BackTable Vascular & Interventional

Teleradiology, artificial intelligence, and private equity takeovers—how do we navigate these rapid changes in the radiology landscape? In this episode, our co-hosts Dr. Ally Baheti and Dr. Mike Barraza bring Dr. Ben White back to the show to provide an update on the current radiology job market and share his insights on reclaiming value for the profession. Dr. White begins by reflecting on the changes since his last appearance with us in 2022, focusing primarily on the ongoing shortage of radiologists, which has lasted longer than anticipated during the pandemic, and the explosion of teleradiology.

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SYNPOSIS

Today’s radiologists are more mobile than ever, with remote work options and the appeal of sensationalized job postings. Dr. White also discusses the instability of more established practices, particularly when legacy partners depart after fulfilling their contractual obligations. In response, many practices are refinancing their debt, which has led to a decrease in practice acquisitions.

Dr. White believes that large-scale healthcare operations often result in increased inefficiency and reduced agility. The downstream effects include the commoditization of teleradiologists, concerns about decreased quality of reads, a limited scope of practice for procedures, reduced access to imaging for smaller hospitals, longer wait times, and more unstable locum staffing. The doctors also speculate about the future division of radiology into different service tiers, depending on the level of access each hospital has to radiologists.

Finally, Dr. White highlights his Independent Radiology job board, which lists open positions from physician-owned practices. His goal in creating the website is to address the pain points of other job advertisement sites, where misleading postings are common. He wants radiologists to consider joining a team of physicians, rather than simply accepting a job. His advice to all radiologists is to expect uncertainty in the job market and to remain flexible.

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TIMESTAMPS

00:00 - Current Radiology Job Market

07:43 - Updates on Private Equity in Radiology

16:26 - Role of Artificial Intelligence

22:46 - Growing Imaging Volume and Efficiency

26:51 - Challenges in Radiology Staffing

36:49 - Independent Radiology Job Board

50:07 - Future of Radiology and Final Thoughts

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RESOURCES

BackTable VI Ep. 277- Private Equity and the Radiology Job Environment with Dr. Ben White:

https://www.backtable.com/shows/vi/podcasts/277/private-equity-the-radiology-job-environment

Independent Radiology Job Board:

https://www.independentradiology.com/

Do you ever wish you could be a fly on the wall at a tumor board meeting? In this episode of BackTable, we’re excited to give you an insider’s view of the real case discussions that take place during hepatocellular carcinoma (HCC) tumor boards. Host Dr. Zach Berman sits down with a multidisciplinary team, including Drs. Adam Burgoyne (medical oncologist), Heather Patton (hepatologist), Siddharth Padia (interventional radiologist), and Gabriel Schnickel (transplant and hepatobiliary surgeon).

Physicians, nurses, nurse practitioners, and physician assistants can follow this link to earn CME / CE credits for completing an accredited learning activity related to this discussion:

https://www.cmeuniversity.com/course/take/125743

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This podcast is supported by an educational grant from AstraZeneca Pharmaceuticals and Boston Scientific.

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SYNPOSIS

The team walks through a range of diverse HCC cases, reviewing patient histories, imaging, and treatment options. They cover eight cases in total, each featuring patients with varying treatment histories, comorbidities, liver function, and lesion characteristics. For the full educational experience, we recommend watching the video format on our YouTube channel.

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TIMESTAMPS

00:00 - Introduction

00:47 - Case 1: Small Lesion in a Young Patient

05:01 - Case 2: Moderate Sized Lesion in an Older Patient

11:10 - Case 3: Multifocal HCC with Dominant Lesion

21:09 - Case 4: Dominant Lesion with Portal Hypertension

32:08 - Case 5: Ruptured Solitary Lesion

34:34 - Case 6: Rupture with Multifocal Lesions

44:08 - Case 7: Portal Vein Invasion

52:12 - Case 8: Metastatic HCC After Transplant

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RESOURCES

CME Accreditation Information:

https://f7cae4ec-b69e-490d-9e0f-19b16a6f146d.usrfiles.com/ugd/f7cae4_a7c37ea3cd1b4d3fa53d5edf8dfe255b.pdf

Medical, surgical, radiation, and interventional oncology all play vital roles in delivering care to patients battling liver cancer. How do we optimize outcomes when so many specialties have something to offer the same patient? The answer is collaborative oncology. Dr. Robert Martin (Director of Surgical Oncology, University of Louisville) and pioneer in liver-directed therapies, joins host Dr. Sabeen Dhand to discuss a collaborative approach to oncology and recent advances in locoregional therapy.

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This podcast is supported by:

RADPAD® Radiation Protection

https://www.radpad.com/

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SYNPOSIS

Dr. Martin discusses the importance of a growth mindset in advancing medical techniques and fostering collaborations between specialists. He then shares insights into minimally invasive procedures, such as microwave ablation and irreversible electroporation (IRE). The doctors also touch on the evolution of liver cancer treatments, emphasizing the significance of clinical trials on the horizon. To conclude, Dr. Martin encourages young professionals in surgery and interventional radiology to stay open-minded, be life-long learners, and find synergistic ways to integrate new technologies into patient care.

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TIMESTAMPS

00:00 - Introduction

02:31 - Dr. Martin’s Background and Career Path

06:18 - Evolution of Liver Directed Therapies

10:12 - Collaboration Between Specialties

18:34 - Clinical Trials and Emerging Therapies

36:08 - Advice for Young Professionals

39:15 - Conclusion

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RESOURCES

Radioembolization Oncology Trial Utilizing Transarterial Eye90 (ROUTE 90) for the Treatment of HCC:

https://clinicaltrials.gov/study/NCT05953337?term=NCT05953337&rank=1

Intratumoral Injection of IP-001 Following Thermal Ablation in Patients With CRC, NSCLC, and STS (INJECTABL-1):

https://clinicaltrials.gov/study/NCT05688280

Immunophotonics, CIRSE, and Next Research Announce Innovative Phase 2/3 Clinical Trial: INJECTABL-3:

https://immunophotonics.com/news/immunophotonics-cirse-and-next-research-announce-innovative-phase-2-3-clinical-trial-injectabl-3/

Are you seeking to build your reputation and patient base within interventional oncology? In this episode, host Dr. Zachary Berman interviews Dr. Siddarth Padia, Dr. Tyler Sandow, Dr. Kavi Krishnasamy, and Dr. Kevin Burns about their journeys into interventional oncology (IO) and their experiences providing care in different practice settings.

Physicians, nurses, nurse practitioners, and physician assistants can follow this link to earn CME / CE credits for completing an accredited learning activity related to this discussion:

https://www.cmeuniversity.com/course/take/125742

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This podcast is supported by an educational grant from AstraZeneca Pharmaceuticals and Boston Scientific.

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SYNPOSIS

The doctors begin by discussing how they became interested in interventional oncology, with most of them recognizing opportunities to address unmet needs in the field. Each guest shares insights on the timelines and challenges involved in starting their IO practices, which vary significantly today. For instance, telehealth clinics are particularly viable in private practice IO, thanks to conferencing software and virtual translators. Hybrid care models, which combine in-person and remote consultations, can help overcome patient-level barriers such as time and transportation. The panel also emphasizes how increased clinic availability can significantly drive growth in procedural volume. Finally, they offer advice for starting an IO practice, including the importance of having clinic support staff, building strong relationships with referring physicians, and staying up to date with new technologies.

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TIMESTAMPS

00:00 - Introduction

05:38 - Balancing Career Interests and Expectations

07:10 - Building an Interventional Oncology Practice

13:42 - Gaining Trust from Referring Physicians

17:33 - Importance of Open Communication

19:19 - Comparing Clinic Settings

26:01 - Essential Components of a Clinic

33:28 - Narrowing Your Interventional Practice

40:09 - Introducing New Technology

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RESOURCES

CME Accreditation Information:

https://f7cae4ec-b69e-490d-9e0f-19b16a6f146d.usrfiles.com/ugd/f7cae4_a7c37ea3cd1b4d3fa53d5edf8dfe255b.pdf

Is there a way to treat liver metastasis secondary to uveal melanoma without introducing systemic, treatment-related toxicity? Dr. Altan Ahmed (interventional radiologist at Moffitt Cancer Center) and Dr. Sid Padia (interventional radiologist at UCLA) join guest-host Dr. Kavi Krishnasamy to discuss HEPZATO, a novel device-based treatment for liver metastases from uveal melanoma.

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This podcast is supported by:

RADPAD® Radiation Protection

https://www.radpad.com/

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SYNPOSIS

Dr. Ahmed and Dr. Padia begin by exploring the design and setup of the HEPZATO clinical trials, while also speaking on patient selection criteria. The doctors then talk through the technical aspects of the intervention. After covering workflow and considerations related to procedure timing and coordination, the doctors go on to discuss drug dosing and optimizing treatment cycles. The episode concludes with current gaps in literature, current and future research aims, and potential future applications of the HEPZATO modality in treating other malignancies such as colorectal cancer.

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TIMESTAMPS

00:00 - Introduction

05:40 - Patient Selection Criteria

09:49 - Workflow

19:17 - Procedure Timing and Coordination

29:39 - Challenges and Considerations in Drug Dosing

32:39 - Optimizing Treatment Cycles and Patient Response

37:56 - Managing Post-Treatment and Adverse Effects

43:43 - Future Research and Gaps in Current Interventions

50:45 - Exploring New Applications for PHP Therapy

55:02 - Conclusion

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RESOURCES

Hepzato:

https://hepzatokit.com/

FOCUS Trial - Efficacy and Safety of the Melphalan/Hepatic Delivery System in Patients with Unresectable Metastatic Uveal Melanoma: Results from an Open-Label, Single-Arm, Multicenter Phase 3 Study:

https://pubmed.ncbi.nlm.nih.gov/38704501/

FOCUS phase 3 trial results: Percutaneous hepatic perfusion (PHP) with melphalan for patients with ocular melanoma liver metastases (PHP-OCM-301/301A):

https://ascopubs.org/doi/pdf/10.1200/JCO.2022.40.16_suppl.9510

Combining Melphalan Percutaneous Hepatic Perfusion with Ipilimumab Plus Nivolumab in Advanced Uveal Melanoma: First Safety and Efficacy Data from the Phase Ib Part of the Chopin Trial:

https://pubmed.ncbi.nlm.nih.gov/36624292/

Troponin Elevation in Patients Undergoing Percutaneous Hepatic Perfusion for Metastatic Uveal Melanoma:

https://pmc.ncbi.nlm.nih.gov/articles/PMC11010739/

Percutaneous Hepatic Perfusion with Melphalan in Patients with Unresectable Ocular Melanoma Metastases Confined to the Liver: A Prospective Phase II Study:

https://pmc.ncbi.nlm.nih.gov/articles/PMC7801354/

Southampton group - Quality of life after melphalan percutaneous hepatic perfusion for patients with metastatic uveal melanoma:

https://pmc.ncbi.nlm.nih.gov/articles/PMC10906212/

Leiden group - Quality of Life Analysis of Patients Treated with Percutaneous Hepatic Perfusion for Uveal Melanoma Liver Metastases:

https://pubmed.ncbi.nlm.nih.gov/38587534/

Is surgery truly the "cure" for hepatocellular carcinoma (HCC), and when is it a viable option? In this episode, Dr. Sabeen Dhand leads a roundtable discussion with interventional radiologist Dr. Siddharth Padia and transplant/hepatobiliary surgeons Dr. John Seal and Dr. Gabriel Schnickel, delving into the complexities of surgical treatments for HCC and the evolving landscape of liver resection and transplantation.

Physicians, nurses, nurse practitioners, and physician assistants can follow this link to earn CME / CE credits for completing an accredited learning activity related to this discussion:

https://www.cmeuniversity.com/course/take/125741

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This podcast is supported by an educational grant from AstraZeneca Pharmaceuticals and Boston Scientific.

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SYNPOSIS

The doctors begin by discussing how they manage patient expectations regarding both palliative and curative treatments, highlighting the risk of recurrent HCC as a new lesion. They then outline key factors that influence their recommendations for liver transplant versus resection, such as the extent of underlying liver disease, the function of the future liver remnant, body habitus, overall health, and organ availability. The surgeons also review various surgical approaches to liver resection and recent advancements in liver transplantation, including living donor transplants and the ability to refer patients for downstaging procedures.

Dr. Padia explains the original role of Y90 as a bridging treatment to downstage tumors and promote hypertrophy in the non-diseased liver segments, preparing the organ for surgical resection. However, Y90 treatment can also lead to the formation of adhesions, which may complicate future surgeries. Finally, the doctors discuss strategies to improve care coordination between community physicians and transplant centers to optimize patient outcomes.

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TIMESTAMPS

00:00 - Curative vs. Palliative Treatment

04:03 - Choosing Between Transplantation and Resection

05:47 - Liver Resection Types

07:27 - Bridging Role of Y90

12:14 - Evolving Landscape of Liver Transplantation

20:59 - Patient Counseling in Minimally Invasive Procedures

28:40 - Considerations for Surgery After Y90

33:32 - Coordination Between Specialists

40:08 - Immunotherapy as a Bridge to Transplant

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RESOURCES

CME Accreditation Information:

https://f7cae4ec-b69e-490d-9e0f-19b16a6f146d.usrfiles.com/ugd/f7cae4_a7c37ea3cd1b4d3fa53d5edf8dfe255b.pdf

Musculoskeletal embolization is generating significant excitement in the field of chronic pain management. In this episode, Dr. Jacob Fleming hosts a discussion with Dr. Yuji Okuno from Japan, a pioneer in both basic science and clinical practice within the field of musculoskeletal embolization.

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This podcast is supported by:

Medtronic MVP

https://www.medtronic.com/mvp

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SYNPOSIS

The conversation delves into Dr. Okuno's groundbreaking work using embolization to treat chronic pain from conditions such as frozen shoulder, knee osteoarthritis, plantar fasciitis, and various sports injuries. Dr. Okuno discusses the development of new temporary embolic agents and compares different approaches to embolization treatments, including the innovative use of antibiotics as embolic material. The doctors also cover the intriguing concept of differential recanalization, where abnormal inflammatory vessels are less likely to recanalize than normal vessels after embolic treatment. Identifying hypervascularity through MRI, ultrasound, or angiogram is a crucial step before attempting embolization.

Overall, Dr. Okuno offers valuable insights into his clinical practice and the potential for groundbreaking advancements in musculoskeletal care worldwide.

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TIMESTAMPS

00:00 - Introduction

01:54 - Origins of Embolization for Pain

04:15 - Basic Science Research Discoveries and Clinical Trials

09:02 - Temporary Embolic Materials

15:28 - Techniques for Embolization

17:33 - Plantar Fasciitis Treatment

24:04 - Future of Embolization in Sports Injuries

28:11 - Diagnostic Imaging in Embolization

36:10 - Global Expansion and Collaborations

The process of liver transplantation involves many complexities, and each patient's path to transplant is unique. To offer insider perspectives on this process, Dr. Zachary Berman sits down with transplant and hepatobiliary surgeon Dr. John Seal, as well as transplant hepatologists Dr. Heather Patton and Dr. Steve Young.

Physicians, nurses, nurse practitioners, and physician assistants can follow this link to earn CME / CE credits for completing an accredited learning activity related to this discussion:

https://www.cmeuniversity.com/course/take/125740

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This podcast is supported by an educational grant from AstraZeneca Pharmaceuticals and Boston Scientific.

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SYNPOSIS

The panel begins by discussing the multidisciplinary pre-transplant evaluation process, which assesses factors such as liver function, comorbidities, surgical risk, and the availability of psychosocial support. Once a patient is listed for transplant, they enter a system that prioritizes those with the highest Model for End-Stage Liver Disease (MELD) score. During the waiting period, several comorbidities should be carefully monitored. Dr. Seal explores the impact of portal vein hypertension and portal vein thrombosis, explaining how these conditions may necessitate intraoperative thrombectomy or bypass. Dr. Patton and Dr. Young focus on considerations for using anticoagulation in patients with a high baseline bleeding risk and selecting the appropriate anticoagulant for patients listed for transplant.

For patients with hepatocellular carcinoma (HCC), eligibility for MELD exception points may depend on factors such as time spent on the waiting list, adherence to the Milan criteria, and the presence of extrahepatic complications of liver disease. The panel also discusses bridging therapies to transplant, including Y90 and TACE. In the peri-transplant phase, they highlight innovations such as living donor transplants, liver perfusion pumps, and the use of hepatitis C- and HIV-positive organs. Finally, the discussion turns to post-transplant considerations, including surgical complications, organ rejection, immunosuppression, predictors of HCC recurrence, and long-term surveillance.

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TIMESTAMPS

00:00 - Introduction

01:16 - Current Landscape of Liver Transplantation

03:22 - Transplant Evaluation Process

09:48 - Timeline from Listing to Transplantion

11:16 - Treating Portal Vein Thrombosis and Hypertension

18:44 - MELD Exception Points

22:05 - Bridging Therapies

25:34 - Peri-Transplant Considerations

30:53 - Post-Transplant Period

37:39 - Repeat Transplantation

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RESOURCES

Model for end-stage liver disease (MELD) and allocation of donor livers (Wiesner et al, 2003):

https://www.gastrojournal.org/article/S0016-5085%2803%2950022-1/fulltext

Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis- Milan Criteria (Mazzaferro et al, 1996):

https://pubmed.ncbi.nlm.nih.gov/8594428/

Validation of the prognostic power of the RETREAT score for hepatocellular carcinoma recurrence using the UNOS database (Mehta et al, 2019):

https://pmc.ncbi.nlm.nih.gov/articles/PMC6445634/

CME Accreditation Information:

https://f7cae4ec-b69e-490d-9e0f-19b16a6f146d.usrfiles.com/ugd/f7cae4_a7c37ea3cd1b4d3fa53d5edf8dfe255b.pdf

Do we finally have definitive data on the efficacy of prostate artery embolization (PAE)? Dr. Shivank Bhatia (interventional radiologist at University of Miami) joins host Dr. Michael Barraza to discuss the findings from his prospective 1,075 patient study on the long-term outcomes of PAE, the largest longitudinal, single-center, single-operator, prospective study in the United States.

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This podcast is supported by:

RADPAD® Radiation Protection

https://www.radpad.com/

Medtronic MVP

https://www.medtronic.com/mvp

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SYNPOSIS

Dr. Bhatia begins by sharing his early years of training, and the steps he took to become an expert in all things PAE. He also covers how he helped build the PAE program at University of Miami, sharing several pearls for young IRs and trainees that are interested in bringing new service lines to their institutions. Dr. Bhatia then talks through the details of the study that he spearheaded, and encourages everyone to tune in - physicians and patients alike.

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TIMESTAMPS

00:00 - Introduction

05:12 - Building a PAE Program

18:55 - PAE Procedure Technicalities

22:30 - Post-Procedure Meds and Care

25:13 - Study Details and Patient Demographics

27:36 - Procedure Time and Technical Success

28:32 - Safety and Efficacy of PAE

38:06 - PSA Levels and Prostate Cancer

40:42 - Urinary Retention and Treatment Prioritization

45:17 - Re-Intervention Rates and Medication Independence

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RESOURCES

Pisco et al (2011) - Prostatic arterial embolization to treat benign prostatic hyperplasia:

https://pubmed.ncbi.nlm.nih.gov/21195898/

Bhatia et al (2024) - Prostatic Artery Embolization: Mid- to Long-Term Outcomes in 1,075 Patients:

https://pubmed.ncbi.nlm.nih.gov/39532156/

Treatment of hepatocellular carcinoma (HCC), like that of many other cancers, spans a spectrum from curative to palliative intent. To explore the "grey zone" of treatment goals for intermediate-stage HCC patients, Dr. Sabeen Dhand interviews a panel of experts in the field: medical oncologists Dr. Adam Burgoyne and Dr. Lingling Du, along with interventional radiologists Dr. Kirema Garcia-Reyes and Dr. Zachary Berman.

Physicians, nurses, nurse practitioners, and physician assistants can follow this link to earn CME / CE credits for completing an accredited learning activity related to this discussion:

https://www.cmeuniversity.com/course/take/125739

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This podcast is supported by an educational grant from AstraZeneca Pharmaceuticals and Boston Scientific.

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SYNPOSIS

The discussion begins with an explanation of the Barcelona-Clinic Liver Cancer (BCLC) staging system. While this system takes into account helpful factors such as liver function, performance status, and tumor burden, it fails to fully capture the true heterogeneity of the HCC patient population. Additional considerations include tumor biology, response to previous treatments, and the location of metastases. The specialists then share their experiences in treating patients with comorbid gastrointestinal cancers and mixed tumors, discuss the benefits of an interventional oncology clinic setting, and highlight virtual opportunities for connecting with tumor boards. They also offer advice on patient education regarding treatment options.

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TIMESTAMPS

00:00 - Introduction to BCLC Staging

03:02 - Impact of Performance Status

06:29 - Predictors of Survival in HCC

09:51 - Palliative versus Curative Treatment Intent

13:55 - Comorbid and Mixed Gastrointestinal Cancers

16:51 - Adverse Effects of Treatment

20:37 - Interventional Oncology in the Clinic Setting

23:06 - Navigating Multiple Provider Viewpoints

28:01 - Complex Case Examples

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RESOURCES

BCLC strategy for prognosis prediction and treatment recommendation: The 2022 update (Reig et al, 2022):

https://www.journal-of-hepatology.eu/article/S0168-8278(21)02223-6/fulltext

CME Accreditation Information:

https://f7cae4ec-b69e-490d-9e0f-19b16a6f146d.usrfiles.com/ugd/f7cae4_a7c37ea3cd1b4d3fa53d5edf8dfe255b.pdf