BackTable Podcast

How do you build a pipeline for passionate, well-prepared interventional radiologists from day one of med school? In this episode of the BackTable Podcast, Dr. Aaron Rohr, interventional radiologist and associate professor at the University of Kansas, joins guest host Dr. Jessica Yoon to discuss how IR is accessed, taught, and experienced by medical students throughout their early education. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction02:49 - Finding IR: Then and Now06:54 - Challenges of Teaching IR in Core10:07 - How IR Thinks Through Problems14:40 - MAVIRIC Symposium20:09 - Engaging Teaching Models27:26 - Increasing Clinical Presence of IR30:17 - Leadership in Educational Initiatives35:57 - Reflections and Advice for Educators39:15 - Final Thoughts and Closing Remarks --- More about this episode The physicians explore ways in which the transition from traditional fellowship models to integrated IR training pathways has increased the specialty's visibility for early learners while also pointing out obstacles that continue to hinder greater integration of IR into the core medical curriculum. They discuss how IR's involvement in diverse systems and disease processes offers valuable opportunities for comprehensive clinical learning, but simultaneously makes the specialty challenging for students with structured rotations to engage within a longitudinal fashion. Dr. Rohr goes on to highlight the Mid-America Vascular and Interventional Radiology Initiative Collegium (MAVIRIC), a student-led, faculty-supervised program hosted by KUMC that aims to introduce medical students to clinical, technical, and industry-related aspects of IR. He reflects on the effectiveness of hands-on interaction with devices and physicians' demonstration of passion for their practice in piquing student interest. While acknowledging the burden of labor beyond work hours that such initiatives often demand of doctors and students alike, the physicians express their optimism for the growth of IR's presence both in the hospital ecosystem and in the medical curriculum. --- Resources MAVIRIChttps://www.maviric.org/ --- BackTable Vascular & Interventional (VI) is the go-to podcast for interventional radiologists, vascular surgeons, and interventional cardiologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

Pulmonary AVM may be rare, but missing them can lead to lifelong complications, especially in patients with hereditary hemorrhagic telangiectasia (HHT). How do you choose the right device and strategy to ensure long-term success with embolization? In this episode of the BackTable Podcast, host Dr. Kavi Krishnasamy is joined by Dr. Brian Funaki and Dr. Nima Kokabi to unpack the evolving treatment landscape for pulmonary arteriovenous malformations (PAVM). Through imaging breakdown, review of challenging real-world cases, and a discussion on advanced treatment strategies, the conversation tackles a key debate in pulmonary embolization: are plugs replacing coils as the new standard? --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by Okamihttps://okamimedical.com/ --- Timestamps 00:00 - Introduction01:43 - Defining HHT and PAVM05:53 - Democratizing Interventions for HHT Patients08:83 - Recommendations to Embolize PAVM13:19 - Imaging Specificity and Procedural Preferences23:29 - Persistence Rates with Plugs and Coils25:59 - Lag in Utilization of Plugs29:18 - Comparison of LOBO to Alternative Vascular Plugs34:26 - Post Embolization Symptoms and Troubleshooting Methods39:04 - PAVM Cases and Treatments54:26 - Wrap Up and Credits --- More about this episode The discussion begins by defining HHT and PAVM, highlighting the risks associated with untreated PAVM and the critical need for genetic screening and multi-organ evaluation. Drs. Funaki and Kokabi review current treatment recommendations, surveillance imaging, and follow-up protocols, with special considerations for pediatric and high-risk patients. They explore practical tips for optimizing embolization performance, focusing on device selection and the evolving role of vascular plugs. By comparing different plug designs, such as wire count and pore size, and sharing lessons from challenging cases, including persistent lesions, tortuous anatomy, and pseudoaneurysm management, they provide advanced troubleshooting and decision-making strategies to achieve more durable, successful PAVM treatments. --- BackTable Vascular & Interventional (VI) is the go-to podcast for interventional radiologists, vascular surgeons, and interventional cardiologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

Why are some GJ tubes more prone to failure, and what can you actually do about it? In this episode of the BackTable Podcast, Dr. Chris Beck hosts Dr. Kevin Wong, a pediatric interventional radiologist at the University of South Alabama, to discuss the complexities of gastrojejunostomy (GJ) tube management in hospital-based IR, especially in pediatric patients. The discussion offers clinically relevant guidance on troubleshooting, device selection, and multidisciplinary approaches to enhance GJ tube care and improve patient outcomes. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction05:40 - Etiologies of GJ Tube Dislodgement and Placement Considerations 12:17 - Spiral Upsizing Solutions14:30 - Parent Education Playbook19:34 - Indications for GJ Conversion21:55 - Criteria for GJ Removal24:12 - Preferred Low-Profile Tube Designs27:15 - Addressing Suboptimal Angles and Guidewire Selection31:26 - Strategies to Prevent Tube Occlusion33:34 - Wish List for Industry 36:12 - Balloon Assisted Placement Techniques37:58 - Wrap Up and Credits --- More about this episode The doctors explore why GJ tubes fail and how to manage common complications, such as balloon failures, vomiting-induced dislodgement, stoma enlargement, and recurrent malfunction due to poor gastrostomy angle or architecture, often seen with surgically placed G-tubes. Dr. Wong shares prevention strategies, including parent education on balloon-volume checks and refills, sending patients home with a backup G-tube, minimizing upsizing, and addressing traction and granulation tissue (including the use of silver nitrate). He also covers approaches to clog management such as warm water, Coke, aggressive flushing, and avoiding routing medications through the G port. The episode wraps up with a discussion on device preferences (AMT G-JET versus MIC-KEY), tips for wire and catheter exchanges, and the need for industry improvements in materials and lumen design. --- BackTable Vascular & Interventional (VI) is the go-to podcast for interventional radiologists, vascular surgeons, and interventional cardiologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

A high-functioning HCC tumor board can turn complex transplant decisions into coordinated treatment plans that account for liver reserve, tumor biology, and evolving biomarkers. In this episode of the BackTable Podcast 2026 HCC Creator Weekend™, abdominal transplant surgeon Dr. Ari Cohen (Ochsner Health) and transplant hepatologist Dr. Neil Mehta (UCSF) join host Dr. Kavi Krishnasamy to map out strategies for effective multidisciplinary treatment and transplantation planning in HCC. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by an educational grant from Sirtex and Boston Scientific. --- Timestamps 00:00 - Introduction00:51 - Starting a Tumor Board06:39 - Building Referral Streams09:03 - Academic and Community Practice Integration14:31 - Treatment Selection Criteria20:38 - Modern HCC Biomarkers25:24 - Role of ctDNA and Biopsy29:37 - Bridging Therapy on Transplant Waitlist32:34 - Downstaging Strategy and Risks39:25 - Final Thoughts and Closing Remarks --- More about this episode The physicians discuss what it takes to build a robust tumor board, from fostering hospital buy-in to engaging leaders across specialties and utilizing virtual formats for consistent participation. The conversation explores clinical decision-making, emphasizing the integration of AFP-L3 and DCP biomarkers alongside AFP to better understand tumor biology and predict post-transplant recurrence. Dr. Mehta and Dr. Cohen also share their patient selection criteria, discussing how bilirubin, liver disease etiology, and INR influence decisions. While radiographic guidance remains central to HCC management, they highlight the growing potential of reliable ctDNA analysis and other biomarkers. The specialists conclude by emphasizing that an integrated, communicative tumor board is the most effective way to navigate the nuances of liver reserve and HCC biology to achieve the best possible patient outcomes. --- Resources Sustained AFP-L3 or DCP expression is associated with progression risk and inferior outcomes in unresectable hepatocellular carcinoma.https://doi.org/10.1007/s10238-025-01877-8 --- BackTable Vascular & Interventional (VI) is the go-to podcast for interventional radiologists, vascular surgeons, and interventional cardiologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

Can arterial closure devices transform your OBL workflow and get patients moving sooner? In this episode of the BackTable Podcast, Dr. Mike Barraza sits down with Interventional Radiologist Dr. Dave Johnson to discuss the ins and outs of launching and running an office-based lab (OBL) in Florida. While covering startup logistics, staffing, regulatory requirements, and cost-saving strategies, the conversation centers on how the use of arterial closure devices can streamline workflow, speed post-procedure recovery, and enhance both efficiency and patient care in the OBL setting. --- Get the BackTable apphttps://www.backtable.com/app --- Terumohttps://www.terumo.com/ --- Timestamps 00:00 - Introduction01:31- Launching The OBL04:41- Logistics And Staffing07:14 - Standardizing Supplies11:57 - OBL vs. Hospital Cases15:30 - Patient Experience Benefits17:41 - Efficiency And Throughput20:49 - Closure Devices For Flow23:28 - Early Ambulation With AngioSeal26:14 - Anticoagulation Decisions28:31 - AngioSeal Access Technique30:20 - Avoiding Hostile CFA Access32:19 - Choosing SFA or Radial34:04 - Do You Need Groin Runs36:14 - Closure Device Fundamentals38:53 - Ultrasound Guided AngioSeal45:11 - Post Op Monitoring Checklist --- More about this episode Dr. Johnson explains that some procedures, such as Prostate Artery Embolization (PAE), may still require a hospital setting due to insurance coverage, patient preference, or unique clinical needs. He compares patient experiences in OBLs versus hospitals, emphasizing the advantages of privacy, convenience, and personalized communication in the OBL environment. A major challenge discussed is managing post-procedure recovery and patient throughput with limited holding beds, where femoral arterial closure devices like Angio-Seal are essential for early ambulation and efficient turnover. The discussion highlights best practices for access site selection, ultrasound guidance, and post-closure assessment, providing actionable insights for IR physicians aiming to optimize office-based procedures. --- Resources Cost Comparison of Prostatic Artery Embolization Between In-Hospital and Outpatient-Based Lab Settingshttps://pubmed.ncbi.nlm.nih.gov/39310461/ Prostate Artery Embolization: Indication, Technique and Clinical Resultshttps://pubmed.ncbi.nlm.nih.gov/29975976/ Ultrasound-guided angio-seal deploymenthttps://pubmed.ncbi.nlm.nih.gov/25735527/ --- BackTable Vascular & Interventional (VI) is the go-to podcast for interventional radiologists, vascular surgeons, and interventional cardiologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

With recent updates to the Barcelona Clinic Liver Classification (BCLC), how should multidisciplinary teams adapt their treatment strategies to accommodate the newest evidence? In this episode of the BackTable Podcast 2026 HCC Creator Weekend™, Dr. Neil Mehta of UCSF and Dr. Riad Salem of Northwestern Medicine join host Dr. Tyler Sandow to explore the complexities of hepatocellular carcinoma (HCC) therapies and the practical application of the latest global algorithms in balancing standardized therapeutic algorithms with individual patient factors. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction01:54 - HCC Case Discussion08:05 - Guest Introductions10:37 - BCLC Committee and 2025 Update15:54 - CUSE and Tumor Board Goals17:46 - Bridging vs Curative Y9022:37 - Patient Factors in Treatment Algorithms26:41 - Liver Function and Hyperbilirubinemia Trends30:25 - HCC Treatment Decision Ownership34:36 - Radiation Segmentectomy vs Surgical Resection37:35 - BCLC B Heterogeneity41:51 - Improving HCC Risk Stratification43:48 - Final Thoughts and Closing Remarks --- More about this episode The discussion begins with an inside look at the consensus process behind the 2025 BCLC updates, highlighting the official inclusion of Y90 radioembolization as a recognized therapeutic option. The experts introduce the "CUSE" (Complexity, Uncertainty, Subjectivity, and Emotion) framework to provide a structured approach to the subjective considerations that modulate purely data-based algorithms in multidisciplinary decision-making. Dr. Salem and Dr. Mehta speak on the nuances of surgical resection versus radiation segmentectomy in a case-based discussion, highlighting how factors such as portal hypertension, patient age, and etiology of cirrhosis should influence treatment pathways. Finally, they underscore the paradigm shift toward pursuing complete pathonecrosis (CPN) as a primary curative goal, regardless of bridging status, and reiterate that success in HCC care is driven by continuous communication and collaboration between physicians and patients. --- Resources BCLC 2026 Updatehttps://doi.org/10.1016/j.jhep.2025.10.020 ---BackTable Vascular & Interventional (VI) is the go-to podcast for interventional radiologists, vascular surgeons, and interventional cardiologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

When a liver tumor is hard to see, the limits of conventional image guidance can become the limits of treatment. In this episode of the BackTable Podcast, Netherlands interventional oncologist Dr. Maarten (M.L.J.) Smits shares a step-by-step walkthrough of the new hepatic arteriography and C-arm CT–guided ablation (HepACAGA) technique, punctuated with a real-world case series at the end. Find out how intra-arterial contrast, cone-beam CT, and 3D needle guidance can improve tumor conspicuity, targeting accuracy, and ablation margin assessment within a single angiography suite. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction02:55 - Netherlands Tech Access04:31 - Origin of HepACAGA07:14 - Why Use a Catheter?11:24 - Tools and Setup13:13 - Catheters and Devices17:06 - Contrast Protocol Basics22:51 - Targeting and Needle Guidance31:09 - Patient Selection35:56 - Extra Benefits and Multimodal39:58 - Workflow and Outcomes46:14 - Evidence and Early Studies51:41 - Rethinking Size Cutoffs57:54 - HCC Case Walkthrough01:02:27 - Hard-to-See Metastasis01:06:22 - Margin Driven Reablation01:11:04 - Bleeding and Embolization01:16:05 - Renal ACAGA Expansion01:23:31 - Adoption and Next Steps --- More about this episode Dr. Smits explains the origins of HepACAGA and why catheter-based contrast delivery can meaningfully change ablation planning, particularly for small lesions, poorly visualized tumors, and cases where ultrasound or conventional CT guidance may be insufficient. He walks through the practical setup, including catheter positioning, contrast dilution, timing protocols, needle navigation, apnea/end-expiration technique, and built-in fusion for immediate ablation verification. He also describes how the angio suite environment supports multimodal treatment, including intraprocedural embolization when bleeding occurs or when additional transarterial therapy is needed. The episode also examines early outcomes from Dr. Smits' group, including a reported reduction in local recurrence from approximately 25% to 5%, with a modest increase in procedure time. Case examples include HCC, small colorectal liver metastases, margin-driven re-ablation, hemorrhage management, and extension of the ACAGA concept to renal tumors (RenACAGA). --- Resources Hepatic Arteriography and C-Arm CT-Guided Ablation (HepACAGA) to Improve Tumor Visualization, Navigation and Margin Confirmation in Percutaneous Liver Tumor Ablationhttps://pubmed.ncbi.nlm.nih.gov/37704863/ Renal Arteriography and C-arm CT-Guided Ablation (RenACAGA) for Thermal Ablation of Challenging Renal Tumorshttps://pubmed.ncbi.nlm.nih.gov/40295401/ --- BackTable Vascular & Interventional (VI) is the go-to podcast for interventional radiologists, vascular surgeons, and interventional cardiologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

Vascular trauma care looks a lot different when the OR is improvised, supplies are limited, and limb salvage decisions cannot wait. On this episode of the BackTable Podcast, host Dr. Sabeen Dhand interviews vascular surgeon Dr. Ahmad Hussain, a Southern California private-practice “hired gun” who volunteered on a WHO/UN-coordinated humanitarian mission to Gaza after an orthopedic colleague requested vascular surgeons due to widespread limb loss. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction04:02 - Why Volunteer In Gaza?07:41 - Logistics and Crossing Into Gaza10:45 - Hospital as Refugee Camp13:34 - First Vascular Trauma Case18:24 - Mass Casualty Triage23:20 - Kids Guiding Doctors27:09 - Evacuation Uncertainty32:03 - Would You Go Back?37:55 - How to Volunteer39:30 - Show Wrap Up and Credits --- More about this episode Dr. Hussain describes entering through the Rafah border with suitcases of medical supplies, working in a hospital functioning as a refugee camp for tens of thousands, and treating shrapnel-related vascular trauma with limited imaging (mainly ultrasound and X-ray), scarce anesthesia, and minimal surgical resources, relying heavily on skilled local medical students and residents. He recounts mass-casualty triage, the emotional impact of caring for injured children, bonding with the children who assisted the volunteers, and the dangerous, militarized evacuation via Israel with U.S. embassy assistance. He says he wants to return, but notes tightened restrictions and dwindling aid, and he recommends other organizations, noting any specialty of medical professionals should consider volunteering. --- Resources Gift of Disability Alleviation (GODA)https://indushospital.ca/appeal/gift-of-disability-alleviation-goda/ --- BackTable Vascular & Interventional (VI) is the go-to podcast for interventional radiologists, vascular surgeons, and interventional cardiologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

For patients who have exhausted conservative management but aren't ready for the knife, shoulder embolization offers a minimally invasive intermediary option. In this episode of BackTable MSK, host Kavi Krishnasamy welcomes Dr. Yan Epelboym, an interventional radiologist trailblazing the MSK IR space. The doctors discuss the rapid development of musculoskeletal embolization applications with an emphasis on shoulder embolization. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction 01:42 - Dr. Yan Epelboym's Origin Story in MSK03:02 - Building Referral Networks06:50 - Details on Clinic Workflow 10:08 - The Run Down on Shoulder Embolization Treatment Targets22:09 - Current Insights on Shoulder OA Embolization27:56 - Shoulder Embolization Setup and Access Choice34:28 - Shoulder Embolization Strategy and Endpoints36:38 - Post-Procedure Pain Control and Activity Limitations42:26 - Shoulder Surgery Status-Post Embolization44:17 - Discussing Existing Research Data on Shoulder Embolization01:00:32 - Key Shoulder Arterial Anatomy and Variants01:04:27 - Shoulder OA Case Discussion01:09:08 - Final Thoughts --- More about this episode The episode begins with Dr. Epelboym outlining how his interest in musculoskeletal embolization developed after exposure to Okuno's early work, along with practical considerations for establishing referral pathways for these procedures. He also provides updates on the ongoing ELECTRC clinical trial at Brigham and Women's Hospital evaluating shoulder embolization. The discussion then turns to outcome measurement, including pain scoring systems and approaches to standardized clinical follow-up. The conversation concludes with a review of the existing literature on adhesive capsulitis, including a meta-analysis demonstrating improvements in pain and range of motion with predominantly minor adverse events, while emphasizing the ongoing need for randomized trials and greater procedural standardization. --- Resources Dr. Yan Epelboym, MD, MPHhttps://www.linkedin.com/in/yan-epelboym-4a84991b/ Embolization Treatment of Chronic Refractory Shoulder Tendinopathy (ELECTRC)https://clinicaltrials.gov/study/NCT06095050 --- BackTable Vascular & Interventional (VI) is the go-to podcast for interventional radiologists, vascular surgeons, and interventional cardiologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

Your guide to better planning, access, and sampling. In this episode of the BackTable Podcast, we revisit every IR's favorite procedure with Dr. Zoe Miller, Assistant Professor of Clinical Interventional Radiology and Associate Program Director at the University of Miami. Together with host Dr. Ally Baheti, Dr. Miller walks through a methodical approach to adrenal vein sampling to help you overcome common procedural challenges and reliably point your patients towards the proper therapies. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction02:26 - Preprocedural Workup Basics06:21 - Planning CT Utility and Protocol08:46 - Access Strategy10:36 - Procedure Day Preparation12:12 - Catheters and Side Holes15:44 - Adrenal Vein Selection Techniques18:50 - Troubleshooting Right Adrenal Vein Selection24:34 - Sample Acquisition Coordination27:38 - Aspiration Flow Optimization29:34 - Preventing Reintervention and Vessel Damage34:06 - Post-Procedure Follow-Up35:46 - AVS in Cushing Syndrome39:38 - Mentorship and Sourcing Knowledge39:25 - Closing Remarks --- More about this episode The physicians outline the key aspects of the pre-procedural workup, from setting expectations with patients to the utility of CT in operative planning. Dr. Miller provides a detailed exploration of strategies and tools for achieving safe access of the adrenal veins, particularly on the right side, and obtaining adequate samples. She emphasizes the importance of collaboration, both within the IR team and with other specialists, to ensure maximal procedural yield and to ultimately provide patients with valuable guidance in their treatment. The episode concludes with a discussion of the challenges presented by co-secreting tumors in hormone level assessment as well as the value of seeking out data and the experiences of mentors in developing your own best practices as an IR. --- BackTable Vascular & Interventional (VI) is the go-to podcast for interventional radiologists, vascular surgeons, and interventional cardiologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

What do the 2026 coding changes mean for the financial viability of IVL in the OBL? In this episode of the BackTable Podcast, host Dr. Ally Baheti sits down with Dr. Nicholas Petruzzi to break down how intravascular lithotripsy fits into OBL workflows, and how upcoming lower-extremity revascularization coding updates may impact outpatient economics. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by Shockwave Medicalhttps://shockwavemedical.com/ --- Timestamps 00:00 - Introduction02:35 - 2026 Coding Changes Overview05:18 - Where IVL Codes Apply06:35 - Iliac Reimbursement Impact08:50 - IVL vs. Atherectomy11:54 - BTK Reality and Future14:44 - When IVL Is Not Ideal16:05 - Catheters and Setup Basics17:50 - Sizing and Technique Tips23:01 - Javelin Forward Emitter26:25 - Wrap Up --- More about this episode The episode starts with a walkthrough of the key 2026 coding updates, including territory-based coding, new IVL add-on codes for aorto-iliac and fem-pop segments, the introduction of below-the-ankle codes, and the shift toward ‘simple' versus ‘complex' designations. From there, the conversation focuses on where IVL makes sense clinically and operationally, particularly as an alternative or complement to atherectomy, with discussion of low embolization risk seen in the DISRUPT PAD trial and the potential to avoid distal protection in select cases. Dr. Petruzzi shares how he approaches IVL in the lab, including catheter selection, sizing, low-pressure technique, and repositioning strategies. They also touch on workflow considerations in the OBL and preview newer concepts like the forward-emitting Javelin device for heavily calcified lesions and situations where device exchange is limited. --- Resources DISRUPT PAD III RCThttps://shockwavemedical.com/en-eu/clinical-evidence/pad-iii-rct/ --- BackTable Vascular & Interventional (VI) is the go-to podcast for interventional radiologists, vascular surgeons, and interventional cardiologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

Pelvic venous disease is often misattributed, until you recognize the venous “detours” driving symptoms. In this episode of the BackTable Podcast, Dr. Ally Baheti speaks with Dr. Deepak Sudheendra (360 Vascular Institute in Columbus, Ohio) about a symptom-first framework for evaluating and treating pelvic venous disease. --- Get the BackTable app https://www.backtable.com/app --- Timestamps 00:00 - Introduction01:40 - Becoming a Pelvic Vein Specialist04:39 - Sorting Causes of Pelvic Pain06:26 - Symptom Checklist Approach09:45 - Nutcracker Red Flags11:37 - Right Sided Symptoms and Detours15:57 - Conservative Care and Stent Counseling17:27 - Rule Out Superficial Venous Disease21:56 - Procedure Planning and Insurance Hurdles24:04 - IJ Access and Inflow Assessment25:18 - IVUS First Renal and Ovarian Evaluation28:07 - IVUS Iliac Compression Map29:44 - Leg Inflow Venography Setup31:15 - Iliac Stenting From IJ32:24 - Stent Sizing Pitfalls36:31 - Gonadal Vein Embolization42:13 - Internal Iliac Varices Caution43:29 - Post Procedure Meds Follow Up46:49 - Wrap Up --- More about this episode Iliac vein compression can manifest through three collateral pathways, contributing to leg heaviness and groin or hip pain, low back pain via the ascending lumbar system, and pelvic organ symptoms through cross-pelvic internal iliac collaterals. The discussion outlines a practical diagnostic approach grounded in clinical pattern recognition, including the significance of prior DVT as a post-thrombotic etiology, differentiation of flank versus low back pain, and the importance of excluding gynecologic pathology. Emphasis is placed on standing venous reflux ultrasound and pelvic ultrasound, with caution against overreliance on cross-sectional imaging for Nutcracker physiology. Procedural strategy centers on IVUS-guided evaluation, targeted iliac vein stenting (often unilateral) and thoughtful use of gonadal vein embolization, including sequencing considerations and avoidance of common pitfalls. The episode also reviews conservative management, follow-up imaging, and post-procedural antithrombotic and pain management protocols. --- BackTable Vascular & Interventional (VI) is the go-to podcast for interventional radiologists, vascular surgeons, and interventional cardiologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

Clean lumen club! This week, BackTable meets you at the carotid bifurcation to discuss all things carotid angioplasty and stenting. Interventional neuroradiologist and cerebrovascular surgeon Dr. Adnan Siddiqui, Vice Chairman of the University of Buffalo's Department of Neurosurgery, joins host Dr. Sameh Sayfo to discuss the evolution and current state of carotid disease treatment. --- Get the BackTable app https://www.backtable.com/app --- This podcast is supported by Terumohttps://www.terumois.com/ --- Timestamps 00:00 - Introduction02:48 - From Aspirin to Endarterectomy03:47 - Rise of Carotid Stenting06:46 - CREST-2 and CMS Coverage09:57 - Management of Severe Asymptomatic Carotid Stenosis 15:35 - New Stent Designs Explained17:56 - Five Tips for New Operators20:08 - Case Selection Algorithm22:04 - Learning Curve and Mentorship28:27 - What's Next: IVL and Outpatient31:24 - Managing Complications Safely35:05 - Closing and Credits --- More about this episode Dr. Siddiqui details the history of carotid stenosis treatment, charting its path and progression from medical therapy to endarterectomy and modern stenting approaches. He includes how recent trial data and updated CMS reimbursements have influenced practice and generated recent developments such as second generation stent technology. Dr. Siddiqui shares perspectives on patient selection, operator learning curve, complication preparedness, and the importance of structured training and proctoring as technology and techniques continue to improve. The physicians close by overviewing future directions for the carotid space such as IVL and how to approach management of procedural complications. --- Resources Dr. Adnan Siddiqui provider profilehttps://www.ubns.com/physicians/dr-adnan-h-siddiqui/ Carotid Endarterectomy for Asymptomatic Carotid Stenosis: Asymptomatic Carotid Surgery Trial (ACAS)https://www.ahajournals.org/doi/10.1161/01.str.0000141706.50170.a7 Asymptomatic Carotid Surgery Trial (ACST-2)https://www.acc.org/latest-in-cardiology/clinical-trials/2021/08/25/23/24/acst2 Protected Carotid-Artery Stenting versus Endarterectomy in High-Risk Patients (SAPPHIRE trial)https://www.nejm.org/doi/full/10.1056/NEJMoa040127 Medical Management and Revascularization for Asymptomatic Carotid Stenosis (CREST-2 trial) https://www.nejm.org/doi/full/10.1056/NEJMoa2508800 The North American Symptomatic Carotid Endarterectomy Trial (NASCET trial)https://www.ahajournals.org/doi/10.1161/01.str.30.9.1751

As interventional radiology cements its position as a primary clinical responder for acute arterial hemorrhage, what if you could achieve rapid and durable arterial occlusion with a single, highly deliverable device? In this episode of the BackTable Podcast, Dr. Alex Villalobos (UNC), Dr. Nima Kokabi (UNC), and Dr. Brian Funaki (UChicago) join host Dr. Kavi Krishnasamy to explore the shifting paradigms of arterial embolization in a case-based discussion highlighting modern vascular plug technologies.--- Get the BackTable app https://www.backtable.com/app --- This podcast is supported by Okami Medicalhttps://okamimedical.com/ --- Timestamps 00:00 - Introduction01:24 - Trauma Activation Workflow06:42 - Empiric Arterial Embolization Indications10:40 - Embolic Agent Preferences and Value Analysis17:18 - Embolics on the Shelf19:32 - LOBO Plug Use Cases20:58 - Case 1: Abdominal Wall Hematoma23:54 - LOBO Advantages, Cost, and Microcatheter Compatibility26:33 - Alternative Access Approaches30:31 - LOBO Sizing and Trackability35:26 - Pusher Wire Features38:20 - Delivery Catheter Requirements43:41 - Case 2: Retroperitoneal Bleed45:15 - LOBO Deployment Technique49:41 - Case 3: Splenic Trauma53:51 - Occlusion Time and Adjunct Embolics57:07 - Closing Remarks --- More about this episode The panel begins by discussing the range of embolic options and combinations at their disposal, sharing their preferences and treatment algorithms in various clinical scenarios. In particular, they emphasize the need for tools that provide immediate, predictable occlusion without the technical burden and cost of needing to deploy multiple embolic agents. The physicians go on to focus on Okami Medical's LOBO vascular plug as a primary solution for rapid vessel occlusion, highlighting the micro-pore architecture and unique deliverability through microcatheters that make it advantageous for precise positioning and reliable embolization. Exploring its use in cases including rectus sheath hematomas, retroperitoneal bleeding, and splenic trauma, the physicians detail the technical nuances of sizing and positioning the LOBO as well as the long-term advantages of its artifact-free design. This episode ultimately underscores a growing preference for streamlined arterial embolization workflows that prioritize rapid stasis and clinical predictability while leveraging the strengths of a multimodal embolic toolkit.

Patients and IRs alike dread the persistent cycles of malfunction and repeated procedures that often accompany biliary drains. What can you do to keep patients off the doorstep of reintervention? In this episode of the BackTable Podcast, Dr. Ahsun Riaz of Northwestern Medicine joins host Dr. Michael Barraza to walk through strategies for preventing and managing complications of percutaneous biliary drain placement. --- Get the BackTable app https://www.backtable.com/app --- Timestamps 00:00 - Introduction01:51 - Complication Rates and Associated Factors06:09 - PTC in Non-Dilated Biliary Systems11:00 - Techniques for Access and Drain Placement15:10 - Drain Flushing, Capping, and Ideal Positioning17:48 - External versus Internal-External Biliary Drains20:42 - Managing Pericatheter Leakage23:01 - Life Expectancy and Stenting Malignant Strictures26:32 - Tract Maturation and Minimizing Access Sites28:56 - Addressing Unresolving Hyperbilirubinemia34:52 - Managing Bloody Drain Output38:12 - Approach to Dislodged Drains39:40 - Drain-Associated Pain and Exchange Timing42:49 - Strategy for Benign Biliary Strictures45:18 - Final Thoughts and Closing Remarks --- More about this episode The discussion begins with a look at the data on biliary drain-related adverse events, emphasizing the need to bring down the high rates of complications that may take a toll on patients' quality of life. Dr. Riaz stresses the importance of employing techniques at initial drain placement, such as placing left-sided drains where appropriate and minimizing biliary pressure buildup, to reduce the starting risk of malfunction. The physicians go on to share their algorithms for approaching various scenarios, from pericatheter leakage and drain dislodgement to unresolving hyperbilirubinemia, pointing out the factors and observations that should influence treatment approaches during planning and intraprocedurally. Finally, the physicians address the evolving landscape of long-term biliary management, assessing potential drainage strategies as survival rates improve in hepatobiliary malignancies, and underscore the critical importance of collaboration with gastroenterologists and surgeons to ensure cohesive, goals-of-care-centered management. --- Resources Adverse Events After Percutaneous Transhepatic Biliary Drainage: A 10-Year Retrospective Analysishttps://doi.org/10.1016/j.jvir.2024.12.022

Radial roots, peripheral reach! Radial to peripheral (R2P) access is the focus of this week's episode with interventional cardiologist Dr. Shailendra Singh (Pennsylvania's Lehigh Valley Heart and Vascular Institute) and dual hosts Hady Lichaa and Sameh Sayfo. The conversation focuses on key techniques, pre-procedure planning and imaging, and ideal case selection for those new to the R2P approach. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by Terumo https://www.terumois.com/ --- Timestamps 00:00 - Introduction04:42 - Radial-to-Peripheral: Right vs Left Radial10:18 - Ultrasound and Pedal Access Applications17:10 - Ideal Cases When Starting Radial to Peripheral25:59 - Impactful Radial Success Stories29:38 - Managing Radial Spasm 35:22 - Left Radial Workflow42:00 - Shelf Setup Essentials48:43 - Renal Mesenteric Access55:37 - Safe Sheath Removal01:01:10 - Training and Courses01:04:48 - Closing Thoughts --- More about this episode Dr. Singh shares how he began incorporating radial-to-peripheral procedures into his practice after fellowship and how his experience with radial coronary access translated naturally to peripheral interventions. The group reviews access strategy, including right versus left radial selection, along with techniques for preventing and managing radial spasm. They also touch on staff workflow and training when introducing R2P into the lab. The episode closes with practical insights on case selection for operators new to the approach, the role of pedal access in selected CTO cases, and strategies for safe sheath removal and hemostasis. --- Resources Dr. Shailendra Singh's Provider Profile https://www.lvhn.org/doctors/shailendra-singh Dr. Sameh Sayfo's Provider Profilehttps://www.bswhealth.com/physician/sameh-sayf Dr. Hady Lichaa's Provider Profilehttps://healthcare.ascension.org/find-care/provider/1336267533/hady-lichaa

With the single-stick technique proving to be an effective addition to the venous line placement toolkit, what is stopping IRs from venturing beyond the traditional dual-incision approach? In this episode of the BackTable Podcast, pediatric interventional radiologist Dr. Kevin Wong of USA Health joins host Dr. Ally Baheti to review the single-stick technique for central venous access, a method widely utilized in pediatric practice. --- Get the BackTable app https://www.backtable.com/app --- Timestamps 00:00 - Introduction01:35 - Origins of Single-Stick Access03:10 - Setup and Bending the Needle07:17 - Tunneling to the IJ10:06 - Line Positioning and Measurement14:45 - Wire Handling Considerations18:55 - Clinical Advantages of Single-Stick Access21:27 - Femoral Single-Stick Tips23:41 - Common Mistakes and Pitfalls27:39 - Needle-Free Lidocaine Administration30:48 - Closing Remarks --- More about this episode Delving into the origins, technical nuances, and clinical advantages, the physicians explore how the single-stick technique can reduce the risk of infection and minimize interference with other lines and tubing to improve patient care. The discussion provides a detailed technical breakdown of the procedure, offering a masterclass on navigating the curves up the neck as well as the equipment selection and sizing necessary to facilitate the process. With the aid of visual slides and demonstrations, Dr. Wong steps us through the specifics of bending the access needle, maneuvering tools to adapt to anatomical configurations, and handling ultrasound movement to confirm and maintain a safe trajectory throughout the procedure. The conversation emphasizes the tactile “feel” and attention to forces acting on the wire that are required to appropriately position the catheter.Recognizing the logistical constraints that make it challenging for attendings to regularly adopt alternative procedural techniques, this episode serves as an accessible primer for clinicians looking to broaden their options for venous access with this effective, patient-centric technique.

The advent of newer thrombectomy devices has turned what were once hours-long surgical cutdowns into endovascular cases that last under an hour. In this episode of BackTable, host Dr. Sabeen Dhand is joined by Dr. Shang Loh from the University of Pennsylvania and Dr. Khanjan Nagarsheth from the University of Maryland to discuss the evolution of arterial thrombectomy devices and modern techniques for acute arterial occlusions. --- This podcast is supported by: Inari Medicalhttps://www.inarimedical.com/artix-system --- SYNPOSIS The episode highlights major technological advancements over the past decade, including the development of mechanical and computer-assisted thrombectomy systems. The physicians review key features of newer devices, such as the ability to combine aspiration with stent retrievers, the use of PTFE baskets to reduce distal embolization, and the advantage of maintaining wire access throughout the case. They share strategies for managing specific cases, including acute femoral-popliteal occlusions with distal reconstitution, intraoperative ischemic pain due to flow arrest, trauma-related thrombosis, and cases complicated by extensive calcification and chronic vascular disease. As vascular surgeons, they also discuss the ongoing role of open approaches, outlining when surgical cutdown is indicated and where they prefer endovascular first. The conversation further explores challenges such as acute limb ischemia, stent thrombosis, and visceral artery thrombosis, emphasizing the importance of staying current with rapidly evolving technologies to improve procedural efficiency and patient outcomes. --- TIMESTAMPS 00:00 - Introduction02:04 - Evolution of Arterial Thrombosis Treatment04:11 - New Devices and Techniques10:42 - Case Studies and Practical Applications24:26 - Techniques and Devices for Thrombectomy25:33 - Managing Flow and Patient Safety27:25 - Surgical vs. Endovascular Approaches29:25 - Dealing with Complications and Failures37:50 - Visceral Thrombosis and Advanced Techniques41:09 - Future of Thrombectomy Devices44:27 - Closing Remarks

Chronic limb-threatening ischemia (CLTI) represents the most advanced stage of peripheral artery disease. While many patients can be treated with endovascular or surgical revascularization, a subset of individuals remain ‘no-option' candidates when conventional therapies fail or distal targets are absent. In this episode of BackTable, host Dr. Ally Baheti speaks with Dr. Mary Costantino, interventional radiologist at Advanced Vascular Centers, and Jill Sommerset, vascular technologist and Director of Clinical Education and Training at Aveera Medical, about the emerging role of spinal cord stimulation (SCS) as a potential therapy for patients with no-option CLTI. --- SYNPOSIS This episode explores where spinal cord stimulation may fit within the treatment landscape for advanced CLTI, particularly for patients who are not candidates for revascularization or deep venous arterialization (DVA). Dr. Costantino describes how interest in the therapy developed through multidisciplinary collaboration and early physiologic observations using pedal acceleration time (PAT) measured with duplex ultrasound alongside angiography. A representative case highlights immediate, setting-dependent improvements in PAT following stimulation, and the group reviews early trends from a small patient cohort suggesting improved distal perfusion in individuals with severe infrapopliteal disease. The conversation also addresses practical barriers to adoption, including site-of-service and reimbursement challenges and the difficulty of implanting permanent stimulators in patients with active wounds. Jill Sommerset adds perspective from the vascular lab, discussing ultrasound-based methods to quantify physiologic changes after DVA and how similar perfusion metrics may help evaluate spinal cord stimulation. The episode concludes with a discussion of the potential role of neuromodulation in this population and the need for larger datasets to better define its clinical impact. --- TIMESTAMPS00:00 - Introduction02:02 - Why CLTI Needs Options06:25 - First No Option Case11:06 - Trial Turns Flow On14:38 - Timing and Reimbursement19:59 - Early Results and Adoption22:45 - How Spinal Cord Stimulation Might Improve Flow26:46 - Patient Selection and Access30:24 - Treatment Algorithm and Timing32:37 - Quality of Life and Mobility37:57 - Implant Delays and Coordination39:41 - Data --- RESOURCES Paper on Maturation after DVAhttps://www.sciencedirect.com/science/article/pii/S1078588426000523

Below-the-knee (BTK) arterial disease remains one of the more challenging areas in vascular care, particularly in patients with chronic limb-threatening ischemia (CLTI), where heavy calcification complicates endovascular treatment. As new calcium-modifying technologies emerge, an important question remains: what evidence supports their use in BTK interventions? In this episode of BackTable Vascular & Interventional, host Dr. Sabeen Dhand speaks with vascular surgeon Dr. Paul Foley of Doylestown Health about the Disrupt BTK II clinical trial from Shockwave Medical, which evaluates the performance of peripheral intravascular lithotripsy (IVL) in heavily calcified BTK disease. --- This podcast is supported by: Shockwave Medicalhttps://shockwavemedical.com/ --- SYNPOSIS Dr. Foley begins by outlining his training and the evolution of his vascular surgery practice, setting the stage for a broader discussion on how BTK interventions have changed over the past decade. The conversation explores shifts in access strategies, procedural approaches, and the unique characteristics of calcification encountered in CLTI. Because BTK calcium differs from calcification seen elsewhere in the peripheral vasculature, imaging and device selection play a particularly important role when planning IVL-based therapies. Dr. Foley reviews the design and outcomes of the Disrupt BTK II trial, where devices such as the Shockwave M5+ and S4 catheters were used to modify calcified plaque, demonstrating encouraging safety and performance signals. The discussion then turns to emerging technologies, including Shockwave's Javelin catheter, designed to deliver focused pressure waves to fracture dense calcium within peripheral arteries. Dr. Foley describes how the device fits into BTK workflows, including technique considerations and its use alongside adjunctive therapies such as balloon angioplasty. The episode also addresses the ongoing skepticism surrounding IVL in BTK disease, emphasizing the need for careful patient selection, procedural precision, and continued multidisciplinary collaboration as the field works to refine treatment strategies and improve outcomes for patients with peripheral artery disease (PAD). --- TIMESTAMPS 00:00 - Introduction08:20 - Evolution of Below-the-Knee Treatments11:10 - Differences in BTK Calcification13:13 - Imaging and Technology in BTK Interventions15:18 - Disrupt BTK II Trial Data and Results23:17 - Introduction to the Javelin Device26:39 - Technique Considerations with Javelin28:36 - Comparing Javelin and E831:17 - Future Directions for Lithotripsy Technology35:30 - Skepticism Around IVL in BTK Disease38:47 - Final Thoughts --- RESOURCES Disrupt BTK II Trialhttps://www.jvascsurg.org/article/S0741-5214(24)02063-9/fulltext

When standard-of-care checkpoint blockade fails in metastatic melanoma, how can oncologists and interventional radiologists join forces to turn around patient outcomes? In this episode of the BackTable Podcast, medical oncologist Dr. Jennifer McQuade and interventional radiologist Dr. Rahul Sheth join host Dr. Tyler Sandow to discuss the growing evidence for intratumoral oncolytics as a therapeutic strategy for frontline immunotherapy-refractory melanoma and the interdisciplinary work that is required for successful implementation in practice. --- SYNPOSIS The physicians review how engineered viral vectors, particularly RP1, complement checkpoint blockade through direct tumor lysis and immune activation, and summarize the IGNYTE trial data supporting their use in patients with metastatic melanoma refractory to anti-PD-1 and anti-CTLA-4 agents. The discussion then shifts to practical administration, highlighting the central role of interventional radiology in delivering these therapies to visceral and deep-seated lesions under image guidance. The doctors go on to address the nuances of patient and lesion selection, injection technique, and response assessment, including the importance of recognizing pseudo-progression. They place particular emphasis on the need for multidisciplinary collaboration and stakeholder buy-in efforts on the part of IRs seeking to integrate intratumoral oncolytic injections into their scope of practice. The episode concludes with a forward-looking discussion on the potential for expansion of oncolytic platforms into other solid tumors, underscoring this field as a growing, IR-forward frontier in cancer treatment. --- TIMESTAMPS 00:00 - Introduction02:28 - Immunotherapy Basics06:51 - How Oncolytic Viruses Work11:01 - IGNYTE Trials and Why IR Matters18:14 - T-VEC vs RP1 Indications and Logistics21:57 - Physician Communication and Multidisciplinary Treatment23:06 - RP1 Protocol and Administration Techniques30:28 - RP1 Safety Profile32:46 - Follow-Up Imaging and Response Assessment35:44 - Future Applications Beyond Melanoma41:42 - Final Thoughts and Closing Remarks --- RESOURCESWong MK, et al. RP1 Combined With Nivolumab in Advance Anti-PD-1-Failed Melanoma (IGNYTE). J Clin Oncol. 2025;43(33):3589-3599.https://doi.org/10.1200/jco-25-01346 IGNYTE-3 Trialhttps://clinicaltrials.gov/study/NCT06264180

With data increasingly positioning thermal ablation as a viable alternative to surgery for select liver metastases, the demands on the interventional oncologist have never been higher. Mastering the nuances of patient selection and precise margin assessment is now essential for ensuring effective disease control locally. In this episode of the BackTable Podcast, interventional radiologist Dr. Jonas Redmond of UC San Diego Health joins host Dr. Sabeen Dhand to discuss the current state of microwave ablation (MWA) in the management of oligometastatic liver disease, focusing on tumor assessment, preprocedural planning, and the integration of local and systemic therapies. --- This podcast is supported by: Varian IntelliBlatehttps://www.varian.com/products/interventional-solutions/microwave-ablation-solutions --- SYNPOSIS The conversation delves into the complexities of timing systemic versus local ablative therapies and explores questions surrounding adequate treatment margins. Dr. Redmond goes on to emphasize the need for operators to approach procedures with a high level of adaptability, advocating for interdisciplinary preprocedural planning and thoughtful modality selection. Exploring the complications that could arise from injury to adjacent viscera, the physicians speak to the critical importance of rigorous intraprocedural reassessment and discuss how modern software and robotics are transforming procedural precision and safety. Framing these MWA pearls within the context of recent clinical trials like COLLISION and ACCLAIM, the episode underscores the transition of interventional oncology from providing palliative services to increasingly curative solutions that may offer better prospects for patients with metastatic disease. --- TIMESTAMPS 00:00 - Introduction04:30 - Role of Local Therapy in Systemic Disease09:49 - Patient Selection and Treatment Modalities13:15 - Challenging Lesion Characteristics and Locations19:56 - Y-90 Radioembolization versus Microwave Ablation23:04 - Intraoperative Ablation and Combining Locoregional Modalities29:36 - Complications of Microwave Ablation in the Liver36:43 - Future of Ablation and Liver Metastases Treatment39:25 - Final Thoughts and Closing Remarks --- RESOURCES UC San Diego Health. Cryoablation and Arterial Infusion of SD-101 in Combination with Durvalumab and Tremelimumab.https://clinicaltrials.ucsd.edu/trial/NCT06710223 COLLISION trialhttps://clinicaltrials.gov/study/NCT03088150 ACCLAIM trialhttps://clinicaltrials.gov/study/NCT05265169

Better habits start now. Poor ergonomics in the angio suite lead to cumulative neck and back injuries, absenteeism, presenteeism, and even early retirement. This episode of the BackTable Podcast offers a guide on on how to improve your ergonomics in the the cath lab, featuring interventional radiologist Dr. Keith Horton and host Dr. Ally Baheti. --- SYNPOSIS Dr. Horton and Dr. Baheti discuss common setup mistakes (especially monitor and ultrasound placement), practical positioning guidance (neutral posture, monitor height/angle, table height at elbow level), lead considerations (two-piece vs one-piece, refitting with body changes, costs vs. injury), and procedural stressors from longer, more complex cases. Horton also reviews evidence and standards (including SIR guidance), highlights surgical ergonomics programs like Duke's education-and-leadership model with scheduled microbreaks, and describes emerging mitigations such as augmented reality guidance, robotics, and “zero-gravity” lead systems, emphasizing that strain prevention and intentional setup are essential for career longevity. --- TIMESTAMPS 00:00 - Introduction01:43 - Defining Ergonomics04:52 - Common Setup Mistakes07:31 - Neutral Posture Basics09:02 - Lead Fit And Support12:33 - Fighting Bad Room Design14:46 - Augmented Reality Workflow17:11 - Leadless Shielding Options20:53 - Repetitive Strain Tactics25:06 - Future Tech On Horizon27:56 - Maternity Lead Frustrations30:22 - Why Incentives Misalign32:45 - When Ergonomics Fails33:59 - Duke Program Blueprint37:02 - Tools Monitor Table Setup39:05 - Microbreaks That Stick42:46 - Room Setup Realities47:08 - Reminders and Wrap Up

Prostate artery embolization may be performed by interventional radiologists, but its indications are rooted in urologic evaluation. In the second installment of our 2026 PAE University Series, Dr. Chris Beck is joined by Dr. Art Rastinehad of Northwell Health, a urologist with formal interventional radiology training, to share how his dual background informs both when to offer PAE and how to execute it thoughtfully. --- This podcast is supported by an educational grant from Guerbert. --- SYNPOSIS Dr. Rastinehad discusses his path from urology into IR and how that combined training shapes his current hybrid practice. He outlines a practical BPH consult framework grounded in urologic evaluation, emphasizing appropriate imaging, careful patient selection, and the importance of ruling out malignancy before proceeding with embolization. From his perspective, durable outcomes begin with disciplined workup and clear counseling around expectations, including sexual side effects and alternative treatment options. The conversation then turns to procedural strategy. Dr. Rastinehad reviews anatomic considerations, large-gland and technically challenging cases, and his experience incorporating liquid embolics into PAE. He compares glue and particles, detailing workflow decisions, medication strategy, and post-procedure management. Throughout, he highlights scenarios where PAE may not be the most appropriate intervention and how other BPH tools may better serve the patient. The episode concludes with a discussion of the future of PAE, including questions of training, collaboration between specialties, and reimbursement; underscoring the value of cross-specialty insight in contemporary BPH care. --- TIMESTAMPS 00:00 - Introduction01:26 - Interventional Urologist with IR Roots04:13 - Leaving Urology for IR: Fellowship Life, Case Volume & Mentors08:45 - Building a Hybrid Urology/IR Practice14:32 - PAE Benefits, Sexual Side Effects & Why MRI Matters17:39 - BPH Consult Playbook22:17 - Anatomy Deep Dive24:27 - Edge Cases & Big Glands28:24 - Why Glue?35:39 - Glue vs Particles39:40 - Post-PAE Follow-Up41:28 - Antibiotics and Medications46:18 - Tough Cases50:53 - The Future of PAE --- RESOURCES Early Outcomes of Prostatic Artery Embolization using n-Butyl Cyanoacrylate Liquid Embolic Agent: A Safety and Feasibility Studyhttps://pubmed.ncbi.nlm.nih.gov/39074551/ Dr. Rastinehad's Websitehttps://drrastinehad.com/

How do experienced operators approach the most technically demanding aspects of Distal Venous Arterialization (DVA)? In this episode of BackTable, host Dr. Sabeen Dhand sits down with Dr. Kumar Madassery for a detailed discussion of procedural strategy, technical decision-making, and real-world troubleshooting in DVA. --- SYNPOSIS Dr. Madassery walks through his approach from pre-procedure planning to final scaffolding. The conversation begins with imaging review, patient selection, and anesthesia considerations, emphasizing how preparation influences technical success. They then examine venous mapping and access strategy, with specific attention to femoral and tibial disease patterns and how these anatomic variables shape crossing techniques.This episode also covers wire and catheter selection, techniques for creating the arteriovenous anastomosis, balloon sizing, valve management, and stent scaffolding. Throughout, Dr. Madassery shares practical solutions to common access challenges and highlights decision points that can determine procedural durability. The discussion closes with reflections on clinical management, operator fatigue, and the value of professional networks when navigating complex limb salvage cases. --- TIMESTAMPS 00:00 - Introduction03:08 - Pre-Procedure Imaging and Setup05:01 - Venous Access and Mapping07:27 - Anesthesia and Patient Preparation12:29 - Femoral and Tibial Disease Considerations23:17 - Crossing Techniques and Tools27:16 - Venous Access Challenges and Solutions35:54 - Creating the Anastomosis37:03 - Balloon Sizing and Scaffolding Techniques38:26 - Navigating Venous Access Challenges39:56 - Wire and Catheter Strategies42:08 - Dealing with Valves and Anastomosis44:16 - Proximal vs. Distal DVA Approaches47:01 - Scaffolding and Stent Techniques50:06 - Clinical Management and Case Fatigue01:01:10 - Networking and Seeking Advice01:05:41 - Concluding Thoughts and Future Directions

Think your medical practice is safe from hackers? Learn why humans, rather than software, are often the weakest link in patient data protection. In this episode of the BackTable Podcast, host Dr. Chris Beck delves into the critical topic of cybersecurity in healthcare with Didier Jourdain, a certified Information Systems Security Professional (CISSP). --- SYNPOSIS Didier discusses his recently approved paper, 'Cybersecurity for Interventional Radiologists: A Clinical Imperative for Protecting Patient Data and Imaging Systems,' and shares his extensive background in software and application security, penetration testing, and cybersecurity risk governance. The conversation covers key issues such as phishing, ransomware, third-party vendor risks, and the vulnerabilities of the Internet of Medical Things (IOMT). Didier emphasizes the importance of education, tabletop exercises, and comprehensive third-party risk management strategies to enhance cybersecurity resilience in both hospital systems and independent physician practices. --- TIMESTAMPS00:00 - Introduction04:03 - Cybersecurity in Healthcare: A Clinical Imperative16:07 - Mitigating Cybersecurity Risks20:23 - Password Management and Best Practices27:33 - The Role of IT in Cybersecurity31:04 - Internet of Medical Things (IoMT) Vulnerabilities39:17 - Top Cybersecurity Recommendations for Physicians

How can patients receive more consistent interventional radiology care amid a national shortage of IR physicians? That question led Dr. Rick Daniels to develop a new outpatient practice model centered on recruiting independent IRs to provide long-term, fractional coverage for groups in need. In this episode of the BackTable Podcast hosted by Dr. Aaron Fritts, Dr. Daniels outlines the thinking behind this approach and how it aims to expand access to IR services in outpatient settings. --- SYNPOSIS The conversation examines the evolving landscape of IR practice, including the challenges associated with transitioning between practice settings and building sustainable outpatient service lines. Dr. Daniels walks through the development of his model, with particular attention to identifying and supporting outpatient embolization opportunities. The discussion also explores the consortium-style structure for independent IRs, emphasizing long-term alignment, professional autonomy, and scalability at a national level. Operational considerations such as technology partnerships, documentation workflows, and targeted marketing strategies offer a practical look at what it takes to make this model work. --- TIMESTAMPS 00:00 - Introduction03:49 - Evolution of an Independent IR Practice05:30 - Challenges and Opportunities in Outpatient IR09:58 - Building Service Lines and Marketing Strategies18:34 - Forming a National IR Group25:21 - Balancing Business and Healthcare25:37 - Evaluating and Correcting Site Performance28:16 - Expanding Geographical Reach30:45 - Recruitment and Retention Challenges38:07 - The Importance of Tech-Doc Teams42:35 - Future Goals and Recruitment Efforts45:58 - Conclusion

As new calcium-modifying technologies expand the repertoire of below-the-knee (BTK) arterial disease interventions, how should your treatment algorithm evolve, and what endpoints matter most? In this episode of the BackTable Podcast, Dr. Constantino Peña of the Baptist Health Miami Cardiac and Vascular Institute joins Dr. Sabeen Dhand to discuss the latest advancements in BTK chronic limb-threatening ischemia (CLTI) therapies and the push to improve on current vessel preparation outcomes. --- This podcast is supported by: Shockwave Medicalhttps://shockwavemedical.com/ --- SYNPOSIS The physicians discuss the evolution of tibial arterial therapies, the challenges presented by heavily calcified lesions, and the impact of new tools, particularly the Shockwave E8 intravascular lithotripsy (IVL) device, on procedural considerations and endpoints. Dr. Peña shares his treatment algorithms and offers practical advice on selecting the right tools for each unique case. The episode closes with speculation on the future of treatment options and technologies for BTK disease, and the growing need for robust data to guide patient-specific treatment. --- TIMESTAMPS 00:00 - Introduction02:11 - Understanding Tibial Disease and Treatment Evolution07:22 - Advancements in Tibial Disease Treatment and the Role of IVL15:31 - Techniques for Effective IVL Sizing and Usage 21:28 - Challenges and Innovations in Tibial Disease Management26:48 - Innovations in Stent Technology30:43 - Combining IVL with Adjunct Therapies32:13 - Addressing Misconceptions in Tibial Treatment37:54 - Advancements in Intravascular Lithotripsy40:59 - Future of Vascular Treatments43:42 - Final Thoughts

Have you ever wondered what it was like to be in the room when the first pelvic embolization was performed or how the TIPS procedure was pioneered? Dr. Ernie Ring, a legendary figure from UCSF and a true forefather of Interventional Radiology, joins host Dr. Peder Horner to recount the early days of the specialty. Dr. Ring shares fascinating stories from his training at Massachusetts General Hospital under Dr. Stanley Baum, where he witnessed the birth of transformative techniques using angiographic catheters to treat life-threatening bleeding. --- SYNPOSIS From improvising the use of autologous blood clot and thrombin to stop massive hemorrhages to his pivotal role in developing the TIPS procedure and specialized biliary catheters, Dr. Ring's career is loaded with innovation. The conversation explores the "cowboy" era of IR, the evolution of essential tools like the glide wire, and the critical importance of maintaining a "high-touch" clinical practice in the face of emerging technologies like AI. Dr. Ring also reflects on his later transition into hospital leadership as Chief Medical Officer, where he applied his problem-solving mindset to institutional quality and safety. --- TIMESTAMPS 00:00 - Introduction01:58 - Upbringing from Detroit to Mass Gen 06:55 - Early IR with an Embo Case13:50 - Trailblazing Cases in IR16:17 - Penn and Innovation20:00 - Polarizing Procedures24:13 - IR Device Innovation33:00 - Dotter's Separation from Diagnostics37:30 - Fear Finds Cowboys39:08 - AI and Robotics40:08 - Fun Hobbies

You're about to biopsy a renal lesion; should you ablate at the same time? In this episode of the BackTable Podcast, host Michael Barraza talks with Dr. Steven Huang from MD Anderson Cancer Center about building an efficient and effective renal biopsy and ablation service line. --- This podcast is supported by: Varian IntelliBlatehttps://www.varian.com/products/interventional-solutions/microwave-ablation-solutions --- SYNPOSIS Dr. Huang first covers referral patterns and the typical pathway that patients take to end up in his clinic. The discussion covers the types of lesions he treats, imaging requirements, and criteria for patient eligibility. He emphasizes the importance of shared decision making when deciding between active surveillance, interventional treatment, and partial nephrectomy. Dr. Huang explains his preferred procedural approach and ablation modalities, including cryo, microwave (MWA), and radiofrequency ablation (RFA). He shares his experiences with challenging cases and integrating new technologies like histotripsy and the Siemens interventional package. They also discuss the possibility of a preoperative embolization for larger lesions that could be susceptible to the heat sink effect. Both experts emphasize the importance of collaboration with urologists and ensuring patient safety and expectations. They also touch on the future of the field, discussing the use of AI and robotics. --- TIMESTAMPS 00:00 - Introduction 02:17 - Training Programs at MD Anderson03:23 - Referral Patterns for Renal Ablations07:25 - Patient Management and Virtual Consultations10:59 - Ablation Techniques and Device Selection26:44 - Challenges and Complications27:25 - Approach to Lesions Near Renal Vasculature28:02 - Patient Expectations and Urologist Collaboration33:26 - Post-Procedure Care and Patient Recovery35:30 - Managing Recurrences and Multiple RCCs47:17 - Closing Remarks

What does day-to-day interventional radiology look like in the military? Here's a firsthand account. Dr. John York, interventional radiologist at University of California San Diego with 37 years of active duty in the Navy joins host Dr. Ally Baheti to share his experiences and perspectives on being an interventional radiologist in the military. --- SYNPOSIS Dr. York recounts his path to the military and how it ultimately led him to interventional radiology. He reflects on his deployments to Afghanistan and Djibouti, highlighting the clinical complexity, operational challenges, and fulfilling aspects of delivering image-guided care in high-acuity environments. Dr. York recounts several remarkable cases from his deployments, including the management of a vertebral artery aneurysm. He underscores how strong foundational training enables creative problem-solving in resource-limited settings. Dr. York also shares his experience as senior medical officer on the USS Theodore Roosevelt during the initial COVID-19 outbreak, offering insight into the clinical, operational, and administrative challenges he faced. He highlights how adaptability and creative problem-solving are essential to managing complex cases in dynamic environments. --- TIMESTAMPS 00:00 - Introduction02:53 - Journey to Medicine: From Naval Academy to Medical School05:55 - Choosing Interventional Radiology08:11 - Military Medical Experience: Portsmouth and Beyond11:38 - First Deployment: Challenges and Adaptations14:38 - Case Studies: Trauma and Innovation in Afghanistan26:15 - A Unique Procedure in a Combat Zone28:49 - Transitioning Back to Civilian Life31:07 - Challenges in Combat Zones34:22 - Deployment in Djibouti38:25 - COVID-19 on the USS Theodore Roosevelt45:50 - Reflections on Military Service

Are balloon occlusion microcatheters your new best friend for prostate artery embolization (PAE)? In this episode of BackTable, Dr. Raj Ayyagari, interventional radiologist at Boston Medical Center, joins Dr. Ally Baheti to tackle complex clinical and technical challenges in PAE. --- This podcast is supported by an educational grant from Guerbert. --- SYNPOSIS Dr. Ayyagari shares his unique journey from urology to interventional radiology and his experience building successful PAE service lines at multiple institutions. He walks through a series of challenging cases involving intraprostatic penile arteries, perivesicular collaterals, and internal pudendal collaterals used to treat bilateral hemi-prostates. The discussion highlights the role of balloon occlusion microcatheters such as the Sniper, his transition from 100–300 micron particles to glue embolization, and scenarios where coil protection is essential to prevent nontarget embolization. He also covers post-procedural management, the importance of setting expectations around suprapubic tube removal, and why thorough patient and provider counseling is critical for optimal care. --- TIMESTAMPS 00:00 - Introduction 02:14 - Building a Practice in Prostate Artery Embolization08:19 - Case Studies and Techniques in Prostate Artery Embolization23:16 - Challenges in Embolization Techniques23:47 - Step-by-Step Guide to Embolizing a Hemi Prostate25:24 - Choosing the Right Beads for Embolization29:10 - Transitioning to Liquid Embolics35:38 - Setting Patient Expectations and Pre-Procedure Evaluation40:17 - Post-Procedure Care and Medications44:06 - Conclusion and Final Thoughts

Have you ever considered taking a sabbatical to practice Interventional Radiology in the Middle East? In this episode, Dr. Jamal AlKoteesh, the Chairman of Clinical Imaging at SEHA and the "Godfather of IR" in the United Arab Emirates, joins host Dr. Sabeen Dhand to discuss the rapid evolution and current state of IR in the Gulf region. --- SYNPOSIS Dr. AlKoteesh shares his journey from training in the UK to establishing the IR specialty in Abu Dhabi over the last 18 years. He details the unique practice environment in UAE government hospitals, where the lack of strict sub-specialization requires IRs to maintain a versatile skillset—handling everything from thyroid FNAs and UFE to complex neurovascular thrombectomies. The conversation highlights the significant government investment in healthcare technology, which allows physicians access to the latest tools—such as the Siemens Artis Icono with integrated RapidAI for stroke—often before they are widely available in other markets. Dr. AlKoteesh also provides a practical guide for US physicians interested in working abroad, covering the licensing timeline, tax-free income, and the high demand for Western-trained physicians. --- TIMESTAMPS 00:00 - Introduction01:39 - Building IR in UAE05:23 - UAE Healthcare System Overview07:54 - IR Residency and Staffing13:15 - Access to Latest Devices15:15 - Compensation and Lifestyle17:58 - PAIRS Conference Overview20:45 - Licensing and Relocation Guide21:39 - Liability and Language Barriers26:33 - Launching Stroke Interventions

Patient access to interventional radiology services remains highly variable worldwide, reflecting global differences in training opportunities and infrastructure. Drawing on responses from more than 1,260 interventional radiologists worldwide, Dr. Justin Guan and Dr. Constantinos Sofocleous unpack the findings of a large international survey, highlighting where IR is advancing, where it remains fragmented, and what the data suggest about the future direction of the specialty. --- SYNPOSIS Key points of the episode involve the collaborative efforts put into this survey, how data was collected, and major findings from the respondents. These findings involve challenges with IR training, the significance of public awareness, and the need for standardized training programs. The discussion also covers the efforts required to promote IR globally, especially at global summits, and the potential steps to address these findings. Finally, the episode highlights the importance of developing region-specific programs and the ongoing efforts to elevate IR practices worldwide. --- TIMESTAMPS 00:00 - Introduction01:57 - Global IR Network and Survey Introduction10:30 - Survey Insights and Results19:26 - Challenges in IR Training and Awareness23:33 - Future Directions and Initiatives36:06 - Conclusion and Final Thoughts --- RESOURCES Results of a Global Survey on the State of Interventional Radiology 2024: https://pubmed.ncbi.nlm.nih.gov/39793699/

Are you getting paid for the work you do? In this episode of the BackTable Podcast, interventional radiology coding expert Dr. David Zielske joins host Dr. Ally Baheti to share practical tips for billing and coding in interventional radiology, focusing on accurate, efficient, and compliant revenue capture. --- SYNPOSIS Dr. Zielske shares his path to becoming a coding expert, highlighting why precise documentation is essential to accurate medical billing. Drawing from personal experience, he breaks down the most common coding pitfalls physicians face and how to avoid them. He highlights the importance of early training in coding and billing during residency and fellowship, reviews key coding updates effective January 2026, and offers guidance on modifier usage. --- TIMESTAMPS 00:00 - Introduction01:34 - The Importance of Accurate Coding and Documentation04:03 - Common Coding Errors and Compliance Issues07:09 - Detailed Coding Guidelines and Best Practices26:20 - Modifiers and Their Proper Use33:53 - Interventional Radiology vs Diagnostic Radiology35:18 - Discussing ENM Billing and Procedural Focus35:45 - Commonly Missed Codes in Dialysis Circuit Interventions37:04 - Balloon Fibrin Sheath Disruption and Thrombectomy37:51 - Importance of Accurate Documentation for Vascular Access40:55 - Moderate Sedation and Ultrasound Guidance42:33 - Selective Imaging and Urinary Access Coding44:48 - Ablations and Biopsies: Guidance and Coding46:53 - Drainages and Intravascular Lithotripsy50:19 - 2026 Coding Changes and Physician Documentation01:00:29 - Resources and Education for Physicians

Is the open thoracotomy becoming outdated as robotic surgery and advanced ablation techniques take center stage in lung cancer treatment? In the final discussion of the 2025 NSCLC Creator Weekend™ series, our virtual tumor board of interventional radiologists and pulmonologists from leading medical institutions discuss recent surgical and interventional advancements in the treatment of lung cancer. --- This podcast is supported by an educational grant from Johnson & Johnson and Varian. --- SYNPOSIS The conversation covers the contemporary role of PET scans, endobronchial ultrasound (EBUS), mediastinal staging, and the importance of perioperative systemic therapy. The doctors explore surgical and non-surgical methods for treating lung cancer, including lymph node dissection, criteria for resection, and the advantages of minimally invasive approaches such as video-assisted thoracoscopic surgery (VATS) and robotic-assisted surgeries.A key focus of this episode is the decision-making process for treating multifocal lung cancers while preserving lung function, and the use of combined therapies like ablation and radiation. The episode concludes with a detailed case study illustrating the long-term management of a patient with multiple lung adenocarcinomas over several years, highlighting the multidisciplinary approach required in such complex scenarios. --- TIMESTAMPS 00:00 - Introduction10:07 - Patient Selection and Comorbid Conditions27:29 - Surgical Margins and Resection Strategies42:11 - Understanding Upstaging in Cancer Treatment53:27 - Technical and Clinical Resectability56:13 - Case Study: Managing Multifocal Lung Cancer01:11:41 - Long-Term Outcomes and Treatment Strategies --- RESOURCES CALGB 140503 Trialhttps://www.nejm.org/doi/full/10.1056/NEJMoa2212083 JCOG0802 Trialhttps://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)02333-3/abstract

A negative angiogram in a patient with recurrent lower GI bleeding often calls for provocative angiography. In this episode of the BackTable Podcast, IR hosts Mike Barraza and Sabeen Dhand team up to talk tools, techniques, and tPA dosing for safe and effective treatment of lower GI bleeds with provocative mesenteric angiography.---This podcast is supported by:RADPAD® Radiation Protectionhttps://www.radpad.com/---SYNPOSISDr. Dhand describes the utility of provocative angiography in recurrent lower GI bleed patients with negative CTA and angiography, addressing common myths and concerns that may contribute to its underutilization. The conversation covers detailed procedure steps for both targeted and untargeted angiography, including access sites, dosing of tPA, and angiographic technique. Dr. Dhand emphasizes the importance of gradual increases in tPA dosage in 2 mg increments, and clear communication with care teams and the patient about the nature of the procedure. He also emphasizes the effectiveness and safety of this procedure by sharing real-world cases.---TIMESTAMPS00:00 - Introduction02:04 - Provocative Angiography for Lower GI Bleeds04:09 - Detailed Protocol for Provocative Angiography11:13 - Technical Details and Best Practices20:07 - Challenges in GI Bleeding Studies22:40 - Selective Embolization Techniques27:44 - Handling Negative Angiograms32:56 - Real-World Case Studies35:15 - Final Thoughts---RESOURCESThiry et al. Provocative Mesenteric Angiography: Outcomes and Standardized Protocol for Management of Recurrent Lower Gastrointestinal Hemorrhagehttps://pubmed.ncbi.nlm.nih.gov/34506023/

Why might simultaneous ablation and biopsy be the new standard for high-probability lung cancer cases where surgery isn't an option? In the penultimate episode of the 2025 NSCLC Creator Weekend™ series, our multidisciplinary tumor board panel discusses the intricacies and decision-making processes surrounding biopsy and ablation procedures in thoracic oncology. --- This podcast is supported by an educational grant from Johnson & Johnson and Varian. --- SYNPOSIS Topics include the prioritization of treatment versus tissue acquisition, the nuances of bronchoscopic versus percutaneous biopsies, and the latest advancements in robotic and cryo-biopsy techniques. The experts also share their approaches to managing pneumothorax, the value of multidisciplinary collaboration, and case studies that highlight personalized patient care. Listeners gain valuable insights into the evolving landscape of thoracic oncology procedures and the importance of patient-centered decision-making. --- TIMESTAMPS 00:00 - Introduction04:12 - Cryobiopy vs. Non-Cryobiopsy08:43 - Biopsy and Ablation: Strategies and Considerations15:31 - Post-Therapy Imaging and Follow-Up25:18 - Treatment Options and Patient Decisions27:08 - Evaluating Ablation Techniques28:59 - Managing Lung Cancer Recurrence39:41 - Case Study: Young Male with Ground Glass Nodule43:15 - Concluding Thoughts

What considerations drive your decision between bland embolization, TACE, and radioembolization in managing neuroendocrine tumors? In this BackTable episode, Dr. Daniel DePietro, interventional radiologist at the University of Pennsylvania joins host Dr. Kavi Krishnasamy for an in-depth discussion on the interventional management of neuroendocrine tumors. --- SYNPOSIS The physicians start by discussing the intricacies of primary and metastatic neuroendocrine tumors, focusing on how treatment decisions are shaped by factors such as symptom burden, extent of disease requiring debulking, and symptom progression despite systemic therapy. Dr. DePietro shares insights from his clinical experience and emphasizes the critical role of interdisciplinary collaboration in optimizing patient outcomes. Dr. DePietro then shares his approach to using Y90 radioembolization in patients with biliary contraindications to TACE or bland embolization—such as those with prior Whipple surgery, sphincterotomy, or biliary stents—where the risk of hepatic abscess with ischemia-based therapies is higher. He also notes that patients who derive less than a year of benefit from prior TACE or bland embolization may be good candidates for radioembolization. The conversation also covers the role of thermal ablation in select patients with solitary lesions, and also touches on several key trials, including the ongoing CapTemY90 study. --- 00:00 - Introduction02:09 - Specialization in Neuroendocrine Tumors06:32 - Patient Selection and Treatment Criteria10:40 - Grading and Treatment of Neuroendocrine Tumors16:09 - Systemic Therapy Options22:22 - Rebiopsy and Its Importance28:01 - Technical Aspects of Local Regional Therapies39:14 - Radioembolization: When and How43:33 - Segmentectomy and Multimodal Approaches45:22 - CapTemY90 Trial and Promising Results49:52 - Hormone Release During Local Regional Therapies53:12 - Combining Radioembolization with PRT56:12 - Thermal Ablation in Neuroendocrine Tumor Patients58:06 - Follow-Up Imaging and Tumor Markers01:02:40 - Updates from Nanets Conference01:05:08 - Collaborating Across Specialties01:07:56 - Managing High Tumor Burden Patients01:13:59 - Treating Carcinoid Heart Disease01:19:37 - Closing Remarks and Acknowledgments --- RESOURCES NETTER-1 Trialhttps://www.nejm.org/doi/full/10.1056/NEJMoa1607427 REMINET Trialhttps://ascopubs.org/doi/10.1200/JCO.2016.34.15_suppl.TPS4148 CapTemY90 Trialhttps://www.clinicaltrials.gov/study/NCT04339036#contacts-and-locations

The ultimate challenge of operating an OBL is staying profitable. In this episode of BackTable, we bring on healthcare administrator Laurie Bouzarelos and interventional radiologist Dr. Mary Costantino to talk through the intricacies of revenue cycle management as an IR managing an OBL. --- SYNPOSIS The conversation covers the full lifecycle of getting paid in an IR practice, from initial patient contact through final claim resolution. Key topics include credentialing, determining medical necessity, coordination of benefits, prior authorizations, and the importance of working with billing and practice management teams experienced in interventional radiology. The episode also examines how EHR and practice management platform selection impacts clinical workflows and reimbursement, and closes with a discussion on payment plans and how emerging technologies, including AI, may shape the future of revenue management in IR-led OBLs. --- TIMESTAMPS 00:00 - Introduction 01:08 - The Importance of Revenue Cycle Management09:29 - The No Surprises Act and Data Transparency12:03 - Professional Societies and Continuing Education17:50 - Credentialing and Taxonomy Codes40:28 - Impact of Insurance Credentialing on Patient Care42:08 - Revenue Cycle Management Walkthrough48:18 - Challenges with Medicare Advantage and Coordination of Benefits54:20 - Covered vs. Non-Covered Services59:03 - Medical Necessity and Insurance Policies01:01:04 - Prior Authorization and Payment Issues01:13:11 - Payment Plans and Compliance01:23:10 - Practice Management Software01:31:10 - AI in Healthcare and Compliance01:38:57 - Final Thoughts --- RESOURCES Medical Group Management Administration (MGMA)https://www.mgma.com/

OpenEvidence was founded in 2022. In just 3 short years, it has become a household name amongst aspiring and established healthcare providers. AI-based tools are now being used to augment workflows, improve productivity, streamline busy work, and assist with clinical decision making. Is AI coming for our jobs? Time will tell. But in the meantime, you can (and probably should) use it to enhance yours. In this episode of BackTable, computer scientist and interventional radiologist Dr. Emil Cohen joins Dr. Chris Beck to share how he's integrated AI tools into his IR practice. --- SYNPOSIS Dr. Cohen and Dr. Beck discuss both the advantages and key limitations of AI resources and tools like OpenEvidence and ChatGPT. They also explore application of AI in daily workflows, structured reports, procedural guidance, and predicting outcomes. Dr. Cohen dives into integrating AI to solve clinical problems and enhance existing technology, such as maskless subtraction angiography and rotational cone beam CT. Finally, Dr. Cohen speaks on the claim of AI replacing interventional radiology, informing those that are nervous about artificial intelligence. --- TIMESTAMPS 00:00 - Introduction05:09 - Computer Science and Medicine09:37 - AI Fundamentals for IRs17:59 - Practical Applications of AI in IR28:14 - The Value and Risks of Patient Data31:22 - Developing Advanced Imaging Techniques34:16 - Maskless Subtraction Angiography40:29 - AI in Clinical Problem Solving45:55 - The Future of AI in IR49:51 - Getting Involved with AI and Volunteering53:01 - Final Thoughts and Resources --- RESOURCES No Mask Subtraction with AI:https://www.smartangio.com/bone_subtraction/

Collaboration between interventional radiology and radiation oncology has enabled high-dose brachytherapy in central lung lesions that were previously untreatable. This episode of the 2025 NSCLC Creator Weekend™ series offers a deep dive into recent advancements in lung ablation and brachytherapy techniques for primary lung cancer. --- This podcast is supported by an educational grant from Johnson & Johnson and Varian. --- SYNPOSIS Key discussion points include ablation zone sizes, confirmation methods for effective treatment, and the integration of different modalities such as microwave and cryoablation. Our tumor board panel also explores the practical and logistic challenges of implementing high-dose brachytherapy, especially for central lesions, and its role in palliative care. Despite the intricate processes and potential complications like pneumothorax, these methods show promising local control rates and provide crucial options for non-operative candidates. --- TIMESTAMPS 00:00 - Introduction and Overview of Lung Ablation07:01 - Microwave Ablation and Ground Glass Attenuation17:53 - Artificial Pneumothorax Techniques27:09 - Technical Aspects and Innovations32:35 - Bronchial Brachytherapy Techniques37:47 - Conclusion and Credits --- RESOURCES 2021 Central Lesion Studyhttps://pmc.ncbi.nlm.nih.gov/articles/PMC8186067/

How is genicular artery embolization reshaping our clinical approach to patients with chronic knee pain? Dr. Rachel Piechowiak and Dr. Faraz Khan, interventional radiologists at IR Centers join Dr. Don Garbett in a deep dive into the current state of Genicular Artery Embolization (GAE). --- This podcast is supported by an educational grant from Varian. --- SYNPOSIS Dr. Piechowiak and Dr. Khan provide a deep dive on the technical nuances of GAE, covering patient selection, access strategies, and key procedural techniques. The conversation also details complex case scenarios and how to tailor catheters and embolics to navigate challenging anatomy. The doctors then share their structured approach to post-procedure follow-up, underscoring the importance of setting realistic treatment expectations with patients. The episode closes with their perspective on the future of genicular artery embolization, emphasizing the need for robust long-term outcomes data to better define the role of GAE in chronic knee pain management. --- TIMESTAMPS 00:00 - Introduction05:54 - Patient Workup for GAE10:42 - Setting Patient Expectations for GAE16:24 - Procedure Approaches and Techniques30:41 - Understanding Artery Targeting Strategies34:56 - Approaches to Microcatheter Selection38:18 - Choosing the Right Embolic Agents47:43 - Managing Complications and Follow-Ups51:23 - Challenges with Post-TKA Patients54:16 - Future Directions

Why might the standard RECIST criteria fail to accurately track success after tumor ablation, and what should you look for instead? In the 4th installment of the 2025 NSCLC Creator Weekend™ series, hosts Drs. Scott Genshaft and Kavi Krishnasamy are joined by specialists from UCLA and USC to discuss and debate advanced treatment options for primary lung cancer. --- This podcast is supported by an educational grant from Johnson & Johnson and Varian. --- SYNPOSIS The panel, including interventional radiologists, pulmonologists, and a radiation oncologist, discusses the intricacies of photon versus proton therapies, the physics behind radiation treatment, and the evolving landscape of ablation technologies. The conversation covers the efficacy and limitations of different treatments, patient selection criteria, and the role of newer technologies like electroporation and robotic-assisted bronchoscopy in enhancing precision and outcomes. Additionally, the panel addresses the practical challenges of intraprocedural imaging, the importance of adequate margins, and the complexities of managing local recurrences and radiation-induced toxicities. --- TIMESTAMPS 00:00 - Tumor Ablation and Recurrence Rates12:53 - Advancements in Ablation Technologies23:31 - Bronchoscopic Approaches in Lung Cancer Treatment38:46 - Challenges in Radiation Dose and Delivery49:21 - Ablation and Radiation Margins01:07:19 - Final Thoughts --- RESOURCES Thierry de Baere Paper on Ablation Margins https://pmc.ncbi.nlm.nih.gov/articles/PMC9815739/

Pseudoaneurysms are among the most common complications of vascular access. Here's a refresher on how to treat them with thrombin injection featuring interventional radiologist Dr. Gabriel Werder from Radiology Associates of Florida. Alongside host Dr. Chris Beck, Dr. Werder outlines both the clinical and procedural approach to thrombin injection for pseudoaneurysms. --- SYNPOSIS This episode covers best practices for thrombin injection procedures, including preferred needle positioning techniques, sedation protocols, ultrasound evaluation, and follow-up care. The physicians discuss recent evidence supporting needle placement at the center of the sac from an inferior approach, and share specific cases that highlight the utility of balloon-assisted thrombin injections. Dr. Werder provides a detailed walkthrough of his technique, including contralateral femoral access, balloon oversizing, and preferences for a post-procedural run-off angiogram. The episode also touches on complex pseudoaneurysms with multiple sacs and learnings from several other unique cases. --- TIMESTAMPS 00:00 - Introduction03:53 - Thrombin Injection Procedural Overview08:14 - Procedure Setup and Execution16:13 - Needle Positioning and Ultrasound Evaluation18:47 - Handling Complex Pseudoaneurysms19:20 - Balloon Occlusion Thrombin Injection19:59 - Case Studies and Practical Insights26:21 - Post-Procedure Care and Follow-Up29:17 - Final Thoughts and Reflections --- RESOURCES Kim et al. “Optimal thrombin injection method for the treatment of femoral artery pseudoaneurysm” - https://www.jthjournal.org/article/S1538-7836(24)00048-5/fulltext

How do leading oncologists interpret the abundance of molecular tests, genomic data, and biomarkers to create a lung cancer patient's treatment plan? In this episode of the 2025 NSCLC Creator Weekend™ series, our tumor board discusses the complexities of lung cancer treatment, including new systemic therapies, lung cancer staging, and the role of molecular diagnostics and liquid biopsies. --- This podcast is supported by an educational grant from Johnson & Johnson and Varian. --- SYNPOSIS The panel, featuring specialists from various institutions, discusses the specifics of sequencing therapies, the impact of targeted and immunotherapies, and the nuances of treating different patient profiles, including non-smokers and those with specific genetic mutations. The conversation also touches on the integration of new staging systems, the benefits of multidisciplinary clinics, and the ongoing evolution of cancer treatment trials. The discussion aims to provide clarity on the latest advancements and future directions in managing lung cancer, emphasizing the importance of tailored treatment plans and the potential of emerging technologies. --- TIMESTAMPS 00:00 - Introduction05:16 - Molecular Diagnostics and Liquid Biopsy21:43 - Targeted Therapy Options27:29 - Managing Toxicities and Treatment Strategies33:13 - Challenges with Immunotherapy in Special Cases34:07 - Lung Transplantation in Cancer Patients48:38 - Multidisciplinary Clinics and Collaboration01:06:29 - Future Directions --- RESOURCES ADAURA Trialhttps://www.nejm.org/doi/full/10.1056/NEJMoa2027071 Gomez NSCLChttps://pmc.ncbi.nlm.nih.gov/articles/PMC5143183/

Are you up to date with the latest guidelines on deep venous thrombosis (DVT) management? Dr. Steven Abramowitz, vascular surgeon at MedStar Health, joins host Dr. Chris Beck for a deep dive into emerging clinical data in DVT management, where they review the evolving indications for mechanical thrombectomy and the implications of studies like the ATTRACT trial, the CLOUT registry, and the ongoing DEFIANCE trial. --- This podcast is supported by: Inari Medicalhttps://www.inarimedical.com/artix-system --- SYNPOSIS Dr. Abramowitz reviews recent data comparing outcomes of mechanical intervention versus lytic-based therapy, outlining how each approach fits into current practice. He underscores the critical role of IVUS in determining treatment endpoints, while noting the ongoing challenge of an absent standardized definition. The conversation also offers practical insights on procedural techniques and the evolving role of anticoagulation, emphasizing the importance of close collaboration and open communication with referring physicians. --- TIMESTAMPS 00:00 - Introduction00:45 - Overview of DVT Management02:50 - New Guidelines for DVT Treatment07:30 - Technical Endpoints in DVT Treatment13:26 - Clout Registry and Its Findings17:57 - Anticoagulation and DVT23:05 - Defining Acute DVT Management27:00 - Evolving Approaches to Acute DVT28:19 - Patient Experience and Quality of Life31:08 - Referring Providers and Data Impact37:01 - Single Session Treatments and Stenting41:07 - Chronic Venous Disease Management --- RESOURCES (ATTRACT) Weinberg I, Vedantham S, Salter A, et al. Relationships between the use of pharmacomechanical catheter-directed thrombolysis, sonographic findings, and clinical outcomes in patients with acute proximal DVT: Results from the ATTRACT Multicenter Randomized Trial. Vasc Med. 2019;24(5):442-451. doi:10.1177/1358863X19862043https://pubmed.ncbi.nlm.nih.gov/31354089/ (CLOUT) Shaikh A, Zybulewski A, Paulisin J, et al. Six-Month Outcomes of Mechanical Thrombectomy for Treating Deep Vein Thrombosis: Analysis from the 500-Patient CLOUT Registry. Cardiovasc Intervent Radiol. 2023;46(11):1571-1580. doi:10.1007/s00270-023-03509-8https://pubmed.ncbi.nlm.nih.gov/37580422/ (DEFIANCE) Abramowitz SD, Marko X, D'Souza D, et al. Rationale and design of the DEFIANCE study: A randomized controlled trial of mechanical thrombectomy versus anticoagulation alone for iliofemoral deep vein thrombosis. Am Heart J. 2025;281:92-102. doi:10.1016/j.ahj.2024.10.016https://pubmed.ncbi.nlm.nih.gov/39491572/