BackTable Podcast

As graduating residents step into the IR job market, the big question remains: What truly makes a great first job? Dr. Subhash Gutti hosts guest Dr. Kavi Devulapalli (Image Guided Solutions of Missouri) and Dr. Christopher Zarour (Huron Valley Radiology in Ann Arbor) as they share early career advice and job search strategies.---This podcast is supported by:RADPAD® Radiation Protectionhttps://www.radpad.com/---SYNPOSISThe doctors begin by highlighting different practice models and emphasize the significance of knowing what type of IR you are - an imager, a surgeon, or dynamic blend of both. They share their personal experiences navigating their early careers and underscore the pivotal role of establishing a robust clinical practice and taking full ownership of the patient. They also explore strategies for practice growth, including availability and network referrals. The episode ends with valuable advice on navigating the early stages of one's career, drawn from personal experiences.---TIMESTAMPS00:00 - Introduction01:16 - Early Career Advice and Job Search04:50 - Exploring the Job Market09:46 - What Makes a Good First Job?14:33 - Challenges in the First Job28:27 - Strategies for Building a Clinical Practice36:56 - Understanding the Business Side of Medicine48:49 - Final Advice for New Graduates

To TIPS or not to TIPS? More than ever, younger patients are presenting with acute portal vein thrombosis (PVT) that requires intervention beyond anticoagulation alone. These patients need safe, effective options that offer long-term resolution and a good quality of life after treatment. In this episode of the BackTable Podcast, Dr. Benjamin May, Interventional Radiologist at Weill Cornell Medicine, discusses the evolving treatment landscape for acute PVT.---SYNPOSISDr. May shares insights into the changing interventional approaches, highlights the utility of tools such as suction thrombectomy devices, and explains how his best practices have developed over time. He emphasizes the continued importance of anticoagulation therapy, explores the potential complications and outcomes of various interventions, and discusses how thrombus location and characteristics influence his clinical decisions. With real-world scenarios and a step-by-step walkthrough of his decision-making process, Dr. May offers a comprehensive look at modern strategies for managing acute portal vein thrombosis.---TIMESTAMPS00:00 - Introduction 05:46 - Diagnosing Portal Vein Thrombosis10:52 - Management Options for Acute PVT and What is Safest?21:09 - Choosing an Intervention Approach26:19 - Tackling Large Bore Thrombectomy32:37 - Learnings and Tips for Successful Thrombectomy39:50 - Impact of Thrombus Location on Intervention Approach 45:01 - Post-Care and Follow-Up49:46 - Final Thoughts and Encouragement---RESOURCES“Transjugular Intrahepatic Portosystemic Shunt and Thrombectomy (TIPS-Thrombectomy) for Symptomatic Acute Noncirrhotic Portal Vein Thrombosis” (Shalvoy, 2023)https://www.jvir.org/article/S1051-0443(23)00341-X/abstract

En este episodio de BackTable, la radióloga intervencionista Dra. Sara Lojo Lendoiro y la Dra. Gloria Salazar discuten los desafíos y las barreras para diagnosticar y tratar el dolor pélvico crónico y las varices pélvicas en mujeres.---SYNPOSISPrimero, abordan la ausencia de diagnóstico y el estereotipo que estigmatiza a las mujeres con problemas psiquiátricos. Dra. Salazar comparte su trayectoria personal desde Brasil hasta su posición de profesora asociada de radiología en la University of North Carolina, y su trabajo centrado en mejorar la salud de la mujer. También se habla sobre la necesidad de colaboración multidisciplinar, la investigación futura para entender mejor la fisiopatología, y cómo la educación y una mayor conciencia pueden mejorar el diagnóstico y tratamiento de estas patologías. Además, destacan la importancia de considerar el impacto económico y social de no tratar adecuadamente estas condiciones en mujeres activas y trabajadoras.---TIMESTAMPS00:00 - Presentación de la Dra. Gloria Salazar 06:25 - Desafíos en el Diagnóstico de la Salud de la Mujer 08:08 - Comprendiendo las Varices Pélvicas y el Dolor Pélvico Crónico 22:23 - Técnicas de Diagnóstico y Desafíos 36:19 - Evaluación del Dolor Pélvico y los Síntomas en las Piernas 41:46 - Variaciones Anatómicas y Técnicas de Diagnóstico 50:40 - La Importancia de los Equipos Multidisciplinarios 58:59 - Direcciones Futuras en la Investigación de las Venas Pélvicas 01:09:50 - Reflexiones Finales y Colaboraciones Futuras

Is it time for interventional radiology to sever ties with diagnostic radiology and define its own future? Dr. Ally Baheti hosts Dr. Mark Lessne, interventional radiologist at Charlotte Radiology and Dr. Saher Sabri, Chief of Interventional Radiology at MedStar Health, to discuss the evolving relationship between interventional radiology (IR) and diagnostic radiology (DR). --- SYNPOSISThe doctors begin the discussion by asking a critical question: 'What defines an interventional radiologist?' They delve into the different practice patterns of IRs, exploring both the opportunities and challenges in interventional radiology forging its own path, independent of diagnostic radiology. The doctors share their thoughts on the financial implications, sustainability of the specialty, and the importance of establishing a clinical and longitudinal practice. The discussion concludes with the notion that an organic separation is likely inevitable, although the timing remains uncertain. --- TIMESTAMPS 00:00 - Introduction03:45 - Challenges in IR Practice12:23 - Financial Models and Sustainability16:13 - The Role of SIR in Supporting IRs34:29 - Defining IR Standards35:28 - SIR's Role38:29 - Future of IR and DR58:36 - Final Thoughts and Call to Action

There are now multiple phase 3 studies on combination transarterial chemoembolization (TACE) and immunotherapy showing a significant benefit over TACE alone. How do these findings change the hepatocellular carcinoma (HCC) treatment algorithm? In this multidisciplinary episode of the BackTable Podcast, Dr. Richard Finn (Medical Oncologist at UCLA) and Dr. Julius Chapiro (Interventional Radiologist at Yale University) join host Dr. Chris Beck to discuss immunotherapy, TACE, emerging trends in HCC treatment, and the future of the field.---This podcast is supported by an educational grant from Guerbet.---SYNPOSISThe doctors highlight the importance of high quality clinical data and the pivotal studies shaping current best practices. They explore the role of the different players on the multidisciplinary team and compare the oncologic and radiologic perspectives. Additionally, they discuss the synergy between TACE and immunotherapy, the criteria for selecting appropriate treatments, and the ongoing need for research and collaboration.---TIMESTAMPS00:00 - Introduction 03:35 - HCC from an Oncologic Perspective 05:33 - Radiological Perspective on Liver Cancer06:50 - Referral Patterns and Organizing a Multidisciplinary Approach18:01 - Explaining TACE and Variations in the Procedure27:27 - Choosing the Right Procedure for HCC36:13 - Making a Decision on Medical Treatment Candidacy 42:23 - Importance of Data Driven HCC Treatment, Practical Insights, and Studies to Know55:30 - Planning an Approach for a TACE Procedure01:02:26 - Final Thoughts and Future Prospects in Liver Cancer Treatment---RESOURCESBarcelona Staging System:https://www.ncbi.nlm.nih.gov/books/NBK569796/table/Ch3-t0001/TRACE Trial:https://pubs.rsna.org/doi/full/10.1148/radiol.211806PREMIERE Trial:https://www.gastrojournal.org/article/S0016-5085(16)34971-X/fulltextEMERALD-1 Trial:https://ascopubs.org/doi/10.1200/JCO.2024.42.3_suppl.LBA432LEAP O12 Study:https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)02575-3/abstract

What is the secret sauce in running an efficient OBL? Dr. Mary Constantino, medical director of Advanced Vascular Centers, joins host Dr. Ali Behati to share some of the key ingredients in keeping it lean in OBL. --- SYNPOSIS The doctors delve into strategies in running a cost-effective OBL while upholding clinical excellence. Dr. Constantino shares her personal insights and experiences in minimizing unnecessary costs while maintaining regulatory compliance, high-performing team, and outstanding patient care. She also underscores the importance of having a clear leadership vision and remaining at the forefront of patient care to proactively identify challenges and develop effective solutions to address them. Lastly, she shares her thoughts on navigating the challenges of balancing personal and professional responsibilities in the growing field of outpatient vascular care. --- TIMESTAMPS 00:00 Introduction 01:46 Expanding Practices and Partnerships 06:24 Navigating Regulatory Requirements 12:26 Building a Lean and Valuable Team 35:01 Leadership 39:54 Opportunity Cost in Practice Management 44:32 Employee Growth and Retention Strategies 46:49 Building and Maintaining a Successful Practice 01:06:54 The Financial Wheel and Its Impact on Small Businesses

This week we bring together urologists and radiologists to work towards a shared goal of innovating on kidney cancer care. Dr. Jason Abel, Professor of Urology and Radiology at the University of Wisconsin, and Dr. Louis Hinshaw, Section Chief of Abdominal Imaging Intervention at the University of Wisconsin, join our host Dr. Ruchika Talwar for a multidisciplinary conversation regarding the treatment of renal tumors. --- SYNPOSIS Their discussion covers the history and benefits of collaboration between urology and interventional radiology (IR), advances in image-guided procedural technologies, and the importance of teamwork in improving patient outcomes. The episode also considers the encouraging, but limited data in IR treatments such as microwave ablation and discusses the lasting role for surgery. Finally, Dr. Abel and Dr. Hinshaw share their experiences in establishing a successful interdisciplinary kidney cancer program. Ultimately, they conclude that the future of renal tumor treatment lies not in silos, but in collaboration. --- TIMESTAMPS 00:00 - Introduction 04:04 - Collaboration Between Urologists and Interventional Radiologists 05:58 - Advancements in Ablation 10:05 - Patient Selection 15:19 - Technical Considerations 26:57 - Post-Ablation Surveillance and Recurrence Management 33:19 - Conclusion

Who is the ultimate candidate for GAE, which technical approach is best, and how do you set your patients up for success? Tune into this week's episode of BackTable to hear from interventional radiologists Dr. Osman Ahmed (University of Chicago Medicine) and Dr. Siddharth Padia (UCLA Health) as they discuss everything from patient selection to follow-up care, covering pre-procedure imaging, access, embolics, technical challenges, clinical data, and the future of genicular artery embolization. --- SYNPOSIS Dr. Ahmed and Dr. Padia debate their approaches to patient selection criteria, the use of MRI and cone beam CT, permanent vs. resorbable embolic materials, how many arteries to embolize, and the relevance of pain metrics post GAE. They also delve into follow-up considerations and the potential for GAE as a long term treatment. --- TIMESTAMPS 00:00 Introduction 01:08 MRI for Patient Selection in GAE 08:53 Access Techniques: Femoral vs. Pedal 17:07 Cone Beam CT in GAE Procedures 27:20 Embolization Strategies 39:30 Challenges and Complications in Embolization 44:50 Follow-Up and Pain Metrics in Clinical Practice and Research 01:06:30 Repeat GAE Procedures: When and Why? 01:11:13 Post-Total Knee Replacement and GAE 01:21:01 Advice for IRs Looking to do GAE 01:24:32 Conclusion and Final Thoughts --- RESOURCES GENESIS Trial: https://pubmed.ncbi.nlm.nih.gov/33474601/ Landers et al Trial: https://pubmed.ncbi.nlm.nih.gov/37051829/

Are you thinking about pursuing a new diagnostic radiology gig? Get the download on the current job market, how to evaluate different compensation models, and what to look out for when considering your next job offer in this week's episode of BackTable, featuring guests Dr. Ned Holman (Neuroradiologist at Alaska Imaging) and Dr. Mike Romeo (Radiologist and President of West Reading Radiology). --- SYNPOSIS The doctors begin by exploring various employment models, including private practice, academic positions, and hybrid arrangements that combine elements of both. They share valuable insights on job transparency and the significance of leveraging professional connections to gain honest, firsthand perspectives on potential employers. They also provide advice on key questions to ask during job interviews and strategies for negotiating contracts. The doctors conclude by sharing tips to help make informed decisions to ensure job satisfaction and professional growth. --- TIMESTAMPS 00:00 - Introduction 04:30 - Employment Models 06:32 - Compensation Structures 08:43 - Evaluating Job Offers 19:05 - Red Flags in Employment 27:13 - Private Equity Jobs: Pros and Cons 31:36 - Navigating Job Boards and Resources 42:03 - Final Advice for Job Seekers

The road towards financial literacy and financial freedom does not need to be a solo, do-it-yourself, figure it out as it goes type of journey. Guest Dr. Jim Dahle (practicing emergency medicine physician and Founder of the White Coat Investor) joins host Dr. Chris Beck to help better illuminate the process of becoming financially literate and securing financial freedom for physicians and others in similar professional arenas. --- This podcast is supported by: RADPAD® Radiation Protection https://www.radpad.com/ --- SYNPOSIS Dr. Dahle begins the episode by driving home how sound and solid financial education coupled with early, prudent financial behaviors can be worth millions over a career. The doctors discuss writing investment plans, goal setting, and understanding of asset allocation to ensure long-term financial success. Dr. Dahle also delves into the Mega Backdoor Roth IRA, practical tips for handling savings and expenses, as well as how to integrate real estate into your investment portfolio. The episode concludes with helpful resources, programs, and conferences available through the White Coat Investor. --- TIMESTAMPS 00:00 - Introduction 04:30 - Savings Tips and Strategies 13:22 - Retirement Goals and Savings Targets 28:20 - Real Estate as an Investment 32:30 - Mega Backdoor Roth IRA 42:59 - Advice for New High-Income Earners 46:09 - Teaching Financial Literacy to Kids 48:15 - Addressing Physician Burnout 53:53 - Common Financial Mistakes by Doctors 58:11 - White Coat Investor Book Giveaway Program --- RESOURCES White Coat Investor: https://www.whitecoatinvestor.com BackTable VI Episode #194 - Financial Basics from the White Coat Investor with Dr. James Dahle: https://www.backtable.com/shows/vi/podcasts/194/financial-basics-from-the-white-coat-investor White Coat Investor Champions Program (For Students): https://www.whitecoatinvestor.com/wci-champions/

Navigating the intricate world of medical billing can be challenging, and knowing the steps needed to ensure fair reimbursement can be even more challenging. Guests Dr. Bret Wiechmann and Dr. Jerry Niedzwiecki (private practice interventional radiologists) join host Dr. Ally Baheti to discuss how IRs in the OBL setting can legislatively rally behind the office-based facility concept and improve physician reimbursement in the light of developments addressed at the recent OEIS meeting. --- SYNPOSIS Dr. Wiechmann and Dr. Niedzwiecki begin the episode by defining several key-terms and processes in physician reimbursement in the outpatient setting to help orient us to the issue at hand. After explaining why and how reimbursement for more advanced procedures in the OBL setting has been lagging behind, the doctors introduce the concept of creating an office-based facility concept. This would help stabilize payments for complex procedures done in the OBL space. The episode concludes with emphasis on more physician involvement and advocacy in pushing reform forward, underscoring how a unified effort is essential for long-lasting, meaningful change. --- TIMESTAMPS 00:00 - Introduction 01:42 - Medicare Physician Fee Schedule 05:46 - Challenges with Current Reimbursement Models 11:28 - Proposing the Office-Based Facility Concept 17:58 - Legislative Efforts and Congressional Involvement 26:53 - Call to Action: How You Can Help 36:40 - Conclusion --- RESOURCES Outpatient Endovascular and Interventional Society: https://oeisweb.com

What are the 10 Commandments of Being a Female Interventional Radiologist? Guest Dr. Maureen Kohi (Chair of Radiology at University of North Carolina Chapel Hill) sits down with host Dr. Ally Baheti to discuss the details of her popular lecture topic and how these 10 rules are actually applicable to all current and future interventional radiologists. --- SYNPOSIS Dr. Kohi begins by going through each of the 10 points - offering detailed advice throughout, while also acknowledging nuances and challenges women and men can encounter in medicine and best approaches. Dr. Kohi also speaks on how to build and navigate strong relationships with industry. The episode concludes with several more pearls of wisdom as Dr. Kohi shares the last of the 10 commandments. --- TIMESTAMPS 00:00 - Introduction 01:08 - 10 Commandments of Being a Female IR 23:06 - Importance of Involvement in Professional Societies 24:46 - Childcare Concerns in Professional Settings 28:58 - Making the Leadership Leap 35:24 - Navigating Gender Bias in Professional Environments 41:51 - Prioritizing Health, Family, and Personal Fulfillment --- RESOURCES From Good to Great (Book): https://a.co/d/gXWW1Qp Start With Why (Book): https://a.co/d/hgaadIt

In honor of the 50th annual meeting of the Society of Interventional Radiology (SIR) in Nashville, let's take it back to the beginning of IR and review how the field became what it is today. Guest host Dr. Andrew Niekamp (interventional radiologist at Miami Vascular) sits down with esteemed guest Dr. Barry Katzen, who began his training at the advent of IR, to discuss the origins and development of the field since its inception. --- This podcast is supported by: RADPAD® Radiation Protection https://www.radpad.com/ --- SYNPOSIS The doctors discuss challenges and innovations that shaped IR's growth, and the importance of clinical practice and patient-centered care. Dr. Katzen shares insights from his extensive career, including his early involvement in advancing image-guided therapies, his role in founding Miami Cardiac & Vascular Institute, and strategies to overcome turf-wars and complacency in medicine. Dr. Katzen emphasizes the need for continuous innovation and dedication towards improving patient outcomes in the evolving landscape of IR. The episode concludes with Dr. Katzen's advice for future and early-career IRs. --- TIMESTAMPS 00:00 - Introduction 03:39 - Early Innovations and Training in Europe 09:08 - Founding the Miami Cardiac and Vascular Institute 17:13 - Challenges and Innovations 25:24 - Importance of Clinical Responsibility 34:07 - Birth of a Specialty 40:35 - Advice for Future Interventional Radiologists 43:29 - Conclusion

Is social media an effective patient acquisition tool for interventional radiologists? In a word: absolutely. Learn how to reach more patients in this week's BackTable Podcast, where Dr. Gustavo Elias joins Dr. Ally Baheti to discuss the benefits he has seen with social media, and the content strategies that he uses in his medical practice. --- SYNPOSIS The episode begins with Dr. Elias sharing his journey of overcoming initial reservations around posting content. The doctors emphasize the importance of individuality and passion in showing what IR can offer to the public in easily-digestible ways. Dr. Elias then discusses the impact of social media on patient engagement, and shares practical tips for physicians who are looking to enhance their online presence. Dr. Elias also touches on optimal posting schedules, collaboration tips, and balancing professionalism with approachability. --- TIMESTAMPS 00:00 - Introduction 04:02 - Social Media for Interventional Radiologists 08:56 - Building a Social Media Presence 19:24 - Optimal Posting Strategies 21:58 - Collaborations and Platforms 25:27 - Conclusion

Let's talk liver ablations. This week's episode of the BackTable Podcast provides a thorough review of modern microwave ablation methods, tools, and tech, featuring Dr. Asad Baig (interventional radiologist at Columbia University) and host Dr. Michael Barraza. --- This podcast is supported by an educational grant from Medtronic . --- SYNPOSIS Dr. Baig shares practical advice on how to become a key contributor at your tumor board and how to position your skillset as an interventional radiologist. He talks through his microwave ablation procedure technique, highlighting the role of ablation zone visualization software. The doctors go on to discuss a variety of ablation approaches, needle placement, intra- and post-operative imaging, and tips for dealing with challenging tumor locations. The episode concludes with Dr. Baig summarizing best practices for ensuring safe and effective ablations, and underscoring the importance of solid patient-physician communication throughout care. --- TIMESTAMPS 00:00 - Introduction 08:28 - Microwave Ablation Techniques 12:54 - Collaborative Approach in Tumor Boards 23:30 - Combined Ablation Cases and Techniques 36:12 - Challenging Liver Ablations 45:56 - Tips for Safe and Effective Ablations 50:07 - Balancing Biopsy and Ablation 01:00:34 - Conclusion --- RESOURCES The Emprint™ Ablation System with Thermosphere™ Technology: One of the Newer Next-Generation Microwave Ablation Technologies: https://pmc.ncbi.nlm.nih.gov/articles/PMC4640908/ Comparison of microwave ablation and surgical resection for treatment of hepatocellular carcinomas conforming to Milan criteria: https://pubmed.ncbi.nlm.nih.gov/24628534/ Percutaneous microwave ablation of hepatic lesions near the heart: https://pubmed.ncbi.nlm.nih.gov/34805581/ Microwave Ablation of Hepatic Tumors Abutting the Diaphragm Is Safe and Effective: https://ajronline.org/doi/10.2214/AJR.14.12879

Targeted, image-guided interventions can make a big difference for patients with hereditary hemorrhagic telangiectasia (HHT). Learn how in this week's BackTable episode featuring Dr. Clifford R. Weiss (Director of the Johns Hopkins Vascular Anomalies Center and HHT Center of Excellence) and host Dr. Michael Barraza. --- SYNPOSIS Dr. Weiss delves into the complexities and multisystem nature of HHT, emphasizing the significance of early diagnosis and multidisciplinary care. He goes on to explain the clinical criteria for diagnosing HHT, the role of genetic and imaging screenings, and the evolving approaches to treating pulmonary arteriovenous malformations (AVMs) in adults and children. The doctors discuss the potential impact of anti-angiogenic medications on the future management of HHT. The episode closes with a nod to the pivotal role that HHT Centers of Excellence play, and the ongoing dedication to improving patient outcomes through collaborative care and innovative research. --- TIMESTAMPS 00:00 - Introduction 03:57 - Diagnosing and Screening for Hereditary Hemorrhagic Telangiectasia (HHT) 07:37 - Treatment Approaches for HHT 12:12 - Embolization Techniques and Safety Measures 19:02 - Future of HHT Treatment and Research 22:30 - Conclusion and Final Thoughts --- RESOURCES The Johns Hopkins Hereditary Hemorrhagic Telangiectasia (HHT) Center of Excellence: https://www.hopkinsmedicine.org/interventional-radiology/hht

Teleradiology, artificial intelligence, and private equity takeovers—how do we navigate these rapid changes in the radiology landscape? In this episode, our co-hosts Dr. Ally Baheti and Dr. Mike Barraza bring Dr. Ben White back to the show to provide an update on the current radiology job market and share his insights on reclaiming value for the profession. Dr. White begins by reflecting on the changes since his last appearance with us in 2022, focusing primarily on the ongoing shortage of radiologists, which has lasted longer than anticipated during the pandemic, and the explosion of teleradiology. --- SYNPOSIS Today's radiologists are more mobile than ever, with remote work options and the appeal of sensationalized job postings. Dr. White also discusses the instability of more established practices, particularly when legacy partners depart after fulfilling their contractual obligations. In response, many practices are refinancing their debt, which has led to a decrease in practice acquisitions. Dr. White believes that large-scale healthcare operations often result in increased inefficiency and reduced agility. The downstream effects include the commoditization of teleradiologists, concerns about decreased quality of reads, a limited scope of practice for procedures, reduced access to imaging for smaller hospitals, longer wait times, and more unstable locum staffing. The doctors also speculate about the future division of radiology into different service tiers, depending on the level of access each hospital has to radiologists. Finally, Dr. White highlights his Independent Radiology job board, which lists open positions from physician-owned practices. His goal in creating the website is to address the pain points of other job advertisement sites, where misleading postings are common. He wants radiologists to consider joining a team of physicians, rather than simply accepting a job. His advice to all radiologists is to expect uncertainty in the job market and to remain flexible. --- TIMESTAMPS 00:00 - Current Radiology Job Market 07:43 - Updates on Private Equity in Radiology 16:26 - Role of Artificial Intelligence 22:46 - Growing Imaging Volume and Efficiency 26:51 - Challenges in Radiology Staffing 36:49 - Independent Radiology Job Board 50:07 - Future of Radiology and Final Thoughts --- RESOURCES BackTable VI Ep. 277- Private Equity and the Radiology Job Environment with Dr. Ben White: https://www.backtable.com/shows/vi/podcasts/277/private-equity-the-radiology-job-environment Independent Radiology Job Board: https://www.independentradiology.com/

Do you ever wish you could be a fly on the wall at a tumor board meeting? In this episode of BackTable, we're excited to give you an insider's view of the real case discussions that take place during hepatocellular carcinoma (HCC) tumor boards. Host Dr. Zach Berman sits down with a multidisciplinary team, including Drs. Adam Burgoyne (medical oncologist), Heather Patton (hepatologist), Siddharth Padia (interventional radiologist), and Gabriel Schnickel (transplant and hepatobiliary surgeon). Physicians, nurses, nurse practitioners, and physician assistants can follow this link to earn CME / CE credits for completing an accredited learning activity related to this discussion: https://www.cmeuniversity.com/course/take/125743 --- This podcast is supported by an educational grant from AstraZeneca Pharmaceuticals and Boston Scientific. --- SYNPOSIS The team walks through a range of diverse HCC cases, reviewing patient histories, imaging, and treatment options. They cover eight cases in total, each featuring patients with varying treatment histories, comorbidities, liver function, and lesion characteristics. For the full educational experience, we recommend watching the video format on our YouTube channel. --- TIMESTAMPS 00:00 - Introduction 00:47 - Case 1: Small Lesion in a Young Patient 05:01 - Case 2: Moderate Sized Lesion in an Older Patient 11:10 - Case 3: Multifocal HCC with Dominant Lesion 21:09 - Case 4: Dominant Lesion with Portal Hypertension 32:08 - Case 5: Ruptured Solitary Lesion 34:34 - Case 6: Rupture with Multifocal Lesions 44:08 - Case 7: Portal Vein Invasion 52:12 - Case 8: Metastatic HCC After Transplant --- RESOURCES CME Accreditation Information: https://f7cae4ec-b69e-490d-9e0f-19b16a6f146d.usrfiles.com/ugd/f7cae4_a7c37ea3cd1b4d3fa53d5edf8dfe255b.pdf

Medical, surgical, radiation, and interventional oncology all play vital roles in delivering care to patients battling liver cancer. How do we optimize outcomes when so many specialties have something to offer the same patient? The answer is collaborative oncology. Dr. Robert Martin (Director of Surgical Oncology, University of Louisville) and pioneer in liver-directed therapies, joins host Dr. Sabeen Dhand to discuss a collaborative approach to oncology and recent advances in locoregional therapy. --- This podcast is supported by: RADPAD® Radiation Protection https://www.radpad.com/ --- SYNPOSIS Dr. Martin discusses the importance of a growth mindset in advancing medical techniques and fostering collaborations between specialists. He then shares insights into minimally invasive procedures, such as microwave ablation and irreversible electroporation (IRE). The doctors also touch on the evolution of liver cancer treatments, emphasizing the significance of clinical trials on the horizon. To conclude, Dr. Martin encourages young professionals in surgery and interventional radiology to stay open-minded, be life-long learners, and find synergistic ways to integrate new technologies into patient care. --- TIMESTAMPS 00:00 - Introduction 02:31 - Dr. Martin's Background and Career Path 06:18 - Evolution of Liver Directed Therapies 10:12 - Collaboration Between Specialties 18:34 - Clinical Trials and Emerging Therapies 36:08 - Advice for Young Professionals 39:15 - Conclusion --- RESOURCES Radioembolization Oncology Trial Utilizing Transarterial Eye90 (ROUTE 90) for the Treatment of HCC: https://clinicaltrials.gov/study/NCT05953337?term=NCT05953337&rank=1 Intratumoral Injection of IP-001 Following Thermal Ablation in Patients With CRC, NSCLC, and STS (INJECTABL-1): https://clinicaltrials.gov/study/NCT05688280 Immunophotonics, CIRSE, and Next Research Announce Innovative Phase 2/3 Clinical Trial: INJECTABL-3: https://immunophotonics.com/news/immunophotonics-cirse-and-next-research-announce-innovative-phase-2-3-clinical-trial-injectabl-3/

Are you seeking to build your reputation and patient base within interventional oncology? In this episode, host Dr. Zachary Berman interviews Dr. Siddarth Padia, Dr. Tyler Sandow, Dr. Kavi Krishnasamy, and Dr. Kevin Burns about their journeys into interventional oncology (IO) and their experiences providing care in different practice settings. Physicians, nurses, nurse practitioners, and physician assistants can follow this link to earn CME / CE credits for completing an accredited learning activity related to this discussion: https://www.cmeuniversity.com/course/take/125742 --- This podcast is supported by an educational grant from AstraZeneca Pharmaceuticals and Boston Scientific. --- SYNPOSIS The doctors begin by discussing how they became interested in interventional oncology, with most of them recognizing opportunities to address unmet needs in the field. Each guest shares insights on the timelines and challenges involved in starting their IO practices, which vary significantly today. For instance, telehealth clinics are particularly viable in private practice IO, thanks to conferencing software and virtual translators. Hybrid care models, which combine in-person and remote consultations, can help overcome patient-level barriers such as time and transportation. The panel also emphasizes how increased clinic availability can significantly drive growth in procedural volume. Finally, they offer advice for starting an IO practice, including the importance of having clinic support staff, building strong relationships with referring physicians, and staying up to date with new technologies. --- TIMESTAMPS 00:00 - Introduction 05:38 - Balancing Career Interests and Expectations 07:10 - Building an Interventional Oncology Practice 13:42 - Gaining Trust from Referring Physicians 17:33 - Importance of Open Communication 19:19 - Comparing Clinic Settings 26:01 - Essential Components of a Clinic 33:28 - Narrowing Your Interventional Practice 40:09 - Introducing New Technology --- RESOURCES CME Accreditation Information: https://f7cae4ec-b69e-490d-9e0f-19b16a6f146d.usrfiles.com/ugd/f7cae4_a7c37ea3cd1b4d3fa53d5edf8dfe255b.pdf

Is there a way to treat liver metastasis secondary to uveal melanoma without introducing systemic, treatment-related toxicity? Dr. Altan Ahmed (interventional radiologist at Moffitt Cancer Center) and Dr. Sid Padia (interventional radiologist at UCLA) join guest-host Dr. Kavi Krishnasamy to discuss HEPZATO, a novel device-based treatment for liver metastases from uveal melanoma. --- This podcast is supported by: RADPAD® Radiation Protection https://www.radpad.com/ --- SYNPOSIS Dr. Ahmed and Dr. Padia begin by exploring the design and setup of the HEPZATO clinical trials, while also speaking on patient selection criteria. The doctors then talk through the technical aspects of the intervention. After covering workflow and considerations related to procedure timing and coordination, the doctors go on to discuss drug dosing and optimizing treatment cycles. The episode concludes with current gaps in literature, current and future research aims, and potential future applications of the HEPZATO modality in treating other malignancies such as colorectal cancer. --- TIMESTAMPS 00:00 - Introduction 05:40 - Patient Selection Criteria 09:49 - Workflow 19:17 - Procedure Timing and Coordination 29:39 - Challenges and Considerations in Drug Dosing 32:39 - Optimizing Treatment Cycles and Patient Response 37:56 - Managing Post-Treatment and Adverse Effects 43:43 - Future Research and Gaps in Current Interventions 50:45 - Exploring New Applications for PHP Therapy 55:02 - Conclusion --- RESOURCES Hepzato: https://hepzatokit.com/ FOCUS Trial - Efficacy and Safety of the Melphalan/Hepatic Delivery System in Patients with Unresectable Metastatic Uveal Melanoma: Results from an Open-Label, Single-Arm, Multicenter Phase 3 Study: https://pubmed.ncbi.nlm.nih.gov/38704501/ FOCUS phase 3 trial results: Percutaneous hepatic perfusion (PHP) with melphalan for patients with ocular melanoma liver metastases (PHP-OCM-301/301A): https://ascopubs.org/doi/pdf/10.1200/JCO.2022.40.16_suppl.9510 Combining Melphalan Percutaneous Hepatic Perfusion with Ipilimumab Plus Nivolumab in Advanced Uveal Melanoma: First Safety and Efficacy Data from the Phase Ib Part of the Chopin Trial: https://pubmed.ncbi.nlm.nih.gov/36624292/ Troponin Elevation in Patients Undergoing Percutaneous Hepatic Perfusion for Metastatic Uveal Melanoma: https://pmc.ncbi.nlm.nih.gov/articles/PMC11010739/ Percutaneous Hepatic Perfusion with Melphalan in Patients with Unresectable Ocular Melanoma Metastases Confined to the Liver: A Prospective Phase II Study: https://pmc.ncbi.nlm.nih.gov/articles/PMC7801354/ Southampton group - Quality of life after melphalan percutaneous hepatic perfusion for patients with metastatic uveal melanoma: https://pmc.ncbi.nlm.nih.gov/articles/PMC10906212/ Leiden group - Quality of Life Analysis of Patients Treated with Percutaneous Hepatic Perfusion for Uveal Melanoma Liver Metastases: https://pubmed.ncbi.nlm.nih.gov/38587534/

Is surgery truly the "cure" for hepatocellular carcinoma (HCC), and when is it a viable option? In this episode, Dr. Sabeen Dhand leads a roundtable discussion with interventional radiologist Dr. Siddharth Padia and transplant/hepatobiliary surgeons Dr. John Seal and Dr. Gabriel Schnickel, delving into the complexities of surgical treatments for HCC and the evolving landscape of liver resection and transplantation. Physicians, nurses, nurse practitioners, and physician assistants can follow this link to earn CME / CE credits for completing an accredited learning activity related to this discussion: https://www.cmeuniversity.com/course/take/125741 --- This podcast is supported by an educational grant from AstraZeneca Pharmaceuticals and Boston Scientific. --- SYNPOSIS The doctors begin by discussing how they manage patient expectations regarding both palliative and curative treatments, highlighting the risk of recurrent HCC as a new lesion. They then outline key factors that influence their recommendations for liver transplant versus resection, such as the extent of underlying liver disease, the function of the future liver remnant, body habitus, overall health, and organ availability. The surgeons also review various surgical approaches to liver resection and recent advancements in liver transplantation, including living donor transplants and the ability to refer patients for downstaging procedures. Dr. Padia explains the original role of Y90 as a bridging treatment to downstage tumors and promote hypertrophy in the non-diseased liver segments, preparing the organ for surgical resection. However, Y90 treatment can also lead to the formation of adhesions, which may complicate future surgeries. Finally, the doctors discuss strategies to improve care coordination between community physicians and transplant centers to optimize patient outcomes. --- TIMESTAMPS 00:00 - Curative vs. Palliative Treatment 04:03 - Choosing Between Transplantation and Resection 05:47 - Liver Resection Types 07:27 - Bridging Role of Y90 12:14 - Evolving Landscape of Liver Transplantation 20:59 - Patient Counseling in Minimally Invasive Procedures 28:40 - Considerations for Surgery After Y90 33:32 - Coordination Between Specialists 40:08 - Immunotherapy as a Bridge to Transplant --- RESOURCES CME Accreditation Information: https://f7cae4ec-b69e-490d-9e0f-19b16a6f146d.usrfiles.com/ugd/f7cae4_a7c37ea3cd1b4d3fa53d5edf8dfe255b.pdf

Musculoskeletal embolization is generating significant excitement in the field of chronic pain management. In this episode, Dr. Jacob Fleming hosts a discussion with Dr. Yuji Okuno from Japan, a pioneer in both basic science and clinical practice within the field of musculoskeletal embolization. --- This podcast is supported by: Medtronic MVP https://www.medtronic.com/mvp --- SYNPOSIS The conversation delves into Dr. Okuno's groundbreaking work using embolization to treat chronic pain from conditions such as frozen shoulder, knee osteoarthritis, plantar fasciitis, and various sports injuries. Dr. Okuno discusses the development of new temporary embolic agents and compares different approaches to embolization treatments, including the innovative use of antibiotics as embolic material. The doctors also cover the intriguing concept of differential recanalization, where abnormal inflammatory vessels are less likely to recanalize than normal vessels after embolic treatment. Identifying hypervascularity through MRI, ultrasound, or angiogram is a crucial step before attempting embolization. Overall, Dr. Okuno offers valuable insights into his clinical practice and the potential for groundbreaking advancements in musculoskeletal care worldwide. --- TIMESTAMPS 00:00 - Introduction 01:54 - Origins of Embolization for Pain 04:15 - Basic Science Research Discoveries and Clinical Trials 09:02 - Temporary Embolic Materials 15:28 - Techniques for Embolization 17:33 - Plantar Fasciitis Treatment 24:04 - Future of Embolization in Sports Injuries 28:11 - Diagnostic Imaging in Embolization 36:10 - Global Expansion and Collaborations

The process of liver transplantation involves many complexities, and each patient's path to transplant is unique. To offer insider perspectives on this process, Dr. Zachary Berman sits down with transplant and hepatobiliary surgeon Dr. John Seal, as well as transplant hepatologists Dr. Heather Patton and Dr. Steve Young. Physicians, nurses, nurse practitioners, and physician assistants can follow this link to earn CME / CE credits for completing an accredited learning activity related to this discussion: https://www.cmeuniversity.com/course/take/125740 --- This podcast is supported by an educational grant from AstraZeneca Pharmaceuticals and Boston Scientific. --- SYNPOSIS The panel begins by discussing the multidisciplinary pre-transplant evaluation process, which assesses factors such as liver function, comorbidities, surgical risk, and the availability of psychosocial support. Once a patient is listed for transplant, they enter a system that prioritizes those with the highest Model for End-Stage Liver Disease (MELD) score. During the waiting period, several comorbidities should be carefully monitored. Dr. Seal explores the impact of portal vein hypertension and portal vein thrombosis, explaining how these conditions may necessitate intraoperative thrombectomy or bypass. Dr. Patton and Dr. Young focus on considerations for using anticoagulation in patients with a high baseline bleeding risk and selecting the appropriate anticoagulant for patients listed for transplant. For patients with hepatocellular carcinoma (HCC), eligibility for MELD exception points may depend on factors such as time spent on the waiting list, adherence to the Milan criteria, and the presence of extrahepatic complications of liver disease. The panel also discusses bridging therapies to transplant, including Y90 and TACE. In the peri-transplant phase, they highlight innovations such as living donor transplants, liver perfusion pumps, and the use of hepatitis C- and HIV-positive organs. Finally, the discussion turns to post-transplant considerations, including surgical complications, organ rejection, immunosuppression, predictors of HCC recurrence, and long-term surveillance. --- TIMESTAMPS 00:00 - Introduction 01:16 - Current Landscape of Liver Transplantation 03:22 - Transplant Evaluation Process 09:48 - Timeline from Listing to Transplantion 11:16 - Treating Portal Vein Thrombosis and Hypertension 18:44 - MELD Exception Points 22:05 - Bridging Therapies 25:34 - Peri-Transplant Considerations 30:53 - Post-Transplant Period 37:39 - Repeat Transplantation --- RESOURCES Model for end-stage liver disease (MELD) and allocation of donor livers (Wiesner et al, 2003): https://www.gastrojournal.org/article/S0016-5085%2803%2950022-1/fulltext Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis- Milan Criteria (Mazzaferro et al, 1996): https://pubmed.ncbi.nlm.nih.gov/8594428/ Validation of the prognostic power of the RETREAT score for hepatocellular carcinoma recurrence using the UNOS database (Mehta et al, 2019): https://pmc.ncbi.nlm.nih.gov/articles/PMC6445634/ CME Accreditation Information: https://f7cae4ec-b69e-490d-9e0f-19b16a6f146d.usrfiles.com/ugd/f7cae4_a7c37ea3cd1b4d3fa53d5edf8dfe255b.pdf

Do we finally have definitive data on the efficacy of prostate artery embolization (PAE)? Dr. Shivank Bhatia (interventional radiologist at University of Miami) joins host Dr. Michael Barraza to discuss the findings from his prospective 1,075 patient study on the long-term outcomes of PAE, the largest longitudinal, single-center, single-operator, prospective study in the United States. --- This podcast is supported by: RADPAD® Radiation Protection https://www.radpad.com/ Medtronic MVP https://www.medtronic.com/mvp --- SYNPOSIS Dr. Bhatia begins by sharing his early years of training, and the steps he took to become an expert in all things PAE. He also covers how he helped build the PAE program at University of Miami, sharing several pearls for young IRs and trainees that are interested in bringing new service lines to their institutions. Dr. Bhatia then talks through the details of the study that he spearheaded, and encourages everyone to tune in - physicians and patients alike. --- TIMESTAMPS 00:00 - Introduction 05:12 - Building a PAE Program 18:55 - PAE Procedure Technicalities 22:30 - Post-Procedure Meds and Care 25:13 - Study Details and Patient Demographics 27:36 - Procedure Time and Technical Success 28:32 - Safety and Efficacy of PAE 38:06 - PSA Levels and Prostate Cancer 40:42 - Urinary Retention and Treatment Prioritization 45:17 - Re-Intervention Rates and Medication Independence --- RESOURCES Pisco et al (2011) - Prostatic arterial embolization to treat benign prostatic hyperplasia: https://pubmed.ncbi.nlm.nih.gov/21195898/ Bhatia et al (2024) - Prostatic Artery Embolization: Mid- to Long-Term Outcomes in 1,075 Patients: https://pubmed.ncbi.nlm.nih.gov/39532156/

Treatment of hepatocellular carcinoma (HCC), like that of many other cancers, spans a spectrum from curative to palliative intent. To explore the "grey zone" of treatment goals for intermediate-stage HCC patients, Dr. Sabeen Dhand interviews a panel of experts in the field: medical oncologists Dr. Adam Burgoyne and Dr. Lingling Du, along with interventional radiologists Dr. Kirema Garcia-Reyes and Dr. Zachary Berman. Physicians, nurses, nurse practitioners, and physician assistants can follow this link to earn CME / CE credits for completing an accredited learning activity related to this discussion: https://www.cmeuniversity.com/course/take/125739 --- This podcast is supported by an educational grant from AstraZeneca Pharmaceuticals and Boston Scientific. --- SYNPOSIS The discussion begins with an explanation of the Barcelona-Clinic Liver Cancer (BCLC) staging system. While this system takes into account helpful factors such as liver function, performance status, and tumor burden, it fails to fully capture the true heterogeneity of the HCC patient population. Additional considerations include tumor biology, response to previous treatments, and the location of metastases. The specialists then share their experiences in treating patients with comorbid gastrointestinal cancers and mixed tumors, discuss the benefits of an interventional oncology clinic setting, and highlight virtual opportunities for connecting with tumor boards. They also offer advice on patient education regarding treatment options. --- TIMESTAMPS 00:00 - Introduction to BCLC Staging 03:02 - Impact of Performance Status 06:29 - Predictors of Survival in HCC 09:51 - Palliative versus Curative Treatment Intent 13:55 - Comorbid and Mixed Gastrointestinal Cancers 16:51 - Adverse Effects of Treatment 20:37 - Interventional Oncology in the Clinic Setting 23:06 - Navigating Multiple Provider Viewpoints 28:01 - Complex Case Examples --- RESOURCES BCLC strategy for prognosis prediction and treatment recommendation: The 2022 update (Reig et al, 2022): https://www.journal-of-hepatology.eu/article/S0168-8278(21)02223-6/fulltext CME Accreditation Information: https://f7cae4ec-b69e-490d-9e0f-19b16a6f146d.usrfiles.com/ugd/f7cae4_a7c37ea3cd1b4d3fa53d5edf8dfe255b.pdf

Given the challenges that our dialysis patients face, how can we as providers stay sharp with the latest access techniques to help ensure the best possible outcomes? Dr. Omar Davis (interventional nephrologist) and Dr. Ari Kramer (general surgeon) join host Dr. Chris Beck to discuss advanced approaches to AV access and share their experiences with the FLEX Vessel Prep device. --- This podcast is supported by: VentureMed FLEX Vessel Prep https://www.venturemedgroup.com/ --- SYNPOSIS The doctors begin by describing how they create dialysis access and what they account for during the procedure. They then focus on the role of the FLEX VP system, its benefits, and how they use it in practice, touching on the latest clinical data. Dr. Kramer and Dr. Davis also stress the importance of mental health in dialysis care and share ways that we can better support our patients through difficult diagnoses and treatments. In fact, one of their patients, Fred Hill, authored the book “Dialysis Is Not Your Life,” which offers a unique perspective for patients feeling overburdened by dialysis, and the healthcare providers who treat them. The episode concludes with case presentations and practical guidance on when to use the FLEX Vessel Prep system. --- TIMESTAMPS 00:00 - Introduction 07:00 - AV Access and Procedures 10:58 - Case Walkthrough 14:19 - Balloon Angioplasty and IVUS 24:43 - Flex VP Device and Vessel Prep 35:03 - Algorithm and Reimbursement Challenges 39:51 - Device Usage and Techniques 46:58 - Clinical Data and Outcomes 01:01:59 - Case Studies --- RESOURCES Fred Hill, “Dialysis Is Not Your Life” Founder and Author: https://www.dialysisisnotyourlife.com/meet-founder.php “Dialysis Is Not Your Life” Book: https://www.amazon.com/DIALYSIS-NOT-YOUR-LIFE-Redefine/dp/B09L4XGGNX Novel Device Prior to Balloon Angioplasty for Dysfunctional Arteriovenous Access: Analysis of a Real-World Registry by Race and Sex Cohorts: https://www.openaccessjournals.com/articles/novel-device-prior-to-balloon-angioplasty-for-dysfunctional-arteriovenousaccess-analysis-of-a-realworld-registry-by-race-and-sex-16852.html FLEX Vessel Prep 12 Month AV Registry Data and 12 Month Belong PAD Data Shows Benefit to Micro-incisions Before Balloon or DCB Treatment: https://www.venturemedgroup.com/wp-content/uploads/2022/12/VEITH-Data-FINAL.pdf Angioplasty with novel, easy-to-use, bladed Flex Vessel Prep system “could replace standard of care”: https://www.youtube.com/watch?v=iRpkrURx1mc Surgical AVF Articles Atlas Condensed - sAVF Overview - Creation Maturation and Difficulties: https://docs.google.com/document/d/1f26FT65s03oZjjeZhBVy8auz0h8PTNvX3CWU5Xi_H5c/edit?usp=share_link Surgical AVF Articles Asif A, Early Arteriovenous fistula failure: https://drive.google.com/file/d/1zZEWgxsdBM4MKCQFjw0U04ra_hB9Ey_N/view?usp=share_link Surgical AVF Articles Asif A - Best Vascular Access in the Elderly - Time for Innovation: https://drive.google.com/file/d/1IpH-KnZyfN5Rqm_kxLnERnEJD6vcjAO8/view?usp=sharing Surgical AVF Articles EV Today - Managing Cephalic Arch Stenosis: https://drive.google.com/file/d/17yVd2M706YCtX-xTK6teesgZqzVIgUoN/view?usp=share_link VentureMed 2024 FLEX Vessel Prep System Reimbursement Guide: https://www.venturemedgroup.com/wp-content/uploads/2024/04/MMA-CTO-15690_FlexVesselPrepSystem-BillingGuide_Lv6-003.pdf BackTable VI Podcast Episode #139 - AV Fistula & Graft Maintenance with Dr. Ari Kramer: https://www.backtable.com/shows/vi/podcasts/139/av-fistula-graft-maintenance BackTable VI Podcast Episode #292 - Dialysis Interventions with Drug-Coated Balloons, Covered Stents and More with Dr. Ari Kramer: https://www.backtable.com/shows/vi/podcasts/292/dialysis-interventions-with-drug-coated-balloons-covered-stents-more

For hepatocellular carcinoma (HCC) patients who are not candidates for liver transplant or resection, lesion ablation can be a curative treatment. With multiple ablation options available and still under investigation, it can be challenging to navigate the differences between them. In this episode, Dr. Tyler Sandow hosts a discussion with interventional radiologists Dr. Kirema Garcia-Reyes, Dr. Sabeen Dhand, and Dr. Kevin Burns on the various ablation options for HCC and when to use each one. Physicians, nurses, nurse practitioners, and physician assistants can follow this link to earn CME / CE credits for completing an accredited learning activity related to this discussion: https://www.cmeuniversity.com/course/take/125738" --- This podcast is supported by an educational grant from: AstraZeneca https://www.astrazeneca.com/our-therapy-areas/oncology.html With additional support from: Boston Scientific https://www.bostonscientific.com/en-US/medical-specialties/interventional-radiology/interventional-oncology.html --- SYNPOSIS The doctors first discuss Barcelona-Clinic Liver Cancer (BCLC) Stage A patients, where lesion size and location are key factors in deciding between ablation and transarterial therapies. They then compare cryoablation and microwave ablation, highlighting that cryoablation offers better visualization and control of the ablation zone, while microwave ablation is more effective for treating larger lesions. Dr. Burns introduces histotripsy, a noninvasive treatment that uses ultrasound energy to mechanically ablate tumors. He shares his experiences as an early adopter of this technology and discusses how intraoperative cone beam CT can help treat lesions located near critical structures or those poorly visualized on ultrasound. Finally, Dr. Garcia-Reyes and Dr. Berman provide insights into patient selection, pre-procedural imaging, and technical tips for Y90. --- TIMESTAMPS 00:00 - Introduction 02:04 - Ablation vs Y90 in BCLC A Patients 05:58 - Same-Day Y90 15:55 - Y90 for Large Tumors 17:51 - Ideal Cases for Cryoablation 19:38 - Explanation of Histotripsy 32:09 - Procedural Specifics for Histotripsy 38:21 - Technical Tips for Y90 --- RESOURCES Including the Hollow Viscera (Stomach or Bowel) within the Ice Ball during Cryoablation: A Review of Adverse Events (Abramyan et al, 2024): https://www.jvir.org/article/S1051-0443(24)00681-X/abstract

When deep sedation is required, it can be challenging to implement due to the difficulty of scheduling dedicated anesthesia coverage in the IR suite. Dr. Amy Deipolyi (interventional radiologist and Division Chief at Charleston Area Medical Center, WY) joins host Dr. Ally Baheti to explain an alternative approach to deep sedation through the use of ketamine. --- This podcast is supported by: Medtronic Abre Stent https://www.medtronic.com/en-us/healthcare-professionals/products/cardiovascular/deep-venous-stents/abre-venous-self-expanding-stent-system.html --- SYNPOSIS Dr. Deipolyi begins by sharing how she built a dedicated, academic IR program at a level 1 trauma center in West Virginia. The doctors then discuss the advantages of ketamine for deep sedation in the IR suite, and how Dr. Deipolyi gained administrative approval and implemented the change to achieve an alternative approach to deep sedation for interventional procedures. The discussion also includes how ketamine compares to traditional agents such as fentanyl and Versed. The episode concludes with Dr. Deipolyi's practical advice to fellow IR's interested in providing their patients deep sedation via ketamine and her ongoing and future research and outreach efforts. --- TIMESTAMPS 00:00 - Introduction 02:04 - Dr. Deipolyi's Practice 14:32 - Overcoming Hurdles and Gaining Support 20:12 - Application and Patient Experiences 26:01 - Future of Deep Sedation in IR 28:55 - Conclusion

In the past five years, the use of immunotherapeutic agents for advanced cancers has emerged as a promising alternative to tyrosine kinase inhibitors and chemotherapy, making it an exciting time to be practicing oncology. In this episode, Dr. Tyler Sandow interviews oncology experts about the landscape of advanced hepatocellular carcinoma (HCC) and the current state of immunotherapy treatments. He is joined by medical oncologists Dr. Jonathan Mizrah, Dr. Lingling Du, and Dr. Adam Burgoyne, as well as interventional oncologist Dr. Zachary Berman. Physicians, nurses, nurse practitioners, and physician assistants can follow this link to earn CME / CE credits for completing an accredited learning activity related to this discussion: https://www.cmeuniversity.com/course/take/125737 --- This podcast is supported by an educational grant from: AstraZeneca https://www.astrazeneca.com/our-therapy-areas/oncology.html With additional support from: Boston Scientific https://www.bostonscientific.com/en-US/medical-specialties/interventional-radiology/interventional-oncology.html --- SYNPOSIS Drs. Burgoyne and Mizrahi provide a primer on immunotherapy and explain how they communicate the principles of this treatment to their patients. Dr. Du discusses the Imbrave clinical trial and how recent studies have shown improved overall survival when immunotherapeutic agents are used, especially when multiple agents targeting various pathways are employed. When choosing between different regimens, the doctors consider factors such as the patient's underlying liver function, symptom burden, and prior treatments. Importantly, the doctors also discuss contraindications to immunotherapy, including a history of organ transplant, autoimmune disease, and poor performance status—all of which put patients at high risk for deterioration with this treatment. The treatment of patients with poor liver function remains controversial, as underlying cirrhosis may prevent the recovery of liver function. Dr. Berman outlines recent clinical trials studying the effects of transarterial chemoembolization (TACE) combined with immunotherapy. Finally, the doctors discuss the future of HCC treatment and the benefits of continued innovation in both interventional and medical oncology. --- TIMESTAMPS 00:00 - Introduction to Immunotherapy 04:32 - Notable Clinical Trials 13:39 - HCC Etiology and Immunotherapy Outcomes 18:43 - Contraindications for Immunotherapy 23:05 - Adverse Effects from Treatment 25:14 - Combination Therapy 36:22 - Considerations for Immunotherapy Dosing 40:26 - The Future of HCC Treatment --- RESOURCES Atezolizumab plus Bevacizumab in Unresectable Hepatocellular Carcinoma, IMbrave150 Trial (Finn et al, 2020): https://pubmed.ncbi.nlm.nih.gov/32402160/ Tremelimumab plus Durvalumab in Unresectable Hepatocellular Carcinoma, HIMALAYA Trial (Abou-Alfa et al, 2022): https://evidence.nejm.org/doi/full/10.1056/EVIDoa2100070 Nivolumab versus sorafenib in advanced hepatocellular carcinoma (CheckMate 459): a randomised, multicentre, open-label, phase 3 trial (Yau, 2022): https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(21)00604-5/abstract Nivolumab (NIVO) plus ipilimumab (IPI) vs lenvatinib (LEN) or sorafenib (SOR) as first-line treatment for unresectable hepatocellular carcinoma (uHCC): First results from CheckMate 9DW (Galle, 2024): https://ascopubs.org/doi/10.1200/JCO.2024.42.17_suppl.LBA4008 Randomized Phase 3 LEAP-012 Study: Transarterial Chemoembolization With or Without Lenvatinib Plus Pembrolizumab for Intermediate-Stage Hepatocellular Carcinoma Not Amenable to Curative Treatment (Llovet, 2022): https://pubmed.ncbi.nlm.nih.gov/35119481/ Find this episode on BackTable.com for more resources.

Proximity to innovation often gives rise to further innovation. This trend is especially true in interventional radiology. Dr. Gregg Alzate (interventional radiologist in San Diego, California) joins host Dr. Ally Baheti to share his career pearls for early and mid-career IRs, and how he came to pioneer the Alzate Retrograde Antegrade Maneuver (A-RAM). --- This podcast is supported by: Reflow Medical https://www.reflowmedical.com/ --- SYNPOSIS Dr. Alzate starts by sharing his early influences, including his time with interventional radiology giant Dr. Harold Coons. The doctors also cover the importance of proper vessel access techniques, innovative approaches to limb salvage, and how to address complex chronic total occlusions (CTOs). Dr. Alzate then goes on to give us a thorough walkthrough of the A-RAM. The episode concludes with Dr. Alzate's closing thoughts on being open to adopt new techniques, the impact of strong mentorship, and importance for consuming and sharing knowledge. --- TIMESTAMPS 00:00 - Introduction 03:05 - Dr. Alzate's Journey 25:52 - A-RAM Technique 34:26 - CTO's and Heavy Calcium 40:16 - Moral Injury in Medical Practice 43:35 - Honoring Dr. Harold Coons 46:23 - Closing Thoughts and Reflections --- RESOURCES Ohki, Takao et al. “Long-term results of the Japanese multicenter Viabahn trial of heparin bonded endovascular stent grafts for long and complex lesions in the superficial femoral artery.” Journal of vascular surgery vol. 74,6 (2021): 1958-1967.e2. https://www.jvascsurg.org/article/S0741-5214(21)01011-9/fulltext Kedora, John et al. “Randomized comparison of percutaneous Viabahn stent grafts vs prosthetic femoral-popliteal bypass in the treatment of superficial femoral arterial occlusive disease.” Journal of vascular surgeryvol. 45,1 (2007): 10-6; discussion 16. https://www.jvascsurg.org/article/S0741-5214(06)01612-0/fulltext

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

Robot-assisted technology has revolutionized surgical fields such as general surgery and urology—could interventional radiology be the next frontier? In this episode of the BackTable podcast, host Dr. Jacob Fleming explores the transformative potential of robotic-assisted percutaneous biopsies and ablations with experts Dr. Govindarajan “Raj” Narayanan from the Miami Cancer Institute and Dr. Sean Tutton from UC San Diego. --- This podcast is supported by: Quantum Surgical https://www.quantumsurgical.com/ --- SYNPOSIS Dr. Narayanan begins by sharing his initial interest in robotic applications for tumor ablations, aiming to maximize efficiency in his practice. Dr. Tutton then highlights the advantages of robotics for probe placement, especially in challenging cases. The two doctors discuss the logistics of the robotic system, including setup, imaging, and access choices. They also reflect on the learning curve associated with robotics and how it gradually enhances procedural efficiency while reducing mental fatigue. This improvement allows them to take on more complex cases with confidence. Overall, both experts agree that robotics has the potential to democratize minimally invasive procedures, offering new opportunities for skill development and advancement within the field of interventional radiology. --- TIMESTAMPS 00:00 - Introduction to the Podcast 03:30 - Developing an Interest in Robotics 10:44 - Integration of Robotics in the Procedural Suite 13:27 - Logistics of Robot System 18:38 - Planning for Percutaneous Access 22:39 - Future Implications of Robotics on Training Programs 35:51 - Efficiency and Volume Management with Robotics 40:39 - Learning Curves for Robotic Procedures 48:09 - Conclusion and Final Thoughts --- RESOURCES Quantum Surgical Epione Robot: https://www.quantumsurgical.com/epione/ ACCLAIM Trial: https://www.sio-central.org/ACCLAIM-Trial

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

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

Interventional radiology is unique in the way that much of what an IR's practice looks like is extremely contingent upon their practice setting following training - whether it be community, academic, private, or hybrid. Dr. Mark Wilson joins host Dr. Donald Garbett to discuss his own journey of transitioning from a large, physician owned group to forming his own private IR practice in Spokane, Washington following a major hospital contract shift. --- This podcast is supported by: Medtronic IN.PACT 018 DCB https://www.medtronic.com/018 --- SYNPOSIS Dr. Wilson shares the emotional impact of the career shift, and the technical aspects of how he was able to succeed following the change, and the details that went into creating his own private IR-only group and securing contracts with local hospitals. The doctors also spend time on the financial dynamics between DR and IR, as well as the true dollar value and impact IR brings to hospitals. The episode concludes with Dr. Wilson's practical and thorough guide on how one can go about starting up their own IR-only private practice. --- TIMESTAMPS 00:00 - Introduction 03:02 - Forming a New IR Group 04:43 - Impact of Practice Changes 11:02 - IR's Value to Hospitals 30:49 - Independent IR Practice Set-Up 36:38 - Conclusion --- RESOURCES Karage, 2024. Attrition Rates in Interventional Radiology Integrated Residency Programs: https://pubmed.ncbi.nlm.nih.gov/39586539/

It might be time to rethink your liver biopsy technique. Transfemoral transcaval core-needle liver biopsy has demonstrated key advantages over the transjugular approach and has become increasingly popular in recent years. Interventional radiologists Dr. Jacob Cynamon and Dr. Kapil Wattamwar join host Dr. Sabeen Dhand to discuss the inception and advantages of their novel approach. --- This podcast is supported by: Reflow Medical https://www.reflowmedical.com/ --- SYNPOSIS The doctors start with how they began using the transfemoral transcaval approach, along with the literature they published following adoption of this novel technique shortly thereafter. Dr. Cynamon and Dr. Wattamwar then go on to discuss the technique in detail, providing a thorough step-by-step and pausing to mention key considerations. The episode concludes with the doctors emphasizing the safety and efficacy of the transfemoral transcaval approach, citing specific findings and sharing exemplary cases. --- TIMESTAMPS 00:00 - Introduction 05:47 - Percutaneous vs. Transvenous Biopsies 08:56 - Evolution of Transfemoral Biopsies 12:41 - Comparing Transjugular and Transfemoral Approaches 24:52 - Pre-Procedural Imaging and Sheath Selection 29:23 - Complications and Case Studies 35:46 - Transcaval Biopsy Technique 45:00 - Conclusion --- RESOURCES Cynamon, 2016. Transfemoral Transcaval Core-Needle Liver Biopsy: An Alternative to Transjugular Liver Biopsy: https://pubmed.ncbi.nlm.nih.gov/26723528/ Wattamar, 2020. Transjugular versus Transfemoral Transcaval Liver Biopsy: A Single-Center Experience in 500 Cases: https://pubmed.ncbi.nlm.nih.gov/32798119/ Wattamar, 2022. The Use of the Transfemoral Transcaval Liver Biopsy Technique for Biopsies of Hepatic Masses: https://pubmed.ncbi.nlm.nih.gov/36182256/ Wattamar, 2022. Transcaval Creation of a Portal Vein Target for Transjugular Intrahepatic Portosystemic Shunt in a Patient with Portal Vein Thrombosis: https://pubmed.ncbi.nlm.nih.gov/34448032/

En este episodio de BackTable, la Dra. María Luisa Die Trill conversa con la Dra. Sara Lojo Lendoiro sobre la gestión emocional y la comunicación con los pacientes. --- SYNPOSIS Se explora la importancia de integrar el sufrimiento como parte de la vida, la necesidad de una formación adecuada en comunicación médico-paciente, y las estrategias para abordar complicaciones y situaciones complejas. Además, se analizan conceptos como la empatía, la escucha activa, y la introspección, para mejorar la relación con los pacientes y con el resto de compañeros del hospital. Finalmente, la Dra. Trill enfatiza la necesidad de centrarse en el bienestar del paciente y en manejar el estrés profesional para poder ofrecer un cuidado de calidad. --- TIMESTAMPS 00:00 - Bienvenida y Comprendiendo la Psicología Oncológica 05:06 Habilidades de Comunicación en la Práctica Médica 10:19 Técnicas Prácticas de Comunicación 22:10 La Importancia de Escuchar 28:18 La Insensibilidad en la Sociedad Moderna 30:49 La Importancia de la Salud Mental en los Profesionales 34:24 La Empatía y la Conexión con los Pacientes 36:22 El Manejo del Estrés en el Personal Sanitario 48:35 El Ego y la Dinámica de Grupo en los Hospitales 52:54 Conclusión y Reflexiones Finales

En este episodio del BackTable, Dr. José Andrés Guirola Ortíz, radiólogo intervencionista, aborda la embolización como tratamiento para las hemorroides, mediante la técnica Emborrhoid y comparte su valoración de la embolización como técnica de futuro. --- SYNPOSIS En primer lugar, la Dra. Sara Lojo Lendoiro le invita a explicar qué son las hemorroides y porqué y cuando hay que tratarlas. Además, el Dr. Guirola Ortíz analiza la historia de las hemorroides, sus síntomas y opciones de tratamiento. También se discuten las indicaciones, técnicas y posibles complicaciones de la embolización hemorroidal, así como el futuro de esta técnica dentro de la radiología intervencionista. --- TIMESTAMPS 00:00 - Introducción al BackTable y Dr. Ortíz 01:56 - Entendiendo las Hemorroides: Historia y Conceptos Básicos 03:39 - Síntomas y Causas de las Hemorroides 07:36 - Opciones de Tratamiento para las Hemorroides 12:50 - Explicación de la Técnica de Embolización 19:25 - Complicaciones y Seguimiento 29:05 - Futuro de la Embolización y Conclusión

For patients with early-stage cancer, minimally invasive image-guided therapies like cryoablation can be both life-altering and life-saving. Patient Clinton Lanier, a kidney cancer survivor who underwent multiple cryoablations, sits down with host Dr. Eric Keller to share his story and raise patient-provider awareness of the positive impacts IR brings. --- This podcast was developed in collaboration with: Interventional Initiative https://theii.org/ --- SYNPOSIS Clinton shares his personal story of being diagnosed with a kidney tumor during a sailing trip and discovering cryoablation as a treatment option through his own research and advocacy. He discusses the effectiveness and ease of the procedure, the positive impact it has had on his quality of life, and the importance of raising awareness about cryoablation among patients and healthcare providers. --- TIMESTAMPS 00:00 - Introduction 03:56 - First Cryoablation Experience 05:20 - Patient Experience 09:12 - Cryoablation Awareness 14:44 - Conclusion --- RESOURCES The Interventional Initiative: https://theii.org

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

500 episodes of BackTable calls for a special reunion! The original hosts—Dr. Aaron Fritts, Dr. Chris Beck, Dr. Ally Baheti, Dr. Sabeen Dhand, Dr. Mike Barraza, and producer Kieran Gannon—come together to celebrate by reminiscing about the podcast's origins and evolution. They discuss the challenges of improving the podcast, share funny behind-the-scenes moments, and highlight their favorite episodes. The team also offers insights into how they choose topics and reflects on their experiences with both virtual and in-person recordings. Finally, they introduce the new BackTable Studio and highlight the upcoming Creator Weekends. --- SYNPOSIS To our BackTable community, thank you for tuning in every week. We look forward to continuing to serve your vascular and interventional education needs! --- TIMESTAMPS 00:00 Introduction 01:43 The Origin Story of Backtable 06:42 From Our Side of the Microphone: Hosting Episodes 25:57 Choosing Topics and Guests 32:55 Introducing the New BackTable Studio 38:27 Favorite Episodes and Memorable Moments 44:02 The Story Behind the Backtable Theme Music 47:49 The Iconic Backtable Hoodies 51:03 Closing Thoughts and Gratitude --- RESOURCES BackTable Special 100th Episode Interview: https://www.backtable.com/shows/vi/podcasts/special/special-100th-episode-interview-with-backtable

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

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

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

Interested in setting up an Ambulatory Surgery Center (ASC) or Outpatient Based Lab (OBL)? Special guest Kristen Richards sits down with host Dr. Aaron Fritts to discuss the importance of establishing and tracking safety and quality metrics in the outpatient space to achieve success. Kristen is Vice President of Ambulatory Care at Cardiovascular Logistics in Chicago, IL. --- This podcast is supported by: Philips Image Guided Therapy Solutions https://www.usa.philips.com/healthcare/solutions/image-guided-therapy/all-products --- SYNPOSIS Kristen shares insights from her experience in the cardiovascular ambulatory space, highlighting the necessity of patient safety, efficient care, and the benefits of outpatient settings over hospital environments. Patient selection, infection control, staff and physician satisfaction, economic drivers, and the future outlook for cardiovascular procedures in ASCs are some of the key topics discussed. Kristen also emphasizes the need for continuous data tracking to demonstrate and improve the quality of care provided in these centers. --- TIMESTAMPS 00:00 - Introduction 06:25 - Benefits of Out-of-Hospital Care 17:47 - Financial Incentives and Ownership Models 18:17 - Technological Advancements and Cost Reduction 25:00 - Considerations for Opening an ASC 31:58 - Importance of Quality Metrics --- RESOURCES BackTable VI Podcast Episode #366 Navigating OBL & ASC Business: Pitfalls to Avoid with Teri Yates https://www.backtable.com/shows/vi/podcasts/366/navigating-obl-asc-business-pitfalls-to-avoid BackTable VI Podcast Episode #431 OBL or ASC for Your Private Practice? How to Decide with Teri Yates https://www.backtable.com/shows/vi/podcasts/431/obl-or-asc-for-your-private-practice-how-to-decide BackTable VI Podcast Episode #431 OBL or ASC for Your Private Practice? How to Decide with Teri Yates https://www.backtable.com/shows/vi/podcasts/486/winning-the-revenue-cycle-game Outpatient Endovascular and Interventional Society (OEIS) 2025 Conference: https://oeisweb.com/ Cardiovascular Business: https://cardiovascularbusiness.com/ SCAI: https://scai.org/

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

How do interventional oncologists fit into the bigger picture of multidisciplinary cancer care? Today we hear the patient's perspective from Lynn Lazzaro, a liver cancer survivor who underwent multiple interventional oncology procedures prior to liver resection and eventual transplant. Lynn sits down with host Dr. Eric Keller to discuss her journey from initial diagnosis to present day. --- This podcast was developed in collaboration with: Interventional Initiative https://theii.org/ --- SYNPOSIS Lynn provides insights on the importance of patient self-advocacy, seeking second opinions, and the benefits of a multidisciplinary approach when fighting cancer. Lynn encourages patients to be informed, ask questions, and connect with mentors, while also emphasizing the important duty physicians have in humanizing patient care. Her story highlights resilience, the value of teamwork among medical specialists, and the transformative potential of minimally invasive procedures. --- TIMESTAMPS 00:00 - Introduction 02:22 - Multidisciplinary Management 06:59 - Navigating TACE and Support Systems 13:39 - Surgical Interventions and Transplant Journey 19:09 - Reflections and Advice for Patients and Clinicians 26:13 - Conclusion --- RESOURCES The Interventional Initiative: https://theii.org/ The Cholangiocarcinoma Foundation: https://cholangiocarcinoma.org/

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