the amount of calcification, either intravascular lithotripsy or calcium modifying technology can be used. Scoring balloons with low pressure may also be used for vessels that are moderately calcified and have been shown to have low rates of recoil and dissection. The main initiative of the procedure is to provide blood flow to the target angiosome which is dependent on the location of the wound. During his last remarks, Dr. Soukas comments on the future of BTK interventions, including Paclitaxel vs Sirolimus eluting stents, the use of self-expanding stents, and LimFlow, a minimally invasive technology that creates a channel between an artery and vein allowing the vein to provide blood flow to the foot. With the increasing prevalence of critical limb-threatening ischemia (CLTI) and high 12-month mortality rates in patients with amputations, Dr. Soukas ends the discussion by emphasizing how revascularization should be the preferred initial approach in treating CLTI due to the potential benefits it offers in terms of limb preservation and mortality reduction, urging practitioners to educate patients in being aggressive in their care. --- RESOURCES CTOP article: https://evtoday.com/articles/2018-may/using-plaque-cap-morphology-to-determine-cto-crossing-approach Disrupt PAD III Observational study: https://pubmed.ncbi.nlm.nih.gov/34380334/ PRELUDE BTK Study: https://pubmed.ncbi.nlm.nih.gov/34802313/ Intravascular Ultrasound study: https://www.jacc.org/doi/10.1016/j.jcin.2022.01.001 Intravascular US in Medicare Beneficiaries: https://pubmed.ncbi.nlm.nih.gov/35998803/ PROMISE II study: https://limflow.com/us/clinical-evidence/promise-ii-study-results/

In this episode, Dr. David Guez discusses the advancements in contrast enhanced ultrasound, its application in detecting endoleaks, and his journey of learning and applying this modality from residency to his current practice. Dr. Guez emphasizes ultrasound’s utility in lesion characterization, endoleak monitoring, and sparing patients from more invasive diagnostic procedures. The doctors delve into the specifics of using ultrasound contrast agents, particularly LUMASON and its intravascular utility for real-time monitoring of disease states with superior resolution compared to CT or MRI. Dr. Guez also discusses the potential for contrast enhanced ultrasound in interventional radiology, including diagnosing vascular lesions and augmenting tumor treatments. The conversation highlights the technique’s advantages, its high sensitivity for endoleaks, and potential areas for future research and application. The episode underscores the underutilized potential of contrast enhanced ultrasound in both diagnostic and interventional radiology settings. --- CHECK OUT OUR SPONSOR Reflow Medical https://www.reflowmedical.com/ --- SHOW NOTES 00:00 - Introduction 03:54 - Exploring the Basics of Contrast Enhanced Ultrasound 06:49 - Clinical Applications and Advantages of Contrast Enhanced Ultrasound 09:15 - Contrast Enhanced Ultrasound in Action: Diagnosing Endoleaks 23:52 - Future of Contrast Enhanced Ultrasound in Interventional Radiology 27:02 - Closing Thoughts --- RESOURCES Bracco LUMASON: https://lumason.com/ Nontraditional Uses of US Contrast Agents in Abdominal Imaging and Intervention: https://pubs.rsna.org/doi/full/10.1148/rg.220016 Book written by Andrej Lyshchik, MD, PhD (Thomas Jefferson) - Specialty Imaging: Fundamentals of CEUS: https://www.amazon.com/Specialty-Imaging-Fundamentals-Andrej-Lyshchik/dp/0323625649 Contrast-enhanced Ultrasound Identifies Patent Feeding Vessels in Transarterial Chemoembolization Patients With Residual Tumor Vascularity: https://pubmed.ncbi.nlm.nih.gov/32890324/ Contrast-enhanced ultrasound (CEUS) versus computed tomography angiography (CTA) in detection of endoleaks in post-EVAR patients. Are delayed type II endoleaks being missed? A systematic review and meta-analysis: https://pubmed.ncbi.nlm.nih.gov/26191109/

In this back to the basics episode, Dr. Christopher Beck interviews Dr. Aaron Fritts about his standard procedure for nephrostomy tube placement, preferred tools, and troubleshooting tips. --- CHECK OUT OUR SPONSOR Reflow Medical https://www.reflowmedical.com/ --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/yEfEUY --- SHOW NOTES Dr. Fritts says that most of his referrals come from urology, and patients need treatment for hydronephrosis, kidney stones, and pre-operative access for lithotripsy. He goes over his workup, which can be expedited in emergency cases. He checks for normal coagulation tests and anticoagulation medications, since bleeding is the most common and dangerous complication of the procedure. Both doctors prefer to use CT imaging to map out the procedure, identify stone burden, and decide which calyx to access. It is important to use CT to make note of and avoid the colon (lateral) and paraspinal muscles (medial) when choosing an access site. Dr. Fritts also marks the access site before the patient gets prepped for the procedure, in order to ensure that the correct area is cleaned. Patients are usually under moderate sedation with versed and fentanyl. Then the doctors walk through a typical nephrostomy tube placement under ultrasound guidance. They emphasize that lidocaine needs to be injected all the way down to the cortex to maximize patient comfort and decrease the likelihood of patient movement during the procedure. Then, the needle is inserted into a calyx. While it is standard to access the lower pole to minimize bleeding risk, Dr. Beck sometimes prefers mid-pole access since this provides a shorter distance from skin to target and a more favorable angle to enter the ureter from the renal pelvis. The upper pole is generally avoided due to risk of diaphragmatic puncture, but it can be accessed if a stone is present there. Dr. Beck shares a tip about injecting saline to plump up the calyces and allow for better access. Dr. Fritts describes the two-stick technique that was primarily used before ultrasound access was available. He also recommends communicating with urologists in lithotripsy patients to identify optimal access sites for each patient’s lithotripsy. If the wire is placed directly on top of the stone and you have difficulty maneuvering the wire around the stone, you can inject saline to dilate the system and obtain a better angle for the wire. Finally, the doctors talk about drain selection, which is usually an 8Fr or 10Fr. The drain is secured with stitches, and possibly a bumper stitch. Pyonephrosis patients are usually kept inpatient, while other patients can get discharged after two hours. It is important to watch for hematuria and distinguish between mildly red venous blood from minor procedural trauma (which will subside) and bright red blood from arterial damage. --- RESOURCES SIR Now: https://sirnow.sirweb.org/ Ep. 97- Nephrostomy Tube Placement with Dr. David Feld: https://www.backtable.com/shows/vi/podcasts/97/nephrostomy-tube-placement-basic-to-advanced Diuretic agent and normal saline infusion technique for ultrasound-guided percutaneous nephrostomies in nondilated pelvicaliceal systems: https://pubmed.ncbi.nlm.nih.gov/22893420/ Bumper Stitch for Drainage Tube Securement: https://www.jvir.org/article/S1051-0443(11)01353-4/pdf

Historically, public recognition and understanding of IR has been limited, with a significant portion of patients unaware of interventional procedures and the field as a whole. How can we improve awareness of IR and minimally invasive treatment options? Dr. Mina Makary discusses this and his recent study on public perceptions of IR, with host Dr. Michael Barraza. Dr. Makary is a vascular and interventional radiologist and an Associate Professor of Radiology at The Ohio State University. --- This podcast is supported by: PearsonRavitz https://pearsonravitz.com/backtable --- SYNPOSIS Dr. Makary states that less than half of the public believes IRs are physicians, highlighting a knowledge gap with potentially significant implications for patient care and treatment decisions. The doctors delve into possible solutions to address this issue, including educational interventions targeting both the public and healthcare providers, the potential impact of name recognition on public perception, and methods to enhance IR awareness through media and direct engagement with primary care providers. The episode also emphasizes the need for ongoing research and efforts to improve understanding and recognition of IR to ensure patients have informed medical options. --- TIMESTAMPS 00:00 - Introduction 03:23 - Study Methodology and Findings 08:13 - Challenges and Solutions in IR Awareness 10:23 - Impact of IR Procedures on Public Perception 15:16 - Future Research and Awareness Efforts 23:40 - Conclusions --- RESOURCES 2023 Paper - Public Awareness of Interventional Radiology: Population-Based Analysis of the Current State of and Pathways for Improvement: https://pubmed.ncbi.nlm.nih.gov/36764444/ 2019 Paper - Primary Care Provider Awareness of IR: A Single-Center Analysis: https://pubmed.ncbi.nlm.nih.gov/31235412/ 2024 Paper - Impact of Educational Videos on Patient Understanding of Interventional Radiology Procedures: https://pubmed.ncbi.nlm.nih.gov/39198139/ BackTable VI Podcast Episode #454 - Moral Injury in Interventional Radiology with Dr. Mina Makary and Dr. Jeffrey Chick: https://www.backtable.com/shows/vi/podcasts/454/moral-injury-in-interventional-radiology BackTable VI Podcast Episode #195 - Disclosures of Conflicts of Interest with Dr. Mina Makary: https://www.backtable.com/shows/vi/podcasts/195/disclosures-of-conflicts-of-interest BackTable VI Podcast Episode #62 - Protect Yourself Before You Wreck Yourself with Dr. Mina Makary: https://www.backtable.com/shows/vi/podcasts/62/protect-yourself-before-you-wreck-yourself

IR technologists are a valuable part of the interventional team due to their technical expertise and hands-on contributions to patient and provider safety. Lake Odom, a seasoned IR tech with over 14 years of experience, sits down with host Dr. Ally Baheti to share his wisdom from his time in hospital-based and outpatient care settings. --- This podcast is supported by: RADPAD® Radiation Protection https://www.radpad.com/ --- SYNPOSIS Lake begins by describing his unconventional career path, the importance of passion in profession, and how he started his consulting businesses: IR Tech Tips and Image Guided Consultants. Lake also speaks on transitioning from the hospital to the outpatient-based lab (OBL) setting, and highlights key aspects of the tech’s role, including inventory management, patient workflow, and building efficient systems. The significance of understanding the financial intricacies within OBLs, common inefficiencies, and strategies to foster a culture of accountability and teamwork are also discussed. The episode provides valuable insights for IR technologists and other professionals seeking to improve their practices and operate at maximum potential. --- TIMESTAMPS 00:00 - Introduction 06:55 - Image Guided Consultants 12:07 - Improving Practice Efficiency 17:51 - Daily IR Tech Responsibilities 20:56 - Inventory Management and Preparedness 28:03 - Building Trust and Credibility --- RESOURCES BackTable Ep. 130- Technologist Training & Retention with Andrew Struchen and Alisha Hawrylack: https://www.backtable.com/shows/vi/podcasts/130/technologist-training-retention Image Guided Consultants: https://igsconsults.com/ IR Tech Tips Course: https://irtechtips.teachable.com/

Of all the topics covered during interventional radiology training, dosimetry education is often delayed until after IRs enter clinical practice. In this episode, Drs. Tyler Sandow and Sabeen Dhand host a roundtable discussion with experts on the dosimetry fundamentals that all Y90 operators should understand. They are joined by interventional radiologists Drs. Zachary Berman, Kirema Garcia-Reyes, and Siddharth Padia, who provide their expert insights. Physicians, nurses, nurse practitioners, and physician assistants can follow this link to earn CME / CE credits for completing an accredited learning activity related to this discussion: https://www.cmeuniversity.com/course/take/125736 --- This podcast is supported by an educational grant from: AstraZeneca https://www.astrazeneca.com/our-therapy-areas/oncology.html With additional support from: Boston Scientific https://www.bostonscientific.com/en-US/medical-specialties/interventional-radiology/interventional-oncology.html --- SYNPOSIS The group agrees that dosimetry is not a one-size-fits-all approach. Dosing strategies depend on factors such as tumor size, perfusion territory, underlying liver function, the choice between glass versus resin spheres, and treatment intent. These considerations are illustrated with real-life case examples. The doctors also explore voxel-based dosimetry, a method for calculating the amount of radiation absorbed by different parts of the tumor. They stress the importance of learning how to perform accurate dosage calculations. Finally, the conversation touches on data from major Y90 trials, current guidelines, and the evolving perspective on Y90 as a potential curative treatment, rather than merely a bridging therapy. --- TIMESTAMPS 00:00 - Introduction 01:59 - Dosimetry Education During Training 05:46 - Benefit of Individualized Dosing 11:01 - Complications from High Doses 15:19 - Dosage Calculation Cases 22:51 - Duration of Response to Y90 25:00 - Dosing Based on Treatment Intent 29:11 - Challenging Case Example 42:31 - Voxel-Based Dosimetry 45:15 - Using Dosimetry Software --- RESOURCES LEGACY Trial (Salem et al, 2021): https://pmc.ncbi.nlm.nih.gov/articles/PMC8596669/ Voxel-based tumor dose correlates to complete pathologic necrosis after transarterial radioembolization for hepatocellular carcinoma (Pianka et al, 2024): https://pubmed.ncbi.nlm.nih.gov/38913189/ RAPY90D Trial (Kappadath et al, 2023): https://jnm.snmjournals.org/content/64/supplement_1/P268 Clinical, dosimetric, and reporting considerations for Y-90 glass microspheres in hepatocellular carcinoma: updated 2022 recommendations from an international multidisciplinary working group (Salem et al, 2023): https://pubmed.ncbi.nlm.nih.gov/36114872/ International recommendations for personalised selective internal radiation therapy of primary and metastatic liver diseases with yttrium-90 resin microspheres (Levillain, 2021): https://link.springer.com/article/10.1007/s00259-020-05163-5)

In this episode, Dr. Aaron Fritts interviews Dr. Gregory Makris about making the transition to industry, including how to market yourself, and how to maintain your clinical and technical skills while working in industry. --- CHECK OUT OUR SPONSOR RADPAD® Radiation Protection https://www.radpad.com/ --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/SFBnOQ --- SHOW NOTES Dr. Makris is from Greece, and he did his initial training there. He then continued his training in vascular medicine in London, and has been working there ever since. Over the past year, he has been working for Bayer Pharmaceuticals in vascular therapeutics as director, and global clinical lead. He has a hybrid work environment where he works virtually for Bayer, and travels frequently, but still maintains a clinical position at his practice one day a week. He wanted to do this because he enjoys practicing IR and wanted to maintain his clinical and technical skills. Next, we discuss how he decided to get into industry, particularly pharmaceuticals. He never envisioned he would join industry while training. A decade ago, there was a bad reputation about physicians who left medicine to join industry. People often remarked these physicians were soulless or had joined the dark side. Now, there is much less criticism, and there are growing numbers of physicians choosing to partner with industry. Dr. Makris was working as an attending when he started getting more exposed to industry at conferences. He started to imagine a role in medical device innovation, and with a background in research, he knew he had expertise that would be useful to industry as a physician scientist. Somewhat surprisingly, an opportunity came up with Bayer in pharmaceuticals. It was a global role, and involved clinical and research development of vascular medications, which was appealing to him as an IR with a PhD in vascular medicine and someone passionate about global outreach. He also sensed he was ready for a new challenge in his career, so he accepted the role. He recommends being very honest with yourself about your abilities and your limitations when starting out in a new role in industry. Additionally, you should be open to learning new roles, and be flexible with time and travel. Dr. Makris says that the best way to maintain a clinical role is to have a frank conversation with your practice and explain what you can offer them and how to work out a deal that benefits both parties. Most practices will be willing to keep you on part time. If they are not, there are numerous opportunities to stay in medicine, whether through locums or reaching out to other practices that need help. Dr. Makris ends by saying that as a physician, there are many ways to have career satisfaction and work-life balance, while still contributing to healthcare and helping patients. He sees his new role as an opportunity to contribute to the bigger picture, which is advancing healthcare and medical standards. --- RESOURCES Ep 128: Device Innovation with Dr. Atul Gupta https://www.backtable.com/shows/vi/podcasts Ep 57: Practicing IR in the UK with Dr. Gregory Makris https://www.backtable.com/shows/vi/podcasts/57/practicing-ir-in-the-uk Linked In: https://www.linkedin.com/in/gregory-makris-m-d-ph-d-dic-frcr-22118660/?originalSubdomain=uk Twitter: @GregMakris23