Ep. 328 Adrenal Vein Sampling with Dr, Fritz Angle

Dr. Aditya Bagrodia sits down with Elie Toubiana, founder and CEO of ScribeMD.ai, to discuss the transformative potential of artificial intelligence (AI) in medical documentation. --- SYNPOSIS Their conversation covers the capabilities and benefits of using an AI-driven medical scribe that ensures HIPAA compliance, reduces physician burnout, and enhances patient interactions. Elie also shares his insights about the technology’s adaptability across various medical fields. Finally, Dr. Bagrodia and Elie discuss ethical considerations surrounding applications of AI in other aspects of healthcare, such as medical workup and diagnosis. --- TIMESTAMPS 00:00 - Introduction 06:00 - How ScribeMD AI Works 14:14 - Integration with EMR 20:31 - Legal Considerations with AI Technology 26:34 - Cost Implications of AI Scribes 38:46 - Future of AI in Medical Diagnosis 41:45 - Conclusion and Final Thoughts --- RESOURCES ScribeMD.ai https://www.scribemd.ai/

21 Jun 202443min

In this episode of the Back Table MSK podcast, Dr. Jacob Fleming and Dr. Douglas Beall dive into the intricacies of sacroplasty, including considerations for selecting cement volume, efficacy of small versus large needles, and biomechanics of the pelvis. --- CHECK OUT OUR SPONSOR Stryker Interventional Spine https://www.strykerivs.com --- SYNPOSIS The doctors review evidence from the SAKOS trial on pain relief and highlight the complexities of billing. They also emphasize proactive treatments for aging populations suffering from fractures and the need for more training and propagation of sacroplasty techniques. Listeners are encouraged to stay informed about new educational opportunities and advancements in sacroplasty through ongoing updates and courses. --- TIMESTAMPS 00:00 - Introduction 02:33 - Expanding Sacroplasty Training and Curriculum 04:50 - Walkthrough of Sacroplasty Technique 10:36 - Mechanical Stabilization and Cement Volume 21:41 - Choosing Hardware and Needle Size 27:37 - Industry-Sponsored Trials and Bias 32:47 - Navigating Billing and Reimbursement 38:05 - Closing Thoughts on Sacroplasty and Osteoporotic Fractures --- RESOURCES BackTable VI Ep. 51- Sacroplasty: Principles & New Data in the Treatment of Sacral Insufficiency Fractures: https://www.backtable.com/shows/msk/podcasts/51/sacroplasty-i-principles-new-data-in-the-treatment-of-sacral-insufficiency-fractures Seattle Science Foundation Annual Image Guided Interventional Spine Procedures Course: https://ssf.cloud-cme.com/course/courseoverview?P=5&EID=1149 Dr. Doug Beall’s Twitter: @dougbeall Vertebral Augmentation: The Comprehensive Guide to Vertebroplasty, Kyphoplasty, and Implant Augmentation: https://www.amazon.com/Vertebral-Augmentation-Comprehensive-Vertebroplasty-Kyphoplasty/dp/1684200156 An Interim Analysis of the First 102 Patients Treated in the Prospective Vertebral Augmentation Sacroplasty Fracture Registry (Beall, 2023): https://www.jvir.org/article/S1051-0443(23)00356-1/fulltext

20 Jun 202440min

Dr. Jacob Fleming and Dr. Douglas Beall discuss the challenges and advancements in treating sacral insufficiency fractures (SIF), the importance of real-world data in evaluating treatment efficacy, and the need to increase awareness of sacral fractures and sacroplasty. --- CHECK OUT OUR SPONSOR Stryker Interventional Spine https://www.strykerivs.com --- SYNPOSIS Dr. Beall emphasizes the underrecognition and undertreatment of sacral insufficiency fractures, pointing out the high mortality and chronic pain rates associated with non-treatment. He urges providers to consider this diagnosis, especially if the patient is describing symptoms of pain with position changes with standing, sitting, and laying, has pubic rami fractures, or reports a history of pelvic radiation. Even with imaging, the diagnosis can remain elusive, since it is not commonly recognized on x-ray and may not show obvious cortical disruption on CT or MRI. We also review the current literature on sacroplasty efficacy in lowering patient-reported pain scores and adverse events associated with treatment versus conservative management. Dr. Beall speaks about the importance of real-world data collection in the form of patient registries and the insight that these resulting studies have on applications of sacroplasty in specific patient populations. --- TIMESTAMPS 00:00 - Introduction 03:01 - Sacral Fractures and Sacroplasty 15:17 - Treatment Options for Sacral Fractures 17:34 - Consequences of Untreated Sacral Fractures 28:32 - Sacroplasty Registry and Current Research 38:08 - Imaging Modalities: CT vs. Fluoroscopy 40:49 - Complications of Sacroplasty: Extravasation 43:21 - Bone Quality and Fracture Healing 45:42 - Growing Awareness of Sacral Fractures and Treatment Options --- RESOURCES Spontaneous osteoporotic fracture of the sacrum. An unrecognized syndrome of the elderly (Lourie, 1982): https://pubmed.ncbi.nlm.nih.gov/7097924/ Percutaneous cementoplasty for pelvic bone metastasis (Marcy, 2000): https://pubmed.ncbi.nlm.nih.gov/11094996/ Safety and Efficacy of Sacroplasty for Sacral Fractures: A Systematic Review and Meta-Analysis (Chandra et al, 2019): https://pubmed.ncbi.nlm.nih.gov/31587952/ Percutaneous sacroplasty for osteoporotic sacral insufficiency fractures: a prospective, multicenter, observational pilot study (Frey et al, 2008): https://pubmed.ncbi.nlm.nih.gov/17981097/ Sacroplasty: A Ten-Year Analysis of Prospective Patients Treated with Percutaneous Sacroplasty: Literature Review and Technical Considerations (Frey et al, 2017): https://pubmed.ncbi.nlm.nih.gov/29149151/ Vertebral Augmentation: The Comprehensive Guide to Vertebroplasty, Kyphoplasty, and Implant Augmentation (Beall, 2020): https://www.thieme-connect.de/products/ebooks/book/10.1055/b000000226 An Interim Analysis of the First 102 Patients Treated in the Prospective Vertebral Augmentation Sacroplasty Fracture Registry (Beall et al, 2023): https://pubmed.ncbi.nlm.nih.gov/37207812/ Clinical Effect of Balloon Kyphoplasty in Elderly Patients with Multiple Osteoporotic Vertebral Fracture (Liu et al, 2019): ​https://journals.lww.com/njcp/fulltext/2019/22030/clinical_effect_of_balloon_kyphoplasty_in_elderly.1.aspx

19 Jun 202451min

Dr. Dylan Suttle and Dr. Harris Chengazi delve into recent advancements in transjugular intrahepatic portosystemic shunt (TIPS) procedures, highlighting the significant reduction in procedural time and improvements in outcomes due to the introduction of Intracardiac Echo (ICE) and the Scorpion Portal Vein Access Series. --- CHECK OUT OUR SPONSOR Argon Medical http://www.argonmedical.com/ --- SYNPOSIS The doctors share their experiences, techniques, and the evolution of their approaches. They emphasize benefits such as high-resolution imaging, cost-effectiveness, and new technologies that make TIPS cases more approachable. --- TIMESTAMPS 00:00 - Introduction 06:17 - Portal Hypertension Clinics 13:17 - Technical Aspects of TIPS Procedures 35:17 - Challenges in Selecting the Right Hepatic Vein 38:48 - Pre-Procedure Planning 39:36 - Puncture Techniques 50:04 - Stent Deployment and Placement 55:35 - Learning Curve of ICE & Advantages 01:07:58 - The Future of TIPS Procedures --- RESOURCES BackTable VI Episode #123 - TIPS University Freshman Year: Referrals and Pre-op Workup with Dr. Emmett Lynskey: https://www.backtable.com/shows/vi/podcasts/123/tips-university-freshman-year-referrals-pre-op-workup BackTable VI Episode #124 - TIPS University Sophomore Year: Basic Procedure Technique with Dr. Emmett Lynskey: https://www.backtable.com/shows/vi/podcasts/124/tips-university-sophomore-year-basic-procedure-technique BackTable VI Episode #125 - TIPS University Junior Year: Advanced Techniques, ICE, and Splenic Access with Dr. Emmett Lynskey: https://www.backtable.com/shows/vi/podcasts/125/tips-university-junior-year-advanced-techniques-ice-splenic-access BackTable VI Episode #126 - TIPS University Senior Year: Gunsight Technique & Splenic Closure with Dr. Emmett Lynskey: https://www.backtable.com/shows/vi/podcasts/126/tips-university-senior-year-gunsight-technique-splenic-closure Dr. Suttle TIPS Technique Video: https://www.youtube.com/watch?v=jYfr_rWe5Ck TIPS prevents further decompensation and improves survival in patients with cirrhosis and portal hypertension in an individual patient data meta-analysis: https://www.journal-of-hepatology.eu/article/S0168-8278(23)00314-8/abstract Intracardiac Echocardiography–Guided TIPS: A Primer for New Operators: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7540636/

18 Jun 20241h 12min

In this episode of the BackTable Podcast, host Dr. Ally Baheti discusses the concept of moral injury with Dr. Mina Makary from Ohio State University and Dr. Jeff Chick from the University of Washington. The conversation focuses on their recent study published in Academic Radiology, which employed a survey to analyze prevalence of moral injury, factors contributing to its occurrence, and strategies to address it. --- CHECK OUT OUR SPONSOR RADPAD® Radiation Protection https://www.radpad.com/ --- SYNPOSIS It is important to distinguish burnout from moral injury, with the former concept more focused on personal resilience, and the latter defined as extrinsic circumstances that lead to disconnection with one’s career. A key finding from the study was the negative correlation between degree of moral injury and quality of life. Respondents’ free text answers identified a variety of factors contributing to moral injury. The doctors also speak about strategies for addressing moral injury such as psychotherapy, spiritual care, and physical exercise. Most importantly, they believe it is crucial to target systemic factors with efforts to increase physician leadership, administrative support, and research in physician wellness. --- TIMESTAMPS 00:00 - Introduction 02:14 - Defining Moral Injury 05:31 - Survey Methodology and Respondent Demographics 07:52 - Key Survey Findings 11:07 - Causes of Moral Injury 12:11 - Personal and Systemic Strategies for Addressing Moral Injury --- RESOURCES Moral Injury Among Interventional Radiologists (Woerner, 2024): https://pubmed.ncbi.nlm.nih.gov/37926643/ Identifying Moral Injury in Healthcare Professionals: The Moral Injury Symptom Scale-HP (Mantri, 2020): https://pubmed.ncbi.nlm.nih.gov/32681398/

14 Jun 202423min

In this episode, Dr. Paul Lewis discusses best practices for thoracentesis. He shares insights on using image guidance, managing complex effusions, and managing complications such as pneumothorax and hemothorax. Dr. Lewis is an interventional radiologist at the University of Pittsburgh Medical Center. --- CHECK OUT OUR SPONSOR Laborie RenovaRP Centesis System https://www.laborie.com/product/renovarp-products/ --- SYNPOSIS Dr. Lewis also speaks on patient selection, procedural techniques, equipment choices, and other troubleshooting tips. Additionally, the doctors cover procedural nuances such as bilateral thoracentesis and patient positioning and highlight the efficiency of the RenovaRP Centesis System. --- TIMESTAMPS 00:00 - Introduction 06:07 - Thoracentesis Procedure Walkthrough 16:49 - Equipment Used 22:14 - Troubleshooting 30:56 - Post-Procedural Care 36:12 - Complications 48:07 - Helpful Resources --- RESOURCES Prospective comparison between a peristaltic pump and vacuum containers for paracentesis: Time, resources and safety: https://pubmed.ncbi.nlm.nih.gov/38042055/ Paracentesis: Faster and easier using the RenovaRP® pump: https://pubmed.ncbi.nlm.nih.gov/35548901/ Society of Interventional Radiology Consensus Guidelines for the Periprocedural Management of Thrombotic and Bleeding Risk in Patients Undergoing Percutaneous Image-Guided Interventions—Part II: Recommendations: https://www.jvir.org/article/S1051-0443(19)30407-5/fulltext The Impact of Gravity vs Suction-driven Therapeutic Thoracentesis on Pressure-related Complications: The GRAVITAS Multicenter Randomized Controlled Trial: https://pubmed.ncbi.nlm.nih.gov/31711990/

11 Jun 202454min

In this episode, Dr. Ally Baheti interviews interventional radiologist Dr. Lorenzo Patrone about his recent multidisciplinary editorial entitled "The 'Woundosome' Concept and Its Impact on Procedural Outcomes in Patients With Chronic Limb-Threatening Ischemia.” --- CHECK OUT OUR SPONSOR Reflow Medical https://www.reflowmedical.com/ --- SYNPOSIS Dr. Patrone explains his interest in critical limb ischemia (CLI) and describes how he reached out to colleagues around the world with the intention of drafting a paper that summarizes research in below-the-ankle interventions and increases awareness of the woundosome concept. He explains the woundosome concept, which aims to understand how each patient’s foot vasculature influences the effectiveness of below-the-ankle interventions and tissue healing. Understanding each patient’s anatomy, having adequate imaging of the foot, obtaining pedal acceleration times, and using micro-oxygen sensors are strategies to assess wound perfusion, which is integral for treatment planning and prognosis. He illustrates these techniques in a case study of a non-healing wound. Finally, Dr. Patrone shares some technical tips for below-the-ankle interventions, including the benefits of ipsilateral antegrade access, sheath selection, and strategic contrast administration. --- TIMESTAMPS 00:00 - Introduction 02:25 - Multidisciplinary and Global Collaboration 05:59 - Explaining the Woundosome Concept 07:51 - Understanding Wound Perfusion 10:20 - Assessing the Effectiveness of Revascularization 20:09 - Case Example with Pictures 28:07 - Technical Tips for CLI Interventions --- RESOURCES Find Your Algorithm (FYA): https://fya-congress.com/ The "Woundosome" Concept and Its Impact on Procedural Outcomes in Patients With Chronic Limb-Threatening Ischemia: https://journals.sagepub.com/doi/10.1177/15266028241231745?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed Vascular imaging of the foot: the first step toward endovascular recanalization (Manzi): https://pubmed.ncbi.nlm.nih.gov/21997985/ BASIL-2 Trial: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)00462-2/fulltext BackTable VI Ep. 90- Pedal Acceleration Time for Limb Salvage with Jill Sommerset and Dr. Mary Constantino: https://www.backtable.com/shows/vi/podcasts/90/pedal-acceleration-time-for-limb-salvage The First-in-Man "Si Se Puede" Study for the use of micro-oxygen sensors (Montero-Baker): https://pubmed.ncbi.nlm.nih.gov/26004327/ PEDRA Perfusion Monitoring: https://www.pedratech.com/ Armada XT Balloon: https://www.cardiovascular.abbott/us/en/hcp/products/peripheral-intervention/peripheral-dilatation-catheters/armada-14.html

7 Jun 202429min

In this episode of the BackTable Podcast, vascular surgeon Dr. Nicolas Mouawad and interventional radiologist Dr. Raja Ramaswamy share their insights on the changing landscape of deep vein thrombosis (DVT) management, steps of mechanical thrombectomy, and current research on DVT interventions. --- CHECK OUT OUR SPONSOR Inari Medical https://www.inarimedical.com/ --- SYNPOSIS The guests start by describing their typical referral patterns, noting that most cases come through the emergency department. In terms of workup, it is important to distinguish between acute and chronic DVTs and classify the thrombosis location as either proximal (femoral vein or higher) or distal. Anticoagulation, usually with direct oral anticoagulants, is always started, with efficacy largely determined by patient compliance. Regarding endovascular intervention, thrombolysis may be an effective adjunctive treatment if the clot occurred within a two-week timespan, but it carries a bleeding risk and requires ICU monitoring. On the other hand, mechanical thrombectomy is an option for both acute and chronic clots, allows for intervention in patients with high bleeding risk, and does not require post-procedural hospitalization. Both physicians emphasize that interventions should be employed if there are long-term benefits of avoiding post-thrombotic syndrome and pulmonary embolism. The physicians walk through a typical mechanical thrombectomy procedure, which involves the thrombectomy device, venogram, intravascular ultrasound, and possible stent placement. Finally, they discuss recent data, including the ATTRACT Trial for thrombolytics and the CLOUT Registry and Trial for ClotTriever use. Notably, they mention the DEFIANCE Trial as a current prospective randomized clinical trial for ClotTriever use in the iliofemoral region. --- TIMESTAMPS 00:00 - Introduction 03:48 - DVT Referral Patterns and Treatment Algorithms 08:55 - Choosing an Anticoagulation Regimen 11:01 - DVT Interventions 13:54 - Patient Scenarios and Treatment Decisions 22:29 - Post-Thrombotic Syndrome 26:16 - Mechanical Thrombectomy Technique 35:45 - Postoperative Care 39:09 - The Evolution of Mechanical Thrombectomy 43:38 - ATTRACT Trial 46:20 - CLOUT Trial --- RESOURCES Inari ClotTriever System: https://www.inarimedical.com/clottriever-system ATTRACT Trial: https://www.nejm.org/doi/full/10.1056/NEJMoa1615066 CLOUT Trial: https://pubmed.ncbi.nlm.nih.gov/35218955/ DEFIANCE Trial: https://evtoday.com/news/inari-medical-begins-defiance-randomized-clinical-trial-of-clottriever-system-in-dvt

4 Jun 202458min