Ep. 485 Mastering Microwave Ablation in HCC Treatment with Dr. Zach Berman

In this episode of the Backtable Podcast, guest host Dr. Paul Bhogal, a consultant interventional neuroradiologist at Royal London Hospital in the UK, and guests Dr. Piotr Walczak and Dr. Prakash Ambady discuss the potential of intra-arterial treatments combined with blood brain barrier (BBB) manipulation in treating various neurological conditions and tumors. The trio of doctors discuss methods such as the use of hyperosmolar mannitol and focused ultrasound to breach the BBB and deliver drugs directly to the brain tissue. Dr. Walczak and Dr. Ambady also highlight their individual research areas, including therapies involving cell delivery and engineered cells. The conversation also covers potential risks and new perspectives in comparison to current techniques such as whole-brain radiation. --- CHECK OUT OUR SPONSOR RADPAD® Radiation Protection https://www.radpad.com/ --- SHOW NOTES 00:00 - Introduction 05:44 - Challenges of Treating Glioblastoma Multiforme 12:52 - Understanding the Blood Brain Barrier 18:30 - Strategies to Negate the Blood Brain Barrier 20:52 - Blood Brain Barrier Disruption Using Intra-Arterial Mannitol 26:35 - Infusion Rates and Magnetic Resonance Guidance 33:47 - Role of Radiolabel Studies in Drug Delivery 36:31 - Future of Therapeutic Agents Design 47:54 - Potential of Focused Ultrasound in Drug Delivery 56:10 - Exploring the Use of Cells in Drug Delivery 58:44 - Future of Intra-Arterial Interventions --- RESOURCES Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma: https://pubmed.ncbi.nlm.nih.gov/15758009/ Effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomized phase III study: 5-year analysis of the EORTC-NCIC trial: https://pubmed.ncbi.nlm.nih.gov/19269895/ REMOVAL OF RIGHT CEREBRAL HEMISPHERE FOR CERTAIN TUMORS WITH HEMIPLEGIA - PRELIMINARY REPORT: https://jamanetwork.com/journals/jama/article-abstract/254927 Real-Time MRI Guidance for Reproducible Hyperosmolar Opening of the Blood-Brain Barrier in Mice: https://www.researchgate.net/publication/328537972_Real-Time_MRI_Guidance_for_Reproducible_Hyperosmolar_Opening_of_the_Blood-Brain_Barrier_in_Mice Dr. Piotr Walczak ResearchGate Profile: https://www.researchgate.net/profile/Piotr-Walczak-6 Dr. Prakash Ambday ResearchGate Profile: https://www.researchgate.net/profile/Prakash-Ambady Maculopathy Associated With Osmotic Blood- Brain Barrier Disruption and Chemotherapy in Patients With Primary CNS Lymphoma: https://pubmed.ncbi.nlm.nih.gov/32484895/ PET imaging of intra-arterial 89 Zr bevacizumab in mice with and without osmotic opening of the blood-brain barrier: distinct advantage of intra-arterial delivery: 10.2967/jnumed.118.218792 Safety of intra-arterial chemotherapy with or without osmotic blood–brain barrier disruption for the treatment of patients with brain tumors: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9307096/ Delivery of chemotherapeutics across the blood-brain barrier: challenges and advances: https://pubmed.ncbi.nlm.nih.gov/25307218/

3 Jan 20241h 6min

In this episode of The Backtable Podcast, host Dr. Aaron Fritts and guests Dr. Mahmood Razavi and Dr. Mark Garcia discuss the intricacies of owning and operating an outpatient-based lab (OBL). Dr. Razavi and Dr. Garcia are practicing interventional radiologists at Vascular and Interventional Specialists of Orange County (California) and American Vascular Associates (Florida), respectively. The doctors explore the advantages of OBLs, including autonomy, flexibility, and patient satisfaction. They also delve into the challenges of financial sustainability, decision-making restrictions, and insurance navigation. The conversation revolves around the need for a solid business plan before stepping into OBL operation. This includes awareness of potential regulatory oversight, costs, and patient sources. They also discuss the impact of OBLs on healthcare, and they specifically warn that the lack of evidence-based practices might have adverse effects. The doctors propose solutions such as societal guidelines, required accreditation, and stringent care delivery. --- CHECK OUT OUR SPONSOR Siemens Healthineers https://www.siemens-healthineers.com/ --- SHOW NOTES 00:00 - Introduction 04:26 - Pros and Cons of Owning and Operating in an OBL 11:07 - Financial Aspects and Profitability of OBLs 23:42 - Exploring Alternative Models for OBLs 32:33 - The Role of Societies in Guiding OBL Practices 36:27 - The Future of OBLs: Regulation, Consolidation, and Quality 42:59 - Exit Strategies and Future Considerations for OBLs 50:38 - Final Thoughts on OBLs and the Importance of Quality Care --- RESOURCES Impact of Office Based Laboratories on Physician Practice Patterns and Outcomes after Percutaneous Vascular Interventions for Peripheral Artery Disease: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8555658/pdf/nihms-1524412.pdf

1 Jan 202454min

In this episode of The Backtable Podcast, host Dr. Michael Barraza and guest Dr. Brandon St. Amant have an in-depth discussion about QGenda, an online scheduling solution. Both doctors practice interventional radiology at Radiology Associates in Baton Rouge, Louisiana. They discuss the initial setup process, from rule setting to managing shift assignments and creating transparency among the team. The key points of the conversation include the concept of the ‘holiday schedule’, the ‘buy sell system’ for open shifts, and making ‘longer schedules’ for predictability. The episode emphasizes the ongoing role of the scheduler and the need to build trust when transitioning to an electronic system like QGenda. --- CHECK OUT OUR SPONSORS Medtronic HawkOne Directional Atherectomy System https://www.medtronic.com/hawkone Reflow Medical https://www.reflowmedical.com/ --- SHOW NOTES 00:00 - Introduction 03:08 - The Challenges of Manual Scheduling 05:00 - Transition to QGenda 09:34 - The Role of Excel in Scheduling 22:06 - Handling Holiday Schedules 26:50 - Buy-Sell System for Shifts 33:17 - Final Tips for Effective Scheduling --- RESOURCES QGenda: https://www.qgenda.com/

29 Dec 202338min

En este episodio del podcast, el Dr. Iñigo Insausti Gorbea y la Dra. Sara Lojo Lendoiro, se centraron en la técnica de embolización prostática como alternativa mínimamente invasiva para el tratamiento de la hiperplasia benigna de próstata. Se detallaron los criterios de inclusión del paciente para poder realizar este procedimiento, las tasas de éxito y los riesgos potenciales. Además, se destaca la importancia de educar a los urólogos y médicos de atención primaria sobre este procedimiento, abogando por una mayor participación clínica de los intervencionistas en la atención al paciente. El Dr. Insausti también abordó la necesidad de que los radiólogos intervencionistas cuenten con consultas y camas propias, para los pacientes. Por último, en el episodio se habla sobre el futuro potencial de la embolización de próstata, incluida la introducción de materiales de embolización alternativos y la tasa de retratamiento de pacientes a largo plazo, en comparación con las opciones quirúrgicas. --- SHOW NOTES 00:00 - Introducción 01:43 - Comprender la hipertrofia prostática benigna 03:42 - Impacto en la calidad de vida de los pacientes 04:31 - Introducción a la embolización de la próstata. 06:25 - Candidatura del paciente para la embolización 07:29 - Comparación de embolización y cirugía. 11:08 - Riesgos asociados con la embolización de la próstata 14:51 - Tasas de éxito de la embolización de la próstata 24:17 - El futuro de la embolización de la próstata 45:01 - Conclusión y pensamientos finales

27 Dec 202348min

In this episode of the BackTable Podcast, hosts Dr. Aaron Fritts and Dr. Chris Beck discuss their Mediport removal workflows and the common challenges of a port removal procedure. Often seen as a significant milestone for cancer patients who have completed their treatment, successful Mediport removal requires a thorough understanding of the catheter and reservoir removal processes. This discussion covers tips and tricks for removing Mediports with minimal discomfort to the patient, effective anesthesia, careful dissection, and appropriate closure procedures. The hosts also emphasize the importance of preparing for unexpected scenarios such as catheter fractures or infection, and they outline strategies to effectively handle these complications. --- CHECK OUT OUR SPONSOR RADPAD® Radiation Protection https://www.radpad.com/ --- SHOW NOTES 00:00 - Introduction 03:06 - Overview of Mediport Removal 13:25 - Mediport Removal Procedure 20:59 - Procedural Challenges and Complications 22:12 - Infected Ports 30:17 - Stuck Ports 33:14 - Fractured Ports

25 Dec 202339min

In this episode of the Back Table Podcast, host Dr. Aaron Fritts and Dr. Sameh Sayfo discuss radial to peripheral interventions, also known as R2P. Dr. Sayfo is an interventional cardiologist and the program director of the endovascular fellowship at Baylor Heart Hospital in Plano, Texas. Dr. Sayfo points out the need for research data on the financial impact of these interventions on patients. Dr. Amit P. Amin’s work in 2017, 2018 and 2021 is highlighted for its valuable contribution in this area, specifically in the radial to coronary world. The conversation then veers into the possibilities for radial to peripheral interventions in the coming years. There’s a discussion about the potential financial impact on the healthcare system, and how radial to peripheral interventions may yield a lower length of stay and more same day discharges, which can serve as motivators for more practitioners to adopt this technology. The episode also highlights training, patient selection, complications, bailout techniques and post-procedure care related to radial to peripheral interventions. --- CHECK OUT OUR SPONSORS Surmodics Sublime Radial Access Platform https://sublimeradial.com/ Reflow Medical https://www.reflowmedical.com/ --- SHOW NOTES 00:00 - Introduction 04:40 - Discussion on Radial to Peripheral 15:52 - Addressing Hesitations about Radial Approach 25:24 - Crossing Complex Lesions: Challenges and Solutions 28:50 - Need for Research and Equipment Advancement 33:43 - Importance of Landmark Study in Radial to Peripheral 35:23 - Complications to Avoid and Bailout Techniques 40:53 - The Radial Movement and Future Prospects --- RESOURCES From Femoral to Radial Approach in Coronary Intervention: https://pubmed.ncbi.nlm.nih.gov/27401210/ Intravascular Lithotripsy for Peripheral Artery Calcification: 30-Day Outcomes From the Randomized Disrupt PAD III Trial: https://pubmed.ncbi.nlm.nih.gov/34167675/ Prospective, Multicenter Registry to Assess Safety and Efficacy of Radial Access for Peripheral Artery Interventions: https://www.jscai.org/article/S2772-9303(23)00813-X/fulltext Distal Versus Proximal Radial Artery Access for Cardiac Catheterization and Intervention: Design and Rationale of the DIPRA Trial: https://pubmed.ncbi.nlm.nih.gov/33926835/ Costs associated with transradial access and same-day discharge after percutaneous coronary intervention: a systematic review and meta-analysis: https://pubmed.ncbi.nlm.nih.gov/34258909/ The Value of Transradial: Impact on Patient Satisfaction and Health Care Economics: https://pubmed.ncbi.nlm.nih.gov/31733737/ Transradial Access for High-Risk Percutaneous Coronary Intervention: Implications of the Risk-Treatment Paradox: https://pubmed.ncbi.nlm.nih.gov/34253050/ Cost of coronary syndrome treated with percutaneous coronary intervention and 30-day unplanned readmission in the United States: https://pubmed.ncbi.nlm.nih.gov/31876371/ Terumo Radial Sheath: https://www.terumois.com/products/access/glidesheath-slender-introducer-sheath.html Cordis Radial Sheath: https://cordis.com/na/products/access/cardiology/rain-sheath-transradial-thin-walled-introducer Surmodic Radial Sheath: https://www.surmodics.com/

22 Dec 202343min

In this episode of the BackTable Podcast, host Dr. Jacob Fleming and Dr. Alexa Levey have an in-depth discussion about the current uses and potential future applications of cryoneurolysis in interventional radiology. Dr. Levey is an interventional radiologist at the Memorial Hermann Health System in Houston, TX. The doctors discuss how cryoneurolysis differs from radiofrequency (RF) ablation, highlighting the increased precision and gentleness to surrounding tissues. Dr. Levey describes the specifics of stellate ganglion procedures and cryoneurolysis techniques. They delve into the importance of research and collaboration in advancing the field, as well as the necessity of being patient-centered. They also address the need for financial discussions in medicine and the prospect for cryoneurolysis as desmoid tumor treatments. Additionally, Dr. Levey shares her journey in building a career as a female in a male-dominated space and emphasizes the importance of physician availability to patients and colleagues. --- CHECK OUT OUR SPONSOR Boston Scientific Visual ICE Cryoablation System https://www.bostonscientific.com/en-US/products/cryoablation/visual-ice.html --- SHOW NOTES 00:00 - Introduction to RF Ablation and Cryoneurolysis 03:20 - Dr. Alexa Levey’s Journey and Inspiration 07:00 - Building a Pain Practice 14:03 - Advantages of Cryoneurolysis over RF 21:09 - Patient Selection and Planning for Cryoneurolysis 32:02 - Understanding Patient’s Condition and Treatment Options 36:21 - Role of Stellate Ganglion Procedures in PTSD and Anxiety Management 37:48 - Challenges and Impact of Long COVID 41:34 - The Future of Cryoneurolysis in Medical Practice 54:55 - Future of Cryo Treatment in Medical Practice --- RESOURCES Safety and Effectiveness of Stellate Ganglion Cryoablation in Complex Regional Pain Syndrome: https://doi.org/10.1016/j.jvir.2023.09.030 Treating phantom limb pain: cryoablation of the posterior tibial nerve: https://pubmed.ncbi.nlm.nih.gov/35801126/ Stellate Ganglion Block for Psychiatric Disorders: A Systematic Review of the Clinical Research Landscape: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8664306/ The Efficacy of the Stellate Ganglion Block as a Treatment Modality for Posttraumatic Stress Disorder Among Active Duty Combat Veterans: A Pilot Program Evaluation: https://pubmed.ncbi.nlm.nih.gov/33242072/ Stellate Ganglion Block in the Treatment of Post-traumatic Stress Disorder: A Review of Historical and Recent Literature: https://pubmed.ncbi.nlm.nih.gov/27739175/ Stellate ganglion block reduces symptoms of Long COVID: A case series: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8653406/ Stellate Ganglion Block Relieves Long COVID-19 Symptoms in 86% of Patients: A Retrospective Cohort Study: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10498998/

18 Dec 20231h 3min

In this episode of the BackTable Podcast, host Dr. Ally Baheti and Dr. Daniel Sheeran discuss the management and treatment of peripartum and postpartum hemorrhage. Dr. Sheeran highlights the importance of imaging-based diagnostics, particularly with MRI, to identify the source of bleeding and guide therapy. He also explains the need to employ a variety of techniques tailored towards each individual situation, which may involve utilizing different types of catheters, occlusion balloons, and embolics. He underlines the necessity to balance effective treatment with the preservation of uterine health, especially for women who may wish to have future pregnancies. In severe cases, he mentions the possibility of temporary aortic occlusion. As a final point, Dr. Sheeran argues that Interventional Radiology can play a crucial role in managing these types of cases and potentially avoiding hysterectomies. --- CHECK OUT OUR SPONSOR Reflow Medical https://www.reflowmedical.com/ --- SHOW NOTES 00:00 - Introduction 03:00 - Breakdown of Types of Hemorrhages 03:26 - Understanding Peripartum Hemorrhage 04:05 - Discussion on Postpartum Hemorrhage 07:52 - Technical Details of Balloon Occlusion 08:00 - Procedure for Peripartum Hemorrhage 21:15 - Blood Loss in Medical Procedures 22:48 - Uterine Artery Embolization 27:10 - Post-Procedure Follow Up and Fertility Concerns 30:05 - Technical Points for Newcomers in the Field 36:12 - The Role of REBOA in Treating Postpartum Hemorrhage --- RESOURCES The role of interventional radiology in the management of abnormally invasive placenta: a systematic review of current evidences: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7276355/ Magnetic Resonance Imaging of Placenta Accreta Spectrum: A Step-by-Step Approach: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7817633/ Role of interventional radiology in placenta accreta spectrum (PAS) disorders: https://www.sciencedirect.com/science/article/pii/S1521693421000146 Perioperative temporary occlusion of the internal iliac arteries as prophylaxis in cesarean section at risk of hemorrhage in placenta accreta: https://pubmed.ncbi.nlm.nih.gov/21598085/ Aberrant Ovarian and Uterine Feeding from the Renal Artery at the End of Gestation: Two Cases: https://www.jvir.org/article/S1051-0443(10)00863-8/fulltext Uterine Fundal Blood Supply from an Aberrant Left Ovarian Artery Originating from the Inferior Mesenteric Artery: Implications for Uterine Artery Embolization: https://www.jvir.org/article/S1051-0443(10)00191-0/fulltext Pregnancy success and outcomes after uterine fibroid embolization: updated review of published literature: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6948071/ Uterine artery embolisation: fertility, adenomyosis and size – what is the evidence?: https://cvirendovasc.springeropen.com/articles/10.1186/s42155-023-00353-2 Use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) for Proximal Aortic Control in Patients With Severe Hemorrhage and Arrest: https://pubmed.ncbi.nlm.nih.gov/28973104/ Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA): https://prytimemedical.com/clinical/reboa/ Resuscitative endovascular balloon occlusion of the aorta (REBOA) for life-threatening postpartum hemorrhage: A nationwide observational study in Japan: https://pubmed.ncbi.nlm.nih.gov/35444149/ Efficacy of resuscitative endovascular balloon occlusion of the aorta (REBOA) for hemorrhage control in patients with abnormally invasive placenta: a historical cohort study: https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-023-05649-8 An elective hybrid suite approach to the management of placenta accreta-associated postpartum hemorrhage (PPH): https://www.jvir.org/article/S1051-0443(13)00311-4/fulltext The role of interventional radiology in primary postpartum hemorrhage: https://www.jstage.jst.go.jp/article/jsshp/4/2/4_HRP2015-016/_article

15 Dec 202340min