BackTable Vascular & Interventional

We talk with Dr. Daryl Goldman, an IR resident at Mount Sinai Health System, about what it takes to "crush" your Interventional Radiology Rotation as a medical student, as well as what makes for a great educational experience from the resident and attending side. --- SHOW NOTES In this episode, interventional radiology resident Dr. Daryl Goldman and our host Dr. Aaron Fritts launch our BackTable Trainee Series by talking about how medical students can perform well on IR rotations, and more broadly, how they can best position themselves to apply for an integrated IR residency. They also discuss actions that program directors can take to ensure that their rotation is effective at teaching and recruiting trainees. Dr. Goldman outlines her path to IR and offers advice to medical students for getting involved in research, networking, and away rotations. For students at sites without IR residency/fellowship programs, she suggests that they reach out to external programs for research opportunities and away rotations. Overall, she encourages interested students to learn how to be good mentees, attend conferences, and get involved with IR interest groups. Dr. Goldman says that a major goal of an IR rotation should be showing students a broad view of the specialty: workups, procedures, inpatient management, clinic time, and follow-up care. She suggests that programs provide students with graduated responsibility, didactic time, and opportunities to give presentations. The doctors advise students to use social media to get connected with their specialty networks. Specifically, they emphasize the collaborative and educational environment of the endovascular community on Twitter. --- RESOURCES BackTable’s Twitter: @_BackTable Dr. Goldman’s Twitter: @Daryl_Goldman SIR Residents, Fellows, and Students (SIR RFS): http://rfs.sirweb.org/ Mt. Sinai Integrated IR Residency: https://icahn.mssm.edu/education/residencies-fellowships/list/msh-interventional-diagnostic-radiology “Five Ways to Be a Great Mentee” by Dr. Yasha Gupta: https://www.acr.org/Member-Resources/rfs/Resident-and-Fellow-News/2020MAR-Mentorship

21 Kesä 202140min

We talk with Dr. Christopher Pittman to better understand Management Services Organizations (MSOs) and what they can do for your practice. We also get the 101 on Value-Based Care payment models. --- SHOW NOTES In this episode, interventional radiologist and vein treatment expert Dr. Chris Pittman and our host Dr. Aaron Fritts discuss the structure and benefits of management services organizations (MSOs). As healthcare moves from a fee-for-service model to a fee-for-value model, MSOs have become increasingly popular. Dr. Pittman gives a brief overview of the services that these organizations can provide to independent physicians. These services can encompass billing, human resources, scheduling, contract negotiation, marketing, and any aspect of practice management outside of direct medical care. We discuss the benefits of joining an MSO, which include sharing resources within the network, offloading non-medical functions, controlling costs, learning best business practices, and ultimately, having more time and energy to deliver quality patient care. Additionally, having a network of practices allows each physician to have access to industry data and benchmark themself from operational, clinical, and patient satisfaction standpoints. Dr. Pittman advises all physicians to have due diligence when deciding to join an MSO. He emphasizes the importance of determining the amount of physician autonomy that will be retained, evaluating the organization based on outcomes of past clients, and having an attorney look over agreements. In general, he believes that the most well-run MSO’s are the ones that focus on a single specialty and have physicians on their leadership teams. --- RESOURCES Health Performance Specialists (HSP): https://www.healthperformancespecialists.com/

18 Kesä 202146min

Bryan Hartley talks with Neurosurgeon Dr. Chris Mansi about the origin story of Viz.ai, a company using Artificial Intelligence to Shorten Time to Treatment and Improve Access to Care for Stroke Patients. --- SHOW NOTES In this episode, neurosurgeon and co-founder/CEO of Viz.ai, Dr. Chris Mansi, and our host Dr. Bryan Hartley discuss the use of AI technology to detect large vessel occlusion (LVO) strokes and increase efficiency of workflow. Dr. Mansi describes his entrepreneurial journey, through the phases of idea formation, funding, growth, and expansion of his company. We start by outlining key advantages that MBA and other graduate degree programs can provide for healthcare entrepreneurs. Both doctors emphasize the value of dedicating space and time, outside of clinical practice, to innovate and test new ideas. Dr. Mansi highlights his collaboration with other disciplines, such as engineering. He also discusses takeaways from his business education-- the importance of patient-centered innovation and having flexible technology that can meet the changing needs of the market. Dr. Mansi gives an overview of Viz.ai’s origins, mission, and product offerings. The company addresses a clinical need for more consistent and efficient stroke care, and aims to move patients from stroke detection to stroke treatment more quickly. Viz.ai employs self-learning technology to provide high-quality imaging, automatic workflow triggers, and HIPAA-compliant communication channels for stroke teams to work together for the benefit of patients. We end this episode by talking about Viz.ai’s plan to expand to more disease states and medical specialties in the near future. --- RESOURCES Viz.ai Platform: https://www.viz.ai/ “Crossing the Chasm” by Geoffrey Moore: Dr. Mansi’s book recommendation for all tech entrepreneurs

14 Kesä 202144min

Dr. Sabeen Dhand chats with Interventional Radiologist Shankar Rajeswaran from Lurie Children's Hospital in Chicago about a novel minimally invasive treatment of unicameral and aneurysmal bone cysts. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/PzYQjW --- SHOW NOTES In this episode, pediatric interventional radiologist Dr. Shankar Rajeswaran joins host Dr. Sabeen Dhand to discuss a novel minimally-invasive treatment for unicameral and aneurysmal bone cysts. Pediatric interventional radiology is a rapidly growing field, and Dr. Rajeswaran describes how it has evolved in complexity and innovation over the course of his career. Dr. Rajeswaran says that there is a significant challenge that pediatric IRs must overcome-- treating children with IR devices that were originally designed to be used in adults. As a result, he emphasizes the need for creativity and flexibility in this field. Next, we define and differentiate between unicameral and aneurysmal bone cysts. Both can be benign; however, they carry the risk of causing pain, bone fracture, and growth deformities. Dr. Rajeswaran outlines the current standard of care, which includes monitoring and curettage and bone grafting. Then, he describes a new method of treatment, which involves needle injection of doxycycline to burn the walls of the cyst and bone paste to help generate new bone. This method can be applied to unicameral bone cysts and aneurysmal bone cysts, and it leaves no scarring. He also discusses the recurrence rate for various treatment methods. Overall, Dr. Rajeswaran encourages anyone interested in pediatric IR to reach out to doctors in the field for shadowing opportunities and guidance. --- RESOURCES Society for Pediatric Interventional Radiology: https://www.spir.org/ Lurie Children’s Hospital blog article over novel treatment of bone cysts: https://www.luriechildrens.org/en/blog/interventional-radiology-cutting-edge-procedure-puts-brooklyn-back-in-the-game/

7 Kesä 202130min

We talk with radiologic technologists Andrew Struchen and Alisha Hawrylack about current training pathways for Vascular and Interventional Technologists, the importance of respect at work and in the lab, as well as key factors in recruiting and retaining top notch A-team technologists. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/xxskLL --- SHOW NOTES In this episode, interventional radiologic technologists Alisha Hawrylack and Andrew Struchen join Dr. Aaron Fritts to discuss the important role of IR technologists in the lab and major factors that affect their recruitment, training, and retention. To start, we discuss the current state of IR technologist training. Alisha describes two major educational pathways, structured training programs and on-the-job training. She says that while both modes of training can be effective, structured training programs are likely to provide deeper knowledge of anatomy and IR procedures. Andrew gives an overview of the yearlong IR technologist program at the University of Virginia, which offers a mix of didactic learning, clinical training, and mentorship. We also briefly outline the ARRT and RCIS certification requirements. Next, we address job satisfaction and turnover of IR technologists. We discuss increasing workload, staffing concerns, and the need to feel engaged in cases. Andrew recognizes that if these problems are not addressed, technologists will start seeking other opportunities, such as careers within industry. Alisha emphasizes that technologists at academic institutions are excited about innovative procedures and seek ways to positively contribute to outcomes. Finally, we discuss team culture and ways to cultivate respectful relationships between technologists and other clinicians. We talk about our experiences with giving team members the benefit of the doubt, learning how to work with other teammates, and resolving miscommunication. --- RESOURCES Charles J. Tegtmeyer Program of Interventional Radiology and Special Procedures at the University of Virginia Medical Center: med.virginia.edu/radiology/educat…ogist-education/ Alisha Hawrylack: ac4nf@hscmail.mcc.virginia.edu Andrew Struchen: ads6r@hscmail.mcc.virginia.edu Association of Vascular and Interventional Radiographers (AVIR): avir.org/ American Registry of Radiologic Technologists (ARRT): https://www.arrt.org/ Registered Cardiovascular Invasive Specialist (RCIS) Exam: cci-online.org/CCI/Certification…OrganizerCommon=2

4 Kesä 202150min

We talk with Vascular Surgeon Jim Melton and Interventional Radiologist Blake Parsons about several key pieces to success in the Outpatient (OBL/ASC) setting, including partnerships, staffing, and case selection. --- CHECK OUT OUR SPONSORS Accountable Physician Advisors http://www.accountablephysicianadvisors.com/ Accountable Revenue Cycle Solutions https://www.accountablerevcycle.com/ --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/9keJUq --- SHOW NOTES In this episode, vascular surgeon Dr. Jim Melton and interventional radiologist Dr. Blake Parsons join our host Dr. Aaron Fritts to discuss how they set up the vision and structure of their Outpatient-Based Lab/Ambulatory Surgery Center (OBL/ASC). Dr. Melton begins by describing how he saw a need to make the surgery experience more patient-centered, which ultimately led him to co-found CardioVascular Health Clinic in 2015. He highlights the importance of staffing his clinic with talented individuals and strategies for retaining talent. Dr. Melton also describes how the practice navigates partnerships, pay structures, and expenses. Dr. Parsons shares his advice for marketing OBLs to referring physicians. This includes staying in touch with local providers, keeping them updated on their patients, and hosting educational events. He also covers their clinic’s process of updating and changing technology, which involves team meetings and potential vendor negotiation. Additionally, we cover virtual strategies for communicating with sales representatives during the COVID era. Overall, the doctors emphasize that the OBL path is risky, but it can turn out to be very rewarding for both patients and providers. --- RESOURCES CardioVascular Health Clinic- https://cvhealthclinic.com/ CardioVascular Health Clinic Twitter- @CVHealthClinic Avail Software- https://www.avail.io/

1 Kesä 202136min

We talk with Interventional Radiologist and Philips Chief Medical Officer Atul Gupta about his path from the interventional suite to the boardroom, and how physicians can work with device companies to innovate and make big impact changes in healthcare. --- SHOW NOTES In this episode, Dr. Bryan Hartley discusses the intersection of IR practice and medical device innovation with Dr. Atul Gupta, interventional radiologist and Chief Medical Officer of Philips’ Image-Guided Therapy division. Throughout the show, Dr. Gupta describes his path from medical student, to IR practice builder, to executive leader. Dr. Gupta describes his philosophy of innovation, which stems from the identification of real clinical needs. He explains why interventional radiologists are well-positioned to be device innovators and cross-specialty collaborators (Hint: It has to do with our curiosity and cool technology!). He recalls innovative mentors, or “gadgeteers,” who have inspired him to work on research projects during residency and onwards. As a result, Dr. Gupta’s work with Philips grew into a partnership and, eventually, a formalized role within the company. In addition to serving as a CMO, Dr. Gupta maintains his clinical skills by continuing to practice IR when he can. To close, we discuss exciting new topics that are on the horizon of image-guided therapy: augmented reality, artificial intelligence, and dielectric imaging. We also highlight tips for any physician who is wanting to get involved with device innovation, as well as any physician who is contemplating a new role. --- RESOURCES Philips Image Guided Therapy- https://www.usa.philips.com/healthcare/solutions/interventional-devices-and-therapies “The Infinite Game” by Simon Sinek A book that Dr. Hartley recommends for anyone interested in learning how to motivate their teams to achieve long-term success.

21 Touko 202141min

Interventional Radiologist Christopher Beck talks with Hepatologist Parvez Mantry about the management of Portal Hypertension and Ascites, and the importance of multi-disciplinary collaborative care for these patients. --- SHOW NOTES In this episode, hepatologist Dr. Parvez Mantry joins our host Dr. Christopher Beck to discuss portal hypertension and ascites, two complications that arise from liver diseases and have a large effect on patients’ quality of life. Dr. Mantry starts the episode by sharing statistics on Chronic Liver Disease (CLD) and specifically highlights the burden of CLD on the U.S. population. He discusses various causes of CLD, including Hepatitis C, Alcohol Liver Disease, and Non-Alcoholic Steatohepatitis. Next, Dr. Mantry takes us through his diagnostic workup, including his physical examination, cross-sectional imaging, percutaneous and transjugular liver biopsies, and serological workup. He checks for complications such as portal hypertension, ascites, pedal edema, and hepatic encephalopathy. We also discuss the diagnosis of Hepatocellular Carcinoma (HCC). Then, we transition to strategies for managing ascites and portal hypertension through diuretics, paracentesis, Transjugular Intrahepatic Portosystemic Shunts (TIPS), liver transplantation, and a few experimental treatments that he is currently researching. Overall, Dr. Mantry advocates for close monitoring of symptoms and making treatment modifications as needed. Finally, when focusing on the patient experience, Dr. Mantry offers troubleshooting tips, especially for patients who struggle with leakage from the paracentesis site. To close, he gives insights on how physicians can best support chronically-ill patients who are awaiting transplantation. --- RESOURCES Methodist Transplant Specialists- https://www.theliverinstitutetx.com/ Information about Dr. Mantry’s transplant center and its satellite locations in the Dallas-Ft. Worth Community. American Association for the Study of Liver Diseases (AASLD) Practice Guidelines- https://www.aasld.org/publications/practice-guidelines Management of HCC- https://www.journal-of-hepatology.eu/article/S0168-8278(12)60009-9/pdf The Management of Ascites in Cirrhosis- https://aasldpubs.onlinelibrary.wiley.com/doi/abs/10.1053/jhep.2003.50315 These are guidelines set by the International Ascites Club. BackTable Pdcast Ep. 123 TIPS University Freshman Year: Referrals and Pre-Op Workup- https://www.backtable.com/shows/vi/podcasts/123/tips-university-freshman-year-referrals-pre-op-workup

17 Touko 202150min