Ep. 233 Desmoid Tumors: IR's Role in Diagnosis and Management with Dr. Jack Jennings

Ep. 233 Desmoid Tumors: IR's Role in Diagnosis and Management with Dr. Jack Jennings

In this episode, host Dr. Jacob Fleming interviews Dr. Jack Jennings about cryoablation, multidisciplinary care, and practice building for the treatment of desmoid tumors. --- 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/aNJOCP --- SHOW NOTES First, Dr. Jennings describes the typical presentation of desmoid tumors, also known as “aggressive fibromatosis.” These are neoplasms of fibrous connective tissue, but unlike sarcomas, they do not metastasize to other parts of the body. We quickly review characteristic imaging findings such as hypointense T1 and T2 signals. In the last decade, sorafenib (tyrosine kinase inhibitor) was established as a therapy for desmoid tumors. However, since sorafenib has failed to show significant efficacy, there has been exploration into other treatments such as surgical resection and cryoablation. Dr. Jennings encourages IRs to attend sarcoma tumor boards to learn about desmoid cases and opportunities to perform cryoablations when desmoids cannot be surgically resected. In extra-abdominal desmoids, cryoablation is ideal, since the interventionist can see the low attenuation ice ball forming and sculpt ablation zones to match irregular desmoid shapes. Dr. Jennings recommends forming a 10mm ablation margin around the tumor. Additionally, he discusses both active and passive thermal protection techniques for surrounding tissues. He utilizes carbon dioxide, hydropneumodissection, and motor/somatosensory evoked potentials to keep non-target tissues out of the ablation zone. The bowel and nerves (especially in the extremities) are critically important to avoid. For post-procedural care, Dr. Jennings emphasizes that pain is very common, due to large inflammatory responses. He usually admits patients overnight to monitor pain levels and give IV Decadron. Patients are then sent home with Medrol Dosepak. We also talk about the importance of informed consent about pain and potential nerve injuries. Finally, we discuss how IRs can be advocates for patients with desmoids. Dr. Jennings believes that preemptive measures can go a long way when talking to third party payers. He will usually include current National Comprehensive Cancer Network (NCCN) guidelines and current cryoablation papers in his clinic notes to support his recommendations. He also encourages IRs to collaborate with oncologists, surgeons, and radiation oncologists to craft the best treatment plan for their patients. --- RESOURCES Washington University MSK Interventions: https://www.mir.wustl.edu/education/subspecialty-programs/musculoskeletal-imaging-and-interventions/ Neuroanatomic Considerations in Percutaneous Tumor Ablation: https://pubs.rsna.org/doi/10.1148/rg.334125141 Anatomically Based Guidelines for Core Needle Biopsy of Bone Tumors: Implications for Limb-sparing Surgery: https://pubs.rsna.org/doi/10.1148/rg.271065092 National Comprehensive Cancer Network (NCCN) Guidelines for Soft Tissue Sarcomas (including Desmoid Tumors): https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1464 Society for Interventional Oncology (SIO): http://www.sio-central.org/ Cryoablation for Palliation of Painful Bone Metastases: The MOTION Multicenter Study: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8011449/

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Ep. 534 What’s a Good Job? Looking at the Diagnostic Job Market with Dr. Ned Holman and Dr. Mike Romeo

Ep. 534 What’s a Good Job? Looking at the Diagnostic Job Market with Dr. Ned Holman and Dr. Mike Romeo

Are you thinking about pursuing a new diagnostic radiology gig? Get the download on the current job market, how to evaluate different compensation models, and what to look out for when considering your next job offer in this week’s episode of BackTable, featuring guests Dr. Ned Holman (Neuroradiologist at Alaska Imaging) and Dr. Mike Romeo (Radiologist and President of West Reading Radiology). --- SYNPOSIS The doctors begin by exploring various employment models, including private practice, academic positions, and hybrid arrangements that combine elements of both. They share valuable insights on job transparency and the significance of leveraging professional connections to gain honest, firsthand perspectives on potential employers. They also provide advice on key questions to ask during job interviews and strategies for negotiating contracts. The doctors conclude by sharing tips to help make informed decisions to ensure job satisfaction and professional growth. --- TIMESTAMPS 00:00 - Introduction 04:30 - Employment Models 06:32 - Compensation Structures 08:43 - Evaluating Job Offers 19:05 - Red Flags in Employment 27:13 - Private Equity Jobs: Pros and Cons 31:36 - Navigating Job Boards and Resources 42:03 - Final Advice for Job Seekers

18 Apr 45min

Ep. 533 Physician’s Guide to Financial Literacy and Investment Strategies with Dr. Jim Dahle

Ep. 533 Physician’s Guide to Financial Literacy and Investment Strategies with Dr. Jim Dahle

The road towards financial literacy and financial freedom does not need to be a solo, do-it-yourself, figure it out as it goes type of journey. Guest Dr. Jim Dahle (practicing emergency medicine physician and Founder of the White Coat Investor) joins host Dr. Chris Beck to help better illuminate the process of becoming financially literate and securing financial freedom for physicians and others in similar professional arenas. --- This podcast is supported by: RADPAD® Radiation Protection https://www.radpad.com/ --- SYNPOSIS Dr. Dahle begins the episode by driving home how sound and solid financial education coupled with early, prudent financial behaviors can be worth millions over a career. The doctors discuss writing investment plans, goal setting, and understanding of asset allocation to ensure long-term financial success. Dr. Dahle also delves into the Mega Backdoor Roth IRA, practical tips for handling savings and expenses, as well as how to integrate real estate into your investment portfolio. The episode concludes with helpful resources, programs, and conferences available through the White Coat Investor. --- TIMESTAMPS 00:00 - Introduction 04:30 - Savings Tips and Strategies 13:22 - Retirement Goals and Savings Targets 28:20 - Real Estate as an Investment 32:30 - Mega Backdoor Roth IRA 42:59 - Advice for New High-Income Earners 46:09 - Teaching Financial Literacy to Kids 48:15 - Addressing Physician Burnout 53:53 - Common Financial Mistakes by Doctors 58:11 - White Coat Investor Book Giveaway Program --- RESOURCES White Coat Investor: https://www.whitecoatinvestor.com BackTable VI Episode #194 - Financial Basics from the White Coat Investor with Dr. James Dahle: https://www.backtable.com/shows/vi/podcasts/194/financial-basics-from-the-white-coat-investor White Coat Investor Champions Program (For Students): https://www.whitecoatinvestor.com/wci-champions/

15 Apr 1h 1min

Ep. 532 OBL Site of Service Update with Dr. Bret Wiechmann and Dr. Jerry Niedzwiecki

Ep. 532 OBL Site of Service Update with Dr. Bret Wiechmann and Dr. Jerry Niedzwiecki

Navigating the intricate world of medical billing can be challenging, and knowing the steps needed to ensure fair reimbursement can be even more challenging. Guests Dr. Bret Wiechmann and Dr. Jerry Niedzwiecki (private practice interventional radiologists) join host Dr. Ally Baheti to discuss how IRs in the OBL setting can legislatively rally behind the office-based facility concept and improve physician reimbursement in the light of developments addressed at the recent OEIS meeting. --- SYNPOSIS Dr. Wiechmann and Dr. Niedzwiecki begin the episode by defining several key-terms and processes in physician reimbursement in the outpatient setting to help orient us to the issue at hand. After explaining why and how reimbursement for more advanced procedures in the OBL setting has been lagging behind, the doctors introduce the concept of creating an office-based facility concept. This would help stabilize payments for complex procedures done in the OBL space. The episode concludes with emphasis on more physician involvement and advocacy in pushing reform forward, underscoring how a unified effort is essential for long-lasting, meaningful change. --- TIMESTAMPS 00:00 - Introduction 01:42 - Medicare Physician Fee Schedule 05:46 - Challenges with Current Reimbursement Models 11:28 - Proposing the Office-Based Facility Concept 17:58 - Legislative Efforts and Congressional Involvement 26:53 - Call to Action: How You Can Help 36:40 - Conclusion --- RESOURCES Outpatient Endovascular and Interventional Society: https://oeisweb.com

8 Apr 40min

Ep. 531 Ten Commandments for Female Interventional Radiologists with Dr. Maureen Kohi

Ep. 531 Ten Commandments for Female Interventional Radiologists with Dr. Maureen Kohi

What are the 10 Commandments of Being a Female Interventional Radiologist? Guest Dr. Maureen Kohi (Chair of Radiology at University of North Carolina Chapel Hill) sits down with host Dr. Ally Baheti to discuss the details of her popular lecture topic and how these 10 rules are actually applicable to all current and future interventional radiologists. --- SYNPOSIS Dr. Kohi begins by going through each of the 10 points - offering detailed advice throughout, while also acknowledging nuances and challenges women and men can encounter in medicine and best approaches. Dr. Kohi also speaks on how to build and navigate strong relationships with industry. The episode concludes with several more pearls of wisdom as Dr. Kohi shares the last of the 10 commandments. --- TIMESTAMPS 00:00 - Introduction 01:08 - 10 Commandments of Being a Female IR 23:06 - Importance of Involvement in Professional Societies 24:46 - Childcare Concerns in Professional Settings 28:58 - Making the Leadership Leap 35:24 - Navigating Gender Bias in Professional Environments 41:51 - Prioritizing Health, Family, and Personal Fulfillment --- RESOURCES From Good to Great (Book): https://a.co/d/gXWW1Qp Start With Why (Book): https://a.co/d/hgaadIt

4 Apr 46min

Ep. 530 Evolution of IR: A Conversation with Dr. Barry Katzen

Ep. 530 Evolution of IR: A Conversation with Dr. Barry Katzen

In honor of the 50th annual meeting of the Society of Interventional Radiology (SIR) in Nashville, let’s take it back to the beginning of IR and review how the field became what it is today. Guest host Dr. Andrew Niekamp (interventional radiologist at Miami Vascular) sits down with esteemed guest Dr. Barry Katzen, who began his training at the advent of IR, to discuss the origins and development of the field since its inception. --- This podcast is supported by: RADPAD® Radiation Protection https://www.radpad.com/ --- SYNPOSIS The doctors discuss challenges and innovations that shaped IR’s growth, and the importance of clinical practice and patient-centered care. Dr. Katzen shares insights from his extensive career, including his early involvement in advancing image-guided therapies, his role in founding Miami Cardiac & Vascular Institute, and strategies to overcome turf-wars and complacency in medicine. Dr. Katzen emphasizes the need for continuous innovation and dedication towards improving patient outcomes in the evolving landscape of IR. The episode concludes with Dr. Katzen’s advice for future and early-career IRs. --- TIMESTAMPS 00:00 - Introduction 03:39 - Early Innovations and Training in Europe 09:08 - Founding the Miami Cardiac and Vascular Institute 17:13 - Challenges and Innovations 25:24 - Importance of Clinical Responsibility 34:07 - Birth of a Specialty 40:35 - Advice for Future Interventional Radiologists 43:29 - Conclusion

1 Apr 45min

Ep. 529 Building a Social Media Presence in IR with Dr. Gustavo Elias

Ep. 529 Building a Social Media Presence in IR with Dr. Gustavo Elias

Is social media an effective patient acquisition tool for interventional radiologists? In a word: absolutely. Learn how to reach more patients in this week’s BackTable Podcast, where Dr. Gustavo Elias joins Dr. Ally Baheti to discuss the benefits he has seen with social media, and the content strategies that he uses in his medical practice. --- SYNPOSIS The episode begins with Dr. Elias sharing his journey of overcoming initial reservations around posting content. The doctors emphasize the importance of individuality and passion in showing what IR can offer to the public in easily-digestible ways. Dr. Elias then discusses the impact of social media on patient engagement, and shares practical tips for physicians who are looking to enhance their online presence. Dr. Elias also touches on optimal posting schedules, collaboration tips, and balancing professionalism with approachability. --- TIMESTAMPS 00:00 - Introduction 04:02 - Social Media for Interventional Radiologists 08:56 - Building a Social Media Presence 19:24 - Optimal Posting Strategies 21:58 - Collaborations and Platforms 25:27 - Conclusion

28 Mars 28min

Ep. 528 Approach to Microwave Liver Ablations with Dr. Asad Baig

Ep. 528 Approach to Microwave Liver Ablations with Dr. Asad Baig

Let’s talk liver ablations. This week’s episode of the BackTable Podcast provides a thorough review of modern microwave ablation methods, tools, and tech, featuring Dr. Asad Baig (interventional radiologist at Columbia University) and host Dr. Michael Barraza. --- This podcast is supported by an educational grant from Medtronic . --- SYNPOSIS Dr. Baig shares practical advice on how to become a key contributor at your tumor board and how to position your skillset as an interventional radiologist. He talks through his microwave ablation procedure technique, highlighting the role of ablation zone visualization software. The doctors go on to discuss a variety of ablation approaches, needle placement, intra- and post-operative imaging, and tips for dealing with challenging tumor locations. The episode concludes with Dr. Baig summarizing best practices for ensuring safe and effective ablations, and underscoring the importance of solid patient-physician communication throughout care. --- TIMESTAMPS 00:00 - Introduction 08:28 - Microwave Ablation Techniques 12:54 - Collaborative Approach in Tumor Boards 23:30 - Combined Ablation Cases and Techniques 36:12 - Challenging Liver Ablations 45:56 - Tips for Safe and Effective Ablations 50:07 - Balancing Biopsy and Ablation 01:00:34 - Conclusion --- RESOURCES The Emprint™ Ablation System with Thermosphere™ Technology: One of the Newer Next-Generation Microwave Ablation Technologies: https://pmc.ncbi.nlm.nih.gov/articles/PMC4640908/ Comparison of microwave ablation and surgical resection for treatment of hepatocellular carcinomas conforming to Milan criteria: https://pubmed.ncbi.nlm.nih.gov/24628534/ Percutaneous microwave ablation of hepatic lesions near the heart: https://pubmed.ncbi.nlm.nih.gov/34805581/ Microwave Ablation of Hepatic Tumors Abutting the Diaphragm Is Safe and Effective: https://ajronline.org/doi/10.2214/AJR.14.12879

25 Mars 1h 2min

Ep. 527 Managing Hereditary Hemorrhagic Telangiectasia and Pulmonary AVMs with Dr. Clifford Weiss

Ep. 527 Managing Hereditary Hemorrhagic Telangiectasia and Pulmonary AVMs with Dr. Clifford Weiss

Targeted, image-guided interventions can make a big difference for patients with hereditary hemorrhagic telangiectasia (HHT). Learn how in this week’s BackTable episode featuring Dr. Clifford R. Weiss (Director of the Johns Hopkins Vascular Anomalies Center and HHT Center of Excellence) and host Dr. Michael Barraza. --- SYNPOSIS Dr. Weiss delves into the complexities and multisystem nature of HHT, emphasizing the significance of early diagnosis and multidisciplinary care. He goes on to explain the clinical criteria for diagnosing HHT, the role of genetic and imaging screenings, and the evolving approaches to treating pulmonary arteriovenous malformations (AVMs) in adults and children. The doctors discuss the potential impact of anti-angiogenic medications on the future management of HHT. The episode closes with a nod to the pivotal role that HHT Centers of Excellence play, and the ongoing dedication to improving patient outcomes through collaborative care and innovative research. --- TIMESTAMPS 00:00 - Introduction 03:57 - Diagnosing and Screening for Hereditary Hemorrhagic Telangiectasia (HHT) 07:37 - Treatment Approaches for HHT 12:12 - Embolization Techniques and Safety Measures 19:02 - Future of HHT Treatment and Research 22:30 - Conclusion and Final Thoughts --- RESOURCES The Johns Hopkins Hereditary Hemorrhagic Telangiectasia (HHT) Center of Excellence: https://www.hopkinsmedicine.org/interventional-radiology/hht

21 Mars 26min

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