Ep. 383 Reflections on a Career in Clinical IR with Dr. Alan Matsumoto

What role does thyroid artery embolization play in contemporary thyroid cancer care? Dr. Juan Camacho, an interventional radiologist from Sarasota, Florida, joins host Dr. Sabeen Dhand to discuss how this emerging technique is reshaping the management of thyroid malignancies. --- SYNPOSIS Dr. Camacho shares his experiences establishing a multidisciplinary team at Memorial Sloan Kettering Cancer Center dedicated to the management of thyroid malignancies, highlighting the critical role of collaboration in the successful implementation of this emerging treatment. He details key procedural techniques, emphasizing the importance of recognizing anatomic variations that can influence technical success. He also examines how arterial supply and lesion location inform procedural planning and decision-making, and outlines his technical approach to thyroid artery embolization, including the use of a radial artery access, catheter selection strategies, and the application of cone-beam CT for procedural optimization. Finally, he reviews his pre- and post-procedural management strategies, including the role of beta blockers in optimizing patient outcomes. The discussion concludes with illustrative case studies demonstrating substantial reductions in thyroid volume and symptomatic relief, notably achieved without post-procedural hypothyroidism. --- TIMESTAMPS 00:00 - Introduction03:31 - Pioneering Thyroid Ablation at Sloan Kettering06:53 - The Need for Thyroid Artery Embolization25:08 - Pre-Procedural Planning32:41 - Embolization Technique and Procedure44:48 - Choosing the Right Catheter for the Job45:43 - Ensuring Patient Comfort and Safety47:09 - High-Stakes Imaging and Safety Protocols47:55 - Innovative Techniques and Case Studies51:02 - Post-Procedure Management and Follow-Up56:30 - Engaging with Endocrinology and Surgeons01:00:00 - Case Studies and Practical Applications

7 Nov 20251h 14min

A patient presents to the ER with hemoptysis. When is bronchial artery embolization (BAE) the right call, and what can you do to tip the odds of procedural success in your favor? In this episode of the BackTable Podcast, interventional radiologist Dr. Alexander Lam of UCSF shares his approach to bronchial artery embolization with host Dr. Ally Baheti.---This podcast is supported by:RADPAD® Radiation Protectionhttps://www.radpad.com/---SYNPOSISThe conversation covers why patients are referred for this procedure, the typical causes of bronchial artery hypertrophy, and Dr. Lam's preferred techniques for embolization, including the use of glue over traditional particles. Dr. Lam emphasizes the importance of multidisciplinary collaboration, detailed pre-procedure preparations, and recognizing potential complications.---TIMESTAMPS00:00 - Introduction01:45 - Patient Evaluation04:22 - Causes of Bronchial Hypertrophy09:03 - Procedure Setup10:35 - Catheter Selection and Techniques13:35 - Embolic Choices and Techniques19:39 - Understanding Different Types of Glue22:48 - Continuous Push Technique24:38 - Managing Complications and Success Rates28:14 - Postoperative Instructions and Follow-Up29:00 - Handling Difficult Bronchial Artery Selections34:02 - Final Thoughts

4 Nov 202536min

With the annual trend of fluctuating reimbursement rates, have you been on the fence about turning your OBL into an ASC? Make sure your OBL is prepared for the surprising changes in coding coming in 2026. In this episode, Dr. Mary Costantino partners with fellow OBL owner Dr. Goke Akinwande and revenue cycle management expert Laurie Bouzarelos to review the new CPT code changes and how they translate to OBL and ASC reimbursement.---SYNPOSISDr. Akinwande discusses many positive takeaways after diving into the recent Medicare documents, and highlights key shifts. He believes these changes to add-on codes and territories means one thing: CLI is being heard. The upcoming code changes improve delineation of vascular territories, differentiating between "simple" (stenosis) and "complex" (CTO) procedures. These changes are aimed at rewarding physicians performing the difficult CLI work while decreasing reimbursement for more straightforward cases.Beyond the CPT code specifics, the conversation also covers real-world implications for OBL owners. Dr. Akinwande explains why these changes might narrow the reimbursement gap between OBLs and ASCs, prompting him to warn against ASC conversion. Laurie Bouzarelos provides guidance on implementation, stressing the importance of updating charge masters, reviewing payer contracts for "gap fill" clauses, and monitoring payments once the new codes go live. The episode ends with a discussion on obstacles in billing, collections, and the need for physicians to master the business side of their practice to ensure financial success.---TIMESTAMPS00:00 - Introduction04:37 - 2026 CPT Changes Overview07:18 - Simple vs. Complex Codes13:16 - Key Add-on Codes19:52 - OBL vs. ASC Conversion?24:56 - IVL Reimbursement Trends29:18 - Update Your Charge Master41:41 - Pricing & Medicare Year46:39 - Billing & Collections Reality

28 Okt 20251h 11min

Is meningeal artery embolization the key to ending the cycle of chronic subdural hematomas? In this episode of the Back Table Podcast, Dr. Paul Gullota from Ochsner Health joins host Michael Barraza to share his technical insights on middle meningeal artery embolization, including patient workup, procedure technique, and post-operative care.---SYNPOSISThe episode begins with a discussion on the evolving role of middle meningeal artery embolization in preventing chronic subdural recurrence. The doctors talk through patient selection and procedural planning for middle meningeal artery embolization, emphasizing the importance of assessing collateral pathways and hemorrhage laterality. Dr. Gullota shares his access techniques, microcatheter and embolic options, and the critical role of teamwork with neurosurgery. He also shares his approach to navigating complex vascular anatomy as well as ensuring appropriate patient follow up.---TIMESTAMPS00:00 - Introduction03:12 - Middle Meningeal Artery Embolization: Rationale and Process04:17 - Patient Evaluation and Procedure Steps06:09 - Outpatient Procedures and Billing07:06 - Candidates for Embolization Post-Evacuation07:56 - Unilateral vs. Bilateral Embolization10:34 - Procedure Techniques and Tools19:48 - Post-Procedure Care and Follow-Up21:35 - Final Thoughts and Conclusion

24 Okt 202525min

From longitudinal monitoring to complex interventions, type II endoleaks often require an individualized approach. In this episode of BackTable, host Dr. Sabeen Dhand welcomes Dr. Matt Givens, Chief of Interventional Radiology at the New Orleans VA and faculty at Louisiana State University Health, to discuss the intricacies of type II endoleak management and repair techniques.---SYNPOSISThe conversation begins with a walkthrough of Dr. Givens’s firstline operative approach, which involves entering the inferior mesenteric artery and choosing a microcatheter that allows for entry into the sac and nidus. The doctors cover nuances in choosing and planning transarterial, translumbar, and transcaval approaches. Dr. Givens also details his embolics of choice, his preferred tools for direct sac puncture, and the rationale behind his embolization endpoints.---TIMESTAMPS00:00 - Introduction 08:12 - Imaging and Follow-Up Protocols16:27 - Transarterial Techniques for Endoleak Management33:45 - Techniques for Targeting and Embolization35:34 - Challenges and Solutions in Embolization36:57 - Transcaval and Translumbar Approaches39:09 - Complications and Case Studies53:58 - Building a Collaborative Practice56:09 - Conclusion

21 Okt 202558min

PERT Consortium 2025 gives interventionalists the reins to tackle even the toughest saddle pulmonary embolisms. In this episode of the BackTable Podcast, host Dr. Aaron Fritts welcomes interventional radiologist Dr. Osman Ahmed and interventional cardiologist Dr. Jonathan Paul to discuss their experiences at the annual PERT Consortium in San Diego, and offer their perspectives on the latest developments in pulmonary embolism (PE) treatment.---SYNPOSISThe doctors delve into advancements and trials within the PE treatment space, including new devices and clinical studies that are set to shape the future of pulmonary embolism care. The conversation highlights the value of collaboration between interventional specialties, the safety and efficacy of various PE interventions, and the growing trend of using combined therapies. They also provide updates on their ongoing innovation with Flow Medical, describing their philosophy and motivation for developing a new device for PE treatment that incorporates real-time pulmonary artery pressures, mean systolic and diastolic pressures, and a potential for AI utilization in the future. ---TIMESTAMPS00:00 - Introduction01:23 - PERT Consortium Highlights02:11 - Emerging Clinical Trials and Innovations03:59 - Thrombectomy Devices and Market Trends12:37 - Flow Medical: Origin and Updates19:37 - Advanced Data Tracking in Cardiology20:45 - Remote Monitoring and Mobile Integration22:45 - Cardiologists’ Data-Driven Approach23:10 - Upcoming Studies and Data Insights24:10 - Interventional Radiology and Cardiology Collaboration25:07 - Access to Care and Procedure Adoption27:32 - Final Thoughts---RESOURCESPulmonary Embolism Response Team (PERT) Consortiumhttps://pertconsortium.org/ Flow Medicalhttps://www.flowmedical.co/ PEERLESS RCThttps://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.124.072364RESCUE-IIhttps://www.jacc.org/doi/10.1016/j.jacadv.2025.101789 PEERLESS II https://www.jscai.org/article/S2772-9303(24)01053-6/fulltextPulmonary Embolism - Thrombus Removal With Catheter-Directed Therapy (PE-TRACT)https://clinicaltrials.gov/study/NCT05591118 The HI-PEITHO Studyhttps://www.bostonscientific.com/en-EU/medical-specialties/vascular-surgery/venous-thromboembolism-portal/pulmonary-embolism/clinical-data/hi-peitho.htmlPRAGUE-26https://eurointervention.pcronline.com/article/design-and-rationale-of-prague-26-a-multicentre-randomised-trial-of-catheter-directed-thrombolysis-for-intermediate-high-risk-acute-pulmonary-embolism Pulmonary Embolism - Thrombus Removal With Catheter-Directed Therapy (PE-TRACT)https://clinicaltrials.gov/study/NCT05591118 Aaron Fritts, MDhttps://www.backtable.com/shows/vi/contributors/dr-aaron-fritts Osman Ahmed, MDhttps://jointvascular.com/team/osman-ahmed-m-d-fcirse/ Jonathan Paul, MDhttps://www.uchicagomedicine.org/find-a-physician/physician/jonathan-d-paul

17 Okt 202529min

From the angio suite to the boardroom, what qualities of an interventional radiologist translate into pioneering leadership? Tune in to hear from Dr. Howard Chrisman, the President and CEO of Northwestern Medicine, as he discusses his journey with hosts Dr. Sabeen Dhand and Dr. Aaron Fritts.---SYNPOSISDr. Chrisman shares his inspiring journey from a student with an initial interest in veterinary medicine to a leader in interventional radiology (IR) and healthcare administration. He recounts his pivotal experiences, including his mentorship under prominent IRs, his decision to pursue an MBA, and the importance of building trust and fostering relationships within clinical and administrative realms. He details his learnings in developing self-awareness, being open to multiple viewpoints, and amplifying your voice as an IR. The discussion touches on the future of interventional radiology, the impact of artificial intelligence on the field, and the essential qualities for leadership in healthcare. Dr. Chrisman also reflects on the significance of learning from mistakes and the role of mentorship in his career, emphasizing the value of collaboration and empathy in achieving success.---TIMESTAMPS00:00 - Introduction 03:21 - Mentorship and Career Development09:55 - Balancing Bias and Decision Making18:32 - Building Trust and Value in Healthcare23:13 - The Future of Radiology and AI Integration28:48 - The Role of MBAs in Healthcare32:24 - Reflections on Leadership and Career35:43 - Conclusion and Final Thoughts

14 Okt 202538min

When a patient presents with portal vein thrombosis (PVT), how do you decide between anticoagulation, intervention, and adjunct therapies? In this episode, Dr. Vijay Ramalingam, vascular and interventional radiologist from Beth Israel Deaconess Medical Center, joins Backtable host Dr. Chris Beck to share his approach to evaluation and management of both acute and chronic PVT.---SYNPOSISThe discussion begins with an overview of the Splanchnic Vein Thrombosis Multidisciplinary Clinic at Beth Israel– a collaboration between Interventional Radiology, Hepatology/Gastroenterology, Surgery and Hematology. Dr. Ramalingam details the clinic's workflow, from initial case conference to the comprehensive single-day patient workup that includes imaging, lab work, and consultations with all three specialties. He shares his algorithm for treatment decisions, breaking down the distinct management pathways for patients with and without cirrhosis, and for those with acute vs. chronic thrombosis.Finally, Dr. Ramalingam details his portal vein recanalization technique during procedure, providing a step-by-step guide to his preferred dual-access approach for complex cases, including his method for trans-splenic access and his trick on how to safely close the splenic tract. He also explains when it’s appropriate to use adjunctive therapies like suction thrombectomy and catheter-directed lysis, and describes preliminary data showing that their comprehensive approach leads to a change in management for about 40% of patients.---TIMESTAMPS00:00 - Introduction05:35 - Splanchnic Vein Thrombosis Multidisciplinary Clinic22:24 - Multidisciplinary Approach26:17 - PVT Classification38:47 - Treatment Evaluation and Intervention44:21 - Alternative Treatment Options for PVT49:00 - Procedural Techniques59:53 - Adjunct Techniques and Case Studies01:02:58 - Review of Preliminary Data & Final Thoughts

10 Okt 20251h 9min