BackTable Vascular & Interventional

Bringing Prostate Artery Embolization (PAE) to the OBL setting means balancing cost efficiency, quality care, and a high procedure volume. What should you know and how can you get started? This week, host Dr. Ally Baheti explores outpatient PAE with Dr. Stephen “Andy” Vartanian, an independent interventional radiologist and medical director of PrecisionIR.
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SYNPOSIS
The doctors discuss Dr. Vartanian’s unique career path and extensive experience with prostate artery embolization (PAE). They discuss his approach to the procedure, best practices, and how he was able to set himself up for success in the transition to an OBL. Dr. Vartanian shares insights into patient workup, collaboration with urologists, and his perspective on the financial and operational challenges of managing an independent practice. The doctors then touch on other outpatient procedures like uterine fibroid embolization (UFE) and genicular artery embolization (GAE) and the difficulties in patient acquisition for these treatments. This episode offers a unique look into factors to consider when optimizing your practice patterns for PAE in an OBL setting.
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TIMESTAMPS
00:00 - Introduction
05:38 - OBL Setting and PAE
10:02 - Approach to PAE, Techniques, and Tools
21:38 - Post-Procedure Care and Managing Patient Expectations
25:32 - Advice to IRs Interested in PAE
27:37 - Challenges and Strategies in Uterine Fibroid Embolization (UFE)
33:14 - Running an OBL: Insights and Experiences
36:40 - Future Plans and Business Reflections
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RESOURCES
PrecisionIR: https://myprecisionir.com/

How is reimbursement decided? Have an inside look from the committee itself as we unpack exactly how a new CPT (Current Procedural Terminology) code is created, assessed, and ultimately valued for physician Medicare reimbursement. In this episode of BackTable, Dr. Sabeen Dhand is joined by radiation oncologist Dr. Amar Rewari and interventional radiologist Dr. Curtis Anderson, both of whom sit on the RVS Update Committee (RUC).
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SYNPOSIS
The conversation covers who participates in the RUC, the preparation it takes to propose a new CPT code, and what it’s like to collaborate with physicians from all specialties. They discuss the confidential yet crucial role of the RUC in determining physician work and practice expenses, advocacy efforts, and the impact of healthcare policies on reimbursement. The doctors stress the importance of physician engagement—especially through member surveys—and share how providers can get involved. The guests also touch on their personal journeys and motivations within the RUC and introduce Dr. Rewari’s podcast, ‘Value Health Voices’, which focuses on healthcare policy and economics.
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TIMESTAMPS
00:00 - Introduction and Importance of Surveys
01:18 - Understanding the RVS Update Committee (RUC)
6:36 - How Does a New CPT Code Get Introduced?
09:44 - Challenges and Dynamics within the RUC
20:52 - Health Value Voices Podcast
22:51 - Transparency in Healthcare Policy
24:39 - Future of Healthcare Payments
29:00 - Getting Involved in Healthcare Policy
33:43- Final Thoughts and Call to Action
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RESOURCES
Health Value Voices Podcast: https://open.spotify.com/show/0cxnf4Il3QK3cvFFKxwPWL?si=212d084a09034cf2

Is minimally invasive ablation the future of metastatic cancer care? We now have the results of the COLLISION Trial, which investigates the non-inferiority of thermal ablation compared to surgical resection. How will these findings change treatment paradigms and practice patterns around metastatic colorectal cancer? In this week’s episode of BackTable, interventional radiologist Dr. Chris Beck discusses the impact and implications of the COLLISION Trial with principal investigator Dr. Martijn Meijerink from Amsterdam UMC.
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SYNPOSIS
The doctors explore the COLLISION Trial’s design, results, complication rates, and future directions. They also cover best practices for ablation techniques and the potential for interventional oncology to enter a “golden era.” Finally, Dr. Meijerink highlights the importance of standardizing intervention quality and being present in tumor boards to ensure optimal patient care.
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TIMESTAMPS
00:00 - Introduction
03:21 - Understanding Metastatic Colorectal Cancer and IR’s Role
05:18 - Introduction to the COLLISION Trial
07:40 - Radiofrequency vs Microwave Ablation and Technological Advancements
09:02 - Trial Design and Patient Eligibility
16:20 - Ablation Techniques and Approaches
22:05 - Trial Results and Analysis
30:19 - Impact on Guidelines and Practice
39:44 - Best Practices in Thermal Ablation
43:27 - Future Directions in Interventional Oncology
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RESOURCES
“Surgery versus thermal ablation for small-size colorectal liver metastases (COLLISION): An international, multicenter, phase III randomized controlled trial.” (Meijerink, 2024)
https://ascopubs.org/doi/10.1200/JCO.2024.42.17_suppl.LBA3501

As graduating residents step into the IR job market, the big question remains: What truly makes a great first job? Dr. Subhash Gutti hosts guest Dr. Kavi Devulapalli (Image Guided Solutions of Missouri) and Dr. Christopher Zarour (Huron Valley Radiology in Ann Arbor) as they share early career advice and job search strategies.
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This podcast is supported by:
RADPAD® Radiation Protection
https://www.radpad.com/
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SYNPOSIS
The doctors begin by highlighting different practice models and emphasize the significance of knowing what type of IR you are - an imager, a surgeon, or dynamic blend of both. They share their personal experiences navigating their early careers and underscore the pivotal role of establishing a robust clinical practice and taking full ownership of the patient. They also explore strategies for practice growth, including availability and network referrals. The episode ends with valuable advice on navigating the early stages of one's career, drawn from personal experiences.
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TIMESTAMPS
00:00 - Introduction
01:16 - Early Career Advice and Job Search
04:50 - Exploring the Job Market
09:46 - What Makes a Good First Job?
14:33 - Challenges in the First Job
28:27 - Strategies for Building a Clinical Practice
36:56 - Understanding the Business Side of Medicine
48:49 - Final Advice for New Graduates

To TIPS or not to TIPS? More than ever, younger patients are presenting with acute portal vein thrombosis (PVT) that requires intervention beyond anticoagulation alone. These patients need safe, effective options that offer long-term resolution and a good quality of life after treatment. In this episode of the BackTable Podcast, Dr. Benjamin May, Interventional Radiologist at Weill Cornell Medicine, discusses the evolving treatment landscape for acute PVT.
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SYNPOSIS
Dr. May shares insights into the changing interventional approaches, highlights the utility of tools such as suction thrombectomy devices, and explains how his best practices have developed over time. He emphasizes the continued importance of anticoagulation therapy, explores the potential complications and outcomes of various interventions, and discusses how thrombus location and characteristics influence his clinical decisions. With real-world scenarios and a step-by-step walkthrough of his decision-making process, Dr. May offers a comprehensive look at modern strategies for managing acute portal vein thrombosis.
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TIMESTAMPS
00:00 - Introduction
05:46 - Diagnosing Portal Vein Thrombosis
10:52 - Management Options for Acute PVT and What is Safest?
21:09 - Choosing an Intervention Approach
26:19 - Tackling Large Bore Thrombectomy
32:37 - Learnings and Tips for Successful Thrombectomy
39:50 - Impact of Thrombus Location on Intervention Approach
45:01 - Post-Care and Follow-Up
49:46 - Final Thoughts and Encouragement
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RESOURCES
“Transjugular Intrahepatic Portosystemic Shunt and Thrombectomy (TIPS-Thrombectomy) for Symptomatic Acute Noncirrhotic Portal Vein Thrombosis” (Shalvoy, 2023)
https://www.jvir.org/article/S1051-0443(23)00341-X/abstract

En este episodio de BackTable, la radióloga intervencionista Dra. Sara Lojo Lendoiro y la Dra. Gloria Salazar discuten los desafíos y las barreras para diagnosticar y tratar el dolor pélvico crónico y las varices pélvicas en mujeres.
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SYNPOSIS
Primero, abordan la ausencia de diagnóstico y el estereotipo que estigmatiza a las mujeres con problemas psiquiátricos. Dra. Salazar comparte su trayectoria personal desde Brasil hasta su posición de profesora asociada de radiología en la University of North Carolina, y su trabajo centrado en mejorar la salud de la mujer. También se habla sobre la necesidad de colaboración multidisciplinar, la investigación futura para entender mejor la fisiopatología, y cómo la educación y una mayor conciencia pueden mejorar el diagnóstico y tratamiento de estas patologías. Además, destacan la importancia de considerar el impacto económico y social de no tratar adecuadamente estas condiciones en mujeres activas y trabajadoras.
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TIMESTAMPS
00:00 - Presentación de la Dra. Gloria Salazar
06:25 - Desafíos en el Diagnóstico de la Salud de la Mujer
08:08 - Comprendiendo las Varices Pélvicas y el Dolor Pélvico Crónico
22:23 - Técnicas de Diagnóstico y Desafíos
36:19 - Evaluación del Dolor Pélvico y los Síntomas en las Piernas
41:46 - Variaciones Anatómicas y Técnicas de Diagnóstico
50:40 - La Importancia de los Equipos Multidisciplinarios
58:59 - Direcciones Futuras en la Investigación de las Venas Pélvicas
01:09:50 - Reflexiones Finales y Colaboraciones Futuras

Is it time for interventional radiology to sever ties with diagnostic radiology and define its own future? Dr. Ally Baheti hosts Dr. Mark Lessne, interventional radiologist at Charlotte Radiology and Dr. Saher Sabri, Chief of Interventional Radiology at MedStar Health, to discuss the evolving relationship between interventional radiology (IR) and diagnostic radiology (DR).

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SYNPOSIS
The doctors begin the discussion by asking a critical question: 'What defines an interventional radiologist?' They delve into the different practice patterns of IRs, exploring both the opportunities and challenges in interventional radiology forging its own path, independent of diagnostic radiology. The doctors share their thoughts on the financial implications, sustainability of the specialty, and the importance of establishing a clinical and longitudinal practice. The discussion concludes with the notion that an organic separation is likely inevitable, although the timing remains uncertain.

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TIMESTAMPS

00:00 - Introduction
03:45 - Challenges in IR Practice
12:23 - Financial Models and Sustainability
16:13 - The Role of SIR in Supporting IRs
34:29 - Defining IR Standards
35:28 - SIR’s Role
38:29 - Future of IR and DR
58:36 - Final Thoughts and Call to Action

There are now multiple phase 3 studies on combination transarterial chemoembolization (TACE) and immunotherapy showing a significant benefit over TACE alone. How do these findings change the hepatocellular carcinoma (HCC) treatment algorithm? In this multidisciplinary episode of the BackTable Podcast, Dr. Richard Finn (Medical Oncologist at UCLA) and Dr. Julius Chapiro (Interventional Radiologist at Yale University) join host Dr. Chris Beck to discuss immunotherapy, TACE, emerging trends in HCC treatment, and the future of the field.
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This podcast is supported by an educational grant from Guerbet.
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SYNPOSIS
The doctors highlight the importance of high quality clinical data and the pivotal studies shaping current best practices. They explore the role of the different players on the multidisciplinary team and compare the oncologic and radiologic perspectives. Additionally, they discuss the synergy between TACE and immunotherapy, the criteria for selecting appropriate treatments, and the ongoing need for research and collaboration.
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TIMESTAMPS
00:00 - Introduction
03:35 - HCC from an Oncologic Perspective
05:33 - Radiological Perspective on Liver Cancer
06:50 - Referral Patterns and Organizing a Multidisciplinary Approach
18:01 - Explaining TACE and Variations in the Procedure
27:27 - Choosing the Right Procedure for HCC
36:13 - Making a Decision on Medical Treatment Candidacy
42:23 - Importance of Data Driven HCC Treatment, Practical Insights, and Studies to Know
55:30 - Planning an Approach for a TACE Procedure
01:02:26 - Final Thoughts and Future Prospects in Liver Cancer Treatment
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RESOURCES
Barcelona Staging System:
https://www.ncbi.nlm.nih.gov/books/NBK569796/table/Ch3-t0001/
TRACE Trial:
https://pubs.rsna.org/doi/full/10.1148/radiol.211806
PREMIERE Trial:
https://www.gastrojournal.org/article/S0016-5085(16)34971-X/fulltext
EMERALD-1 Trial:
https://ascopubs.org/doi/10.1200/JCO.2024.42.3_suppl.LBA432
LEAP O12 Study:
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)02575-3/abstract

What is the key to running an efficient OBL? Dr. Mary Costantino, medical director of Advanced Vascular Centers, joins host Dr. Ally Baheti to share some of the key ingredients in keeping it lean in OBL.

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SYNPOSIS

The doctors delve into strategies in running a cost-effective OBL while upholding clinical excellence. Dr. Costantino shares her personal insights and experiences in minimizing unnecessary costs while maintaining regulatory compliance, high-performing team, and outstanding patient care. She also underscores the importance of having a clear leadership vision and remaining at the forefront of patient care to proactively identify challenges and develop effective solutions to address them. Lastly, she shares her thoughts on navigating the challenges of balancing personal and professional responsibilities in the growing field of outpatient vascular care.

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TIMESTAMPS

00:00 - Introduction

01:46 - Expanding Practices and Partnerships

06:24 - Navigating Regulatory Requirements

12:26 - Building a Lean and Valuable Team

35:01 - Leadership

39:54 - Opportunity Cost in Practice Management

44:32 - Employee Growth and Retention Strategies

46:49 - Building and Maintaining a Successful Practice

01:06:54 - The Financial Wheel and Its Impact on Small Businesses