BackTable Vascular & Interventional

As new graduates enter the workforce, what are the key differences between academic, private, and hybrid practice models? Dr. Oleksandra Kutsenko, Chief of Interventional Radiology at Red Rock Radiology Associates, joins host Dr. Ally Baheti to discuss her experiences working in a private equity group in Nevada.
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This podcast is supported by:
Medtronic Emprint
https://www.medtronic.com/emprint
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SYNPOSIS
Dr. Kanko discusses her career trajectory, her experiences with private equity, and the benefits and challenges of working in such a setting. She highlights the value of stepping into leadership roles, cultivating a versatile skill set, and navigating the complexities of working within a large, multifaceted organization like Radiology Partners. The conversation covers day-to-day operations, educational opportunities, and her perspective on balancing clinical work with administrative responsibilities. She emphasizes the importance of investing early in one’s career to build credibility and establish a lasting presence.
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TIMESTAMPS
00:00 - Introduction
01:50 - Career Journey and Challenges
03:15 - Private Practice vs. Academics
07:11 - Daily Life as an Interventional Radiologist
12:19 - Involvement with RAD Partners
13:42 - Educational Tools and AI in Radiology
24:08 - Clinic Operations and RVU Discussion
31:59 - Advice for Trainees and Career Insights
33:13 - Conclusion and Final Thoughts

Resorbable embolics are gaining traction in musculoskeletal interventions, but what are the key technical considerations? Dr. Keerthi Prasad, interventional radiologist at the Centers for Pain Control and Vein Care joins host Dr. Ally Baheti to share practical insights when using resorbable embolics in MSK interventions.
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This podcast is supported by:
OBL Marketing
https://www.oblmarketing.com
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SYNPOSIS
Dr. Prasad opens the conversation with an overview of embolic agents used in MSK interventions—including Imipenem, Lipiodol, and Nexsphere-F—and shares practical insights into technique selection. He explores the nuances of working with various resorbable embolics, highlighting clinical cases from his personal experience. The discussion also highlights Dr. Prasad’s innovative approach to establishing an outpatient-based lab (OBL) focused on musculoskeletal interventions. Additionally, Dr. Prasad also offers insight into the expanding role of resorbable embolics in treating conditions such as knee arthritis, plantar fasciitis, and adhesive capsulitis. The episode ends with a call to broaden access to this evolving treatment.
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TIMESTAMPS
00:00 - Introduction
01:55 - Outpatient Embolization and MSK Procedures
04:20 - Resorbable Embolics in Joint Embolization
04:52 - Available Resorbable Embolics in the US
07:57 - Technical Insights on Using Resorbable Embolics
15:18 - Patient Outcomes and Long-Term Durability
22:24 - Future of MSK Embolization Techniques
24:05 - Exploring New Applications for Resorbable Embolics
27:30 - Innovative Procedures and Techniques
37:00 - Final Thoughts and Advice for Practitioners

Can you manipulate blood flow in the tumor microenvironment to optimize drug delivery? In this episode of the BackTable Podcast, interventional oncologist Dr. Zachary Berman (UC San Diego) joins host Dr. Christopher Beck to discuss real-world applications of pressure-enabled drug delivery in locoregional liver-directed therapies like TACE and Y90.
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This podcast is supported by:
TriSalus Life Sciences
http://trinavinfusion.com/
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SYNPOSIS
The conversation begins with an overview of the tumor microvascular environment, focusing on the abnormal nature of the new vessels that feed tumors. They then discuss the genesis of pressure-enabled drug delivery and the theory behind its efficacy. Dr. Berman explains the TriNav catheter’s micro-valve design, its anti-reflux properties, and how these features enhance tumor drug delivery. He walks through his own procedure technique, comparing and contrasting it to standard embolization, and details the utility of pressure-enabled drug delivery in lobar radioembolization and larger tumors. They also explore the benefits of both balloon occlusion and microvalve catheters.
Real-world cases—including neuroendocrine tumors, segmental HCC, and more—illustrate the thought process around when to use specialized technologies. The episode wraps up with a discussion of the future implications for this technology in other pathologies, cost considerations, and the potential for enhancing drug delivery with innovative approaches.
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TIMESTAMPS
00:00 - Introduction
01:39 - The Tumor Microenvironment
06:59 - Pressure-Enabled Drug Delivery Explained
09:37 - Technical Aspects of Pressure-Enabled Catheters
21:48 - Case 1: Grade 3 Neuroendocrine Tumor
34:06 - Case 2: Hepatocellular Carcinoma with Tumor and Vein
36:01 - Case 3: TACE for Segmental HCC in Decompensated Cirrhosis
38:58 - Case 4: Large Heterogenous Cholangiocarcinoma
40:40 - Case 5: Lobar Neuroendocrine Tumor
42:38 - Case 6: Segmental HCC with Central Necrosis
47:52 - Best Practices and Technical Considerations
57:52 - Future Directions in Pressure-Directed Embolotherapy
59:48 - Conclusion and Final Thoughts
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RESOURCES
JVIR 2024 Jaroch et al.:
https://pubmed.ncbi.nlm.nih.gov/38969336/

The toolbox for vessel preparation is rapidly expanding. Are you keeping up? In this episode, host Dr. Sabeen Dhand is joined by Dr. Jay Mathews, interventional cardiologist (Manatee Memorial Hospital) and Dr. Michael Siah, vascular surgeon (UT Southwestern), to explore the latest innovations and strategies in vessel prep.

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This podcast is supported by:

Cagent Vascular
https://cagentvascular.com/

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SYNPOSIS

The discussion opens with a look at new additions to their practice over the past few years, including bioresorbable scaffolds for below-the-knee interventions and retrievable stent technologies. Both experts emphasize the role of imaging—particularly CT angiography and IVUS—and discuss how renal disease impacts their use of contrast during diagnosis and intervention. They then walk through how they assess vessels on angiography or IVUS to decide when and where to use specialty tools. From intravascular lithotripsy for managing dense calcification to serration angioplasty, the conversation highlights how the doctors decide to use specialty balloons and devices. The episode also touches on the practical challenges of balancing device cost with treatment effectiveness. The physicians break down the latest specialty balloons and devices and touch on their own experiences with them. To close, the guests share what emerging technologies they’re most excited about and how these devices could change their day-to-day practice. Whether you’re in IR, cardiology, or vascular surgery, this episode offers a valuable roadmap to the current and future state of vessel preparation.

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TIMESTAMPS

0:00 - Introduction
4:07 - New Changes in Techniques
14:57 - Vessel Characteristics on Angiogram
18:10 - Approaches to Above-the-Knee vs. Below-the-Knee Disease
23:48 - Latest Specialty Balloons
46:14 - New Devices on the Horizon
50:58 - Words of Advice and Final Thoughts

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RESOURCES

POINT FORCE Registry: ​​https://evtoday.com/news/cagent-initiates-point-force-registry-of-serranator-pta-catheter?c4src=news

What are the key elements of a robust interventional radiology practice, and how can IRs effectively demonstrate their value to hospitals? Guest, Dr. Harris Chengazi, interventional radiologist at Great Lakes Medical Imaging, joins host Dr. Sabeen Dhand to explore the core strategies behind developing a successful and sustainable clinical IR practice.

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This podcast is supported by:

RADPAD® Radiation Protection
https://www.radpad.com/

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SYNPOSIS

Dr. Chengazi reflects on formative experiences from the early stages of his career, highlighting the importance of joining a group that shares your vision for a clinical interventional radiology (IR) practice. He underscores the unique value IR offers hospitals—particularly through longitudinal patient care, which not only enhances reimbursement opportunities but also strengthens interdisciplinary collaboration and drives outpatient referrals.
He shares insights on balancing complex cases with essential procedures, while underscoring the importance of clear communication and articulating IR’s value to hospital leadership. He also highlights the critical need for physicians to understand the business side of medicine—including coding, billing, and reimbursement—in order to effectively advocate for the specialty. He concludes the episode with a compelling message on the importance of taking ownership of both our patients and the future of our profession.

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TIMESTAMPS
00:00 - Introduction and Overview
01:55 - Building a Private Practice
05:22 - Challenges and Successes
24:58 - The Value of Complex Cases in Medical Practice
27:00 - Improving Hospital Efficiency Through IR Services
29:18 - Involvement of IR in Hospital Administration
31:26 - Building a Successful IR Practice
36:14 -The Financial Dynamics of IR and DR Practices
41:14 -The Essential Role of IR in Hospital Operations

When is Y90 the right treatment for metastatic disease? Join Drs. Tyler Sandow, Zach Berman and host Kavi Krishnasamy in the conclusion of Dosimetry University where they discuss the complexities of treating different variations of metastatic disease and review how they’ve approached complicated cases with Y90.

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SYNPOSIS

The interventional oncologists first outline the types of metastases that they treat, including colorectal, lung, cholangiocarcinoma, breast, gastric, RCC, and melanoma. The doctors then discuss the potential for Y90 to provide palliative relief by reducing tumor-related pain. The conversation also covers key differences between treating liver-dominant and liver-only disease, along with their algorithm for patients not on systemic chemotherapy.
The episode then covers advanced concepts in Y90, such as sub-ablative dosing, the possibility of creating an abscopal effect, and how radiation thresholds change depending on treatment goals.

They outline their approach to partition dosimetry, using SPECT/CT to calculate tumor-to-normal ratios, and explain how they modify particle counts and microsphere activity, using flow augmentation based on tumor vascularity. Additional discussion includes the impact of mutation status, prior lines of chemotherapy, and tumor response criteria like RECIST 1.1 and mRECIST.

The experts conclude with a case series that illustrates decision-making around when to consider Y90, thermal ablation, TACE, or alternative approaches—even in complex cases like sphincter of Oddi dysfunction. The session underscores the nuanced nature of advanced dosimetric techniques and the evolving landscape of interventional oncology.

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TIMESTAMPS

00:00 - Introduction
01:30 - Types of Metastases Treated with Y90
02:50 - Liver-Dominant vs. Liver-Only Disease
07:20 - Sub-Ablative Dosing and the Abscopal Effect
09:55 - Tips for Partition Dosimetry
15:30 - Clinical Factors in Treatment Planning
23:50 - Choosing Ablation, Resection, or Y90 for mCRC
30:27 - Case Series: Colorectal Metastases, Biliary Complications, and more
46:00 - Final Thoughts: The Evolving Field

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RESOURCES

RECIST 1.1 and mRECIST Criteria:
https://pmc.ncbi.nlm.nih.gov/articles/PMC9161105/

COLLISION Trial:
https://ascopubs.org/doi/10.1200/JCO.2024.42.17_suppl.LBA3501

BackTable Episode on COLLISION Trial:
https://www.youtube.com/watch?v=NQLKcv1BRVM

FOXFIRE, SIRFLOX, FOXFIRE-Global:
https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(17)30457-6/fulltext

Symptomatic gallstones that can’t be treated with surgery? Interventional radiology can help. In this episode of BackTable, Dr. John Smirniotopoulos, IR at MedStar Health, joins Dr. Michael Barraza to share the latest advancements and techniques in biliary endoscopy.

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SYNPOSIS

Dr. Smirniotopoulos reflects on his early work with cholangioscopy at Cornell, highlighting ongoing innovation and evolving tools. The conversation covers the practical aspects of patient selection, procedural steps, and overcoming technical challenges. Dr. Smirniotopoulos shares his personal experiences managing small and large biliary stones, emphasizing the important role of selecting appropriate equipment to navigate procedural challenges.

Dr. Smirniotopoulos also highlights the collaborative role of surgeons and gastroenterologists throughout patient management. He also provides insights into the management of biliary strictures and emphasizes the importance of accurate billing and coding. The episode concludes with advice for clinicians seeking to integrate these techniques into their practice.

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TIMESTAMPS

00:00 - Introduction
01:09 - Early Experiences with Biliary Endoscopy
03:35 - Procedure Techniques and Tools
05:36 - Patient Selection and Case Studies
11:01 - Advanced Techniques and Equipment
14:02 - Patient Management and Follow-Up
18:21 - Technical Considerations and Best Practices
20:14 - Managing Stones in the Gallbladder
35:42 - Collaborating with Surgeons and GI Teams
37:59 - Advice for New Practitioners

The balance between targeting tumor and sparing healthy liver is delicate. How do the experts do it? In this case-based review, Drs. Zach Berman (UC San Diego) and Tyler Sandow (Ochsner Health) join host Dr. Kavi Krishnasamy to walk us through real-world scenarios and share how they approach Y90 dose optimization.

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This podcast is supported by:

Sirtex
https://www.sirtex.com/

Medtronic Emprint
https://www.medtronic.com/emprint

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SYNPOSIS

First, the doctors review a case of HCC and discuss key lab values, like albumin, and their role in planning. They also break down how they manipulate variables like microsphere activity, perfusion density, and total dose to deliver a tumor dose of around 1,100 Gy. The doctors also challenge the standard perfused dose of 400 Gy for large tumors and share when they feel comfortable pushing beyond it.
Next, they discuss nuances in treating portal vein tumor invasion and what decides which Vp classifications can be treated with Y90 or combination immunotherapy. A subsequent case involving a large central HCC tumor explores the risks of biliary stricture from high radiation and the challenge of missing tumor margins with overly selective catheterization. In the last case, the doctors discuss different scenarios in multifocal HCC liver lesions. Overall, the conversation explores different approaches based on tumor size, location, and patient liver function, and highlights the importance of multidisciplinary collaboration in optimizing patient outcomes.

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TIMESTAMPS

00:00 - Introduction and Case Overview
01:28 - Patient Case Study - Hep C and Alcoholic Cirrhosis
02:05 - Evaluating Liver Function and Treatment Approach
04:50 - Tumor Dose and Perfusion Density
15:49 - Portal Vein Tumor Invasion
21:42 - Case Study: Large Central HCC Tumor Treatment
22:19 - Challenges in Treating Large Central Tumors
22:48 - Dosimetry Considerations and Biliary Strictures
27:24 - Case Study: Assorted Multifocal HCC Lesions Scenarios

Are your current stroke interventions in line with the latest clinical data? Dr. Blaise Baxter, interventional radiologist at Sutter Health, and Dr. Jim Milburn, interventional neuroradiologist at the Ochsner Health, join host Dr. Michael Barraza to discuss the latest advancements in stroke interventions.

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This podcast is supported by:

Imperative Care
https://imperativecare.com/stroke/zoom-stroke-solution/

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SYNPOSIS

The episode begins with a discussion on the different pathways to becoming a neurointerventionalist, emphasizing why interventional radiologists are uniquely equipped for this transition. They dive into cutting-edge stroke interventions, sharing key takeaways from major trials on large core and medium vessel occlusions. Dr. Baxter and Dr. Milburn highlight the HERMES trial, which showed that endovascular thrombectomy led to beneficial effects on patients with anterior circulation occlusion. They then cover the BAOCHE trial, which showed better functional outcomes with thrombectomy over medical therapy.

Milburn and Baxter also share their perspectives on the shifting role of perfusion imaging and why the field may be moving beyond it. To close the discussion, the doctors underscore the powerful impact of rehabilitation in driving patient recovery, and stress the ongoing need for innovation and improved training in the field of neurointerventional radiology.

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TIMESTAMPS

00:00 - Introduction
06:18 - Training and Certification in Neurointervention
13:11- Large Core Trials and Their Impact
19:42 - CT Perfusion and Treatment Decisions
29:45 - Understanding Stroke Scale Scores and ICAD
30:31 - Thrombectomy Trials and Treatment Strategies
34:48 - Challenges in Randomizing Patients for Trials
44:25 - Advancements in Robotics and Stroke Treatment
51:37 - Future Directions in Stroke Rehabilitation
53:11 - Global Thrombectomy Adoption and Training

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RESOURCES

Hermes trial: Goyal M, Menon BK, van Zwam WH, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet. 2016;387(10029):1723-1731. doi:10.1016/S0140-6736(16)00163-X

BAOCH trial: Jovin TG, Li C, Wu L, et al. Trial of Thrombectomy 6 to 24 Hours after Stroke Due to Basilar-Artery Occlusion. N Engl J Med. 2022;387(15):1373-1384. doi:10.1056/NEJMoa2207576

How can interventional radiologists turn their unique capabilities into revenue? Dr. Matt Hawkins, interventional radiologist and Health Policy and Economics councilor at the Society of Interventional Radiology (SIR), joins host Dr. Ally Baheti to discuss how interventional radiologists can prove (and get paid for) the value that they bring to hospitals.

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This podcast is supported by:

Medtronic Emprint
https://www.medtronic.com/emprint

RADPAD® Radiation Protection
https://www.radpad.com/

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SYNPOSIS

The doctors discuss key physician reimbursement models, including the Hospital Outpatient Prospective Payment System (HOPPS) for hospital outpatient and Diagnosis-Related Groups (DRGs) for hospital inpatient, as well as strategies for negotiating subsidies. Dr. Hawkins covers key strategies for proving the value of IR to hospitals, emphasizing the importance of moving beyond work RVUs and focusing on the technical revenue generated for hospitals. The discussion underscores the critical role that IR plays in trauma, transplant, and cancer care. Lastly, Dr. Hawkins highlights SIR’s economic initiative emphasizing the importance of accurate documentation and coding in order to turn our clinical impact into measurable value.

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TIMESTAMPS

00:00 - Introduction
01:58 - Understanding Professional and Technical Reimbursement
04:49 - Hospital Reimbursement Structures
07:59 - Quantifying Value and Negotiating Contracts
15:55 - Economic Arguments for IR in Trauma, Transplant, and Cancer
23:01 - The Importance of IR Leadership in Mixed IRDR Groups
25:13 - Challenges and Strategies for Independent IR Practices
28:41 - Maximizing Revenue Through Evaluation and Management (E&M)
36:40 - Navigating Coding and Documentation for Better Negotiation
38:54 - Financial Literacy and Business Strategies