Ep. 335 Transcranial Focused Ultrasound: Next Generation Imagine-Guided Therapy of the Brain with Dr. Bhavya Shah

BSA, MIRD, or voxel-based dosimetry? Join us for part 2 of Dosimetry University where interventional oncologists Dr. Tyler Sandow, Dr. Nima Kokabi, and Dr. Kavi Krishnasamy explore and debate the critical nuances of a successful Y90 procedure, covering dosing methods, lung shunt management, and when to incorporate other therapeutic approaches. --- This podcast is supported by: Sirtexhttps://www.sirtex.com/ Medtronic Emprinthttps://www.medtronic.com/emprint --- SYNPOSIS The episode begins with a discussion on methodologies for calculating lung shunt fractions using planar imaging versus SPECT CT. The physicians highlight the implications of various dosimetry models, including BSA (Body Surface Area), MIRD (Medical Internal Radiation Dose), and voxel-based dosimetry for determining prescribed activity. Drawing on their clinical experience, they address the management of high lung shunt fraction cases and the application of therapeutic strategies like TACE (Transarterial Chemoembolization) and SBRT (Stereotactic Body Radiotherapy). The conversation also covers the roles of cryoablation and microwave ablation in treating centrally located lesions. The episode concludes with a case study emphasizing the importance of individualized dosimetry planning. --- TIMESTAMPS 00:00 - Introduction01:05 - Lung Shunt Calculation Methods06:42 - BSA, MIRD, and Voxel-Based Dosimetry16:03 - High Lung Shunt Management30:02 - Case Study: Liver Tumor Treatment34:10 - Cryo vs Microwave: A Safer Option?35:42 - Y-90 Procedure: Imaging and Techniques43:35 - Dosimetry and Dose Calculations51:10 - Post-Treatment Analysis and Outcomes57:51 - Transplant Considerations and Aggressive Treatments58:18 - Conclusion and Final Thoughts

24 Kesä 20251h 1min

Dosimetry University is now in session! First up—how do you plan your Y90 treatments and what can you do in the planning phase to maximize efficacy? Find out in Part I of BackTable’s Dosimetry University series featuring interventional oncologists Dr. Nima Kokabi from the University of North Carolina Chapel Hill and Dr. Tyler Sandow from Ochsner Health. This episode is hosted by Dr. Kavi Krishnasamy and recorded live in the BackTable studio. --- This podcast is supported by: Sirtexhttps://www.sirtex.com/ Sponsor This podcast is supported by: Medtronic Emprinthttps://www.medtronic.com/emprint --- SYNPOSIS The doctors first discuss the structure of their Y90 service lines, including the impact of multidisciplinary tumor boards and clinics on time to treatment for liver cancer patients. They then talk through their technical preferences—whether to use glass or resin, preferred dosimetry guidelines and apps, and the dosimetry softwares that they use in treatment planning. The doctors also discuss the utility of the T2N ratio, advanced imaging like cone beam CT, and angiographic targeting software—emphasizing how these tools can help achieve the delicate balance of preserving normal tissue while treating as much tumor as possible. This episode also highlights the importance of collaboration between academic and private practices to optimize patient care and treatment outcomes. --- TIMESTAMPS 00:00 - Introduction and Overview02:21 - Multidisciplinary Clinics and Tumor Boards13:12 - Dosimetry Guidelines and Practices27:46 - Nuances in Tumor Dosage and Segmentectomy32:00 - Angiographic Targeting Software33:18 - Cone Beam CT Techniques48:33 - Anesthesia, Access, and Catheters

17 Kesä 202555min

What would you do if your IR/DR practice underwent major ownership and staffing changes just one week after signing your first attending contract? In this episode of BackTable, Dr. Waqaar Diwan joins host Dr. Michael Barraza to share his experience facing exactly that challenge—and how it led to the eventual development of his own independent IR practice.---This podcast is supported by:RADPAD® Radiation Protectionhttps://www.radpad.com/OBL Marketinghttps://oblmarketing.com/Medtronic Emprinthttps://www.medtronic.com/emprint---SYNPOSISDr. Diwan discusses how he navigated the unexpected transition of ownership and staffing changes, and ultimately secured a hospital contract that allowed him to perform IR procedures full-time. Since then, he has been building an independent IR practice with the support of his partner and a growing team. Dr. Diwan shares his goals for the practice, including staffing and equipment logistics, strategic planning, and patient outreach. He emphasizes the importance of leveraging personal and professional networks to guide his business development. He also outlines key differences between independent IR practices and combined IR/DR models. These include the need for greater investment in the outpatient experience, actively seeking referrals, and navigating hospital politics without the backing of a larger department. His top advice for building a referral base is to first earn trust—by excelling in straightforward cases and ensuring strong outcomes—and to market the practice directly to potential referring providers. Overall, Dr. Diwan encourages early-career interventional radiologists to know their worth. He notes that in the real world, IRs are often seen as providers of “catch-all” services, making it crucial to ensure fair compensation. He stresses the importance of striking a balance between self-advocacy and humility, all while staying focused on serving patients.---TIMESTAMPS00:00 - Introduction 01:42 - Navigating Contracts and Restructuring8:07 - Upcoming Goals for His IR Group14:00 - Strategic Planning and Marketing20:16 - Compensation and Finances of Independent IR27:38 - Future Plans and Market Trends29:48 Advice for New Interventional Radiologists---RESOURCESMinimally Invasive Specialists of Texas: https://www.mist-health.com/

10 Kesä 202536min

What do you do when conventional gastric tubes are not an option? In this week’s episode of BackTable, host Dr. Ally Baheti speaks with interventional radiologist Dr. Alex Wallace and physician assistant Lisa Rotellini-Colvet from the Mayo Clinic in Arizona about the percutaneous transesophageal gastrostomy (PTEG) procedure. The discussion explores how PTEG offers a transformative solution for patients who are not candidates for traditional transabdominal gastrostomy access. Suitable candidates for PTEG include individuals with malignancies, peritoneal carcinomatosis, prior gastrectomies, or ascites. --- This podcast is supported by: Medtronic Emprinthttps://www.medtronic.com/emprint --- SYNPOSIS Dr. Wallace and Lisa provide valuable insights on the benefits of early patient selection, thorough pre-procedural evaluation, step-by-step procedural guidance, and key considerations for post-procedural care. They also highlight the critical role of patient and staff education in achieving successful outcomes. The episode features real-world experiences, including a powerful story of a patient who benefited from her PTEG for over 560 days. Our guests advocate for increased awareness of PTEG and its early consideration in patients with advanced abdominal cancers, emphasizing its potential to greatly improve quality of life. --- TIMESTAMPS 00:00 - Introduction01:38 - History and Explanation of PTEG08:12 - Pre-Procedure Evaluation11:48 - Procedural Walkthrough20:46 - Post-Procedure Care and Suction Management24:45 - Exchange Process and Troubleshooting30:11 - Patient Education and Staff Training35:54 - Improved Quality of Life for Patients --- RESOURCES Percutaneous Transesophageal Gastrostomy: Procedural Technique and Outcomes (Rotellini-Coltvet, Wallace et al, 2023):https://pubmed.ncbi.nlm.nih.gov/37419279/

6 Kesä 202541min

Liquid embolics are a relatively new addition to the interventional radiology toolkit—how well do you understand the technical considerations that come with using these agents? Get up to speed in this episode of the BackTable Podcast where Dr. Gary Siskin, Chair of Radiology at Albany Medical Center, shares his expertise. --- This podcast is supported by: Sirtexhttps://www.sirtex.com/us/ --- SYNPOSIS Dr. Siskin provides expert insights into the use of liquid embolic agents, including Onyx and LAVA, with a focus on their practical applications, techniques for safe and effective deployment, and the critical role they play in treating complex cases which range from peripheral and traumatic hemorrhage to portal vein embolization. He highlights the importance of understanding the viscosity and flow characteristics of various liquid embolic agents, providing expert guidance on ensuring optimal catheter positioning, case selection, and avoidance of common pitfalls. Additionally, he shares strategies for tailoring injection speed based on vessel caliber to mitigate reflux. The episode ends with final thoughts on best practices and future directions for the technology. --- TIMESTAMPS 00:00 - Introduction02:09 - Historical Perspective on Liquid Embolics06:37 - Practical Applications and Techniques16:14 - Handling Catheters and Reflux Concerns22:38 - Trauma Embolization26:53 - Visibility and Injection Techniques29:06 - Catheter Compatibility and Vessel Size32:53 - Best Practices and Common Mistakes45:55 - Final Thoughts and Advice --- RESOURCES Arslan B, Razavi MK, Siskin G, et al. The LAVA Study: A Prospective, Multicenter, Single-Arm Study of a Liquid Embolic System for Treatment of Peripheral Arterial Hemorrhage. J Vasc Interv Radiol. 2025;36(3):436-445.e2. doi:10.1016/j.jvir.2024.11.005 Onyx Liquid Embolic System: https://europe.medtronic.com/xd-en/healthcare-professionals/products/cardiovascular/peripheral-embolization/onyx-liquid-embolic-system.html LAVA Liquid Embolic System:https://www.sirtex.com/us/products/lava-liquid-embolic-system/product-information/

3 Kesä 202550min

It’s official — NeuWave is exiting the market. In this episode, Dr. Christopher Beck hosts a conversation with Dr. Josh Kuban, an interventional radiologist at MD Anderson Cancer Center, to discuss the impact that NeuWave's microwave tumor ablation technology has had on the field of interventional oncology and the recent announcement of its discontinuation, scheduled for March 2026. --- This podcast is supported by: Medtronic Emprint --- SYNPOSIS Dr. Kuban reflects on NeuWave’s innovative beginnings in microwave ablation, which expanded to include four distinct systems and advanced ablation confirmation software. At its peak, the company held over 50% of the microwave ablation market and played a pivotal role in reshaping interventional radiology's view of the safety and effectiveness of this treatment approach. He also shares how NeuWave’s departure will affect his practice and outlines the steps he’s taking to prepare his team for the transition to alternative devices. The discussion broadens to the current landscape of microwave ablation, spotlighting emerging players in ablation confirmation software and robotic technologies. --- TIMESTAMPS 00:00 - Introduction2:14 - Overview of Neuwave’s Rise7:01 - Decision to Discontinue 14:56 - Navigating the Switch Different Technologies 21:54 - Buyback Program24:33 - Forecasting New Developments --- RESOURCES BackTable IND Ep. 23- Approach the Problem with Vision: Part I of the Neuwave Story : https://www.backtable.com/shows/industry/podcasts/23/approach-the-problem-with-vision-part-i-of-the-neuwave-story BackTable IND Ep. 24- Trials and Tribulations: Part II of the Neuwave Story: https://www.backtable.com/shows/industry/podcasts/24/trials-tribulations-part-ii-of-the-neuwave-story BackTable IND Ep. 25- Next Level Stuff, the Exit: Part III of the Neuwave Story:https://www.backtable.com/shows/industry/podcasts/25/next-level-stuff-the-exit-part-iii-of-the-neuwave-story Johnson & Johnson Press Release Regarding Discontinuation of NeuWave:https://www.medline.com/media/assets/pdf/vendor-list/Disco_notice.pdfMedTronic Emprint Ablation: https://www.medtronic.com/covidien/en-gb/products/ablation-systems/emprint-ablation-system.html Varian MicroThermX Ablation: https://www.varian.com/products/interventional-oncology/microthermx Safety and Effectiveness of Microwave Ablation of Liver Tumors: Initial Real-World Results from the Multinational NeuWave Observational Liver Ablation (NOLA) Registry (Odisio, 2025):https://pubmed.ncbi.nlm.nih.gov/39848330/

30 Touko 202531min

Making strides against melanoma: how can medical oncologists and interventional oncologists join forces to deliver smarter, patient-centered care? In this episode of BackTable, Dr. Tyler Sandow,hosts Dr. Sunandana Chandra, medical oncologist at Northwestern, and Dr. Riad Salem, interventional oncologist at Northwestern, to discuss the evolving management of advanced melanoma. --- This podcast is supported by an educational grant from Replimune. --- SYNPOSIS The doctors open the episode with an overview of melanoma and recent advances in its treatment, highlighting key trials such as DREAMseq and CheckMate 067. The discussion explores the shift from medical oncologist as solo primary providers to a dynamic, multidisciplinary approach to advanced cancer care—emphasizing cutting-edge treatments like immunotherapy and intratumoral oncolytic viruses. Dr. Salem shares practical insights on the procedural techniques of administering intratumoral oncolytics like Replimune, emphasizing the importance of thorough documentation and patient-centered care. The doctors also provide an overview of the ongoing IGNYTE-3 Trial, a Phase 3 study assessing the safety and efficacy of the oncolytic immunotherapy RP1 in combination with nivolumab for the treatment of advanced melanoma. The episode underscores the transformative potential of innovative melanoma treatments and the crucial role of integrated, team-based approaches in improving cancer patient outcomes. --- TIMESTAMPS 00:00 - Introduction03:48 - The Evolution of Melanoma Treatment: From Chemotherapy to Immunotherapy14:05 - The Role of Oncolytic Viruses in Melanoma Treatment20:14 - Interventional Radiology’s Role in Cancer Treatment27:00 - Collaborative Approach to Cancer Care32:53 - Hyper Documentation and Communication Efficiency44:47 - Future of Intratumoral Oncolytics48:10 - Multidisciplinary Approach in Advanced Cancer Management51:46 - Conclusion and Final Thoughts --- RESOURCES DREAMseq Trial: Atkins MB, Lee SJ, Chmielowski B, et al. Combination Dabrafenib and Trametinib Versus Combination Nivolumab and Ipilimumab for Patients With Advanced BRAF-Mutant Melanoma: The DREAMseq Trial-ECOG-ACRIN EA6134. J Clin Oncol. 2023;41(2):186-197. doi:10.1200/JCO.22.01763 CheckMate 067 trial: Wolchok JD, Chiarion-Sileni V, Rutkowski P, et al. Final, 10-Year Outcomes with Nivolumab plus Ipilimumab in Advanced Melanoma. N Engl J Med. 2025;392(1):11-22. doi:10.1056/NEJMoa2407417

27 Touko 202554min

23 Touko 20251h 1min