BackTable Vascular & Interventional

Radiation segmentectomy: who, when, how? Interventional oncologists Dr. Nima Kokabi, Dr. Tyler Sandow, and Dr. Kavi Krishnasamy continue their in-studio discussion on all things Y90 in Part 4 of Dosimetry University, focusing on specific applications of radiation segmentectomy.

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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

This session kicks off with a discussion on the curative potential of Y90, comparing it to other curative modalities like resection. The doctors discuss the importance of achieving a complete pathological necrosis (CPN) with Y90 for better survival outcomes, especially in the context of liver transplantation. The conversation also covers personalized approaches for treating liver-dominant metastatic cancers using Y90, and strategic considerations when choosing between techniques like radiation lobectomy, thermal ablation, and chemoembolization.

The interventional oncologists explore the viability of radiation segmentectomy in treating small lesions and discuss data supporting its efficacy. Real-world clinical cases are examined to highlight the practical application of these therapies, their impact on overall survival, and the intricacies of dosimetry and patient selection.

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TIMESTAMPS

00:00 - Introduction
01:07 - Ablative Y90 Curative Outcomes and Survival Rates
02:16 - Radiation Segmentectomy vs. Ablation
09:22 - Case Study: Metastatic Colorectal Cancer
18:06 - Tumor Distinction on Cone Beam CT
19:58 - Case Study: 77-Year-Old Female with Breast and Colorectal Cancer
21:09 - Challenges and Techniques in Selective Radiation Segmentectomy
24:28 - Avastin and Y90
28:16 - Case Study: 53-Year-Old Male with Metastatic Colorectal Cancer
29:40 - Radiation Lobectomy and Hypertrophy Strategies
32:37 - Approaches for Metastatic and HCC Patients

Will single session Y90 become the standard of care for HCC and oligo-metastatic disease? Tune in to our third installment of Dosimetry University with interventional oncologists Drs. Tyler Sandow, Nima Kokabi, and Kavi Krishnasamy as they share their experiences and best practices in single session Y90 treatment.

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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

The doctors discuss the application and workflow of single session Y90 therapy for primary and oligo-metastatic liver tumors. They discuss the latest data from various institutions, emphasizing reduced lung dose, lower time to treatment, improved cost-efficiency, and the advantageous safety profile associated with single session treatment. The discussion also covers ideal patient selection based on tumor location and vascular characteristics, the importance of cone beam CT, and how to identify red-flag features of vascular enhancement.

Our panel then reviews key technical considerations for single session success, including the use of flow-modifying microcatheters, gelfoam, and strategies for flow redirection. The episode concludes with a case discussion to explore the best strategy for a large liver tumor, detailing the specifics of each treatment and the potential role of combined therapies to achieve better long-term outcomes.

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TIMESTAMPS

00:00 - Introduction
00:47 - Single Session Y90: Workflow and Benefits
03:52 - Patient Selection
04:31 - Tumor Location and Preferred Techniques
14:31 - Reperfusion and Redirection Techniques
26:16 - Case Study: Large Tumor Treatment
37:01 - Long-Term Outcomes and Surgical Considerations

So you’re going to be an IR resident–what exactly did you sign up for? Find out with Dr. Neil Jain, an integrated IR resident at Georgetown as he hosts a discussion on optimizing integrated IR residency programs with Dr. Nicole Lamparello, an Assistant Professor of Clinical Radiology at Weill Cornell Medicine, and Dr. Gregg Khodorov, a PGY-5 resident at Thomas Jefferson University Hospital. The conversation covers a comprehensive range of topics, including optimal rotation schedules, early IR exposure, consult services, and the benefits of structured clinics.

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This podcast is supported by:
Medtronic Emprint
https://www.medtronic.com/emprint

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SYNPOSIS

The doctors first discuss the nuances of choosing a surgical, medicine, or transitional intern year, and the electives that best prepare junior trainees for a career in IR. They then discuss the optimal balance between diagnostic and interventional training in DR years, and the best way to keep junior trainees involved in IR throughout their residency.

The conversation moves on to the different structures of the consult service at each of the speakers’ programs and what this means for training quality and patient care. The doctors then break down what the last year of IR residency looks like, and the residents detail what they would like to see in order to prepare best for attending life. They explore exposure to private practice, subspecialty clinic, and elective time; sharing innovative practices from their own institutions and emphasizing the importance of mentorship, integration, and resident retention. The episode also addresses the challenges and potential solutions for resident attrition within the integrated IR residency track.

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TIMESTAMPS

0:00 - Host Introductions
3:34 - PGY1: Medicine, Surgery or Transitional Intern Year?
15:41 - PGY2-PGY4: Diagnostic Radiology Years
24:46 - IR Clinic Training Throughout IR/DR Curriculum
27:49 - IR Consult Service Structure
38:23 - PGY5: Credentialing in Nuclear Medicine and Mammography
43:58 - PGY6: Preparing for Attending Life
53:00 - Minimizing Attrition Rate

BSA, MIRD, or voxel-based dosimetry? Join us for part 2 of Dosimetry University where interventional oncologists Dr. Tyler Sandow, Dr. Nima Kokabi, and Dr. Kavi Krishnasamy explore and debate the critical nuances of a successful Y90 procedure, covering dosing methods, lung shunt management, and when to incorporate other therapeutic approaches.

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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

The episode begins with a discussion on methodologies for calculating lung shunt fractions using planar imaging versus SPECT CT. The physicians highlight the implications of various dosimetry models, including BSA (Body Surface Area), MIRD (Medical Internal Radiation Dose), and voxel-based dosimetry for determining prescribed activity. Drawing on their clinical experience, they address the management of high lung shunt fraction cases and the application of therapeutic strategies like TACE (Transarterial Chemoembolization) and SBRT (Stereotactic Body Radiotherapy). The conversation also covers the roles of cryoablation and microwave ablation in treating centrally located lesions. The episode concludes with a case study emphasizing the importance of individualized dosimetry planning.

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TIMESTAMPS

00:00 - Introduction
01:05 - Lung Shunt Calculation Methods
06:42 - BSA, MIRD, and Voxel-Based Dosimetry
16:03 - High Lung Shunt Management
30:02 - Case Study: Liver Tumor Treatment
34:10 - Cryo vs Microwave: A Safer Option?
35:42 - Y-90 Procedure: Imaging and Techniques
43:35 - Dosimetry and Dose Calculations
51:10 - Post-Treatment Analysis and Outcomes
57:51 - Transplant Considerations and Aggressive Treatments
58:18 - Conclusion and Final Thoughts

Dosimetry University is now in session! First up—how do you plan your Y90 treatments and what can you do in the planning phase to maximize efficacy? Find out in Part I of BackTable’s Dosimetry University series featuring interventional oncologists Dr. Nima Kokabi from the University of North Carolina Chapel Hill and Dr. Tyler Sandow from Ochsner Health. This episode is hosted by Dr. Kavi Krishnasamy and recorded live in the BackTable studio.

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This podcast is supported by:

Sirtex
https://www.sirtex.com/

Sponsor

This podcast is supported by:

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

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SYNPOSIS

The doctors first discuss the structure of their Y90 service lines, including the impact of multidisciplinary tumor boards and clinics on time to treatment for liver cancer patients. They then talk through their technical preferences—whether to use glass or resin, preferred dosimetry guidelines and apps, and the dosimetry softwares that they use in treatment planning. The doctors also discuss the utility of the T2N ratio, advanced imaging like cone beam CT, and angiographic targeting software—emphasizing how these tools can help achieve the delicate balance of preserving normal tissue while treating as much tumor as possible. This episode also highlights the importance of collaboration between academic and private practices to optimize patient care and treatment outcomes.

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TIMESTAMPS

00:00 - Introduction and Overview
02:21 - Multidisciplinary Clinics and Tumor Boards
13:12 - Dosimetry Guidelines and Practices
27:46 - Nuances in Tumor Dosage and Segmentectomy
32:00 - Angiographic Targeting Software
33:18 - Cone Beam CT Techniques
48:33 - Anesthesia, Access, and Catheters

What would you do if your IR/DR practice underwent major ownership and staffing changes just one week after signing your first attending contract? In this episode of BackTable, Dr. Waqaar Diwan joins host Dr. Michael Barraza to share his experience facing exactly that challenge—and how it led to the eventual development of his own independent IR practice.
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This podcast is supported by:
RADPAD® Radiation Protection
https://www.radpad.com/
OBL Marketing
https://oblmarketing.com/
Medtronic Emprint
https://www.medtronic.com/emprint
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SYNPOSIS
Dr. Diwan discusses how he navigated the unexpected transition of ownership and staffing changes, and ultimately secured a hospital contract that allowed him to perform IR procedures full-time. Since then, he has been building an independent IR practice with the support of his partner and a growing team.

Dr. Diwan shares his goals for the practice, including staffing and equipment logistics, strategic planning, and patient outreach. He emphasizes the importance of leveraging personal and professional networks to guide his business development.

He also outlines key differences between independent IR practices and combined IR/DR models. These include the need for greater investment in the outpatient experience, actively seeking referrals, and navigating hospital politics without the backing of a larger department. His top advice for building a referral base is to first earn trust—by excelling in straightforward cases and ensuring strong outcomes—and to market the practice directly to potential referring providers.

Overall, Dr. Diwan encourages early-career interventional radiologists to know their worth. He notes that in the real world, IRs are often seen as providers of “catch-all” services, making it crucial to ensure fair compensation. He stresses the importance of striking a balance between self-advocacy and humility, all while staying focused on serving patients.
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TIMESTAMPS
00:00 - Introduction
01:42 - Navigating Contracts and Restructuring
8:07 - Upcoming Goals for His IR Group
14:00 - Strategic Planning and Marketing
20:16 - Compensation and Finances of Independent IR
27:38 - Future Plans and Market Trends
29:48 Advice for New Interventional Radiologists
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RESOURCES
Minimally Invasive Specialists of Texas:
https://www.mist-health.com/

What do you do when conventional gastric tubes are not an option? In this week’s episode of BackTable, host Dr. Ally Baheti speaks with interventional radiologist Dr. Alex Wallace and physician assistant Lisa Rotellini-Colvet from the Mayo Clinic in Arizona about the percutaneous transesophageal gastrostomy (PTEG) procedure. The discussion explores how PTEG offers a transformative solution for patients who are not candidates for traditional transabdominal gastrostomy access. Suitable candidates for PTEG include individuals with malignancies, peritoneal carcinomatosis, prior gastrectomies, or ascites.

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This podcast is supported by:

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

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SYNPOSIS

Dr. Wallace and Lisa provide valuable insights on the benefits of early patient selection, thorough pre-procedural evaluation, step-by-step procedural guidance, and key considerations for post-procedural care. They also highlight the critical role of patient and staff education in achieving successful outcomes. The episode features real-world experiences, including a powerful story of a patient who benefited from her PTEG for over 560 days.

Our guests advocate for increased awareness of PTEG and its early consideration in patients with advanced abdominal cancers, emphasizing its potential to greatly improve quality of life.

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TIMESTAMPS

00:00 - Introduction
01:38 - History and Explanation of PTEG
08:12 - Pre-Procedure Evaluation
11:48 - Procedural Walkthrough
20:46 - Post-Procedure Care and Suction Management
24:45 - Exchange Process and Troubleshooting
30:11 - Patient Education and Staff Training
35:54 - Improved Quality of Life for Patients

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RESOURCES

Percutaneous Transesophageal Gastrostomy: Procedural Technique and Outcomes (Rotellini-Coltvet, Wallace et al, 2023):
https://pubmed.ncbi.nlm.nih.gov/37419279/

Liquid embolics are a relatively new addition to the interventional radiology toolkit—how well do you understand the technical considerations that come with using these agents? Get up to speed in this episode of the BackTable Podcast where Dr. Gary Siskin, Chair of Radiology at Albany Medical Center, shares his expertise.

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This podcast is supported by:

Sirtex
https://www.sirtex.com/us/

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SYNPOSIS

Dr. Siskin provides expert insights into the use of liquid embolic agents, including Onyx and LAVA, with a focus on their practical applications, techniques for safe and effective deployment, and the critical role they play in treating complex cases which range from peripheral and traumatic hemorrhage to portal vein embolization. He highlights the importance of understanding the viscosity and flow characteristics of various liquid embolic agents, providing expert guidance on ensuring optimal catheter positioning, case selection, and avoidance of common pitfalls. Additionally, he shares strategies for tailoring injection speed based on vessel caliber to mitigate reflux. The episode ends with final thoughts on best practices and future directions for the technology.

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TIMESTAMPS

00:00 - Introduction
02:09 - Historical Perspective on Liquid Embolics
06:37 - Practical Applications and Techniques
16:14 - Handling Catheters and Reflux Concerns
22:38 - Trauma Embolization
26:53 - Visibility and Injection Techniques
29:06 - Catheter Compatibility and Vessel Size
32:53 - Best Practices and Common Mistakes
45:55 - Final Thoughts and Advice

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RESOURCES

Arslan B, Razavi MK, Siskin G, et al. The LAVA Study: A Prospective, Multicenter, Single-Arm Study of a Liquid Embolic System for Treatment of Peripheral Arterial Hemorrhage. J Vasc Interv Radiol. 2025;36(3):436-445.e2. doi:10.1016/j.jvir.2024.11.005

Onyx Liquid Embolic System:
https://europe.medtronic.com/xd-en/healthcare-professionals/products/cardiovascular/peripheral-embolization/onyx-liquid-embolic-system.html

LAVA Liquid Embolic System:
https://www.sirtex.com/us/products/lava-liquid-embolic-system/product-information/

It’s official — NeuWave is exiting the market. In this episode, Dr. Christopher Beck hosts a conversation with Dr. Josh Kuban, an interventional radiologist at MD Anderson Cancer Center, to discuss the impact that NeuWave's microwave tumor ablation technology has had on the field of interventional oncology and the recent announcement of its discontinuation, scheduled for March 2026.

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This podcast is supported by:

Medtronic Emprint

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SYNPOSIS

Dr. Kuban reflects on NeuWave’s innovative beginnings in microwave ablation, which expanded to include four distinct systems and advanced ablation confirmation software. At its peak, the company held over 50% of the microwave ablation market and played a pivotal role in reshaping interventional radiology's view of the safety and effectiveness of this treatment approach.

He also shares how NeuWave’s departure will affect his practice and outlines the steps he’s taking to prepare his team for the transition to alternative devices. The discussion broadens to the current landscape of microwave ablation, spotlighting emerging players in ablation confirmation software and robotic technologies.

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TIMESTAMPS

00:00 - Introduction
2:14 - Overview of Neuwave’s Rise
7:01 - Decision to Discontinue
14:56 - Navigating the Switch Different Technologies
21:54 - Buyback Program
24:33 - Forecasting New Developments

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RESOURCES

BackTable IND Ep. 23- Approach the Problem with Vision: Part I of the Neuwave Story : https://www.backtable.com/shows/industry/podcasts/23/approach-the-problem-with-vision-part-i-of-the-neuwave-story

BackTable IND Ep. 24- Trials and Tribulations: Part II of the Neuwave Story: https://www.backtable.com/shows/industry/podcasts/24/trials-tribulations-part-ii-of-the-neuwave-story

BackTable IND Ep. 25- Next Level Stuff, the Exit: Part III of the Neuwave Story:
https://www.backtable.com/shows/industry/podcasts/25/next-level-stuff-the-exit-part-iii-of-the-neuwave-story

Johnson & Johnson Press Release Regarding Discontinuation of NeuWave:
https://www.medline.com/media/assets/pdf/vendor-list/Disco_notice.pdf
MedTronic Emprint Ablation: https://www.medtronic.com/covidien/en-gb/products/ablation-systems/emprint-ablation-system.html

Varian MicroThermX Ablation:
https://www.varian.com/products/interventional-oncology/microthermx

Safety and Effectiveness of Microwave Ablation of Liver Tumors: Initial Real-World Results from the Multinational NeuWave Observational Liver Ablation (NOLA) Registry (Odisio, 2025):
https://pubmed.ncbi.nlm.nih.gov/39848330/

Making strides against melanoma: how can medical oncologists and interventional oncologists join forces to deliver smarter, patient-centered care? In this episode of BackTable, Dr. Tyler Sandow,hosts Dr. Sunandana Chandra, medical oncologist at Northwestern, and Dr. Riad Salem, interventional oncologist at Northwestern, to discuss the evolving management of advanced melanoma.

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This podcast is supported by an educational grant from Replimune.

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SYNPOSIS

The doctors open the episode with an overview of melanoma and recent advances in its treatment, highlighting key trials such as DREAMseq and CheckMate 067. The discussion explores the shift from medical oncologist as solo primary providers to a dynamic, multidisciplinary approach to advanced cancer care—emphasizing cutting-edge treatments like immunotherapy and intratumoral oncolytic viruses.

Dr. Salem shares practical insights on the procedural techniques of administering intratumoral oncolytics like Replimune, emphasizing the importance of thorough documentation and patient-centered care. The doctors also provide an overview of the ongoing IGNYTE-3 Trial, a Phase 3 study assessing the safety and efficacy of the oncolytic immunotherapy RP1 in combination with nivolumab for the treatment of advanced melanoma.

The episode underscores the transformative potential of innovative melanoma treatments and the crucial role of integrated, team-based approaches in improving cancer patient outcomes.

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TIMESTAMPS

00:00 - Introduction
03:48 - The Evolution of Melanoma Treatment: From Chemotherapy to Immunotherapy
14:05 - The Role of Oncolytic Viruses in Melanoma Treatment
20:14 - Interventional Radiology’s Role in Cancer Treatment
27:00 - Collaborative Approach to Cancer Care
32:53 - Hyper Documentation and Communication Efficiency
44:47 - Future of Intratumoral Oncolytics
48:10 - Multidisciplinary Approach in Advanced Cancer Management
51:46 - Conclusion and Final Thoughts

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RESOURCES

DREAMseq Trial: Atkins MB, Lee SJ, Chmielowski B, et al. Combination Dabrafenib and Trametinib Versus Combination Nivolumab and Ipilimumab for Patients With Advanced BRAF-Mutant Melanoma: The DREAMseq Trial-ECOG-ACRIN EA6134. J Clin Oncol. 2023;41(2):186-197. doi:10.1200/JCO.22.01763

CheckMate 067 trial: Wolchok JD, Chiarion-Sileni V, Rutkowski P, et al. Final, 10-Year Outcomes with Nivolumab plus Ipilimumab in Advanced Melanoma. N Engl J Med. 2025;392(1):11-22. doi:10.1056/NEJMoa2407417