BackTable Vascular & Interventional

In this episode of the BackTable Podcast, host Dr. Ally Baheti interviews Dr. Michael Cumming about the issue of site of service differentials in healthcare. Dr. Cumming is an interventional radiologist and the founder of Vascular and Interventional Experts. They discuss the history and the impact of these differentials, which often result in higher costs for identical services depending on the site they’re carried out in. For example, services offered within hospitals typically cost significantly more than those offered in ambulatory surgery centers or physician offices. The doctors also describe the role of key stakeholders such as lobbyists and industry players, the outcomes of care provided in various settings, and ongoing legislative efforts to address these issues. Finally, they discuss how physicians can advocate for high quality, value-based care. --- CHECK OUT OUR SPONSORS Siemens Healthineers https://www.siemens-healthineers.com/ Varian, a Siemens Healthineers company https://www.varian.com/products/interventional-solutions/embolization-solutions --- SHOW NOTES 00:00 - Introduction 03:33 - Site of Service and Its Impact on Payment 06:15 - Role of CMS in Determining Payment 09:09 - Role of Advocacy Groups in Site of Service Payments 17:51 - Future of Site of Service Payments 20:17 - Negative Consequences of Site of Service Differentials 24:01 - Closing Remarks and Reflections --- RESOURCES CMS.gov website: https://www.cms.gov/ Preliminary Results of the Outpatient Endovascular and Interventional Society National Registry: https://journals.sagepub.com/doi/10.1177/1526602820949970

15 Tammi 202427min

In this episode of the BackTable podcast, host Dr. Ally Baheti interviews interventional radiologist Dr. Merve Ozen about the potential of the Percunav system, an advanced needle guidance technology used in interventional and endovascular procedures. Dr. Ozen is an Assistant Professor of Radiology, Surgery, Obstetrics, and Gynecology at the University of Kentucky. The uniqueness of the Percunav system lies in its 3D ultrasound image fusion and navigation capabilities, which enable doctors to combine the advantages of different imaging techniques including CT, MR, PET, and ultrasound. This allows for more precise and accurate procedures, while reducing radiation exposure. However, the utilization of this technology requires understanding and overcoming the learning curve. Additionally, Dr. Ozen explores the various applications of this technology including biopsies, drain placements and other challenging interventions. --- SHOW NOTES 00:00 - Introduction 02:42 - Clinical Applications of 3D Fusion and Navigation Systems 11:43 - Limitations and Challenges of the Technology 17:30 - Exploring Different Needle Tracking Technologies 18:44 - Future Applications of the Technology 20:17 - Advice for Incorporating the Technology into Practice --- RESOURCES Percunav System: https://www.usa.philips.com/healthcare/product/HCNOCTN150/fusion-and-navigation-image-fusion-and-needle-navigation

12 Tammi 202424min

In this episode, guest-host Dr. Paul Bhogal invites Dr. Adnan Qureshi, an interventional neurologist at the University of Missouri, to share his insights on innovative treatments for migraines. Dr. Qureshi covers his pioneering work in intra-arterial lidocaine injections and their effect on patients with severe migraines. Injections have shown a significant relief in symptoms immediately following treatment. He emphasizes the importance of identifying the right patient group for such treatments and highlights the potential of interventions beyond standard drug therapy. The conversation also explores the role of interventional neuroradiology in treating migraines and the potential development of new medical devices and alternatives to lidocaine. The podcast ends with Dr. Qureshi endorsing the upcoming Brain Conference and encouraging participation. --- CHECK OUT OUR SPONSOR RADPAD® Radiation Protection https://www.radpad.com/ --- SHOW NOTES 00:00 - Introduction and Overview of Migraine Treatment 05:35 - Initial Experiments with Lidocaine Treatment 17:45 - Potential for New Migraine Treatments 18:23 - Procedure for Intra Arterial Injections of Lidocaine 36:41 - Potential for Other Treatments and Future Research --- RESOURCES BRAIN Conference London December 2024 Use code ‘BACKTABLE10’ to register: https://www.millbrook-events.co.uk/event/a68ab951-6a92-4a9a-88ca-3e8dad79d971/summary Dr. Qureshi’s Email Address: qureshi@gmail.com Intra-arterial injection of lidocaine into middle meningeal artery to treat intractable headaches and severe migraine: https://pubmed.ncbi.nlm.nih.gov/34388298/ MIDAS Score: https://headaches.org/wp-content/uploads/2018/02/MIDAS.pdf Chronic headaches and middle meningeal artery embolization: https://pubmed.ncbi.nlm.nih.gov/33888570/ Intra-arterial lidocaine therapy via the middle meningeal artery for migraine headache: Theory, current practice and future directions: https://pubmed.ncbi.nlm.nih.gov/37574789/ Dr. Nathan Manning ResearchGate Profile: https://www.researchgate.net/profile/Nathan-Manning-4

10 Tammi 202444min

In this episode, Dr. Tyler Sandow (Ochsner Health) interviews interventional radiologists Dr. Edward Kim (Mount Sinai) and Dr. Terence Gade (University of Pennsylvania) about the future directions of hepatocellular carcinoma (HCC) treatments, specifically focusing on the adoption of precision medicine and multidisciplinary approaches. They delve into various HCC treatments, such as locoregional therapies like transarterial chemoembolization (TACE) and transarterial radioembolization (TARE), as well as the roles of systemic immunotherapies and checkpoint inhibitors. They highlight the importance of sequential order and timing of treatments and the use of imaging biomarkers for individualized cancer care. Throughout the discussion, influential clinical trials in HCC treatment are discussed and summarized. The doctors unanimously agree that as the sphere of interventional oncology is rapidly evolving, the focus should be centered on providing the most effective and patient-specific care with a deep understanding of combination therapies. --- CHECK OUT OUR SPONSOR AstraZeneca https://www.astrazeneca-us.com/ --- SHOW NOTES 00:00 - Introduction 05:45 - The Beginnings of Systemic Therapy for HCC 08:28 - The Role of Immunotherapy in HCC Treatment 11:09 - Multidisciplinary Clinics and Tumor Boards 20:21 - The Society of Interventional Oncology and Treatment Guidelines 24.59 - Choosing Between Locoregional and Combination Therapies 39:17 - The Use of Immunotherapy in Early Stage Patients 42:08 - Current Safety Data for Immunotherapy 48.56 - TACE Drug Choice 53:16 - How to Approach Treatment of Multifocal or Large Tumors 01:00 - Timeline for Imaging to Assess Treatment Response 01:03 - The Future of Immunotherapy and Interventional Oncology --- RESOURCES Society of Interventional Oncology (SIO): https://www.sio-central.org/ Sorafenib in Advanced Hepatocellular Carcinoma (SHARP Trial) https://www.nejm.org/doi/full/10.1056/nejmoa0708857 Efficacy and Safety of Sorafenib in Patients in the Asia-Pacific region with Advanced Hepatocellular Carcinoma: https://pubmed.ncbi.nlm.nih.gov/19095497/ Efficacy and Safety of Nivolumab Plus Ipilimumab in Patients With Advanced Hepatocellular Carcinoma Previously Treated With Sorafenib (CheckMate 040 Trial): https://jamanetwork.com/journals/jamaoncology/fullarticle/2771012 Tremelimumab and Durvalumab as First-line Therapy in Patients with Unresectable Hepatocellular Carcinoma (HIMALAYA Trial): https://ascopubs.org/doi/10.1200/JCO.2022.40.4_suppl.379 Atezolizumab plus Bevacizumab in Unresectable Hepatocellular Carcinoma (IMbrave 150 Trial): https://www.nejm.org/doi/full/10.1056/nejmoa1915745 Lenvatinib Combined With Transarterial Chemoembolization as First-Line Treatment for Advanced Hepatocellular Carcinoma (LAUNCH Trial): https://ascopubs.org/doi/abs/10.1200/JCO.22.00392 Randomised, Multicentre Prospective Trial of Transarterial Chemoembolisation Plus Sorafenib as Compared with TACE Alone in Patients with Hepatocellular Carcinoma (TACTICS Trial): https://pubmed.ncbi.nlm.nih.gov/31801872/ Uncoupling Immune Trajectories of Response and Adverse Events from Anti-PD-1 Immunotherapy in Hepatocellular Carcinoma: https://pubmed.ncbi.nlm.nih.gov/35430299/ Personalised Versus Standard Dosimetry Approach of Selective Internal Radiation Therapy in Patients with Locally Advanced Hepatocellular Carcinoma (DOSISPHERE-01 Trial): https://pubmed.ncbi.nlm.nih.gov/33166497/ Radiation Segmentectomy for Curative Intent of Unresectable Very Early to Early Stage Hepatocellular Carcinoma (RASER Trial): https://www.thelancet.com/journals/langas/article/PIIS2468-1253(22)00091-7/fulltext Immunotherapy and Transarterial Radioembolization Combination Treatment for Advanced Hepatocellular Carcinoma: https://journals.lww.com/ajg/abstract/2023/12000/immunotherapy_and_transarterial_radioembolization.23.aspx Find this episode on BackTable.com to see additional resources.

8 Tammi 20241h 13min

In this episode of the BackTable Podcast, host Dr. Jacob Fleming and guest Dr. Jack Jennings discuss advancements in interventional oncology, specifically regarding cryoablation for bone metastases. Dr. Jennings is an interventional musculoskeletal radiologist at Washington University School of Medicine and President of the American Society of Spine Radiology. They discuss the results of the MOTION Study, the benefits of industry collaboration, and the future of robotic guidance systems in interventional procedures. They also explain techniques like hydrodissection and pneumodissection in detail. With constant advancements in technology such as guidance navigation systems to reduce pain from bone metastases, it is crucial for interventional radiologists to adapt to these changes. At the end of the episode the doctors give a shout out to the upcoming Society of Interventional Oncology (SIO) 2024 meeting and the enriching opportunities that it offers for interventional radiologists. --- CHECK OUT OUR SPONSOR Boston Scientific Visual ICE Cryoablation System https://www.bostonscientific.com/en-US/products/cryoablation/visual-ice.html --- SHOW NOTES 00:00 - Introduction 02:25 - Overview of the MOTION Study 04:23 - Benefits and Challenges of Cryoablation 09:37 - Results of the MOTION Study 12:13 - Future of Interventional Oncology 19:38 - Role of Imaging Guidance in Cryoablation 23:07 - Future of Robotic Guidance Systems 31:40 - Importance of Industry Partnerships --- RESOURCES Society of Interventional Oncology Annual Meeting, Long Beach, CA January 25th-29th: https://www.sio-central.org/Events/Annual-Scientific-Meeting/Registration Interventional Oncology MOTION Multicenter Study: https://www.bostonscientific.com/en-EU/medical-specialties/interventional-radiology/interventional-oncology/latest-evidence/motion-study.html Percutaneous image-guided cryoablation of painful metastases involving bone: multicenter trial: https://pubmed.ncbi.nlm.nih.gov/23065947/ Cryoablation Needles from Boston Scientific: https://www.bostonscientific.com/en-US/products/cryoablation/visual-ice/visual-ice-cryoablation-needles.htm

5 Tammi 202436min

In this episode of the Backtable Podcast, guest host Dr. Paul Bhogal, a consultant interventional neuroradiologist at Royal London Hospital in the UK, and guests Dr. Piotr Walczak and Dr. Prakash Ambady discuss the potential of intra-arterial treatments combined with blood brain barrier (BBB) manipulation in treating various neurological conditions and tumors. The trio of doctors discuss methods such as the use of hyperosmolar mannitol and focused ultrasound to breach the BBB and deliver drugs directly to the brain tissue. Dr. Walczak and Dr. Ambady also highlight their individual research areas, including therapies involving cell delivery and engineered cells. The conversation also covers potential risks and new perspectives in comparison to current techniques such as whole-brain radiation. --- CHECK OUT OUR SPONSOR RADPAD® Radiation Protection https://www.radpad.com/ --- SHOW NOTES 00:00 - Introduction 05:44 - Challenges of Treating Glioblastoma Multiforme 12:52 - Understanding the Blood Brain Barrier 18:30 - Strategies to Negate the Blood Brain Barrier 20:52 - Blood Brain Barrier Disruption Using Intra-Arterial Mannitol 26:35 - Infusion Rates and Magnetic Resonance Guidance 33:47 - Role of Radiolabel Studies in Drug Delivery 36:31 - Future of Therapeutic Agents Design 47:54 - Potential of Focused Ultrasound in Drug Delivery 56:10 - Exploring the Use of Cells in Drug Delivery 58:44 - Future of Intra-Arterial Interventions --- RESOURCES Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma: https://pubmed.ncbi.nlm.nih.gov/15758009/ Effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomized phase III study: 5-year analysis of the EORTC-NCIC trial: https://pubmed.ncbi.nlm.nih.gov/19269895/ REMOVAL OF RIGHT CEREBRAL HEMISPHERE FOR CERTAIN TUMORS WITH HEMIPLEGIA - PRELIMINARY REPORT: https://jamanetwork.com/journals/jama/article-abstract/254927 Real-Time MRI Guidance for Reproducible Hyperosmolar Opening of the Blood-Brain Barrier in Mice: https://www.researchgate.net/publication/328537972_Real-Time_MRI_Guidance_for_Reproducible_Hyperosmolar_Opening_of_the_Blood-Brain_Barrier_in_Mice Dr. Piotr Walczak ResearchGate Profile: https://www.researchgate.net/profile/Piotr-Walczak-6 Dr. Prakash Ambday ResearchGate Profile: https://www.researchgate.net/profile/Prakash-Ambady Maculopathy Associated With Osmotic Blood- Brain Barrier Disruption and Chemotherapy in Patients With Primary CNS Lymphoma: https://pubmed.ncbi.nlm.nih.gov/32484895/ PET imaging of intra-arterial 89 Zr bevacizumab in mice with and without osmotic opening of the blood-brain barrier: distinct advantage of intra-arterial delivery: 10.2967/jnumed.118.218792 Safety of intra-arterial chemotherapy with or without osmotic blood–brain barrier disruption for the treatment of patients with brain tumors: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9307096/ Delivery of chemotherapeutics across the blood-brain barrier: challenges and advances: https://pubmed.ncbi.nlm.nih.gov/25307218/

3 Tammi 20241h 6min

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

1 Tammi 202454min

In this episode of The Backtable Podcast, host Dr. Michael Barraza and guest Dr. Brandon St. Amant have an in-depth discussion about QGenda, an online scheduling solution. Both doctors practice interventional radiology at Radiology Associates in Baton Rouge, Louisiana. They discuss the initial setup process, from rule setting to managing shift assignments and creating transparency among the team. The key points of the conversation include the concept of the ‘holiday schedule’, the ‘buy sell system’ for open shifts, and making ‘longer schedules’ for predictability. The episode emphasizes the ongoing role of the scheduler and the need to build trust when transitioning to an electronic system like QGenda. --- CHECK OUT OUR SPONSORS Medtronic HawkOne Directional Atherectomy System https://www.medtronic.com/hawkone Reflow Medical https://www.reflowmedical.com/ --- SHOW NOTES 00:00 - Introduction 03:08 - The Challenges of Manual Scheduling 05:00 - Transition to QGenda 09:34 - The Role of Excel in Scheduling 22:06 - Handling Holiday Schedules 26:50 - Buy-Sell System for Shifts 33:17 - Final Tips for Effective Scheduling --- RESOURCES QGenda: https://www.qgenda.com/

29 Joulu 202338min