Think your medical practice is safe from hackers? Learn why humans, rather than software, are often the weakest link in patient data protection. In this episode of the BackTable Podcast, host Dr. Chris Beck delves into the critical topic of cybersecurity in healthcare with Didier Jourdain, a certified Information Systems Security Professional (CISSP).

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SYNPOSIS

Didier discusses his recently approved paper, 'Cybersecurity for Interventional Radiologists: A Clinical Imperative for Protecting Patient Data and Imaging Systems,' and shares his extensive background in software and application security, penetration testing, and cybersecurity risk governance. The conversation covers key issues such as phishing, ransomware, third-party vendor risks, and the vulnerabilities of the Internet of Medical Things (IOMT). Didier emphasizes the importance of education, tabletop exercises, and comprehensive third-party risk management strategies to enhance cybersecurity resilience in both hospital systems and independent physician practices.

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TIMESTAMPS
00:00 - Introduction
04:03 - Cybersecurity in Healthcare: A Clinical Imperative
16:07 - Mitigating Cybersecurity Risks
20:23 - Password Management and Best Practices
27:33 - The Role of IT in Cybersecurity
31:04 - Internet of Medical Things (IoMT) Vulnerabilities
39:17 - Top Cybersecurity Recommendations for Physicians

How can patients receive more consistent interventional radiology care amid a national shortage of IR physicians? That question led Dr. Rick Daniels to develop a new outpatient practice model centered on recruiting independent IRs to provide long-term, fractional coverage for groups in need. In this episode of the BackTable Podcast hosted by Dr. Aaron Fritts, Dr. Daniels outlines the thinking behind this approach and how it aims to expand access to IR services in outpatient settings.

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SYNPOSIS

The conversation examines the evolving landscape of IR practice, including the challenges associated with transitioning between practice settings and building sustainable outpatient service lines. Dr. Daniels walks through the development of his model, with particular attention to identifying and supporting outpatient embolization opportunities. The discussion also explores the consortium-style structure for independent IRs, emphasizing long-term alignment, professional autonomy, and scalability at a national level. Operational considerations such as technology partnerships, documentation workflows, and targeted marketing strategies offer a practical look at what it takes to make this model work.

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TIMESTAMPS

00:00 - Introduction
03:49 - Evolution of an Independent IR Practice
05:30 - Challenges and Opportunities in Outpatient IR
09:58 - Building Service Lines and Marketing Strategies
18:34 - Forming a National IR Group
25:21 - Balancing Business and Healthcare
25:37 - Evaluating and Correcting Site Performance
28:16 - Expanding Geographical Reach
30:45 - Recruitment and Retention Challenges
38:07 - The Importance of Tech-Doc Teams
42:35 - Future Goals and Recruitment Efforts
45:58 - Conclusion

As new calcium-modifying technologies expand the repertoire of below-the-knee (BTK) arterial disease interventions, how should your treatment algorithm evolve, and what endpoints matter most? In this episode of the BackTable Podcast, Dr. Constantino Peña of the Baptist Health Miami Cardiac and Vascular Institute joins Dr. Sabeen Dhand to discuss the latest advancements in BTK chronic limb-threatening ischemia (CLTI) therapies and the push to improve on current vessel preparation outcomes.

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This podcast is supported by:

Shockwave Medical
https://shockwavemedical.com/

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SYNPOSIS

The physicians discuss the evolution of tibial arterial therapies, the challenges presented by heavily calcified lesions, and the impact of new tools, particularly the Shockwave E8 intravascular lithotripsy (IVL) device, on procedural considerations and endpoints. Dr. Peña shares his treatment algorithms and offers practical advice on selecting the right tools for each unique case. The episode closes with speculation on the future of treatment options and technologies for BTK disease, and the growing need for robust data to guide patient-specific treatment.

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TIMESTAMPS

00:00 - Introduction
02:11 - Understanding Tibial Disease and Treatment Evolution
07:22 - Advancements in Tibial Disease Treatment and the Role of IVL
15:31 - Techniques for Effective IVL Sizing and Usage
21:28 - Challenges and Innovations in Tibial Disease Management
26:48 - Innovations in Stent Technology
30:43 - Combining IVL with Adjunct Therapies
32:13 - Addressing Misconceptions in Tibial Treatment
37:54 - Advancements in Intravascular Lithotripsy
40:59 - Future of Vascular Treatments
43:42 - Final Thoughts

Have you ever wondered what it was like to be in the room when the first pelvic embolization was performed or how the TIPS procedure was pioneered? Dr. Ernie Ring, a legendary figure from UCSF and a true forefather of Interventional Radiology, joins host Dr. Peder Horner to recount the early days of the specialty. Dr. Ring shares fascinating stories from his training at Massachusetts General Hospital under Dr. Stanley Baum, where he witnessed the birth of transformative techniques using angiographic catheters to treat life-threatening bleeding.

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SYNPOSIS

From improvising the use of autologous blood clot and thrombin to stop massive hemorrhages to his pivotal role in developing the TIPS procedure and specialized biliary catheters, Dr. Ring’s career is loaded with innovation. The conversation explores the "cowboy" era of IR, the evolution of essential tools like the glide wire, and the critical importance of maintaining a "high-touch" clinical practice in the face of emerging technologies like AI. Dr. Ring also reflects on his later transition into hospital leadership as Chief Medical Officer, where he applied his problem-solving mindset to institutional quality and safety.

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TIMESTAMPS

00:00 - Introduction
01:58 - Upbringing from Detroit to Mass Gen
06:55 - Early IR with an Embo Case
13:50 - Trailblazing Cases in IR
16:17 - Penn and Innovation
20:00 - Polarizing Procedures
24:13 - IR Device Innovation
33:00 - Dotter’s Separation from Diagnostics
37:30 - Fear Finds Cowboys
39:08 - AI and Robotics
40:08 - Fun Hobbies

You’re about to biopsy a renal lesion; should you ablate at the same time? In this episode of the BackTable Podcast, host Michael Barraza talks with Dr. Steven Huang from MD Anderson Cancer Center about building an efficient and effective renal biopsy and ablation service line.

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This podcast is supported by:

Varian IntelliBlate
https://www.varian.com/products/interventional-solutions/microwave-ablation-solutions

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SYNPOSIS

Dr. Huang first covers referral patterns and the typical pathway that patients take to end up in his clinic. The discussion covers the types of lesions he treats, imaging requirements, and criteria for patient eligibility. He emphasizes the importance of shared decision making when deciding between active surveillance, interventional treatment, and partial nephrectomy. Dr. Huang explains his preferred procedural approach and ablation modalities, including cryo, microwave (MWA), and radiofrequency ablation (RFA). He shares his experiences with challenging cases and integrating new technologies like histotripsy and the Siemens interventional package. They also discuss the possibility of a preoperative embolization for larger lesions that could be susceptible to the heat sink effect. Both experts emphasize the importance of collaboration with urologists and ensuring patient safety and expectations. They also touch on the future of the field, discussing the use of AI and robotics.

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TIMESTAMPS

00:00 - Introduction
02:17 - Training Programs at MD Anderson
03:23 - Referral Patterns for Renal Ablations
07:25 - Patient Management and Virtual Consultations
10:59 - Ablation Techniques and Device Selection
26:44 - Challenges and Complications
27:25 - Approach to Lesions Near Renal Vasculature
28:02 - Patient Expectations and Urologist Collaboration
33:26 - Post-Procedure Care and Patient Recovery
35:30 - Managing Recurrences and Multiple RCCs
47:17 - Closing Remarks

What does day-to-day interventional radiology look like in the military? Here’s a firsthand account. Dr. John York, interventional radiologist at University of California San Diego with 37 years of active duty in the Navy joins host Dr. Ally Baheti to share his experiences and perspectives on being an interventional radiologist in the military.

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SYNPOSIS

Dr. York recounts his path to the military and how it ultimately led him to interventional radiology. He reflects on his deployments to Afghanistan and Djibouti, highlighting the clinical complexity, operational challenges, and fulfilling aspects of delivering image-guided care in high-acuity environments. Dr. York recounts several remarkable cases from his deployments, including the management of a vertebral artery aneurysm. He underscores how strong foundational training enables creative problem-solving in resource-limited settings.

Dr. York also shares his experience as senior medical officer on the USS Theodore Roosevelt during the initial COVID-19 outbreak, offering insight into the clinical, operational, and administrative challenges he faced. He highlights how adaptability and creative problem-solving are essential to managing complex cases in dynamic environments.

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TIMESTAMPS

00:00 - Introduction
02:53 - Journey to Medicine: From Naval Academy to Medical School
05:55 - Choosing Interventional Radiology
08:11 - Military Medical Experience: Portsmouth and Beyond
11:38 - First Deployment: Challenges and Adaptations
14:38 - Case Studies: Trauma and Innovation in Afghanistan
26:15 - A Unique Procedure in a Combat Zone
28:49 - Transitioning Back to Civilian Life
31:07 - Challenges in Combat Zones
34:22 - Deployment in Djibouti
38:25 - COVID-19 on the USS Theodore Roosevelt
45:50 - Reflections on Military Service

Are balloon occlusion microcatheters your new best friend for prostate artery embolization (PAE)? In this episode of BackTable, Dr. Raj Ayyagari, interventional radiologist at Boston Medical Center, joins Dr. Ally Baheti to tackle complex clinical and technical challenges in PAE.

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This podcast is supported by an educational grant from Guerbert.

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SYNPOSIS

Dr. Ayyagari shares his unique journey from urology to interventional radiology and his experience building successful PAE service lines at multiple institutions. He walks through a series of challenging cases involving intraprostatic penile arteries, perivesicular collaterals, and internal pudendal collaterals used to treat bilateral hemi-prostates. The discussion highlights the role of balloon occlusion microcatheters such as the Sniper, his transition from 100–300 micron particles to glue embolization, and scenarios where coil protection is essential to prevent nontarget embolization. He also covers post-procedural management, the importance of setting expectations around suprapubic tube removal, and why thorough patient and provider counseling is critical for optimal care.

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TIMESTAMPS

00:00 - Introduction
02:14 - Building a Practice in Prostate Artery Embolization
08:19 - Case Studies and Techniques in Prostate Artery Embolization
23:16 - Challenges in Embolization Techniques
23:47 - Step-by-Step Guide to Embolizing a Hemi Prostate
25:24 - Choosing the Right Beads for Embolization
29:10 - Transitioning to Liquid Embolics
35:38 - Setting Patient Expectations and Pre-Procedure Evaluation
40:17 - Post-Procedure Care and Medications
44:06 - Conclusion and Final Thoughts

Have you ever considered taking a sabbatical to practice Interventional Radiology in the Middle East? In this episode, Dr. Jamal AlKoteesh, the Chairman of Clinical Imaging at SEHA and the "Godfather of IR" in the United Arab Emirates, joins host Dr. Sabeen Dhand to discuss the rapid evolution and current state of IR in the Gulf region.

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SYNPOSIS

Dr. AlKoteesh shares his journey from training in the UK to establishing the IR specialty in Abu Dhabi over the last 18 years. He details the unique practice environment in UAE government hospitals, where the lack of strict sub-specialization requires IRs to maintain a versatile skillset—handling everything from thyroid FNAs and UFE to complex neurovascular thrombectomies.

The conversation highlights the significant government investment in healthcare technology, which allows physicians access to the latest tools—such as the Siemens Artis Icono with integrated RapidAI for stroke—often before they are widely available in other markets. Dr. AlKoteesh also provides a practical guide for US physicians interested in working abroad, covering the licensing timeline, tax-free income, and the high demand for Western-trained physicians.

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TIMESTAMPS

00:00 - Introduction
01:39 - Building IR in UAE
05:23 - UAE Healthcare System Overview
07:54 - IR Residency and Staffing
13:15 - Access to Latest Devices
15:15 - Compensation and Lifestyle
17:58 - PAIRS Conference Overview
20:45 - Licensing and Relocation Guide
21:39 - Liability and Language Barriers
26:33 - Launching Stroke Interventions

Patient access to interventional radiology services remains highly variable worldwide, reflecting global differences in training opportunities and infrastructure. Drawing on responses from more than 1,260 interventional radiologists worldwide, Dr. Justin Guan and Dr. Constantinos Sofocleous unpack the findings of a large international survey, highlighting where IR is advancing, where it remains fragmented, and what the data suggest about the future direction of the specialty.

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SYNPOSIS

Key points of the episode involve the collaborative efforts put into this survey, how data was collected, and major findings from the respondents. These findings involve challenges with IR training, the significance of public awareness, and the need for standardized training programs. The discussion also covers the efforts required to promote IR globally, especially at global summits, and the potential steps to address these findings. Finally, the episode highlights the importance of developing region-specific programs and the ongoing efforts to elevate IR practices worldwide.

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TIMESTAMPS

00:00 - Introduction
01:57 - Global IR Network and Survey Introduction
10:30 - Survey Insights and Results
19:26 - Challenges in IR Training and Awareness
23:33 - Future Directions and Initiatives
36:06 - Conclusion and Final Thoughts

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RESOURCES

Results of a Global Survey on the State of Interventional Radiology 2024: https://pubmed.ncbi.nlm.nih.gov/39793699/