Ep. 590 Deep Venous Arterialization: Techniques & Outcomes with Dr. Miguel Montero Baker and Dr. Lucas M Ferrer Cardona

Dr. Eric Keller talks with Dr. Lola Oladini from Stanford Medicine Department of Radiology about what makes optimal training for Interventional Radiologists, including discussion on the variety of strengths of programs across the country, balancing diagnostics with procedural training, and what it means in being a "clinical IR". --- CHECK OUT OUR SPONSOR Medtronic Chocolate PTA Balloon https://www.medtronic.com/peripheral --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/bOp6I7 --- SHOW NOTES In this episode, interventional radiology residents Dr. Lola Oladini and Dr. Eric Keller discuss ideas to strengthen IR/DR residency training in multiple aspects, including clinical exposure, practice building, and personalization for the learner’s career goals. Dr. Oladini shares preliminary results from her research, which consisted of interviews with various IR stakeholders. She highlights common themes on what interviewees value in a residency program: longitudinal patient care experience, practice-building education, exposure to interdisciplinary collaboration, exposure to clinical decision making, strong diagnostic radiology training, and graduated autonomy. She also shares common concerns that interviewees had about the disconnects between clinical education in residency training and real world practices that may not have the same clinical focus. Additionally, residents spoke about balancing the paradigm between wanting to get early IR exposure and training to be excellent diagnostic radiologists. Finally, the doctors discuss different interpretations of the commonly used term, “clinical IR,” and brainstorm ways that residency programs can involve trainees in patient-centered initiatives and cross-speciality relationship building. --- RESOURCES SIR Residency Essentials: https://www.sirweb.org/learning-center/learning-center/residency-essentials-and-fundamentals/residency-essentials/

6 Des 202139min

Dr. Aditya Bagrodia and Dr. Aaron Fritts talk with Dr. Phillip Pierorazio from Penn Urology about his Operate with Zen podcast and tips for surgeon wellness. They cover Dr. Pierorazio's motivation for starting a wellness podcast, preventing physician burnout, achieving work-life balance, and managing healthy competitiveness. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/A9shzj --- SHOW NOTES In this crossover episode of BackTable Urology and BackTable VI, Dr. Aaron Fritts and Dr. Aditya Bagrodia speak with Dr. Phil Pierorazio about surgeon wellness and his mindfulness podcast, Operate with Zen. First, Dr. Pierorazio discusses his motivation for starting the Operate with Zen podcast. During the pandemic, he crafted a new goal for himself: to be happier in surgery. He defines mindfulness as taking a moment to enjoy his livelihood and being more present at work and at home. Next, the doctors tackle the topic of physician burnout. All three doctors agree that burnout is not a badge of honor and are glad that the culture of medicine is progressing towards one that reprimands toxic attitudes early in training. As for managing work-life balance, Dr. Pierorazio explains that once he started creating boundaries for his work schedule, he expanded what he could do. He encourages other surgeons to trust that their colleagues can handle emergencies, even if the patients are not their own patients. Collaboration with colleagues also leads to healthy competitiveness, a concept in which physicians stop comparing themselves to each other and instead celebrate their fellow colleagues. Dr. Pierorazio recommends channeling toxic competitive energy towards a drive to better a broader institution and patient care. Finally, Dr. Pierorazio shares two of his personal tips for wellness. He avidly journals each day in order to exercise gratitude, reflect on his day, and set priorities for the next day. Finally, he emphasizes the importance of finding a wellness mentor or counselor in order to expand surgeon wellness and talent.

3 Des 202149min

Dr. Renato Abu Hana walks us through how to perform fallopian tube recanalization for infertility, including patient selection, HSG and recanalization technique, as well as pitfalls to avoid. --- CHECK OUT OUR SPONSOR RADPAD® Radiation Protection https://www.radpad.com/ --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/gJb6X6 --- SHOW NOTES In this episode, interventional radiologist Dr. Renato Abu Hana and our host Dr. Chris Beck discuss fallopian tube recanalization procedure and patient counseling. Tubal occlusion is one of the leading causes of infertility, and can be diagnosed with a hysterosalpingogram (HSG), a procedure that uses X-ray to check for blockages. Blockages can be cured by subsequent selective salpingography. Since the HSG can be a sensitive gynecologic examination with little to no sedation, Dr. Hana shares advice on how to explain the procedure to patients and make them feel more comfortable during the exam. Dr. Hana describes his HSG procedure to us. He notes that the initial speculum insertion can be difficult because of differences in cervical anatomy. He also discusses patient positioning, different tool sets, and his method of injection. To address complications and risks, Dr. Hana recommends prescribing antibiotics to prevent post-procedural infection. Additionally, he emphasizes the need to minimize radiation exposure as much as possible in a patient who is trying to become pregnant. Finally, we highlight the benefits of fallopian tube recanalization, which include low risk of complications, potentially large impacts on the patients’ ability to conceive, and medical cost savings (when used as an alternative to in vitro fertilization).

29 Nov 202144min

We talk with Dr. Cullen Ruff about common misconceptions when it comes to IV contrast and issues with the "contrast allergy", including ways we can improve patient care and clinical workflows by clarifying the true source of these reactions. --- CHECK OUT OUR SPONSOR RADPAD® Radiation Protection https://www.radpad.com/ --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/16AayH --- SHOW NOTES In this episode, diagnostic radiologist Dr. Cullen Ruff and our host Dr. Chris Beck discuss the research and patient education surrounding contrast allergies. Dr. Cullen starts the episode by commenting on the history of contrast media, noting that the earlier ionic contrast agents are more allergenic than the more recent non-ionic ones. By knowing the time period during which many radiologists switched to non-ionic agents (around 1985), we can identify during a medical history which of these types caused a patient’s allergic reaction. The doctors discuss current research, which shows that substituting for a different contrast media is more effective than giving steroid premedication and using the allergy-inducing contrast media. Unfortunately, many patients are unable to recall the year when they experienced their allergy or the name of the contrast agent given. This lack of information makes it difficult to administer a substitute contrast media to the patient. To address these workflow inefficiencies, Dr. Cullen advocates for individualized patient education over specific contrast allergies. He believes that taking the time to discuss allergies and giving the patient the name of their allergen, in writing, is essential for future imaging studies. He advises against the use of the vague and nonsensical term of “iodine allergy”, noting that patients are never allergic to the iodine itself, but rather a different component in the iodinated contrast media. Finally, we discuss Dr. Cullen’s book, “Looking Within: Understanding Ourselves Through Human Imaging” in which he shares patient stories and introduces the general public to the retrospective and predictive values of diagnostic imaging. --- RESOURCES “Patients Have a Very Limited Knowledge of Their Contrast Allergies”: https://www.clinicalimaging.org/article/S0899-7071(21)00324-7/fulltext “Prevention of Allergic-like Reactions at Repeat CT: Steroid Pretreatment versus Contrast Material Substitution”: https://pubmed.ncbi.nlm.nih.gov/34342504/ “Iodine Allergy: Common Misperceptions”: https://academic.oup.com/ajhp/article-abstract/78/9/781/6129459 American College of Radiology Manual on Contrast Media, 2021: https://www.acr.org/Clinical-Resources/Contrast-Manual Dr. Cullen’s book, “Looking Within: Understanding Ourselves Through Human Imaging”: https://www.cullenruff.com/books “The Immunology of the Vermiform Appendix: A Review of the Literature”: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5011360/

26 Nov 202150min

We talk with Dr. Mary Costantino and Dr. Goke Akinwande about their experiences and advice on making equipment purchase decisions for OBLs and outpatient centers, including pitfalls to avoid. --- CHECK OUT OUR SPONSOR Siemens Healthineers https://www.siemens-healthineers.com/ --- SHOW NOTES In this episode, interventional radiologists Dr. Mary Constantino, Dr. Goke Akinwande, and Dr. Aaron Fritts discuss the process of choosing and financing equipment for office-based labs (OBLs). This episode focuses on three major types of equipment: C-arms or fixed units, disposables, and ultrasound machines. First, the doctors discuss the fundamental differences between mobile C-arms and fixed units. Drs. Constantino and Akinwande agree that while the fixed unit is more ergonomically advantageous, it carries significantly more cost. While a fixed unit must be incorporated into the architectural planning of the OBL, a C-arm can be adapted to an existing space. Both doctors emphasize the importance of vendor support and knowing that they have quick access to technicians in the area. Dr. Constantino provides her perspective on disposables and device partnerships, noting that an IR’s priority should be obtaining the equipment that allows them to operate to the best of their abilities. Dr. Akinwande obtains most of his disposables through consignment inventory in order to minimize waste. Finally, the doctors talk about ultrasound technology and situations where different types may be more appropriate than others. Overall, they emphasize that while the OBL model grants autonomy to IRs, this pursuit introduces a large financial risk that should be carefully considered. --- RESOURCES Midwest Institute for Non-Surgical Therapy: https://www.mintstl.com/ Advanced Vascular Centers: https://www.advancedvascularcenters.com/

22 Nov 202155min

Dr. Donald Garbett interviews Dr. Joseph Couvillon about how he helped his group build an OBL practice in a rural setting, including the importance of hitting the pavement and phones to drive awareness with referring docs. Dr. Couvillon also raves about his recent trip to East Africa to help out the Road2IR team. --- CHECK OUT OUR SPONSORS Accountable Revenue Cycle Solutions https://www.accountablerevcycle.com/ Accountable Physician Advisors http://www.accountablephysicianadvisors.com/ --- SHOW NOTES In this episode, interventional radiologist Dr. Joe Couvillon and our guest host Dr. Donald Garbett discuss the opportunities and obstacles that arise with building an OBL practice in the Shenandoah Valley and lessons learned from Dr. Couvillon’s trip to Tanzania with Road2IR. Dr. Couvillon recounts the process of building up his referral base for uterine fibroid embolizations (UFEs) in his practice, and shares his current experience in doing the same for peripheral arterial disease (PAD). He employs marketing strategies such as reading noninvasive studies and offering his services, as well as fostering a collaborative approach with cardiologists and vascular surgeons. He also speaks to the importance of reaching out to the referring doctors’ staff (NPs, PAs, and administrative assistants), since they can influence referral patterns. In addition, Dr. Couvillon updates us on his recent trip with Road2IR. He gives his perspective on teaching procedures to IR fellows in Tanzania and being inspired by their enthusiasm and resourcefulness. --- RESOURCES Bringing IR to East Africa: The Road2IR Story: https://www.backtable.com/shows/vi/podcasts/104/bringing-ir-to-east-africa-the-road2ir-story Road2IR: https://www.road2ir.org/

19 Nov 202156min

Interventional radiologist Michael Barraza talks with orthopedic spine surgeon Thomas Andreshak about his approach to vertebral augmentation for compression fractures, including unipedicular vs. bipedicular approach, technique pearls, and post-procedure care. --- CHECK OUT OUR SPONSOR Medtronic Kyphon https://www.medtronic.com/kyphoplasty --- SHOW NOTES In this episode, orthopedic surgeon Dr.Thomas Andreshak and our host Dr. Michael Barraza discuss kyphoplasty technique, including different methods of imaging, approaches, sedation, and follow-up. Dr. Andreshak starts with obtaining a standing X-ray because it allows him to better observe cases of spondylolisthesis. He describes both unipedicular and bipedicular approaches, noting that the unipedicular approach can allow for greater cost savings, less cement used, and lower radiation exposure. The doctors also review the stages of bone healing: hematoma formation, fibrocartilage formation, bony callus formation, and bone remodeling. Dr. Andreshak warns against overfilling the vertebra, which creates stiffness and puts stress on the adjacent endplate. Finally, they discuss follow-up and considerations for future treatment if pain persists. --- RESOURCES Consulting Orthopedic Associates: https://consulting-ortho.com/ Kyphon Assist: https://www.medtronic.com/us-en/healthcare-professionals/products/spinal-orthopaedic/vertebral-augmentation/kyphon-assist.html

15 Nov 202125min

Urologist Dr. Claus Roehrborn and Interventional Radiologist Dr. Sandeep Bagla discuss the pros and cons of Prostate Artery Embolization (PAE) compared to other Minimally Invasive Surgical Treatments (MISTS) for Benign Prostate Hyperplasia (BPH). They also discuss the importance of a collaborative, multidisciplinary approach when offering these treatment options, including agreeing on the best treatment for the patient. --- CHECK OUT OUR SPONSOR RADPAD® Radiation Protection https://www.radpad.com/ --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/Daw1w2 --- SHOW NOTES In this episode, urologist Dr. Claus Roehrborn and interventional radiologist Dr. Sandeep Bagla discuss benign prostatic hyperplasia (BPH) and prostate artery embolization (PAE) in the context of counseling patients and cross-specialty collaboration. Dr. Roehrborn starts by reviewing the history of BPH treatment, from medications like alpha-blockers and anticholinergics, to minimally invasive options like UroLift, Rezum, and PAE. He emphasizes that the latter options are growing in popularity, since they provide treatment alternatives for patients who are concerned about side effects from medications, or have not experienced symptom relief from medications. Dr. Sandeep Bagla describes Prostate Cancer USA’s philosophy on IR/Urology partnership and how it can ultimately benefit patients. This model provides the patient with both an IR suite for the PAE procedure and a urology clinic for diagnostic assessment, determination of PAE candidacy, and follow-up assessment. Both doctors describe ideal patients for PAE. These are usually patients with a gland size above 60 g, confirmed bladder function, and a desire to preserve ejaculation function. Contraindications include urinary retention, chronic prostatitis, and heavily calcified glands. Finally, they describe how they manage minor short-term complications such as frequency and dysuria with medication. They track symptom relief using the International Prostate Symptom Score (IPSS), Dr. Bagla notes that the largest drop in IPSS usually occurs about 4-5 weeks post-procedure.

8 Nov 202158min