BackTable Vascular & Interventional

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

26 Marras 202448min

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

22 Marras 202423min

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/ --- DISCLAIMER Kristen Richards is a consultant for Philips. She has been compensated by Philips for their services in preparing and presenting this material. The opinions and clinical expertise presented herein by are specific to the featured speakers and are for informational purposes only. The results from their experiences may not be predicative for all subject, physicians or patients. Individual results may vary depending on a variety of patient-specific attributes and related factors. Nothing in this article is intended to provide specific medical advice or to take the place of written law or regulations.

19 Marras 202436min

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

12 Marras 202459min

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

8 Marras 202430min

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

1 Marras 202438min

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

29 Loka 202452min

As providers, we know firsthand how impactful interventional radiology procedures can be. Today, we hear the perspective of Suzanne Martin, a patient who underwent life-saving radioembolization for stage 4 colorectal cancer. Suzanne shares her story with host Dr. Eric Keller, including how things took a positive turn when she was introduced to interventional radiologist Dr. Charles Nutting after initially undergoing ineffective chemotherapy treatment. --- This podcast was developed in collaboration with: Interventional Initiative https://theii.org/ --- SYNPOSIS Suzanne discusses her role as a motivational speaker and highlights the importance of patient self-advocacy and the collaborative efforts between oncologists and interventional radiologists. This inspiring episode underscores the transformative power of minimally invasive treatments and the significance of hope and teamwork in overcoming cancer. --- TIMESTAMPS 00:00 - Introduction 04:25 - SIR Spheres Procedure 07:10 - Post-Procedure Recovery Experience 09:49 - Long-Term Outcomes and Reflections 17:48 - Advocating for Yourself 19:07 - Finding Support and Hope 23:35 - Advice for Patients and Doctors --- RESOURCES Dr. Charles Nutting Denver Practice: https://www.drnutting.com/ Say Yes to Hope Cancer Support Group: https://www.sayyestohope.org/

25 Loka 202430min