Ep. 432 AI in Medicine: Navigating the New Frontier with Confidence with Dr. Matthew Lungren

In this episode, our host Dr. Chris Beck interviews interventional radiologist Dr. Riad Salem about indications, technique, and cross-specialty collaboration in portal vein recanalization in the cirrhotic patient population. The CME experience for this Podcast is powered by CMEfy - click here to reflect and unlock credits & more: https://earnc.me/M2xtKL

8 Jul 202245min

In this episode, host Dr. Chris Beck interviews interventional radiologist Dr. George Behrens about how he built a robust multidisciplinary portal hypertension clinic in a community hospital, tips for common challenges during a TIPS, and post-TIPS management. --- CHECK OUT OUR SPONSOR Argon Medical Scorpion Portal Vein Access Series https://www.argonmedical.com/scorpion --- SHOW NOTES We begin by discussing Dr. Behrens portal hypertension practice. He sees patients in conjunction with hepatology and transplant surgery. The model of his clinic is the opposite of the standard practice. The specialists come to the community hospital, and their clinic gets referrals from tertiary hospitals in Chicago. This took years to build, and they received enormous pushback. This model encompasses patient-centered care because it removes many of the barriers that patients face to travel into Chicago for the workup and management plan of portal hypertension. In this clinic, they also evaluate the underlying cause of cirrhosis including more uncommon causes such as hemochromatosis, Wilson disease, and alpha 1 antitrypsin deficiency. Next, Dr. Behrens details the typical procedure and provides tips for commonly encountered challenges during a TIPS (transjugular intrahepatic portosystemic shunt). He does all TIPS under general anesthesia. He drains ascites, then uses a multipurpose catheter to enter the hepatic vein, without a preference for which hepatic vein he is in. He uses a Launcher AL 11 1 ½ or 2 if he is having difficulty entering a hepatic vein. He then does a CO2 portogram. Next, he advances the cannula into the hepatic veins, unsheathes the cannula, then brings it back to about 2cm from the pedicle, close to the ostium of the hepatic vein. He discusses the differences in technique between the Rösch-Uchida and the Scorpion. He likes to place his stent with the proximal portion where the diaphragm crosses the right atrium and the distal part at the entry site of the portal vein. He uses a VIATORR stent, and always dilates to 8mmHg first, then re-measures pressures. His general rule for dilation is less than 12mmHg for bleeding and less than 8mmHg for ascites. Dr. Behrens discusses follow-up for patients and post-procedure care. All patients are started on rifaximin 2 weeks prior to TIPS. If ascites drained was 4L or more, he gives 100g albumin and 20mg Lasix. He measures pressures via a right heart cath before and after the procedure. Depending on the MELD, he may send patients to the floor or home same day, while others go to the ICU. He starts all patients on lactulose and zinc 220mg BID the day of the procedure. He advises all patients against using PPIs due to the increased risk of encephalopathy. He maintains pre-procedure Lasix and spironolactone dosing for the first 3 months. At one month, patients get a TIPS US with velocities, CMP, CBC, and INR. At 3 months they get cross-sectional imaging and repeat labs. He starts managing diuretics at 3 months. After this, he sees patients every 6 months and screens for hepatocellular carcinoma. --- RESOURCES Argon Scorpion: https://www.argonmedical.com/products/scorpion Cook Rösch-Uchida: https://www.cookmedical.com/products/ir_rups_webds/ Gore VIATORR: https://www.goremedical.com/products/viatorr Medtronic Launcher: https://www.medtronic.com/us-en/healthcare-professionals/products/cardiovascular/catheters/launcher.html MELD score: https://www.mdcalc.com/calc/78/meld-score-model-end-stage-liver-disease-12-older

4 Jul 20221h 9min

Dr. Jacob Fleming talks with Dr. Alan Alper Sag about building a musculoskeletal (MSK) interventions practice at Duke University Medical Center, collaborating with other specialists, and future predictions for MSK IR. The CME experience for this Podcast is powered by CMEfy - click here to reflect and unlock credits & more: https://earnc.me/o00BlF  --- CHECK OUT OUR SPONSOR RADPAD® Radiation Protection https://www.radpad.com/ --- SHOW NOTES In this episode, our host Dr. Jacob Fleming interviews Dr. Alan Sag about building a musculoskeletal (MSK) interventions practice at Duke University Medical Center, collaborating with other specialists, and future predictions for MSK IR. Dr. Sag starts the episode by sharing his unique experience abroad. His first job was centered around helping to build an IR practice at a teaching hospital in Istanbul. This process helped him discover that the key to practice building was forming foundational cross-specialty relationships. These eventually led to more patient referrals and a higher level of care coordination. When he transitioned to an academic position, Dr. Sag first saw an unmet need in bone cryoablation. He recognized that IR procedures could be powerful alternatives to opioid escalation. A key turning point for his department came when a local TV station covered one of his patient’s stories, and he saw a large increase in referrals. Dr. Sag emphasizes that it was important to ensure that the practice was set up with enough resources to accomodate a large volume of patients. Additionally, it was crucial to recognize when to say “no” to patients when a procedure was contraindicated for them. This patient-first approach also showed referring doctors that he was independently and objectively assessing patients, which helps with trust-building. As we move onto discussing multidisciplinary care, Dr. Sag says that learning another specialty’s vocabulary can greatly enhance your communication and show your desire to collaborate. He encourages IRs to be flexible and learn which conditions are important to the referring doctors. When working with anesthesiology and PM&R, IRs can offer their services to enhance their pain palliation efforts. When working with oncologists, this pain palliation can allow cancer patients to continue participating in clinical trials. Finally, we discuss the next frontiers of MSK interventions. Dr Sag is excited by the prospect of standardization of MSK training, internally cemented screws, and vertebral body stents. --- RESOURCES Dr. Alan Sag Twitter: https://twitter.com/AlanAlperMD?s=20&t=8RGQsroHPZ9Vyc-0lpkiVQ Bone Cryoablation Media Coverage: https://www.wral.com/komen-s-kohl-tries-tumor-freezing-therapy-in-ongoing-cancer-fight/18974441/ Duke Center for Brain & Spine Metastasis: http://dukecancerinstitute.org/DCBSM SpineJack System: https://strykerivs.com/products/families/spinejack-system Society of Interventional Oncology (SIO): http://www.sio-central.org/ SIO’s “Language of Oncology” Course: http://www.sio-central.org/p/cm/ld/fid=385 Visible Body Anatomy Atlas: https://www.visiblebody.com/anatomy-and-physiology-apps/human-anatomy-atlas e-Anatomy Atlas: https://www.imaios.com/en/e-Anatomy Ep. 199- Advanced Minimally Invasive Pain Interventions: https://www.backtable.com/shows/vi/podcasts/199/advanced-minimally-invasive-pain-interventions

1 Jul 202255min

STREAM Meeting Founders Ari Isaacson and Sandeep Bagla tell us about what to expect at the next meeting in September, including PAE and GAE practice building tips, as well learn about new embolization procedures such as adhesive capsulitis and thyroid arterial embolization. The CME experience for this Podcast is powered by CMEfy - click here to reflect and unlock credits & more: https://earnc.me/CIj1ey --- SHOW NOTES In this episode, host Dr. Aaron Fritts and interventional radiologists Drs. Ari Isaacson and Sandeep Bagla discuss new programming for their upcoming STREAM Conference in September 2022. See our “Resources” section below for a special promotion code for BackTable listeners! As they enter their fifth year of hosting the STREAM, the doctors describe the conference’s evolution beyond procedural teaching of prostate artery embolization (PAE). This year, they will focus more programming on practical factors such as decision-making strategies, malpractice considerations (with both plaintiff and defense attorneys), and new frontiers of embolization. They highlight the increased efforts for cross-specialty collaboration, since the conference will include sessions on genicular artery, shoulder, and hemorrhoid embolization. Finally, we share more ways to learn about PAE. Our guests describe opportunities to shadow at Prostate Centers USA and request to be proctored for initial cases. --- RESOURCES The STREAM Meeting: https://www.thestreammeeting.com/ Promotion Code for 25% off registration for the STREAM Meeting: BACKTABLE22 Prostate Centers USA: https://www.prostatecentersusa.com/

29 Jun 202228min

27 Jun 202240min

We talk with Dr. Shamit Desai about resources and tips for endovascular and interventional specialists to continue building clinical and procedural skills beyond training. --- CHECK OUT OUR SPONSORS RapidAI http://rapidai.com/?utm_campaign=Evergreen&utm_source=Online&utm_medium=podcast&utm_term=Backtable&utm_content=Sponsor Medtronic AV DCB https://www.medtronic.com/avdata --- SHOW NOTES In this episode, host Dr. Aaron Fritts and interventional radiologist Dr. Shamit Desai discuss resources and tips for IRs to continue building clinical and procedural skills beyond residency and fellowship training. The doctors start by recognizing that every training program has specific focuses, which influence the skills that IRs have when they first emerge from the program. With the breadth of IR procedures available today, there are many service lines that are not addressed in formal training. However, Dr. Desai believes that any graduating IR has a foundation of proficient catheter skills and they have the potential to learn most image guided procedures. Dr. Desai emphasizes that a big part of building a new skill set is having the support to learn the skills and let it flourish. He recounts his path to learning how to treat kyphoplasty and PAD and the integral role that IR mentors and device companies played in helping him develop knowledge and confidence. Dr. Desai also advises listeners to branch out into reading journals from other specialties. WIth PAD, he highly recommends learning from the Journal of Vascular Surgery (JVS), which can provide valuable perspective on clinical management. We also highlight national conferences that are tailored specifically to educate on certain procedures. Additionally, Dr. Desai emphasizes that it is important for each IR to identify their true passion. Passion fuels the drive to learn as much as possible about a procedure, which leads to better outcomes for patients. It is also important to have clinical infrastructure in place before marketing the service line to patients and referrers, in order to create a quality patient experience. --- RESOURCES Ep. 198- Privademics and Advantages of Lesser Known Community Programs with Dr. Shamit Desai and Dr. Saud Ahmed: https://www.backtable.com/shows/vi/podcasts/198/privademics-advantages-of-lesser-known-community-programs Ep. 210- Modern Vertebral Augmentation with Dr. Doug Beall: https://www.backtable.com/shows/vi/podcasts/210/modern-vertebral-augmentation Vertebral Augmentation by Dr. Douglas Beall: https://www.amazon.com/Vertebral-Augmentation-Comprehensive-Vertebroplasty-Kyphoplasty/dp/1684200156 Medtronic OsteoCool System: https://www.medtronic.com/us-en/healthcare-professionals/products/spinal-orthopaedic/tumor-management/osteocool-ablation-system-rf.html Vascupedia: https://vascupedia.com/ Dr. Srini Tummala’s YouTube Channel: https://www.youtube.com/c/DrTummalasVascularChannel?app=desktop Journal of Vascular Surgery (JVS): https://www.jvascsurg.org/ SIR Y90 Course: https://www.sirweb.org/learning-center/meetings/y-90-the-complete-course/ SIR LEARN Conference: https://www.sirweb.org/learning-center/meetings/2022-learn-and-active-meeting/ AMP (Amputation Prevention) Symposium: https://www.amptheclimeeting.com/ NCVH (New Cardiovascular Horizons) Conference: https://ncvh.org/meeting/ncvh-2022/ OEIS (Outpatient Endovascular and Interventional Society) Conference: https://oeisociety.com/

24 Jun 202245min

Dr. Merve Ozen, interventional radiologist, and Dr. Mark Hoffman, minimally invasive gynecologic surgeon (MIGS), discuss how collaboration between IR and gynecologic surgery provides comprehensive medical, surgical, and interventional treatment options for women suffering from uterine fibroids, pelvic congestion syndrome and other causes of chronic pelvic pain. --- CHECK OUT OUR SPONSORS Athletic Greens https://www.athleticgreens.com/backtablevi Medtronic AV DCB https://www.medtronic.com/avdata --- SHOW NOTES In this episode, host Dr. Aparna Baheti interviews Dr. Merve Ozen, interventional radiologist, and Dr. Mark Hoffman, minimally invasive gynecologic surgeon (MIGS) about how collaboration between IR and gynecologic surgery provides comprehensive medical, surgical, and interventional treatment options for women suffering from uterine fibroids, pelvic congestion syndrome and other causes of chronic pelvic pain. Drs. Hoffmann and Ozen began a combined clinic after a discussion between their two departments. Though IRs were enthusiastic about performing uterine fibroid embolization (UFE), they were not able to due to a lack of referring gynecologists. Dr. Hoffman was interested in this collaboration, and he knew a very supportive and motivated nurse who wanted to lead this initiative. He says that despite pushback from other MIGs in his department, he had a supportive department chair who allowed the project to go forward. Next, Dr. Ozen describes a day in their collaborative clinic. She begins by reviewing imaging and patients for the day, ordering new imaging if needed, and discussing patients with Dr. Hoffman. They each see their patients which takes about 45 minutes per visit due to the complexity of chronic pelvic pain and the many potential causes and contributing factors. Some patients require meeting with both physicians to discuss all options. They see four to five patients each day. Every day runs differently depending on the patients and their individual needs, but it runs smoothly due to the supportive nursing staff. Dr. Hoffman discusses medical management including birth control pills, which are often a first-line option or an option for someone who wants the least invasive treatment. He also offers hysterectomy (laparoscopic, robotic, vaginal, abdominal) for women who wish to never have more uterine bleeding, and myomectomy, with hysteroscopic myomectomy being the most minimally invasive and allowing patients to go home the same day after recovering from anesthesia. Dr. Ozen discusses UFE and treatments for other causes of pelvic pain. She does hypogastric nerve blocks for pain, ovarian vein embolization for pelvic congestion syndrome, and cryoablation for chronic pelvic pain. She has also been able to treat some unique ectopic pregnancies that Dr. Hoffman has seen, including a cervical and an abdominal ectopic pregnancy which provided lifesaving treatment without invasive surgical evacuation. --- RESOURCES BackTable Ep. 199: Advanced Minimially Invasive Pain Interventions with Dr. Prologo: https://www.backtable.com/shows/vi/podcasts/199/advanced-minimally-invasive-pain-interventions Non-surgical management of abdominal ectopic pregnancy with uterine artery embolization: https://pubmed.ncbi.nlm.nih.gov/35321265/

20 Jun 202246min

In this episode of our Health Equity Series, guest host Dr. Vishal Kumar interviews emergency medicine resident Dr. Jamal Jefferson about the presence of law enforcement in emergency rooms and challenges with patient privacy and trust in the healthcare system. The CME experience for this Podcast is powered by CMEfy - click here to reflect and unlock credits & more: https://earnc.me/1zdevF --- SHOW NOTES In this episode, guest host Dr. Vishal Kumar interviews emergency medicine resident Dr. Jamal Jefferson about the presence of law enforcement in emergency rooms and its effects on patient privacy and trust in the healthcare system. Dr. Jefferson explains the role that the emergency department plays in his community. He outlines its medical role, as well as its extension into “social emergency medicine.” This term refers to the fact that the ED can be an important access point to services that could improve social determinants of health. Overall the ED often sees community members in their most vulnerable states, and it has the opportunity to track trends in community needs. Next, the doctors discuss how healthcare providers can be unknowingly complicit in further injustices to their patients. Dr. Jefferson urges physicians to think about the ramifications of their actions. For example, using a 5150 code to place a patient on psychiatric hold could affect court decisions and child custody outcomes in the future. Furthermore, when patient belongings are being itemized in a public space such as the ED, this routine procedure could trigger a downstream search/seizure, interrogation, and detainment of the patient. Dr. Jefferson emphasizes the importance of being an active participant in protecting patient privacy. In his patient encounters, he separates the police from the doctor-patient relationship and dispels the idea that the medical team will report protected health information to the police. He explicitly lets patients know that the preceding events that brought them to the hospital do not have an impact on how he will treat them. Additionally, the negative experience of a single patient will send a ripple effect through the community. The patient’s friends and family members may trust the ED less, which delays care and increases morbidity and mortality. Finally, the doctors highlight important research and court rulings over the criminalization of patients. --- RESOURCES A National Evaluation of the Effect of Trauma-Center Care on Mortality: https://www.nejm.org/doi/full/10.1056/nejmsa052049 Police Brutality and Black Health: Setting the Agenda for Public Health Scholars: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5388955/ Policing the Emergency Room (Harvard Law Review): https://harvardlawreview.org/2021/06/policing-the-emergency-room/ Weapons Use Among Hospital Security Personnel: https://cdn.ymaws.com/www.iahss.org/resource/collection/48907176-3B11-4B24-A7C0-FF756143C7DE/2014_Weapons_use_among_hosptial_security_personnel.pdf Ferguson vs. Charleston: https://supreme.justia.com/cases/federal/us/532/67/ #WhiteCoatsForBlackLives — Addressing Physicians’ Complicity in Criminalizing Communities: https://www.nejm.org/doi/full/10.1056/NEJMp2023305

17 Jun 202244min