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For much of their education, physicians are encouraged to focus on developing clinical and procedural skills, with little formal training in business. For those who aspire to innovate and lead, is an MBA degree a worthwhile investment? In this episode of the Back Table Innovation podcast, Dr. Aaron Fritts explores the relevance and benefits of obtaining an MBA for physicians, joined by guests Dr. Roger Tomihama and Dr. Raj Khalsa. --- SYNPOSIS The discussion covers various MBA programs, including the Wharton Executive MBA and the Quantic Executive MBA, highlighting their strengths, particularly for mid-career physicians. Drs. Tomihama and Khalsa share their personal experiences with these programs, comparing in-person and online formats. They also explore the advantages of structured learning, networking opportunities, and how an MBA can empower physicians to bridge the gap between clinical expertise and administrative or entrepreneurial roles. This conversation underscores the importance of continuous learning in fostering a more impactful and fulfilling career in healthcare. --- TIMESTAMPS 00:00 - Introduction 01:34 - Dr. Tomihama's Wharton MBA Experience 06:10 - Dr. Khalsa's Quantic MBA Journey 09:39 - Comparing MBA Programs and Networking Opportunities 23:10 - Thoughts on MBA Learning Styles 26:10 - The Language of Business 26:50 - In-Person vs. Online Learning 27:21 - Foundational Knowledge for Startups 28:56 - Applying Business Skills in Healthcare 32:16 - Marketing and Behavioral Psychology 43:52 - Timing and Career Advancement 47:52 - Final Thoughts and Reflections --- RESOURCES BackTable VI Ep. 230: The Physician's MBA: Is It Worth It, and Where to Start: https://www.backtable.com/shows/vi/podcasts/230/the-physicians-mba-is-it-worth-it-where-to-start
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
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/
How can physicians and industry partners collaborate effectively to enhance patient care? Dr. Adam Tanious, Assistant Professor of Vascular Surgery at the Medical University of South Carolina, joins host Dr. Aaron Fritts to explore strategies for navigating physician-industry relationships. --- SYNPOSIS The doctors share their experiences in partnering with the medical device industry. The conversation covers the benefits of industry partnerships, the challenges of avoiding conflicts of interest, and the critical role of education in preparing new physicians for these interactions. Dr. Tanious also delves into his thought-provoking TED Talk on big business in surgery, and discusses the value of business education for physicians. --- TIMESTAMPS 00:00 - Introduction 02:12 - Medicine and Business 05:01 - Business Knowledge for Physicians 15:05 - Physician-Industry Relationships 27:26 - Industry Relationships in Medical Training 33:08 - Ethical Considerations and Influence in the OR 35:00 - Leveraging Industry Resources for Better Training 43:24 - Future of Medical Technology and Collaboration --- RESOURCES Big Business and Surgery: Who Belongs in Your Operating Room?: https://youtu.be/kksVjF0fI_w?si=LADwqrbXPz3VsFm4 Quantic MBA Program: https://quantic.edu/blog/category/fields-of-study/accounting/ The price of a cup of coffee: https://vascularspecialistonline.com/the-price-of-a-cup-of-coffee/
Dr. Samir Shah and our host, Dr. Aaron Fritts, discuss upcoming disruptions in radiology due to artificial intelligence (AI), including AI's role in making healthcare more accessible and affordable. --- SYNPOSIS Dr. Shah outlines his career trajectory, from his interventional radiology (IR) training to his entry into teleradiology. He describes his first encounter with AI through natural language processing for encoding radiology reports. Currently, he serves as the Chief Medical Officer of Qure AI, a platform that utilizes deep learning to aid in diagnosing medical conditions from pathology and radiology imaging. He emphasizes that AI will streamline medical workflows by automating patient summaries, image recognition, and cancer detection. These changes are particularly crucial in today's healthcare environment, which emphasizes productivity. The discussion also explores the benefits and challenges of integrating AI into modern radiology workflows and the learning opportunities it presents for trainees. --- TIMESTAMPS 00:00 - Introduction to the Podcast 03:12 - Dr. Shah's Professional Journey 17:59 - Starting the CMO Role at Qure AI 20:42 - Mainstream Integration of AI 30:39 - Qure's Mission and Global Impact 37:20 - Early Cancer Detection 46:18 - Training Radiologists in AI --- RESOURCES BackTable Innovation Ep. 7- Viz.AI: Improving Access to Stroke Care using AI with Dr. Chris Mansi: https://www.backtable.com/shows/innovation/podcasts/7/vizai-improving-access-to-stroke-care-using-ai BackTable Innovation Ep. 29- Artificial Intelligence & Imaging: Present & Future with Aidoc Founder Elad Walach: https://www.backtable.com/shows/innovation/podcasts/29/artificial-intelligence-imaging-present-future-with-aidoc-founder-elad-walach BackTable Innovation Ep. 68- Transforming Radiology with Workflow Solutions with Dr. Woojin Kim: https://www.backtable.com/shows/innovation/podcasts/68/transforming-radiology-with-workflow-solutions BackTable Innovation Ep. 73- AI in Medicine: Navigating the New Frontier with Confidence with Dr. Matthew Lungren: https://www.backtable.com/shows/innovation/podcasts/73/ai-in-medicine-navigating-the-new-frontier-with-confidence Qure AI: https://www.qure.ai/ Dr. Samir Shah's email: Samir.Shah@qure.ai NightHawk Radiology: https://www.nighthawkradiology.com/ vRad Teleradiology: https://www.vrad.com/ Radiology Partners: https://www.radpartners.com/ AI Doc: https://www.aidoc.com/ Subtle Medical: https://subtlemedical.com/
On this episode of the BackTable MSK podcast, co-hosts Dr. Chris Beck and Dr. Aaron Fritts review the basics of bone lesion biopsy, including patient selection, imaging modalities, and procedural steps. They begin with summarizing indications for bone lesions, which are most common in the setting of metastatic disease. Patients usually get referred for biopsy when a bone lesion is caught on CT imaging of the chest, abdomen, and pelvis. The doctors emphasize that imaging multiple areas is needed to find the most easily accessible lesion, which is sometimes located within a solid organ, rather than within bone. While PET imaging can be useful for confirmation of sclerotic bone lesions, patients usually cannot receive PET scans without an established cancer diagnosis. Dr. Beck highlights the fact that lytic lesions with soft tissue components are technically easier to access than sclerotic lesions and result in higher yield. He occasionally uses a soft tissue biopsy needle for these lesions. For sclerotic lesions, he prefers the OnControl or Stryker bone biopsy coaxial systems. With the coaxial system, it can be hard to adjust the biopsy tract after you have already started drilling, but he recommends obtaining multiple cores at different angles of approach. He also advises listeners to choose the shortest needle possible, since this makes it easier to control and image the needle within the lesion.The doctors also discuss biopsy of tricky locations. Sternal lesions carry the risk of lung injury and pneumothorax, so when faced with these, Dr. Beck picks an oblique tract that has a longer trajectory. For lesions located in proximal extremities, he secures the limb to minimize movement. Next, disc biopsies are discussed. Patients usually present with discitis osteomyelitis from prior back surgery, IV drug use, or idiopathic causes. It is important to distinguish between infection of the disc space versus chronic degenerative disc disease, which can be identified by comparison with prior imaging and lab workup. For the lumbar spine disc biopsy, fluoroscopy is Dr. Beck's preferred imaging modality, and he reviews imaging landmarks. Dr. Fritts usually biopsies both bone and disc. Finally, they discuss post-procedural complications to watch for, such as chest x-rays in checking for lung injury and neurological exams to assess for new deficits. --- CHECK OUT OUR SPONSOR Stryker Interventional Spine https://www.strykerivs.com --- SHOW NOTES 00:00 - Introduction 03:12 - Referrals and Imaging Techniques for Bone Lesion Biopsy 07:09 - Procedural Steps of Bone Lesion Biopsy 12:32 - Choosing Biopsy Tools 23:22 - Approach to Tricky Biopsy Locations 28:19 - Workup and Indications for Disc Biopsy 32:08 - Fluoroscopy vs. CT for Disc Biopsy 40:15 - Handling Biopsy Samples 48:03 - Post-Procedure Care and Complications --- RESOURCES Arrow OnControl Powered Bone Biopsy System: https://irc.teleflex.com/oncontrolsystem/ Stryker Bone Biopsy Coaxial System: https://www.stryker.com/us/en/interventional-spine/products/bone-biopsy.html BD Trek Powered Bone Biopsy System: https://www.bd.com/en-us/products-and-solutions/products/product-families/bd-trek-powered-bone-biopsy-system Jamshidi Evolve Bone Marrow Needle: https://www.bd.com/en-us/products-and-solutions/products/product-families/jamshidi-evolve-bone-marrow-needle BD Illinois Sternal/Iliac Bone Marrow Aspiration Needles: https://www.bd.com/en-ca/products-and-solutions/products/product-families/illinois-sternal-iliac-bone-marrow-aspiration-needles BD Mission Disposable Core Biopsy Instrument: https://www.bd.com/en-us/products-and-solutions/products/product-families/mission-disposable-core-biopsy-instrument Disc Biopsy Visualization Website: https://www.pediatricir.com/disc-aspiration-for-discitis.html
In this episode of the BackTable Podcast, host Dr. Aaron Fritts interviews Dr. Osman Ahmed about treatment algorithms and new technologies for upper gastrointestinal (GI) bleed embolization. Dr. Ahmed is an interventional radiologist at the University of Chicago. The doctors dive into various embolization techniques, microcatheters, and embolic materials that are ideal for managing upper GI bleeds. Dr. Ahmed highlights the importance of understanding the etiology of bleeding, differences between arterial vs. venous bleeding, and first-line therapies such as endoscopy. Dr. Ahmed also discusses the utilization of new embolic materials like Obsidio Embolic, which is designed specifically for peripheral use, and its advantages in achieving rapid and complete vessel occlusion. Additionally, the doctors cover pre-procedural imaging, procedural techniques, and operator preferences for microcatheters and embolic devices. They emphasize the procedural nuances, operator comfort, and evolving technologies in the management of GI bleeds. --- CHECK OUT OUR SPONSOR Boston Scientific Obsidio Embolics https://www.bostonscientific.com/obsidio --- SHOW NOTES 00:00 - Introduction 03:29 - Discussion on Upper GI Bleeds 06:35 - Pre-Procedure Imaging for Upper GI Bleeds 11:16 - Procedure Walkthrough for Upper GI Embolization 19:51 - Understanding Mesenteric Anatomy 22:50 - Embolization Devices: Coils and More 25:31 - Exploring Obsidio: A New Embolic 32:55 - Post-Procedure Care 34:17 - Case Discussions and Final Thoughts --- RESOURCES Navigating Early Cases with the Obsidio™ Conformable Embolic - GEST 2023 Webinar with Dr. Ahmed: https://thegestgroup.com/webinar-featuring-obsidio/ BackTable VI Episode #179 - Happiness is a Warm Coil: Treating GI Bleeds with Dr. Donald Garbett: https://www.backtable.com/shows/vi/podcasts/179/happiness-is-a-warm-coil-treating-gi-bleeds BackTable VI Episode #216 - Stick It: Glue Embo with Dr. Ziv Haskal: https://www.backtable.com/shows/vi/podcasts/216/stick-it-glue-embo BackTable VI Episode #321 - New Innovations in Lower GI Bleed Embolization with Dr. Kevin Henseler: https://www.backtable.com/shows/vi/podcasts/321/new-innovations-in-lower-gi-bleed-embolization Obsidio - Conformable Embolic: https://www.bostonscientific.com/obsidio
In this episode of the BackTable Podcast, host Dr. Aaron Fritts interviews guest Dr. Ramsey Al-Hakim about the inception and journey of Auxetics, a med-tech company innovating in the vein stent market. Dr. Al-Hakim is the co-founder of Auxetics and the Section Chief of the Division of Interventional Radiology at Scripps Hospital in San Diego, CA. Dr. Al-Hakim covers the initial challenges of understanding the market and securing capital, the clinical significance of addressing stent-adjacent stenosis, and the process of developing a stent with a negative Poisson effect to counteract it. Dr. Al-Hakim highlights Auxetics' approach to combining cutting-edge interventional technologies with world-class imaging tools for enhanced procedural efficiency in venous interventions. The company's progress through benchtop work, animal testing, and plans for first-in-human studies outside the U.S., aiming for commercialization within the next four to five years, is also outlined. Contributions from key figures in the vascular community and the role of mentorship and perseverance in navigating the complexities of medical device innovation are discussed as well. --- CHECK OUT OUR SPONSORS Varian, a Siemens Healthineers company https://www.siemens-healthineers.com/ Reflow Medical https://www.reflowmedical.com/ --- SHOW NOTES 00:00 - Introduction 03:11 - The Market and Problem Solving 12:13 - Journey of Creating a Stent 22:28 - Birth of Auxetics 26:53 - Learning Process and Support from the University 29:16 - Building the Dream Team 33:01 - Starting a Company 36:42 - Challenges and Triumphs of Fundraising 37:44 - Current Status and Future Plans 45:32 - Importance of Community and Mentorship --- RESOURCES Auxetics: https://www.auxeticsinc.com In-stent restenosis and stent compression following stenting for chronic iliofemoral venous obstruction: https://pubmed.ncbi.nlm.nih.gov/34174500/ Venous Stenosis Animal Model Utilizing Endovenous Radiofrequency Ablation: https://pubmed.ncbi.nlm.nih.gov/30717966/ The Messy Middle: Finding Your Way Through the Hardest and Most Crucial Part of Any Bold Venture: https://www.amazon.com/Messy-Middle-Finding-Through-Hardest/dp/0735218072
In this episode of the BackTable Podcast, host Dr. Aaron Fritts interviews guest Dr. Ramsey Al-Hakim about the inception and journey of Auxetics, a med-tech company innovating in the vein stent market. Dr. Al-Hakim is the co-founder of Auxetics and the Section Chief of the Division of Interventional Radiology at Scripps Hospital in San Diego, CA. Dr. Al-Hakim covers the initial challenges of understanding the market and securing capital, the clinical significance of addressing stent-adjacent stenosis, and the process of developing a stent with a negative Poisson effect to counteract it. Dr. Al-Hakim highlights Auxetics' approach to combining cutting-edge interventional technologies with world-class imaging tools for enhanced procedural efficiency in venous interventions. The company's progress through benchtop work, animal testing, and plans for first-in-human studies outside the U.S., aiming for commercialization within the next four to five years, is also outlined. Contributions from key figures in the vascular community and the role of mentorship and perseverance in navigating the complexities of medical device innovation are discussed as well. --- CHECK OUT OUR SPONSORS Varian, a Siemens Healthineers company https://www.siemens-healthineers.com/ Reflow Medical https://www.reflowmedical.com/ --- SHOW NOTES 00:00 - Introduction 03:11 - The Market and Problem Solving 12:13 - Journey of Creating a Stent 22:28 - Birth of Auxetics 26:53 - Learning Process and Support from the University 29:16 - Building the Dream Team 33:01 - Starting a Company 36:42 - Challenges and Triumphs of Fundraising 37:44 - Current Status and Future Plans 45:32 - Importance of Community and Mentorship --- RESOURCES Auxetics: https://www.auxeticsinc.com In-stent restenosis and stent compression following stenting for chronic iliofemoral venous obstruction: https://pubmed.ncbi.nlm.nih.gov/34174500/ Venous Stenosis Animal Model Utilizing Endovenous Radiofrequency Ablation: https://pubmed.ncbi.nlm.nih.gov/30717966/ The Messy Middle: Finding Your Way Through the Hardest and Most Crucial Part of Any Bold Venture: https://www.amazon.com/Messy-Middle-Finding-Through-Hardest/dp/0735218072
In this episode of the BackTable Podcast, host Dr. Aaron Fritts interviews guest Dr. John Qiao about exploration of physicians' role in medical innovation, particularly among interventional radiologists. Dr. Qiao shares insightful information about the origin of RadioClash and details his journey as an entrepreneur. Through this discussion, Dr. Qiao covers the challenges encountered during the startup phase, the invention of a single-probe electroporation device, and the future applications of this novel medical technology. The episode concludes with broader advice on how to manage the demands of professional work, entrepreneurship, and personal life. --- CHECK OUT OUR SPONSORS Reflow Medical https://www.reflowmedical.com/ Medtronic Concerto https://mobile.twitter.com/mdtvascular --- SHOW NOTES 00:00 - Introduction 02:39 - Dr. Qiao's Journey into Medicine and Entrepreneurship 11:40 - Birth of Radioclash: A Unique Solution for Cancer Treatment 17:58 - Future of RadioClash: Targeting Metastatic Cancer 25:20 - Future of Electroporation Therapy 35:21 - Challenges of Building a Company 44:37 - Path to Market and Future Plans 47:28 - Balancing Clinical Practice and Entrepreneurship --- RESOURCES RadioClash website: https://www.radioclash.co/ News Article on Dr. John Qiao: https://voyagehouston.com/interview/meet-john-qiao-m-d-of-radioclash-ltd-co/ Radiation Therapy as a Modality to Create Abscopal Effects: Current and Future Practices: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7086111/ The Abscopal Effect: A Reemerging Field of Interest: https://ascopost.com/issues/november-25-2018/the-abscopal-effect-a-reemerging-field-of-interest/ BackTable VI Episode #402 - Immunotherapy in HCC: Evolving Treatment Paradigms: https://www.backtable.com/shows/vi/podcasts/402/immunotherapy-in-hcc-evolving-treatment-paradigms Tavo and Pembrolizumab in Patients With Stage III/IV Melanoma Progressing on Either Pembrolizumab or Nivolumab Treatment (Keynote-695): https://clinicaltrials.gov/study/NCT03132675 PANFIRE-3 Trial: Assessing Safety and Efficacy of Irreversible Electroporation (IRE) + Nivolumab + CpG for Metastatic Pancreatic Cancer: https://classic.clinicaltrials.gov/ct2/show/NCT04612530 Radiofrequency Ablation for the Palliative Treatment of Bone Metastases: Outcomes from the Multicenter OsteoCool Tumor Ablation Post-Market Study (OPuS One Study) in 100 Patients: https://pubmed.ncbi.nlm.nih.gov/33129427/ The improvement of irreversible electroporation therapy using saline-irrigated electrodes: a theoretical study (Northwestern study): https://pubmed.ncbi.nlm.nih.gov/21728392/ Irreversible electroporation reverses resistance to immune checkpoint blockade in pancreatic cancer: https://www.nature.com/articles/s41467-019-08782-1
In this episode of the BackTable Podcast, host Dr. Aaron Fritts interviews guest Dr. John Qiao about exploration of physicians' role in medical innovation, particularly among interventional radiologists. Dr. Qiao shares insightful information about the origin of RadioClash and details his journey as an entrepreneur. Through this discussion, Dr. Qiao covers the challenges encountered during the startup phase, the invention of a single-probe electroporation device, and the future applications of this novel medical technology. The episode concludes with broader advice on how to manage the demands of professional work, entrepreneurship, and personal life. --- SHOW NOTES 00:00 - Introduction 02:39 - Dr. Qiao's Journey into Medicine and Entrepreneurship 11:40 - Birth of Radioclash: A Unique Solution for Cancer Treatment 17:58 - Future of RadioClash: Targeting Metastatic Cancer 25:20 - Future of Electroporation Therapy 35:21 - Challenges of Building a Company 44:37 - Path to Market and Future Plans 47:28 - Balancing Clinical Practice and Entrepreneurship --- RESOURCES RadioClash website: https://www.radioclash.co/ News Article on Dr. John Qiao: https://voyagehouston.com/interview/meet-john-qiao-m-d-of-radioclash-ltd-co/ Radiation Therapy as a Modality to Create Abscopal Effects: Current and Future Practices: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7086111/ The Abscopal Effect: A Reemerging Field of Interest: https://ascopost.com/issues/november-25-2018/the-abscopal-effect-a-reemerging-field-of-interest/ BackTable VI Episode #402 - Immunotherapy in HCC: Evolving Treatment Paradigms: https://www.backtable.com/shows/vi/podcasts/402/immunotherapy-in-hcc-evolving-treatment-paradigms Tavo and Pembrolizumab in Patients With Stage III/IV Melanoma Progressing on Either Pembrolizumab or Nivolumab Treatment (Keynote-695): https://clinicaltrials.gov/study/NCT03132675 PANFIRE-3 Trial: Assessing Safety and Efficacy of Irreversible Electroporation (IRE) + Nivolumab + CpG for Metastatic Pancreatic Cancer: https://classic.clinicaltrials.gov/ct2/show/NCT04612530 Radiofrequency Ablation for the Palliative Treatment of Bone Metastases: Outcomes from the Multicenter OsteoCool Tumor Ablation Post-Market Study (OPuS One Study) in 100 Patients: https://pubmed.ncbi.nlm.nih.gov/33129427/ The improvement of irreversible electroporation therapy using saline-irrigated electrodes: a theoretical study (Northwestern study): https://pubmed.ncbi.nlm.nih.gov/21728392/ Irreversible electroporation reverses resistance to immune checkpoint blockade in pancreatic cancer: https://www.nature.com/articles/s41467-019-08782-1
In this episode of the BackTable Podcast, host Dr. Aaron Fritts interviews guest Dr. Ilan Rzadkowolsky-Raoli about his experience of being diagnosed with a large saddle embolus and subsequently being treated by his best friend, Dr. Ripal Gandhi. Dr. Rzadkowolsky-Raoli is an interventional radiologist at Palmetto General Hospital in Miami, Florida. Dr. Rzadkowolsky-Raoli discusses the impact of his diagnosis on his practice, how it has changed the way he approaches and speaks to his patients, and his advice for clinicians. --- CHECK OUT OUR SPONSORS Varian, a Siemens Healthineers company https://www.varian.com/products/interventional-solutions/embolization-solutions Medtronic ClosureFast https://www.medtronic.com/closurefast6f --- SHOW NOTES 00:00 - Introduction 06:18 - Dr. Rzadkowolsky-Raoli's Personal Journey 09:41 - Diagnosis and Treatment Process 12:18 - Post-Treatment Recovery and Reflections 24:18 - Impact on Practice and Patient Care 31:45 - Final Thoughts and Appreciation --- RESOURCES Pulmonary Embolism Response Team (PERT) Consortium: https://pertconsortium.org/ Inari FlowTriever: https://www.inarimedical.com/flowtriever/
In this episode, Dr. Aaron Fritts interviews Dr. Patrick Neville, a vascular surgeon and entrepreneur. Dr. Neville shares his journey of identifying a clinical problem and developing a solution, which culminated in the innovation of Wire Watch, a tool designed for efficient wire management during endovascular cases. Dr. Neville discusses the importance of believing in your solutions, the need for persistence, and the value of strategic partnerships in navigating the startup process. His partnership with the engineering firm BioTex led to the development of a simple product that is now used in cases by interventionalists across multiple specialties. --- SHOW NOTES 00:00 - Introduction 02:12 - Recognizing the Importance of Wire Management 06:42 - Partnership in Product Development 09:14 - Wire Watch in Action: User Experience 16:15 - Cost Savings and Clinical Adoption 22:44 - Mindset for Approaching Device Innovation --- RESOURCES Wire Watch: https://www.biotexmedical.com/wirewatch/ BioTex Medical: https://www.biotexmedical.com/
In this episode of the BackTable Podcast, host Dr. Aaron Fritts interviews guest Dr. Thomas Sullivan about the findings from a recent survey exploring the reasons behind professional job changes among interventional radiologists. Dr. Sullivan is the Assistant Program Director of Diagnostic and Integrated Interventional Radiology Residency programs at Wake Forest University. Dr. Sullivan highlights the importance of mentorship during residency and notes the huge impact of geography and financial compensation in determining job satisfaction and longevity in a role. He also discusses some surprising insights about trainee expectations of future practice settings, the need for a variety in practice caseload, and the desire for about 80% of clinical time to be spent on dedicated IR activities. The conversation also delves into the challenges of equipping residents for rural practice and the potential value of developing a procedural radiology curriculum. Dr. Sullivan anticipates that the survey results will help improve and adapt training paradigms to better align with the evolving landscape of interventional radiology practice. --- CHECK OUT OUR SPONSOR RADPAD® Radiation Protection https://www.radpad.com/ --- SHOW NOTES 00:00 - Introduction 02:50 - Discussion on IR Training and Practice 04:51 - Survey Discussion and Key Findings 16:47 - Importance of Diagnostic Skills in IR 19:01 - Deciding Factors for First Job After Training 21:04 - Need for Medical Services in Rural Settings 25:23 - Role of Mentorship in Job Seeking 28:21 - Importance of Networking in Career Development 32:37 - Future of IR Training and Practice 38:23 - Role of BackTable in IR Training --- RESOURCES SIR 2024 Monday Session (3:27 PM - 3:36 PM MT): Trainee perceptions of current IR workforce: Are we setting our residents up for failure? With Dr. Thomas Sullivan: https://www.sirmeeting.org/fsPopup.asp?PresentationID=1348792&mode=presInfo
In this episode, host Dr. Aaron Fritts is joined by interventional cardiologists Dr. Sameh Sayfo (Baylor Scott & White in Plano, TX) and Dr. Nicolas Shammas (Cardiovascular Medicine in Davenport, IA) for a discussion about critical limb ischemia (CLI) and the use of lasers in below-the-knee (BTK) treatment. To start, Dr. Shammas explains that infrapopliteal disease is difficult to treat due to the high rate of total occlusions and the high degree of medial calcinosis. Next, he gives an introduction to laser atherectomy for certain plaque locations and morphologies, and he describes previous studies that have shown its efficacy for calcified lesions. Intravascular ultrasound (IVUS) can also help guide vessel sizing, plaque morphology, and appropriate device selection. Dr. Shammas believes that the current atherectomy devices on the market are easy to learn to use and can be incorporated into any CLI program. The doctors discuss the ongoing multicenter study on outcomes of the Auryon laser atherectomy system in CLI patients. Dr. Shammas reviews the study design, proposed endpoints, and current data on 30 day outcomes. We end the episode with advice on building a strong CLI program, which includes multidisciplinary collaboration, advocating for resources, a variety of different tools, and appropriate management of cardiovascular risk factors. --- CHECK OUT OUR SPONSOR AngioDynamics Auryon System https://www.auryon-system.com/ --- SHOW NOTES 00:00 - Introduction 04:18 - Current Treatment Limitations for Infrapopliteal Disease 07:38 - Laser Atherectomy for Calcified Lesions 12:10 - Learning Curve for Laser Atherectomy Devices 15:38 - 30-Day Results of the Auryon BTK Study 23:35 - Technical Approach and Tools for Infrapopliteal Segments 29:00 - Upcoming Developments in CLI Treatment 31:33 - Advice for Building a CLI Program --- RESOURCES Calcium 360 Trial: https://pubmed.ncbi.nlm.nih.gov/22891826/ Auryon Laser Atherectomy System: https://www.angiodynamics.com/product/auryon/ Nexcimer Laser Atherectomy System: https://www.usa.philips.com/healthcare/product/HCIGTDPHLLSRSYSTM/laser-system-hcigtdphllsrsystm 30-Day Results of the Auryon BTK Study: https://www.jacc.org/doi/10.1016/j.jacc.2023.09.194 Midwest Cardiovascular Research Foundation: http://www.mcrfmd.com/ Life-BTK Study: https://www.cardiovascular.abbott/us/en/patients/treatments-therapies/peripheral-artery-disease/life-btk.html Promise II Study: https://www.nejm.org/doi/full/10.1056/NEJMoa2212754 BackTable Ep. 350- Building a CLI Program with Dr. Zola N'Dandu: https://www.backtable.com/shows/vi/podcasts/350/building-a-cli-program
In this episode of the Back Table MSK podcast, co-hosts and interventional radiologists Dr. Aaron Fritts and Dr. Chris Beck have an in-depth discussion about bone marrow biopsies, including their preferred techniques and devices, potential complications, and management of patient expectations. To start, they cover the typical referral pathway for biopsies, the majority of which involve hematology/oncology indications. Preoperatively, managing patient expectations is important to communicate, especially regarding sedation and pain control. The IRs also walk through the biopsy steps, anatomy of the ilium, and confirmatory imaging with CT and fluoroscopy. They also share their experiences with different biopsy needles such as the OnControl, Jamshid, and Trek systems. There are advantages to using a system that comes with a powered drill, but these can also increase patient anxiety. Additionally, it is important to consider the bone density of the patient when selecting the tool. A manual system may offer sufficient force for demineralized or osteoporotic bone. The hosts also discuss potential unintended outcomes of the procedure, including dry taps and entry into joints or sacral foramina. Finally, they review post-procedural care and patient emergence from sedation. --- SHOW NOTES 00:00 Introduction 03:36 Indications for Biopsy 05:40 Patient Consent and Sedation 13:58 Procedural Steps and Confirmatory Imaging 27:04 Comparison of Different Biopsy Tools 36:11 Dealing with Complications 41:00 Post-Procedural Care --- RESOURCES BackTable VI Episode 381- Anesthesia vs. Moderate Sedation: A Spectrum of Care with Dr. Vishal Kumar: https://www.backtable.com/shows/vi/podcasts/381/anesthesia-vs-moderate-sedation-a-spectrum-of-care OnControl Powered Bone Biopsy System: https://oncontrolsystem.com/ Jamshidi Evolve Bone Marrow Needle: https://www.bd.com/en-us/products-and-solutions/products/product-families/jamshidi-evolve-bone-marrow-needle Trek Powered Bone Biopsy System: https://www.bd.com/en-us/products-and-solutions/products/product-families/bd-trek-powered-bone-biopsy-system
In this episode of The Backtable Podcast, host Dr. Aaron Fritts and guests Dr. Mahmood Razavi and Dr. Mark Garcia discuss the intricacies of owning and operating an outpatient-based lab (OBL). Dr. Razavi and Dr. Garcia are practicing interventional radiologists at Vascular and Interventional Specialists of Orange County (California) and American Vascular Associates (Florida), respectively. The doctors explore the advantages of OBLs, including autonomy, flexibility, and patient satisfaction. They also delve into the challenges of financial sustainability, decision-making restrictions, and insurance navigation. The conversation revolves around the need for a solid business plan before stepping into OBL operation. This includes awareness of potential regulatory oversight, costs, and patient sources. They also discuss the impact of OBLs on healthcare, and they specifically warn that the lack of evidence-based practices might have adverse effects. The doctors propose solutions such as societal guidelines, required accreditation, and stringent care delivery. --- CHECK OUT OUR SPONSOR Siemens Healthineers https://www.siemens-healthineers.com/ --- SHOW NOTES 00:00 - Introduction 04:26 - Pros and Cons of Owning and Operating in an OBL 11:07 - Financial Aspects and Profitability of OBLs 23:42 - Exploring Alternative Models for OBLs 32:33 - The Role of Societies in Guiding OBL Practices 36:27 - The Future of OBLs: Regulation, Consolidation, and Quality 42:59 - Exit Strategies and Future Considerations for OBLs 50:38 - Final Thoughts on OBLs and the Importance of Quality Care --- RESOURCES Impact of Office Based Laboratories on Physician Practice Patterns and Outcomes after Percutaneous Vascular Interventions for Peripheral Artery Disease: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8555658/pdf/nihms-1524412.pdf
In this episode of the BackTable Podcast, hosts Dr. Aaron Fritts and Dr. Chris Beck discuss their Mediport removal workflows and the common challenges of a port removal procedure. Often seen as a significant milestone for cancer patients who have completed their treatment, successful Mediport removal requires a thorough understanding of the catheter and reservoir removal processes. This discussion covers tips and tricks for removing Mediports with minimal discomfort to the patient, effective anesthesia, careful dissection, and appropriate closure procedures. The hosts also emphasize the importance of preparing for unexpected scenarios such as catheter fractures or infection, and they outline strategies to effectively handle these complications. --- CHECK OUT OUR SPONSOR RADPAD® Radiation Protection https://www.radpad.com/ --- SHOW NOTES 00:00 - Introduction 03:06 - Overview of Mediport Removal 13:25 - Mediport Removal Procedure 20:59 - Procedural Challenges and Complications 22:12 - Infected Ports 30:17 - Stuck Ports 33:14 - Fractured Ports
In this episode, Dr. Aaron Fritts and Dr. Jose Silva invite interventional radiologist Dr. Jamil Muasher to highlight the potential that interventional radiologists possess in offering prostate biopsy work alongside Urology colleagues. Given the advancement in MRI guidance, the discussion addresses the opportunity for radiologists to step in and provide crucial expertise to optimize patient outcomes. Dr. Muasher talks about his approach of using an MR imaging to guide the biopsy procedure. He further expresses importance in understanding the grading, reading, interpreting systems like Prostate Imaging-Reporting and Data System (PI-RADS) and significant experience needed for accurate results. The doctors also explain various biopsy procedures, details about post-procedure care and follow-ups, and observations about billing for the services. --- CHECK OUT OUR SPONSOR RADPAD® Radiation Protection https://www.radpad.com/ --- SHOW NOTES 00:00 - Introduction 07:29 - Learning to Read Prostate MRI 09:43 - The Role of Radiologists and Grading Systems in Prostate Biopsies 24:00 - Techniques in Prostate Biopsy 31:16 - The Role of Antibiotics in Biopsy 32:34 - The Debate Between Transperineal and Transrectal Biopsy 40:36 - Post-Procedure Care and Follow-Up 45:49 - The Future of Biopsy --- RESOURCES Decipher Prostate Genomic Classifier by Veracyte: https://decipherbio.com/
In this episode, Dr. Aaron Fritts and Dr. Jose Silva invite interventional radiologist Dr. Jamil Muasher to highlight the potential that interventional radiologists possess in offering prostate biopsy work alongside Urology colleagues. Given the advancement in MRI guidance, the discussion addresses the opportunity for radiologists to step in and provide crucial expertise to optimize patient outcomes. Dr. Muasher talks about his approach of using an MR imaging to guide the biopsy procedure. He further expresses importance in understanding the grading, reading, interpreting systems like Prostate Imaging-Reporting and Data System (PI-RADS) and significant experience needed for accurate results. The doctors also explain various biopsy procedures, details about post-procedure care and follow-ups, and observations about billing for the services. --- CHECK OUT OUR SPONSOR Veracyte https://www.veracyte.com/decipher --- SHOW NOTES 00:00 - Introduction 07:29 - Learning to Read Prostate MRI 09:43 - The Role of Radiologists and Grading Systems in Prostate Biopsies 24:00 - Techniques in Prostate Biopsy 31:16 - The Role of Antibiotics in Biopsy 32:34 - The Debate Between Transperineal and Transrectal Biopsy 40:36 - Post-Procedure Care and Follow-Up 45:49 - The Future of Biopsy --- RESOURCES Decipher Prostate Genomic Classifier by Veracyte: https://decipherbio.com/
In this episode, host Dr. Aaron Fritts interviews Dr. Rehan Quadri about the impact of intra-procedural arterial monitoring via sheath technology. Dr. Quadri is a practicing interventional radiologist at UT Southwestern in Dallas, Texas. --- CHECK OUT OUR SPONSOR Endophys https://endophys.com/ --- SHOW NOTES Dr. Quadri begins by telling us about a new arterial sheath, the EndoPhys Pressure Sense Arterial Sheath, which enables real-time blood pressure monitoring in a number of different cases and advantages that it offers over arterial lines and cuff monitors. We also discuss specific indications for utilizing this technology, such as trauma, GI bleeds, stroke, fistulas, and other emergent arterial interventions requiring minute-to-minute monitoring. We also breakdown the specs of the sheath, including its setup, calibration, placement, recorded measurements, and the accuracy of the read-outs when compared to those of past technologies. Dr. Quadri speaks on the cost and the overall value of the EndoPhys sheath. He concludes the episode by discussing new advancements in the technology such as improved device warmup times and a radial-specific sheath. --- RESOURCES Endophys Pressure Sense Arterial Sheath: https://endophys.com/
In this episode, host Dr. Aaron Fritts interviews vascular surgeon Dr. Syed Hussain and interventional radiologist Dr. Omar Saleh about new innovations in closure devices. --- CHECK OUT OUR SPONSOR Vasorum https://www.vasorum.ie/ --- SHOW NOTES We begin the episode by discussing how closure devices have evolved over recent years and gained popularity in both hospital and OBL settings. Dr. Hussain and Dr. Saleh highlight the logistical advantages associated with a consistent, reliable closure device. Both doctors speak about their patients' reported experiences and preferences for different types of closure devices and the importance of having a variety of options at hand. Dr. Saleh and Dr. Hussain also introduce the new CELT ACD closure device from Vasorum. We learn how to place a CELT, and Dr. Saleh highlights the ease of deployment and the reliability of results. Dr. Hussain also shares his experience in using the CELT, comparing its deployment to a “mic drop”. Additionally, we discuss if there are any potential drawbacks or special considerations that may exist in using CELT compared to other devices. The doctors cover the time from CELT closure to ambulation/discharge, citing an abstract published in Journal of Vascular Surgery (see resources below). Dr. Hussain and Dr. Saleh also report very few closure-site complications when using CELT, good outcomes with calcified arteries, and ease of bailout options. To conclude the episode, we discuss how physicians can get CELT and other products into their hospital or OBL through the Agency for Healthcare Research and Quality (AHRQ), Consumer Assessment of Healthcare Providers and Systems (CAHPS) scores, and other methods. --- RESOURCES Safety and Efficacy of the CELT ACD Femoral Arteriotomy Closure Device in the Office-based Laboratory: https://www.jvascsurg.org/article/S0741-5214(22)00945-4/fulltext Silent cerebral infarct after cardiac catheterization as detected by diffusion weighted Magnetic Resonance Imaging: a randomized comparison of radial and femoral arterial approaches: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1896179/ Vasorum CELT ACD Closure Device: https://www.vasorum.ie/
In this episode, interventional radiologists Dr. Aaron Fritts, Dr. Vishal Kumar, and Dr. Chris Beck discuss types of sedation for IR procedures. --- CHECK OUT OUR SPONSOR Medtronic OBL https://www.medtronic.com/obl --- SHOW NOTES We start the discussion off by dividing the spectrum of patient sedation into three tiers: local anesthesia, moderate sedation with fentanyl and Versed, and deep sedation which encompasses anything beyond fentanyl and Versed. The conversation revolves around the fluidity of this spectrum, underscoring the ease with which patients can transition between these sedation levels, thereby adding layers of complexity to the decision-making process. Chris emphasizes the significance of embracing trauma-informed care, highlighting the potential for IR procedures to be maximally traumatic despite their minimally invasive nature. The doctors emphasize the importance of establishing comprehensive pre-procedural patient education to align expectations about pain management. Procedures that automatically trigger the requirement for an anesthesia team include procedures such as TIPS, tumor ablations, as well as declot procedures more recently. Decisions regarding anesthesia for these procedures are additionally influenced by factors such as the patient's condition, history of methadone exposure, the preference of the IR providers, and the comfort level of nursing staff. Vishal highlights the game-changing concept of having an anesthesia team present for real-time monitoring and the administration of nerve blocks during IR procedures. This collaboration is especially helpful for complex interventions. Vishal advocates for prioritizing patient safety over logistical considerations. He firmly contends IRs should be empowered to decide the level of anesthesia care since they have the most experience with the specific procedures and are best suited to recognize anesthesia needs. The conversation delves into the American Society of Anesthesiologists (ASA) scoring system, which categorizes patients based on their health status from ASA 1 (healthy) to ASA 6 (brain death). While IR procedures usually involve ASA 3 or ASA 4 patients, today's discussion uncovers the tendency among clinicians to underestimate a patient's ASA classification while overestimating their pain tolerance. The discussion raises critical questions about whether the IR community has grown complacent with moderate sedation in procedures and whether alternative approaches are warranted. --- RESOURCES American Society of Anesthesiologists Classification (ASA) Classification: https://www.ncbi.nlm.nih.gov/books/NBK441940/
In this episode, hosts Dr. Aaron Fritts and Dr. Bryan Hartley interview Scott Becker, founder and publisher of Becker's Healthcare, a media company dedicated to serving the specialized interests of healthcare leaders. --- SHOW NOTES Scott's background consists of a blend between healthcare law and media. He attended Harvard Law School, where he served as a teaching assistant for many students, including young President Obama, a third year law student at the time. In his twenties, Scott worked at a large firm and specialized in healthcare law, representing surgeons and surgical centers. While working within a large law firm, he realized that he wanted to take control of his own career and subsequently transitioned to a healthcare media focus in his 30s. He brought on Jessica Cole, a college student at the time, to handle team organization and commercialization for his small newsletter. Together, they expanded into websites, newsletters, and organized conferences in Chicago. Recognizing the growing interest in these conferences, Scott expanded his team to cater to a wider customer base. Due to higher demand and larger hospital budgets, hospitals and health systems ultimately became their primary focus. After talking to target customers, they developed separate media service lines including reading and audio content. Scott talks about the transition from brand advertising to lead generation advertising, a strategy focused on reaching the target customer and generating profits from those leads. The journalists at Becker's Healthcare generate these leads by consistently staying updated on healthcare leadership trends, evolving perspectives, and audience engagement to create personalized content and maintain their connection with the audience. Scott and the hosts explore the challenges of artificial intelligence and Chat GPT in engaging with audiences, strategies for distinguishing a business in a media landscape inundated with information, and methods for creating highly engaging and interactive conferences. This year marks the 29th Annual ASC Conference, with hundreds of participants and notable speakers including Rob Gronkowski and Mia Hamm. --- RESOURCES ASC Annual Conference https://conferences.beckershospitalreview.com/beckers-october-asc-annual-conference-2023 Becker's Hospital Review https://www.beckershospitalreview.com/ Good to Great by Jim Collins https://www.amazon.com/Good-Great-Some-Companies-Others/dp/0066620996 Peter Attia https://peterattiamd.com/
In this episode, host Dr. Aaron Fritts interviews Dr. Maureen Kohi and Dr. Niten Singh on the VIVA Foundation's multidisciplinary approach to advancing vascular medicine. --- CHECK OUT OUR SPONSORS Medtronic ClosureFast https://www.medtronic.com/closurefast6f Philips Image Guided Therapy Devices Academy https://resource.philipseliiteacademy.com --- SHOW NOTES Maureen is an interventional radiologist and Professor and Chair of the Department of Radiology at University of North Carolina - Chapel Hill. Niten is a vascular surgeon and Associate Chief of Vascular Surgery at University of Washington. Both serve on the board of directors at VIVA. We begin with how Maureen and Niten became involved at VIVA. They discuss the history and foundations of VIVA. The duo goes on to describe how VIVA has evolved throughout the years. Maureen speaks on how VEINS has become a comprehensive educational meeting for all things venous disease and interventions, which complements VIVA's arterial focus. Niten and Maureen then explain how VIVA and VEINS have become more than just meetings. They are conglomerates of multiple initiatives for all things vascular driven by the central question of “What is best for the patient?” The duo also sheds light on the unique inner-workings of VIVA, highlighting the foundation's speedy, nimble, and inclusive approach to the rapidly advancing landscape of vascular and endovascular surgery. We get a special look of what to expect at VIVA & VEINS Annual 2023 Conference at Wynn Las Vegas (October 28th - November 2nd) from Niten and Maureen. We conclude this episode with Maureen and Niten's thoughts on how we can improve vascular care for our underserved patient populations and what role OBLs will play in this equation going forward. --- RESOURCES VIVA 2023 Annual Conference Registration: https://viva-foundation.org/viva-programming VEINS 2023 Annual Conference Registration: https://viva-foundation.org/veins-programming VIVA Vascular Leaders Forum on Paclitaxel Safety (2019): https://evtoday.com/articles/2019-mar/highlights-from-the-viva-vascular-leaders-forum-on-paclitaxel-safety
In this episode, host Dr. Aaron Fritts and Dr. Krishna Mannava engage in a discussion with Dr. Bret Wiechmann about a concerning trend in the field—insurance denials for critical limb ischemia (CLI) interventions. --- CHECK OUT OUR SPONSOR Philips SymphonySuite https://www.philips.com/symphonysuite --- SHOW NOTES Bret is an IR in Gainesville, Florida with over 26 years of experience and is one of the founders of the Outpatient Endovascular & Interventional Society (OEIS). OEIS was started 10 years ago to advocate for the viability of non-hospital IR services. We start the episode with Bret sharing his staff's firsthand encounters with pre-authorization challenges for atherectomy procedures.The panel discusses how the recent inflammatory NY Times article regarding the use of atherectomy to treat peripheral artery disease has exacerbated these challenges. The doctors delve into the perplexing use of non-scientific articles as evidence by insurance companies, which are often influenced by third-party recommendations. The disconnect between insurance decisions and patients' actual needs becomes evident, as peer-to-peer reviews usually involve physicians unfamiliar with the specific medical speciality. Next, we explore strategies for navigating the intricacies of insurance approvals, a particularly challenging task as each insurance company has its unique set of requirements for procedure coverage. Evaluating these requirements for each patient not only limits the capabilities of the physician, but also decreases the quality of the patient's care. One strategy that is discussed is compiling a list of different payers and their specific requirements for each procedure, but this takes away valuable time away from a patient's care. Another strategy includes the intriguing notion of physicians noting the names of insurance companies and peer reviewers on medical records as reasons for denying certain procedures. While promising, the effectiveness of this approach remains uncertain. Furthermore, the episode contemplates the possibility of refusing to work with insurance companies that consistently denying coverage— a bold strategy that warrants careful consideration as it may drop patient volumes. To combat the rising tide of insurance denials, the discussion emphasizes the pivotal role played by organizations like OEIS. It highlights the importance of involving referring physicians in various specialties, patients themselves as well as industry stakeholders manufacturing relevant devices to bring about meaningful change in the insurance approval process. --- RESOURCES New York Times Article: https://www.nytimes.com/2023/07/15/health/atherectomy-peripheral-artery-disease.html OEIS: https://oeisweb.com
In this episode, host Dr. Aaron Fritts interviews Dr. Aaron Kovaleski on good old-fashioned TV and radio marketing. Aaron is an interventional radiologist and founder of Endovascular Consultants of Colorado, who has found success in using tried and true methods of advertising to grow his practice. --- CHECK OUT OUR SPONSOR Philips SymphonySuite https://www.philips.com/symphonysuite --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/pL6Ay0 --- SHOW NOTES We begin with Aaron's initial dive into marketing, tips that he learned, and surprising discoveries during this endeavor. He discusses differences between TV and radio advertising and ideal promotions to run through each medium. He also notes the importance of supplementing these strategies with a physical presence. Aaron also shares advice for building a marketing budget. He breaks down categories and percentage of funds invested towards his OBL's TV and radio outreach. Aaron then speaks on how his practice measures the success of their efforts through analytics provided to them by TV and radio stations and CRM technology. We also discuss the time investment and step-by-step approaches for newer OBLs that are new to marketing outreach. We conclude this episode with future directions for marketing and a shoutout for next year's Outpatient Endovascular and Interventional Society (OEIS) Annual Meeting in Las Vegas (April 25th-27th, 2024), which will have a dedicated session on marketing and practice building led by Aaron. --- RESOURCES Outpatient Endovascular and Interventional Society (OEIS) Annual 2024 Meeting: https://oeisweb.com/meetings/2024-annual-meeting/
In this episode, Dr. Aaron Fritts interviews Dr. Mehdi Razavi about his journey to entrepreneurship and in developing Saranas Early Bird, a vascular device that allows for early detection of perioperative bleeding. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/8OyLFJ --- SHOW NOTES Before venturing into entrepreneurship, Mehdi was a dedicated EP cardiologist with limited exposure to entrepreneurship. After his fellowship, Mehdi took part in a Medtronic project. This experience energized him and ignited a desire to explore more opportunities for entrepreneurship. Mehdi conceived the idea for Early Bird when he suspected a hematoma in one of his patients following an atrial ablation procedure. Recognizing the risk of postoperative bleeding in such procedures, he envisioned a solution for early hematoma detection. The device that he developed is a specialized venous axis sheath equipped with ringed electrodes. These electrodes continuously emit sub-physiologic electrical signals both throughout and after a medical procedure, enabling real-time monitoring of the sheath's impedance or resistance. This technology can detect a drop in impedance, indicating potential bleeding, as blood exhibits the lowest impedance in the body. Because their technology works as a warning system, Mehdi and his co-founder Alex Arevalos decided to name their company after the early bird genus, Serenus. Despite working for 5-6 years to secure a patent for the idea, Mehdi remained persistent in his preclinical studies, understanding the significant impact his innovation could have on his medical specialty and the potential benefit for patients. For physicians transitioning into entrepreneurship, Mehdi suggests initiating the process of establishing a company early on to introduce more organization and delegate specific roles effectively, which allows for more time to continue working as a clinician. --- RESOURCES Saranas Early Bird: https://saranas.com/
In this episode, host Dr. Aaron Fritts is joined by Dr. Pranav Moudgil, a new IR graduate who has just completed his first IR job search. Today's discussion revolves around the job landscape for recent interventional radiology graduates. --- CHECK OUT OUR SPONSOR Philips Image Guided Therapy Devices Academy https://resource.philipseliiteacademy.com --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/rhaY4i --- SHOW NOTES The episode begins by introducing Pranav, who hails from Michigan and has recently completed his IR training at Beaumont. His discussion on today's podcast was influenced by the recurring question he faced during his job hunt: “What do candidates like him seek in their careers?” Pranav's job search began in January of his PGY-5 year, 18 months before his graduation. When compared to his initial expectations of a robust job market, reality both did and did not meet these expectations. Pranav found that while there were a lot of job postings online, he was aware that there were just as many, if not more, word-of-mouth job opportunities. During his early training years, Pranav initially thought that he wanted a 100% IR role, but after getting more exposure to DR, he later realized that he wanted a balanced mix of DR and IR. When searching for jobs, Pranav found that many of his interviews came from listings on the ACR job board. However, after seeing the jobs his peers ended up taking, Pranav realized that personal connections played a significant role in job placement for him and his peers. As we delve into the core aspects of Pranav's job search strategy, he emphasizes the importance of being aware of which factors you value most in a job. Pranav also encourages new grads to evaluate job offers in terms of technical staff support and long-term job satisfaction. He advises job seekers to be vigilant for red flags during negotiations and emphasizes the importance of clear communication. The topic of locums tenens work also gets brought up during this discussion, as a means to explore diverse job opportunities before committing to a permanent position. Overalll, for a new IR graduate, Pranav recommends engaging in candid discussions about pay and structural aspects with mentors, understanding personal priorities, and evaluating job offers with a discerning perspective. --- RESOURCES ACR Job Listings: https://jobs.acr.org/
In this episode, host Dr. Aaron Fritts interviews interventional radiologists Dr. Kumar Madassery and Dr. Shelly Bhanot about catheter shapes and when to use each type in basic and challenging cases. --- CHECK OUT OUR SPONSOR Cook Medical https://www.cookmedical.com/divisions/vascular-division/ --- SHOW NOTES Kumar serves as an Associate Professor and Director of Peripheral Vascular Interventions/Critical Limb Ischemia and Shelly is a PGY-6 IR resident at Rush University Medical Center in Chicago, IL. Kumar and Shelly walk us through a number of different catheters and techniques, along with tips that they have learned from their experiences in the cath lab. They pair complex and challenging anatomy with catheter types, and they describe their reasoning behind different approaches. After going through case-based examples, both Kumar and Shelly share advice on how trainees can become more familiar with tools on the back table. These include observing supply shelves, asking questions, and learning from IR techs and device representatives. We conclude the episode by emphasizing the power of teaching and how experience is a big factor in becoming more and more familiar with all the catheters that are available to our specialty. Disclaimer: The content, information, opinions and viewpoints contained in this presentation are for educational purposes only. Some opinions expressed may represent those of the speaker and are based on their own clinical experience in their practice. This information is not meant or intended to serve as a substitute for a healthcare professional's clinical training, experience or judgment. Guest speakers are paid consultants of Cook Medical. Always refer to the Instructions for Use for complete prescribing information including indications for use, warnings, precautions, adverse events and deployment/use instructions.
In this episode, host Aaron Fritts is joined by Lake Odom and Chas Sanders. Lake is an IR technologist with over a decade of experience, and Chas is the founder and CEO of MARGIN, a company that handles supply chain and outpatient OBLs and ASCs. They focus on the vital role that techs play in maintaining the culture, workflow, and efficiency in an office-based lab (OBL). --- CHECK OUT OUR SPONSOR Siemens Healthineers https://www.siemens-healthineers.com/ --- SHOW NOTES The episode starts with a discussion on what a team lead should be looking for when hiring a IR or cath lab tech. Lake notes that experience and teamwork skills are essential. However, the willingness to learn can also make up for the lack of experience, especially because experience in one office does not always translate to another practice, since every practice has different needs and procedures. Positive work culture and fair compensation are crucial to employee retention. While the physician plays a large role in defining the culture in a practice, it is also important that IR techs are trusted with the responsibility of maintaining the culture, as their roles are very patient-facing and key in practice efficiency. In the discussion of paying techs on a salary versus an hourly system, Lake notes how a salaried tech is more likely to feel like a part of the team and is more invested in the success of the practice. As the discussion shifts to increasing the efficiency and profitability of a practice, Chas discusses how cost awareness is key. It is vital that the physician engages the techs in this conversation, since they are the ones who order tools. The guests wrap up the episode by emphasizing how putting trust in the techs is crucial to the efficiency and profitability of each practice, as they will be the biggest advocates of the practice to the patients.
In this episode, host Dr. Aaron Fritts interviews interventional radiologist Dr. Eric DePopas about digital marketing strategies for physicians. Eric is the Co-Founder and Chief Medical Officer of Helped, a company designed to connect patients to IR physicians. --- CHECK OUT OUR SPONSORS Siemens Healthineers https://www.siemens-healthineers.com/ Medtronic Ellipsys Vascular Access System https://www.medtronic.com/ellipsys --- SHOW NOTES To begin the episode, Eric shares his motivations behind starting Helped and the unique story of sharing this undertaking with his brother and co-founder Kevin DePopas. He discusses his uphill battle of marketing IR services and building a strong patient base. Eric also covers differences between digital versus in-person marketing. He emphasizes that the digital world is not a substitute for boots on the ground, and he underscores the importance of building word of mouth through strong clinical work and regularly interacting with referring physicians. Eric also shares valuable digital marketing takeaways and questions to ask marketing agencies. Then, Eric breaks down paid-search (Google), paid-social (Facebook, Instagram, TikTok), and radio marketing strategies. Aaron and Eric discuss how to approach the bottom of the marketing funnel (where potential patients become treated patients), and how to engage and guide patients with interactive online quizzes. Finally, the doctors examine the value of customer relation management systems (CRMS). Eric explains how CRMS is a high fidelity approach to assessing patient knowledge and how it is a key component in building a truly robust funnel. The episode concludes with Eric giving parting advice and encouragement for physicians in the marketing world. --- RESOURCES Helped Website: https://www.tryhelped.com/patient-home
In this episode, co-hosts Dr. Aaron Fritts, Dr. Michael Barraza, and Dr. Eric J. Keller discuss social media ethics in medicine. --- CHECK OUT OUR SPONSOR RADPAD® Radiation Protection https://www.radpad.com/ --- SHOW NOTES To kick-off the episode, the three IR physicians discuss “clot porn” and all the debate associated with posting case-related findings (clots, imaging, etc) on social media with device/company name visible. Dr. Keller, who has a strong background in medical ethics, shares his thoughts on the matter and underscores the 6 pitfalls of medical social media: patient privacy, patient dignity, information accuracy, conflict of interest, justice inequity, and interprofessional respect. From Dr. Keller, we learn that the crux of the matter tends to circle back to two central issues– how the case is shared and intentions behind sharing. Additionally, Dr. Keller shares unique data on the relation between how often a medical device company is mentioned in social media posts, how often physicians are compensated for their public endorsements, and whether or not conflict of interests are disclosed. Dr. Barraza and Dr. Keller then compare TikTok, Instagram, and Twitter's roles and potentials in medicine. The trio discuss Twitter's past, present, and future influences on medical research, networking, innovation, and education. They also consider the need for more clear, comprehensive social media posting guidelines issued by specialty societies and ideas for patient consent forms over social media posting. To wrap up the episode, the doctors discuss interprofessionalism, dealing with social media trolls/negativity, and personal vs. professional accounts. Dr. Keller notes that 85% of the general public turns to social media networks to seek healthcare information, which highlights the online presence of physicians and how they are often held to a higher ethical standard on social media platforms. For listeners wanting to learn more about social media ethics in medicine, the annual Western Angiographic Interventional Society (WAIS) in Palm Springs, California (October 7-11, 2023) will have dedicated medical social media ethics panels and discussions built into programming. Be sure to register and attend! Link to the WAIS webpage below. --- RESOURCES Western Angio Interventional Symposium 2023 Schedule: https://www.westernangio.org/ Western Angio Interventional Symposium 2023 Registration: https://www.westernangio.org/event-5048807 Link to Thomas Webb study: https://www.jvir.org/article/S1051-0443(22)01727-4/fulltext CMS Sunshine Database: https://openpaymentsdata.cms.gov/
In this episode, host Dr. Aaron Fritts interviews Dr. Junjian Huang & Dr. Sean Maratto on navigating early-career changes. Both Dr. Huang and Dr. Maratto touch on a range of their early-career experiences and offer their advice, insights, and realizations. --- CHECK OUT OUR SPONSOR RADPAD® Radiation Protection https://www.radpad.com/ --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/9clNvR --- SHOW NOTES The trio begin by discussing the responsibilities of stepping up as new attendings and dive into all that goes into maintaining and building new service-lines. Both Dr. Huang and Dr. Maratto underscore the importance of being as available as possible, taking every brick and mortar case with enthusiasm and drive, and truly getting to know your referring physicians. These actions go a long way in successfully establishing and expanding IR service-lines. Dr. Huang and Dr. Maratto also speak on the nuances of cultural awareness and sensitivity, as every region, hospital, and/or practice does not operate in the same fashion. Both early-career physicians convey the gravity of quickly adapting to the cultural norms of a new workplace and becoming comfortable in new environments. Dr. Maratto adds how conflict resolution is a mainstay throughout all career stages and highlights leadership and clear communication as vital qualities. We then hear about the ins-and-outs of early-career mentorship from both physicians. Dr. Huang states how some of the most pivotal mentors can be from different fields, to always search for mentors, and to even make mentors through industry. Dr. Maratto shares how it is important to have mentors for both professional and emotional support and to always pay it forward to the next-generation of physicians and trainees. Dr. Fritts, Dr. Huang, and Dr. Maratto share a real-time mentorship moment and have a conversation on how becoming an attending can be accompanied by extremely important life milestones such as getting married, starting a family, buying a house, and more. We conclude the episode by discussing some challenges new attendings can face, such as navigating the business-side of medicine and becoming confident in marketing, insurance, and billing. Both early-career physicians agree how these tasks should not be delegated, as they are very worth knowing. Dr. Juang and Dr. Maratto leave us with important parting advice on what they wish they were told when they finished training and became attending physicians. --- RESOURCES Early Career Section (ECS) of SIR: https://www.sirweb.org/member-central/volunteer/early-career-section2/
In this episode, host Dr. Aaron Fritts interviews Jason Newton - an attorney with 14 years of private practice defense experience and current General Counsel at Curi - about cybersecurity in medicine and healthcare. --- SHOW NOTES Jason begins by introducing how he became an expert in cybersecurity law. Dr. Fritts and Jason then segue to the present day threats of ransomware in healthcare, beginning with a birds eye view and progressively getting more granular. They cover the topics of staffing shortage, how threat-actors are akin to present-day pirates, and the chief risk of ransomware. We learn that healthcare is the most common target of ransomware from threat-actors and how “big fish” are not only the main targets, meaning many smaller health entities are also under real threat. Jason explains well documented reports which detail the intense interest in health information of several US targets such as government leaders, military personnel, celebrities, and popular athletes. Dr. Fritts and Jason underscore how money is the central driving force behind ransomware attacks on healthcare. Mr. Newton also takes a deep dive into how threat-actors engage in social engineering to ensure their success. Troubling enough, Jason also shares how threat-actors (on average) have already infiltrated health systems 66 days prior to the day the breach has been discovered. Essentially health systems will only see threat-actors when these hackers want to be seen and demand ransom. ChatGPT, AI, and deep-fake technology is also discussed and how it can be used by threat-actors to bolster their ransomware attacks on healthcare. Jason also mentions the need for health systems to invest in cybersecurity insurance and the inverse relation between “secure” and “easy”. Health systems' responsibility to secure their data is paramount to mitigating and avoiding ransomware. Jason highlights the necessity of training, the fact that people can be the weakest link in security, and how it is critical for everyone to approach their email inbox with a “no-trust” policy. Anti-phishing software can also be a very helpful addition to health systems looking to bolster their cybersecurity. Mr. Newton supplies some helpful training, consultation, and investigation resources from the Cybersecurity and Infrastructure Security Agency. While we hope this discussion may be helpful, there are no guarantees that the information and resources shared will prevent and/or mitigate bad outcomes, and no guarantees or endorsements are made. Although Jason is an attorney, he cannot and does not offer legal advice to external parties and an attorney-client relationship is not established with listeners of this podcast. Please contact your personal or corporate attorney if you require legal advice. --- RESOURCES Cybersecurity and Infrastructure Security Agency website: https://www.cisa.gov/resources-tools
In this episode, host Dr. Aaron Fritts interviews Dr. Peter Soukas taking a deep dive into novel balloon technologies, appropriate uses below the knee, and how these new balloons are highly effective in treating patients with critical limb ischemia (CLI). Dr. Soukas explains how these new balloon technologies can minimize the risk of dissections (therefore decreasing the need for bailout stents), create effective lumen gain in concentric and eccentric calcified lesions with minimal recoil, and keep pressures low compared to legacy products. --- CHECK OUT OUR SPONSOR Cagent Vascular Serranator https://www.cagentvascular.com --- SHOW NOTES Dr. Soukas is an Interventional Cardiologist who is the Founder and Director of the Brown Vascular and Endovascular Medicine Fellowship program, serves as the Director of the Interventional PV Lab at the Lifespan Cardiovascular Institute of Brown, and an Associate Professor of Medicine at the Warren Alpert School of Medicine. We begin by discussing the treatment of CLI, particularly with new below the knee balloon angioplasty devices like the Cagent Serranator and how balloon tech has evolved over time. These new technologies allow for 1000x more force than previous balloon models through unique serration technology at significantly lesser pressures, minimizing the risk of barotrauma and iatrogenic lumen dissections, while allowing for effective luminal gain, and showing success in treating CLI even when calcified lesions are present. What's more is that there is now a variety of serration balloon lengths available, which was definitely a huge shortcoming in prior scoring balloons with limited sizing. While IVL is the preferred option in terms of treating concentric (360°) calcified lesions, new serration balloons are cheaper and show success in treating both concentric and eccentric calcified lesions with minimal recoil. Dr. Soukas and Dr. Fritts also go on to discuss how using IVUS is critical in visualizing the size, shape, and depth of possible calcifications but also important in picking the correctly sized serration-balloon to get the job done. Dr. Soukas also explains how the serration balloon technology is easily deployable, tracks very well within vasculature, and can even be used below the ankle if needed (with some pre-dilation of the lumen) stating that if the IVUS can fit, usually so can the serration balloon. To wrap up the episode we underscore how important it is to have the right tools in our toolbox to treat patients with CLI, getting as much “red gold” down to the foot as possible to avoid loss of the limb, and a few papers our listeners can check out to learn more about serration balloons (find linked in Resources below). --- RESOURCES CagentVascular.com Prospective Study of Serration Angioplasty in the Infrapopliteal Arteries Using the Serranator Device: PRELUDE BTK Study DOI: 10.1177/15266028211059917 Standard Balloon Angioplasty Versus Serranator Serration Balloon Angioplasty for the Treatment of Below-the-Knee Artery Occlusive Disease: A Single-Center Subanalysis From the PRELUDE-BTK Prospective Study DOI: 10.1177/15266028221134891 PRELUDE Prospective Study of the Serranator Device in the Treatment of Atherosclerotic Lesions in the Superficial Femoral and Popliteal Arteries DOI: 10.1177/1526602818820787
In this episode, host Dr. Aaron Fritts and interventional radiologist Dr. Alex Pavidapha give a primer on the emerging field of hemorrhoidal artery embolization (HAE), including patient presentations and referrals, treatment algorithms, procedural steps, and follow up care. --- CHECK OUT OUR SPONSOR Boston Scientific Nextlab https://www.bostonscientific.com/en-US/nextlab.html?utm_source=oth_site&utm_medium=native&utm_campaign=pi-at-us-nextlab-hci&utm_content=n-backtable-n-backtable_site_nextlab_1_2023&cid=n10013202 --- SHOW NOTES To start. Dr. Pavidapha describes the typical patient presenting with hemorrhoids. This is a prevalent condition that peaks at the ages of 45-65 and in the pregnant population. There are a variety of treatment options ranging from banding, hemorrhoidectomy, and cryotherapy; however, many patients may experience recurrence after these treatments or they may not be suitable candidates for surgery. Next, we discuss the current landscape of HAE. This treatment is a good option for patients who have failed other treatment options. The majority of Dr. Pavidapha's patients come from referrals by gastroenterologists, although some come based on their own research on the web. It is important that all patients have a colonoscopy before HAE, to rule out the possibility of colon cancer. Additionally, a full history and rectal exam should be performed, since the choice to treat can be guided by the patient's symptom severity and the degree of internal hemorrhoid prolapse. It is also advisable to identify extremely painful external hemorrhoids, since these can be addressed with conservative measures. Dr. Pavidapha notes that patient counseling is extremely important, since hemorrhoids have a high risk of recurrence and bowel habits play a large part in this. In terms of procedural risks, he counsels patients about standard risks of bleeding and infection, recurrence, mild pain in the few days after the procedure, and although it is rare, non-target embolization of skin or other organs. During the procedure, Dr. Pavidapha prefers femoral access, since this is the easiest way to select the internal mesenteric artery. He does a base catheter run here to visualize the superior rectal arteries. These vessels are the most commonly involved in internal hemorrhoids, and if they are feeding the hemorrhoid, he will inject 500 micron beads and then follow with embolic coils. Next, he navigates through the internal iliac and pudendal arteries to arrive at the middle rectal arteries for another run. If they also supply the hemorrhoids, he will embolize them. The inferior rectal arteries are usually not involved in hemorrhoid formation, embolization of them carries a high risk of skin necrosis. Treatment of inferior rectal arteries is usually avoided. It is important to know typical anatomy very well so you can determine targets for embolization and recognize whether a patient has variant anatomy. Finally, Dr. Pavidapha sees his patients for follow-up at 1 month, 4 months, and 1 year to check for symptomatic improvement, primarily decreased bleeding. If bleeding has worsened, the patient most likely needs a repeat procedure to identify new blood vessels supplying the hemorrhoid. To IRs who are interested in starting an HAE service line, Dr. Pavidapha advises them to read the existing literature about hemorrhoids and HAE and be able to show clinical outcomes data to gastroenterologists. Overall, patients with recurrent hemorrhoids are typically an underserved population and have the potential to benefit from this novel procedure. --- RESOURCES Ep. 319 - How to Collaborate with GI on a New Outpatient Service Line: https://www.backtable.com/shows/vi/podcasts/319/how-to-collaborate-with-gi-on-a-new-outpatient-service-line Outcomes of Hemorrhoidal Artery Embolization from a Multidisciplinary Outpatient Interventional Center: https://pubmed.ncbi.nlm.nih.gov/36736822/ The STREAM Meeting: https://www.thestreammeeting.com/
In this episode, host Dr. Aaron Fritts and interventional radiologist Dr. Kevin Henseler discuss his treatment algorithm and new technologies for embolization of GI bleeds. --- CHECK OUT OUR SPONSOR Boston Scientific Obsidio Embolic https://www.bostonscientific.com/obsidio --- SHOW NOTES Dr. Henseler starts by differentiating between lower and upper GI bleeds. Upper GI bleeds tend to be more life-threatening and are most commonly caused by esophageal varices or duodenal ulcers, and many of these consults come from the endoscopy suite. These upper GI bleeds also have a higher risk of recurrence. On the other hand, lower GI bleeds can be more indolent. CTA is the most efficient way to assess the source of GI bleeding. It provides valuable information about the vascular territory, including localization of bleeding, planning where to inject during angiography, and variant anatomy. If CTA is negative for bleeding, Dr. Henseler does not move onto angiography. He monitors the patient for further signs of intermittent bleeding and may re-image or intervene the following day. If CTA does show bleeding, Dr. Henseler moves onto angiography and embolization. He finds that there are few contraindications to angiography. Relative contraindications include renal insufficiency, which is a small tradeoff for a lifesaving procedure, and contrast allergy, which can be addressed with a preprocedural steroid dose. When it comes to methods of embolization, detachable coils have been a mainstay. While they are more expensive than pushable coils, detachable coils allow for more exact placement and increased safety and more IRs are being trained to use these now. Dr. Henseler also discusses the use of embolic particles, which carry risks of end-organ damage and ischemia, as well as embolic glue, which can be difficult to use if the operator does not have sufficient training. Then, we shift gears to discuss Obsidio, a new injectable solid that is soon to be commercially available. It exists as a liquid when it is in its pressurized form within the microcatheter; however, it immediately solidifies in the vessel as soon as the injection ceases. Obsidio is made of radio-opaque tantalum so it is visible on CT, stays permanently in the vessel, and can be used in conjunction with coils if desired. Additionally, its cohesive properties decrease the risk of abdominal extravasation and it can be used with any catheter. --- RESOURCES Dr. Kevin Henseler LinkedIn: https://www.linkedin.com/in/kevin-henseler-364832231/ CTA for Lower GI Bleeds: https://www.youtube.com/watch?v=UWEf_sAUGKU Ep. 179- Happiness is a Warm Coil: Treating GI Bleeds: https://www.backtable.com/shows/vi/podcasts/179/happiness-is-a-warm-coil-treating-gi-bleeds Ep. 216- Stick It: Glue Embo: https://www.backtable.com/shows/vi/podcasts/216/stick-it-glue-embo
In this episode, Dr. Aaron Fritts interviews Dr. Gregory Makris about making the transition to industry, including how to market yourself, and how to maintain your clinical and technical skills while working in industry. --- CHECK OUT OUR SPONSOR RADPAD® Radiation Protection https://www.radpad.com/ --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/SFBnOQ --- SHOW NOTES Dr. Makris is from Greece, and he did his initial training there. He then continued his training in vascular medicine in London, and has been working there ever since. Over the past year, he has been working for Bayer Pharmaceuticals in vascular therapeutics as director, and global clinical lead. He has a hybrid work environment where he works virtually for Bayer, and travels frequently, but still maintains a clinical position at his practice one day a week. He wanted to do this because he enjoys practicing IR and wanted to maintain his clinical and technical skills. Next, we discuss how he decided to get into industry, particularly pharmaceuticals. He never envisioned he would join industry while training. A decade ago, there was a bad reputation about physicians who left medicine to join industry. People often remarked these physicians were soulless or had joined the dark side. Now, there is much less criticism, and there are growing numbers of physicians choosing to partner with industry. Dr. Makris was working as an attending when he started getting more exposed to industry at conferences. He started to imagine a role in medical device innovation, and with a background in research, he knew he had expertise that would be useful to industry as a physician scientist. Somewhat surprisingly, an opportunity came up with Bayer in pharmaceuticals. It was a global role, and involved clinical and research development of vascular medications, which was appealing to him as an IR with a PhD in vascular medicine and someone passionate about global outreach. He also sensed he was ready for a new challenge in his career, so he accepted the role. He recommends being very honest with yourself about your abilities and your limitations when starting out in a new role in industry. Additionally, you should be open to learning new roles, and be flexible with time and travel. Dr. Makris says that the best way to maintain a clinical role is to have a frank conversation with your practice and explain what you can offer them and how to work out a deal that benefits both parties. Most practices will be willing to keep you on part time. If they are not, there are numerous opportunities to stay in medicine, whether through locums or reaching out to other practices that need help. Dr. Makris ends by saying that as a physician, there are many ways to have career satisfaction and work-life balance, while still contributing to healthcare and helping patients. He sees his new role as an opportunity to contribute to the bigger picture, which is advancing healthcare and medical standards. --- RESOURCES Ep 128: Device Innovation with Dr. Atul Gupta https://www.backtable.com/shows/vi/podcasts Ep 57: Practicing IR in the UK with Dr. Gregory Makris https://www.backtable.com/shows/vi/podcasts/57/practicing-ir-in-the-uk Linked In: https://www.linkedin.com/in/gregory-makris-m-d-ph-d-dic-frcr-22118660/?originalSubdomain=uk Twitter: @GregMakris23
In this episode, host Dr. Aaron Fritts interviews Dr. Jim Melton and Amanda Stanley about intravascular lithotripsy in the ASC, including reimbursement trends, patient selection and the future of the device. --- CHECK OUT OUR SPONSOR Shockwave Medical https://shockwavemedical.com/?utm_source=Backtable-Podcast&utm_campaign=Backtable-Podcast --- SHOW NOTES We begin by discussing Amanda's role in the practice. She is an ex OR nurse and has been clinical director for their original hybrid ASC/OBL in Oklahoma City for 8 years. She has taken on many roles over the years, the most recent being COO. Some of her functions under this title include clinical revenue cycle management (RCM), payer negotiation, credentialing and accreditation. Since partnering with a private equity firm, she has also been collaborating with others in ASCs they have acquired around the country. Dr. Melton states that intravascular lithotripsy (IVL) reimburses very well in the outpatient space, but that this is only true in the ambulatory surgery center (ASC) and does not translate to outpatient based labs (OBLs). Medicare pays for all associated Shockwave intravascular lithotripsy CPT codes, commercial insurance does not. They found in their practice that by using the Medicare fee schedule, they could prove to their local commercial insurance providers that it was worth paying for, and they are now getting it approved via both parties. Specifically, C9765, which is for IVL, percutaneous transluminal angioplasty (PTA) and stenting, pays $5000 more than the code that is just for PTA and stenting. Lastly, we go over sizing and patient selection. In the ASC, he most commonly uses the 5.5, 6 and 7, which all go through a 5-6 Fr slender sheath in the foot. If you use an 8 then you'll need a 7 Fr sheath, and if you use a size 9, 10, or 12, you'll need an 8 Fr sheath. Dr. Melton emphasizes the importance of selecting the right patients for the ASC and hospital. In those with significant comorbidities or a femoral artery that will need a size 9, 10 or 12 balloon, he tends to do these in the hospital. He finds that he places a stent more often than not after IVL and PTA because of what he sees using intravascular ultrasound (IVUS). He shares a tip for using the current IVL balloon. Because it emits the strongest sonic pressure impulse at the center of the balloon, he uses IVUS to mark the most calcified segment, then targets this area with the center of the balloon. He remarks that the newer version, coming out soon, has a shorter balloon and emits the same strength across its entire length, allowing you to skip this step. --- RESOURCES Ep. 287 OBL/ASC Reimbursement Update January 2023 https://www.backtable.com/shows/vi/podcasts/287/obl-asc-reimbursement-update-jan-2023
In this episode, Dr. Aaron Fritts interviews Dr. Nisha Mehta, a radiologist and founder of the Physician Side Gigs online community. --- CHECK OUT OUR SPONSORS Medtronic AV DCB https://www.medtronic.com/avdata Reflow Medical https://www.reflowmedical.com/ --- SHOW NOTES Dr. Mehta traces her journey from being a radiologist between jobs to managing and advocating for one of the largest grassroots physician communities, with more than 162,000 online members. She started Physician Side Gigs as a private Facebook group with a few doctors to get advice on managing finances for her paid writing and speaking engagements. Overtime, the size and scope of the group grew so much that there was a branch point where a separate group, Physician Community, formed. Both groups remain active today– while Physician Side Gig still centers around business and personal finance education, Physician Community is more free flowing and fosters a variety of conversations about the healthcare environment, clinical practice, and physician advocacy. This advocacy really came into the spotlight during the peak of COVID-19, when members of the online community collaborated to create a list of physician demands for the federal government and were successful in securing $70 billion for physicians in a stimulus package. Dr. Mehta cites the lack of bureaucracy in the group as factors that helped contribute to this outcome. The groups' goals are to provide members with peer support and bridge them to opportunities to pursue other interests and revenue streams. We also discuss Dr. Mehta's personal career trajectory and how her priorities shifted throughout the years. In the beginning stages of Physician Side Gigs, she was able to balance a full time clinical practice and manage the online group in her free time. However, as the group grew in audience and partnerships, she re-evaluated her priorities and saw that fostering the community gave her more energy and allowed her to make more impact than her clinical practice did. She now practices radiology on a per diem basis and devotes most of her time to Physician Side Gigs and physician advocacy. She has also hired staff members to help moderate the group and ensure that it remains a safe and supportive environment. Finally, Dr. Mehta speaks about physician autonomy. The decision to pursue a side gig is not always based on revenue maximization. Instead, side gigs can be a way for physicians to dedicate time to pursuing their non-clinical interests and prevent burnout. Her biggest advice for doctors is to be intentional about what they want their lives to look like, and to not get caught up in others' expectations for them. In the long run, having career autonomy can extend career longevity and allow physicians to navigate their lives on their own terms. --- RESOURCES Physician Side Gigs Website: https://www.physiciansidegigs.com/ Ep. 194 (VI)- Financial Basics with the White Coat Investor: https://www.backtable.com/shows/vi/podcasts/194/financial-basics-from-the-white-coat-investor Ep. 277 (VI)- Private Equity and the Radiology Job Environment with Ben White: https://www.backtable.com/shows/vi/podcasts/277/private-equity-the-radiology-job-environment Ep. 27 (INN)- Physician Underdog with LOUD Capital Founder Navin Goyal: https://www.backtable.com/shows/innovation/podcasts/27/physician-underdog
In this episode, host Dr. Aaron Fritts interviews Dr. Elsie Koh about physician coaching and leadership training, including the difference between mentorship and coaching, how to break through common barriers, and how to empower yourself to realize your potential. --- CHECK OUT OUR SPONSORS Medtronic AV DCB https://www.medtronic.com/avdata Reflow Medical https://www.reflowmedical.com/ --- SHOW NOTES Dr. Elsie Koh is an interventional radiologist and founder of Lead Physician, a physician specific coaching company. She trained in coaching at the Proctor Gallagher Institute (PGI), the International Coaching Federation (ICF), and received an Executive Master in Healthcare Leadership at Brown University. After working for only two years out of fellowship, she became the medical director of a surgery center. She had no experience in leadership, and due to her own insecurity and modeling after what she had seen in her medical training, she failed at this position. She was given feedback at a work event, which changed the trajectory of her career. After this occurred, she began reading self-help and personal development books. She sought out the PGI institute, and ended up training in their program to become a coach. Through this difficult experience, she realized other physicians could benefit from this type of guidance. Next, Dr. Koh explains the difference between mentorship and coaching. Mentorship is having someone tell you what to do, or modeling a behavior or career path that you want to emulate. Coaching allows a person to discover more of themselves, become aware of their blind spots, and learn what makes them unique. We discuss some of the most common barriers she sees among physicians that prevent them from seeking out coaching. She believes many hesitate because they don't believe it will work for them. Many physicians simply don't know what coaching involves and what their goals should be. Sometimes cost is prohibitive, mostly due to the fact that people are not used to investing in themselves in this way. Many physicians lack the confidence to admit they don't know how to do something, such as start a company or be a successful leader. At Lead Physician, they have the advantage of only coaching physicians, which helps clients let their guard down, because they are around like-minded thinkers. Dr. Koh likes group coaching sessions because it allows people to build off each other's inspiration, and yields greater idea sharing than one-on-one sessions. --- RESOURCES Ep. 194: Financial Basics from the White Coat Investor https://www.backtable.com/shows/vi/podcasts/194/financial-basics-from-the-white-coat-investor BackTable Innovation Ep 27: Physician Underdog https://www.backtable.com/shows/innovation/podcasts/27/physician-underdog Contact Dr. Elsie Koh: info@drelsiekoh.com Lead Physician: https://www.leadphysician.org Elsie Koh TED Talk: https://www.youtube.com/watch?v=hX19-7VRRfI
In this episode, co-hosts Dr. Aaron Fritts and Dr. Diana Velazquez-Pimentel interview Dr. Phil Haslam, founder of Which Medical Device and current president of BSIR, about the process of creating a resource bank of medical devices that spans multiple specialties. --- CHECK OUT OUR SPONSOR RADPAD® Radiation Protection https://www.radpad.com/ --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/SfFu13 --- SHOW NOTES Dr. Haslam began his career as a clinician in medicine, but always knew he wanted to do radiology, specifically interventional radiology. In the UK, you have to train in either medicine or surgery before subspecialty training. He had been an IR consultant for around 8 years when he suddenly couldn't find the right t-fasteners for a gastrostomy tube placement. He searched the internet for alternatives, but realized it was very cumbersome to complete such a search. Around this same time, he was getting into photography and frequented the website DP Review, which was a way to browse different lenses and parts for cameras, with ratings and information about the pieces. Inspired by this website, he thought a similar website for IR devices would be helpful to clinicians who practice in different environments and are required to know different devices. He began by finding a local web developer and used his own money to pay for the initial website development. He then began loading products he had used, specifically devices he liked or didn't like. He started telling colleagues about the website, and the word spread fast. What he found difficult was not traction to the website, but getting members to contribute to content, such as writing device ratings or uploading instructional videos. After a couple years, he decided to branch outside of IR into other device heavy specialties like cardiothoracics and orthopedics. He asked colleagues from other specialties to contribute as editors. Dr. Haslam believes the high traction in the IR device section is due to his frequent attendance of conferences, as well as his relationships with industry. Finally, we discuss future goals for Which Medical Device. Dr. Haslam hopes to upload more instructional videos to the website and the YouTube page. Additionally, he plans to bolster his editorial board to include even more specialties. He encourages people to engage by suggesting new devices for the website; they can do so via the home page of the website. He will add more in-depth reviews and device comparisons, as well as launch a device of the month column. --- RESOURCES Website: https://www.whichmedicaldevice.com YouTube Channel: https://www.youtube.com/channel/UCYnn3mCZGfgbUJmmehopcnw Email: phil@whichmedicaldevice.com British Society of Interventional Radiology: https://www.bsir.org
In this episode, host Aaron Fritts interviews engineer Lucien Blondel, co-founder and CTO of Quantum Surgical. We discuss robotic applications for interventional oncology procedures and the Epione robot's impacts on workflow and accuracy. --- CHECK OUT OUR SPONSOR RADPAD® Radiation Protection https://www.radpad.com/ --- SHOW NOTES Lucien first started innovating with robotics in the orthopedics, then neurosurgery fields. He has worked in startups and large corporations. Now, he is focused on interventional oncology. The catalyst for his idea came when his former startup was acquired. Lucien chose to create a company with three other co-founders and then explore. Quantum Surgical's mission is to democratize minimally invasive cancer treatment through pre-planning, advanced robotic assistance, and tumor ablation confirmation. Lucien started by obtaining the broad vision of the market. He noticed a clear unmet need: There was a proven clinical technique, but outcomes were very operator-dependent. Quantum Surgical's Epione robot could help alleviate this gap. Higher accuracy can lead to decreased invasiveness and more patient comfort in the outpatient setting. The first application for Quantum Surgical was pre planning software for interventional oncology procedures. He noticed that operators had difficulty visualizing masses for ablation. The robotic image vision software allows merging of CT and MRI images. Additionally, it can provide 3D modeling of ablation zones, map out needle trajectories, and confirm ablation by comparing pre-procedure and post-procedure imaging. Lucien emphasizes that the Epione robot can provide multiple functionalities for the same procedure, reducing the need to utilize different devices. The built-in features are programmed to adjust to patient movements and allow the physician to choose the safest path for needle placement. Finally, we discuss implications of robotics for workflow. Doctors can be more efficient in reviewing images, placing needles, and confirming ablation zones. Epione also reduces the need to obtain images during the procedure. At the moment, Epione is primarily focused on ablation of liver and kidney tumors. However, Lucien envisions the technology expanding to tumor biopsies, especially those that are located in high risk areas. Quantum Surgical is also looking into machine learning and prediction of local tumor progression. --- RESOURCES Quantum Surgical: https://www.quantumsurgical.com/epione/ Less Invasive Podcast: https://podcasts.apple.com/us/podcast/less-invasive/id1604673690 ROSA One Robot: https://www.zimmerbiomet.com/en/products-and-solutions/zb-edge/robotics/rosa-brain.html
In this episode, host Dr. Aaron Fritts interviews FLOW Medical cofounders Dr. Osman Ahmed and Dr. Jonathan Paul about how they built a company with the goal of designing a data-driven thrombolytic device that can deliver personalized care for patients with pulmonary embolism. --- CHECK OUT OUR SPONSOR RapidAI http://rapidai.com/?utm_campaign=Evergreen&utm_source=Online&utm_medium=podcast&utm_term=Backtable&utm_content=Sponsor --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/KikSeM --- SHOW NOTES Dr. Paul, interventional cardiologist, begins by explaining how he and Dr. Ahmed, interventional radiologist, came to work together. Dr. Ahmed came to the University of Chicago shortly after Dr. Paul started a pulmonary embolism response team (PERT) program. Dr. Ahmed, through his IR training, had experience with PE/VTE. They met and decided to combine their knowledge to build the program together. They both saw a need for new catheter directed thrombolytic (CDT) devices in their respective fields. The landscape of thrombectomy device innovation was booming, but they did not see the same innovation happening for CDT. After they both received the COVID vaccine, they were eating at Panera and drew out the idea for their device on a napkin. Neither of them had prior engineering experience and didn't know how to proceed after this, so they relied on the University of Chicago's entrepreneurial programs as a starting place. They then did market research and used their own internal research funding to subcontract with an engineering firm. They have been working on the design prototype since, and are conducting animal studies to trial the device. Once they reach design freeze, they will start the regulatory process and NIH 510(k) submission. They also have an NIH SBIR grant for small businesses doing innovative research. They plan to have the device on market in mid 2024. The goal for their device is to make it a catheter that can provide real-time feedback to minimize the complications of both too little or too much thrombolytic therapy. They are installing a sensor on the device that displays how much of the clot is lysed and allows for personalized PE treatment. They hope to incorporate AI into their data management, which they will use to tailor treatment in future patients. --- RESOURCES FLOW Medical: https://www.flowmedical.co
In this episode, cohosts Dr. Aaron Fritts and Dr. Krishna Mannava interview vascular surgeon Dr. Sean Hislop about building an ambulatory surgery center, including where to purchase property, how to plan your build, and how to prepare for expansion. --- CHECK OUT OUR SPONSOR Medtronic OBL https://www.medtronic.com/obl --- SHOW NOTES We begin by discussing Dr. Hislop's current practice in Charleston, South Carolina. He is part of a group of eight vascular surgeons, and is also chief of vascular surgery at a local hospital. Their group has 8 offices, 2 of which are outpatient based labs (OBLs). They are currently working on building an ambulatory surgery center (ASC) that is projected to open in April 2023. Dr. Hislop describes how ownership of the ASC was determined. Five interested partners in their group used their personal funds (5 equal parts) and in turn all 5 are on the board of directors. They keep 100% of their profits and work with a local banker that they have built a trusted relationship with from their prior experience with OBLs. To plan for future expansion, each partner will devote a certain percentage of their shares which will go into a pot to provide shares for future partners to buy in. When it came to deciding where to buy property and build their ASC, they factored in weather, price, and proximity to patients. They did market research to evaluate where to build that would be close to their target patient population. They were able to find an affordable property in an area with a high concentration of retirees. Their LLC leased the land, and their practice leased space from the building owner. They built out one procedure room with a portable 9900 OEC C-arm, 4 prep and 4 recovery bays where patients can stay for up to 48 hours. South Carolina is a certificate of need (CON) state, meaning they had to apply for a CON to do all their procedures. Their current CON is procedure specific, not specialty specific, though it does not currently include coronary interventions. This allows them to bring in interventional cardiologists, interventional radiologists or podiatrists in the future. Lastly, Dr. Hislop talks about the hiring process in the ASC. Throughout the COVID-19 pandemic, there has been a huge surge in travel nursing, which has caused retention problems throughout the country. Dr. Hislop remarks that he has recently seen the tides shift back towards normal employment. He believes that in order to recruit and retain high quality staff, it is vital to understand the market and offer competitive salaries. Some of the benefits to working at an ASC instead of a hospital is the lack of nights, weekends, and call coverage. For Dr. Hislop and his partners, they believe that efficiency and work satisfaction are more important than a big financial outcome, which is why they are passionate about building this ASC. They believe it will provide a much better patient experience while also keeping physicians and staff happy. --- RESOURCES Ep. 193: Managing Supplies in your Outpatient Facility https://www.backtable.com/shows/vi/podcasts/193/managing-supplies-in-your-outpatient-facility Ep. 202: Staffing the OBL https://www.backtable.com/shows/vi/podcasts/202/staffing-the-obl
In this episode, host Dr. Aaron Fritts interviews Dr. Jim Melton, vascular surgeon, and Dr. Blake Parsons, interventional radiologist, about progress in the OBL and ASC space, including reimbursement updates, partnering with a private equity firm, and value based care. --- CHECK OUT OUR SPONSOR Surmodics Pounce Thrombectomy https://pouncesystem.com/ --- SHOW NOTES We begin by discussing new developments in Dr. Melton's and Dr. Parson's practice. Over the past year, they have partnered with a private equity firm, Assured Healthcare Partners to create Heart and Vascular Partners (HVP). They now cover Oklahoma City, Colorado Springs, Denver, Pueblo, and parts of Illinois and Indiana. They employ mostly hospital based physicians' ready to start their own office based lab (OBL) or ambulatory surgery center (ASC). The physicians under HVP are cardiologists, vascular surgeons, and interventional radiologists. The two discuss the advantages of aligning with a private equity firm. For them, it provided the scale and capability to provide value-based care when it becomes widely adopted. Additionally, the payer has a much lower cost for the service in the outpatient space versus the hospital. All the physicians in HVP maintain local control over their practices, which was one of their main goals when they decided to partner with a firm. Next, we cover reimbursement cuts and the trends in OBLs and ASCs. On the arterial side of business, they are seeing that OBLs are down 10-15% in reimbursement rates, whereas ASCs are up 3-30%. For iliac interventions in the ASC, they have seen a 30-50% increase in balloon angioplasty and stenting, and up to a 60% increase for Shockwave. On the embolization side, arterial and venous reimbursement has dropped in the OBL by 7-8% and increased in the ASC by 3-30%. Alternatively, the CPT code for embolization for end organ ischemia (UFE, PAE) is still well reimbursed in the OBL. They caution listeners on genicular artery embolization and cryoneurolysis due to the risk of not getting it reimbursed and having to pay money back. --- RESOURCES Heart and Vascular Partners: https://heartandvascularpartners.com
In this episode, cohosts Dr. Aparna Baheti and Dr. Aaron Fritts interview interventional radiologist Dr. Sandeep Bagla about “The Halo Effect”, including how to recognize when you are being subjected to bias, and how to critically evaluate bad outcomes to improve your practice and enhance patient safety. The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/FSZCxF --- CHECK OUT OUR SPONSORS Accountable Physician Advisors http://www.accountablephysicianadvisors.com/ Accountable Revenue Cycle Solutions https://www.accountablerevcycle.com/ --- SHOW NOTES Dr. Bagla begins by describing the halo effect. The halo effect describes the tendency for people to overestimate the value of individual positive attributes when evaluating the whole. Thiis can happen when we form our opinions of people, techniques, and even medical devices. The opposite is also true, named the horn effect, where we tend to overestimate negative attributes. They are both forms of bias. In interventional radiology, the halo effect can impact case outcomes by contributing to operator tunnel vision and the reluctance to waver from the desired way of executing a procedure. For Dr. Bagla, the idea of the halo effect came about while working with new colleagues, many of whom do things differently than he did. He realized that in IR, physicians do things a certain way because that's how they learned in training, whether it really is the safest and best way, or just the most familiar. He also sees the horn effect occur often when people start using a new device. If the device doesn't work well for them the first time, many often refuse to use it in the future based on that first experience. He summarizes by noting that in IR, there are so many opportunities to become biased, whether through the halo effect or the horn effect. Lastly, Dr. Bagla reviews how he works to avoid these inherent biases. The first step in overcoming this bias is to understand its presence. Next, you must stop and realize that what you are doing is not working, whether due to the procedural approach, the device, or the way you are using the device. Dr. Bagla believes we must be critical of ourselves and try to think outside of our preferred wire, catheter, or device. In order to do this, you must go through the steps and review your checklist in order to determine which step the problem occurred at. Only by doing this can you avoid falling victim to these biases that are so prevalent in medicine. --- RESOURCES BackTable Episode 195: Disclosures of Conflicts of Interest https://www.backtable.com/shows/vi/podcasts/195/disclosures-of-conflicts-of-interest
In this next installment of our Back to the Basics series, Drs. Aaron Fritts and Chris Beck discuss their techniques, considerations, and tips for ensuring safe and high quality renal biopsies. The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/bYgmZk --- CHECK OUT OUR SPONSORS Laurel Road for Doctors https://www.laurelroad.com/healthcare-banking/ RADPAD® Radiation Protection https://www.radpad.com/ --- SHOW NOTES First, the doctors discuss indications and contraindications for biopsy. In the outpatient setting, the doctors have noticed that proteinuria is the most common reason for referral, followed by lupus nephritis. For inpatients, acute unexplained kidney failure is an additional indication. It is important to talk with nephrologists to weigh the risks and benefits of renal biopsy, especially if the patient has a coagulopathy, is experiencing uncontrolled hypertension, or is too unstable to lay prone on the table. The SIR Guidelines app is a useful tool to risk stratify patients. In terms of imaging, CT or ultrasound can be used, although they each have unique advantages. Ultrasound allows for real-time guidance and the ability to use the probe to hold pressure on the kidney to prevent bleeding. On the other hand, CT allows for better imaging in patients with larger body habitus and allows the patients to lay prone. Dr. Fritts emphasizes that the best imaging modality is the one that the operator is most comfortable with, since this will ensure maximal safety for the patient. One helpful tip when planning a biopsy is to avoid needle entry into the paraspinal muscles, since this could change the trajectory of the needle and cause pain. Both doctors prefer to use moderate sedation if the patient can tolerate it. This sedation usually has the added benefit of facilitating an intra-procedural blood pressure dip, which protects against bleeding when biopsying hypertensive patients. Since sedation can alter breathing patterns, starting sedation early (before scanning the patient) can be helpful in establishing a steady breathing pattern before the procedure starts. Dr. Beck also recommends checking blood pressure while the patient is in pre-operative care, in order to predict whether or not they might require additional intra-procedural antihypertensive medications such as hydralazine, labetalol, or clonidine. Since blood pressure control is a cornerstone of a safe procedure, each doctor has their own safety threshold for blood pressure. Then, the doctors discuss different types and sizes of biopsy needles. While a 16G needle can obtain better diagnostic samples, the 18G needle might have a lower risk of bleeding complications. The doctors also share their preferred brands of needles. The episode concludes with tips for surveilling patients in the post-procedural period and dealing with bleeding complications. Dr. Beck describes his protocol for re-scanning patients to check for large hematomas and keeping them under observation for at least three hours. If there is a large hematoma, emergency embolization must be performed. --- RESOURCES SIR Guidelines App: https://apps.apple.com/us/app/sir-guidelines/id1552455529 SIR Consensus Guidelines for the Periprocedural Management of Thrombotic and Bleeding Risk in Patients Undergoing Percutaneous Image-Guided Interventions: https://www.jvir.org/article/S1051-0443(19)30407-5/fulltext 18G BioPince Biopsy Needle: https://www.argonmedical.com/products/biopince-full-core-biopsy-instrument Bard Mission Biopsy Needle: https://www.bd.com/en-us/products-and-solutions/products/product-families/mission-disposable-core-biopsy-instrument Temno Biopsy Needle: https://www.merit.com/peripheral-intervention/biopsy/soft-tissue-biopsy/temno-evolution-biopsy-device/
In this episode, host Dr. Aaron Fritts interviews interventional cardiologist Dr. Rohit Amin about his private practice PE response team, including his treatment algorithm, follow-up protocol, and how he believes AI can contribute to PE care. --- CHECK OUT OUR SPONSOR RapidAI http://rapidai.com/?utm_campaign=Evergreen&utm_source=Online&utm_medium=podcast&utm_term=Backtable&utm_content=Sponsor --- SHOW NOTES Dr. Amin trained at Ochsner Clinic in New Orleans, and now works in private practice in Pensacola, Florida. He and a partner decided to start a PE response team (PERT) to better serve patients in the area and expand their practice. It took a lot of groundwork. They had to pitch it to administration and raise awareness, which they did by hosting CME such as grand rounds. They struggled to get a pulmonologist on board in 2013 when there was less clinical data and guidelines. Next, we discuss how the PERT algorithm functions in his private practice. An ER doctor or hospitalist evaluates the patient first. If the CT shows proximal thrombus, the PERT is notified. If it is a massive PE or submassive with clinical severity, he does thrombectomy promptly. If there is no elevated troponin and normal hemodynamics, the patient gets admitted and evaluated with a stat echo and venous doppler. Dr. Amin's practice prefers an echo with PE protocol to risk stratify RV dysfunction - i.e. RV size, tricuspid annular plane systolic excursion (TAPSE). He also evaluates pulmonary artery (PA) pressure, PA saturation, and cardiac index which are important clinical factors that determine the optimal route of intervention. For patients with submassive PE who get admitted overnight, he gives all patients a heparinoid, preferably lovenox over heparin. He sees the patient in the morning and if the clot is submassive or proximal, he does a thrombectomy that day. Lastly, we cover the importance of treating PE and how Dr. Amin approaches longitudinal follow up. Dr. Amin refers to the ICOPER trial that showed that the 30 day mortality for submassive PE is 15%, higher than that of NSTEMIs. If a PE is left untreated or if treatment is significantly delayed, a patient can develop post-PE syndrome or chronic thromboembolic pulmonary hypertension (CTEPH), which significantly worsen morbidity and mortality. Dr. Amin treats his PE / DVT patients with one week of lovenox before transitioning to a direct oral anticoagulant (DOAC). He sees them in the office in one month and gets an echo at 3 months. He then sees patients semi-annually or annually for 3-5 years. --- RESOURCES BackTable Episode 196: https://www.backtable.com/shows/vi/podcasts/196/building-a-pe-response-team PERT Consortium: https://pertconsortium.org ICOPER Trial: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(98)07534-5/fulltext
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