BackTable Vascular & Interventional

Bringing more interventional radiology to rural America would benefit many patients who currently do not have access to minimally invasive, image guided medicine. In today's episode, Dr. Frederick Johnson, an interventional radiologist practicing in Thomasville, Georgia joins us to discuss the unique dynamics and challenges of setting up and maintaining a successful rural IR practice.

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Medtronic ClosureFast

https://www.medtronic.com/us-en/c/cardiovascular/closurefast-rfa-system.html

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SYNPOSIS

Dr. Johnson provides insights into the professional service agreement (PSA) model that allows his practice to maintain autonomy while collaborating with the local hospital. The episode explores the complexities of recruiting to a rural setting, maintaining a broad case mix, ensuring financial stability, and fostering professional satisfaction. The conversation highlights the importance of redefining independence and the benefits of integrating collaboration into IR practices.

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TIMESTAMPS

00:00 - Introduction

02:29 - Dr. Johnson’s Background and Journey

11:46 - Professional Service Agreement (PSA) Explained

18:48 - Daily Operations and Structure

24:19 - Teamwork in Rural Healthcare

30:35 - Recruitment and Growth

33:33 - Compensation and Financial Incentives

42:05 - Benefits of Small Town Living

44:34 - Advice for Aspiring Rural Healthcare Practitioners

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RESOURCES

Vita Surgery/Vascular Website:

https://vitadr.org/

Ever wonder what it’s like to practice interventional radiology down under? Dr. Chris Rogan joins us on the BackTable Podcast this week to tell us about his IR practice in Australia, with special emphasis on healthcare system and interventional practice model differences between our two countries.

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SYNPOSIS

We cover a wide range of topics, including the differences in IR training pathways between Australia and the U.S., the impact of healthcare models on IR practice, and the cooperation between public and private healthcare. We also highlight the urgent need for more IR specialists in Australia. Additionally, the doctors explore the challenges of public awareness, interdisciplinary and global collaboration, and the ongoing efforts by the Interventional Radiology Society of Australasia (IRSA) to promote IR through public outreach and educational strategies.

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TIMESTAMPS

00:00 - Introduction

04:08 - Australia vs. US Healthcare Systems

08:21 - Compensation and Career Mobility

16:52 - IR Public Awareness and Marketing

25:56 - Global Collaboration and Conferences

30:53 - Travel Tips for Australia

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RESOURCES

Dr. Chris Rogan’s practice:

https://drrogan.com/

Interventional Radiology Society of Australasia (IRSA):

https://irsa.com.au/

IRSA 2024 Annual Meeting:

https://irsa.com.au/education-events/irsa-annual-scientific-meeting-2024/

Superficial venous disease can pose significant management challenges, particularly after patients have exhausted conservative and invasive therapies. This week, our host, Dr. Sabeen Dhand, interviews Dr. Ali Golshan, an interventional radiologist and the founder of SOLVEIN. Dr. Golshan discusses the latest advancements in treating superficial venous disease, highlighting both the benefits and complexities of thermal and non-thermal ablation techniques.

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BD Advance Clinical Training & Education Program

https://page.bd.com/Advance-Training-Program_Homepage.html

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SYNPOSIS

Dr. Golshin introduces SOLVEIN, his innovative medical device designed to address these challenges. The conversation also includes practical tips for managing patients with venous insufficiencies, along with insights into the entrepreneurial journey involved in developing a new medical device.

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TIMESTAMPS

00:00 - Introduction

02:02 - Defining Superficial Venous Disease

05:43 - Diagnostic Techniques and Imaging

08:29 - Current Treatment Options for Venous Insufficiency

20:07 - Introducing SOLVEIN

29:42 - FDA Approval Pathway

33:37 - Advice for Aspiring Medical Entrepreneurs

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RESOURCES

Dr. Ali Golshan’s Practice:

https://www.beachwellnessmd.com/

Dr. Venkatesh Krishnasamy shares techniques and specific cases for challenging lung biopsies, his insights on mentorship, importance of multidisciplinary tumor boards, and the evolution of lung biopsy practices. Dr. Krishnasamy is an interventional radiologist and Director of Interventional Oncology at the University of Alabama Birmingham.

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Merit Biopsy Solutions

https://www.merit.com/solutions/biopsy-solutions/

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SYNPOSIS

The doctors cover practical advice on handling complications like pneumothorax and hemoptysis, and share strategies for optimizing workflows to improve patient outcomes. Dr. Krishnasamy encourages listeners to leverage mentor experience and partake in continued learning to advance their practice.

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TIMESTAMPS

00:00 - Introduction

05:16 - Lung Biopsy Referrals and Multidisciplinary Approach

12:03 - Complex Lung Biopsies

25:43 - Needle Position Verification

27:29 - Importance of Cytopathologist Presence

28:51 - Blood Patching vs. Plug Technique

33:54 - Post-Procedure Protocols

36:15 - Advanced Techniques and Mentorship

44:26 - Handling Hemoptysis During Biopsies

47:50 - Encouragement for Trainees

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RESOURCES

Society of Interventional Oncology:

https://www.sio-central.org/

BackTable VI Podcast Episode #278 - Minimizing Complications for Lung Biopsies with Dr. Robert Suh:

https://www.backtable.com/shows/vi/podcasts/278/minimizing-complications-for-lung-biopsies

BackTable VI Podcast Episode #156 - Percutaneous Lung Biopsies: The Basics with Dr. Fred Lee (Part 1 of 2):

https://www.backtable.com/shows/vi/podcasts/156/percutaneous-lung-biopsies-the-basics

BackTable VI Podcast Episode #157 - Percutaneous Lung Biopsies: Pleural & Parenchymal Blood Patching with Dr. Fred Lee (Part 2 of 2):

https://www.backtable.com/shows/vi/podcasts/157/percutaneous-lung-biopsies-pleural-parenchymal-blood-patching

In this episode, Dr. Alexander Vezeridis discusses advanced biliary interventions; covering stone removal procedures, technical success rates, and practical tips for using Spyglass cholangioscopy, laser lithotripsy, and endobiliary ablation. Dr. Vezeridis is an interventional radiologist, physician-scientist, and Assistant Professor of Radiology at Stanford.

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RADPAD® Radiation Protection

https://www.radpad.com/

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SYNPOSIS

Dr. Vezeridis highlights the importance of continuous learning, collaboration with other specialties, and shares his experiences and tips for optimizing patient outcomes. The doctors also touch on innovative approaches such as photodynamic therapy and the use of various tools in managing benign and malignant biliary diseases.

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TIMESTAMPS

00:00 - Introduction

03:25 - Setting Up Spyglass in Your Practice

10:50 - Patient Selection and Procedure Details

24:27 - Stone Fragmentation Techniques

27:35 - Success Rates and Patient Outcomes

35:06 - Endobiliary Ablation Techniques

47:35 - Laser Treatment for Biliary Obstructions

49:18 - Future Innovations

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RESOURCES

BackTable VI Podcast Episode #146 - Spyglass Interventions with Dr. Jeffrey Chick and Dr. Ravi Srinivasa:

https://www.backtable.com/shows/vi/podcasts/146/spyglass-interventions

Spyglass - Boston Scientific:

https://www.bostonscientific.com/en-US/medical-specialties/gastroenterology/advancements-cholangioscopy.html

Percutaneous Gallstone Removal: Long-term Follow-up (Dr. Hovsepian Paper):

https://www.jvir.org/article/S1051-0443(96)70766-2/pdf

SIR’s Percutaneous Cholangiopancreatoscopy (PCPS) registry:

https://clinicaltrials.gov/study/NCT05210322

StarMed Endoscopic RFA Clinical Articles:

https://www.starmedacademy.com/endoscopic-rfa-clinical-articles-elra

Habib Endobiliary Ablation Catheter:

https://www.bostonscientific.com/en-US/products/rf-ablation/habib-endohpb-bipolar-radiofrequency-catheter.html

Interventional Radiology-Operated Choledochoscopic-Guided Radiofrequency Wire and Holmium Laser Ablations May Facilitate Treatment and Long-Term Patency of Benign Biliary Strictures:

https://www.jvir.org/article/S1051-0443(18)31535-5/abstract

Percutaneous Cholangioscope-Assisted Laser Incision of Severe Benign Hepaticojejunostomy Stenoses:

https://pubmed.ncbi.nlm.nih.gov/35504434/

Percutaneous Endoluminal Benign Biliary Laser (PEBBL) (Clinical Trial):

https://clinicaltrials.gov/study/NCT05567003

In this episode of the Back Table Podcast, interventional radiologist Dr. Noor Ahmad discusses his algorithm for complex inferior vena cava (IVC) filter retrievals and reviews several cases that utilize various retrieval tools.

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Argon Medical

http://www.argonmedical.com/

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SYNPOSIS

Dr. Ahmad emphasizes that most patients are referred by physicians with whom he maintains good relationships, and both specialties jointly monitor patients after IVC filters are placed. Generally, it is ideal to remove IVC filters around the 3-month mark, with filters in place for over 6 months posing a higher risk of requiring complex retrieval. For preoperative evaluation, obtaining a history of the filter type and placement date, along with CT scans (non-contrast and venogram), is crucial. Anticoagulation is typically discontinued two days prior to retrieval.

During the procedure, moderate sedation and internal jugular access are used. However, complex retrievals may necessitate general anesthesia and access through the femoral vein or dual sites. The initial device employed is usually the CloverSnare to hook and extract the IVC filter. If unsuccessful, Dr. Ahmad proceeds with techniques such as the hangman (modified loop snare), endobronchial forceps, and finally the CavaClear laser sheath. He highlights that particularly challenging cases might require collaboration with colleagues, especially when dual access is needed, possibly requiring rescheduling for general anesthesia availability. Patient safety is emphasized in these scenarios. Lastly, Dr. Ahmad presents past cases with imaging to illustrate various retrieval methods.

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TIMESTAMPS

00:00 - Introduction

03:29 - Referrals and Tracking for Filter Removal

08:49 - Working Up Complex Cases

13:19 - Patient Selection

20:14 - Procedure Walkthrough

23:22 - Different Strategies for Filter Removal

31:23 - Laser Techniques

34:47 - Sheath Sizing

36:06 - Enhancing Patient Safety

43:34 - Cheat Sheet for IVC Filters and Case Studies

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RESOURCES

BackTable Ep. 204- Filter Indications and Filter Tracking: Up Your Game with Dr. Stephen Wang:

https://www.backtable.com/shows/vi/podcasts/204/filter-indications-filter-tracking-up-your-game

BackTable Ep. 339- The Importance of a Multidisciplinary Filter Retrieval Program with Dr. Robert Ryu, Dr. Warren Clements, and Dr. Premal Trivedi:

https://www.backtable.com/shows/vi/podcasts/339/the-importance-of-a-multidisciplinary-filter-retrieval-program

Dr. Sameh Sayfo discusses advanced techniques in radial to peripheral (R2P) interventions, the importance of having multiple techniques, the role of different devices, troubleshooting tips, and the evolving landscape of R2P interventions. Dr. Sayfo is an interventional cardiologist at the Baylor Heart Hospital, and serves as program director for the endovascular fellowship and pulmonary embolism response team (PERT) program.

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CHECK OUT OUR SPONSOR

AngioDynamics Auryon System

https://www.auryon-system.com/

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SYNPOSIS

Dr. Sayfo shares his experience and insights on using various devices, such as the new Auryon laser, for treating peripheral arterial disease (PAD).Additionally, the doctors address the benefits of radial access over traditional femoral approaches, patient selection, and procedural planning. Listeners are encouraged to adopt a flexible approach and learn from each other’s experiences to improve patient outcomes.

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TIMESTAMPS

00:00 - Introduction

05:24 - Incorporating Radial into Peripheral Practice

11:19 - Right vs. Left Radial Access

20:01 - Room Setup and Procedure Planning

25:13 - Radial vs. Femoral Access

33:01 - Advancements in Laser Atherectomy

41:33 - Laser Atherectomy Tips

45:52 - Advantages of Radial Access in Specific Cases

51:33 - Post-Op Care and Best Practices

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RESOURCES

BackTable VI Podcast Episode #30 - Transradial Access Basic to Advanced with Dr. Aaron Fischman:

https://www.backtable.com/shows/vi/podcasts/30/transradial-access-basic-to-advanced

BackTable VI Podcast Episode #148 - Radial vs. Femoral for Prostate Artery Embolization with Dr. Blake Parsons:

https://www.backtable.com/shows/vi/podcasts/148/radial-vs-femoral-for-prostate-artery-embolization

BackTable VI Podcast Episode #342 - Radial Access for PAD with Dr. Rami Tadros:

https://www.backtable.com/shows/vi/podcasts/342/radial-access-for-pad

BackTable VI Podcast Episode #395 - Radial to Peripheral Tools & Technique with Dr. Sameh Sayfo:

https://www.backtable.com/shows/vi/podcasts/395/radial-to-peripheral-tools-technique

BackTable VI Podcast Episode #443 - Innovative Approaches in Radial to Peripheral Interventions with Dr. Amit Srivastava:

https://www.backtable.com/shows/vi/podcasts/443/innovative-approaches-in-radial-to-peripheral-interventions

BackTable VI Podcast Episode #390 - Laser Atherectomy: An Overview of the Pathfinder Registry with Dr. Tony Das:

https://www.backtable.com/shows/vi/podcasts/390/laser-atherectomy-an-overview-of-the-pathfinder-registry

BackTable VI Podcast Episode #408 - Laser BTK Study Insights: Navigating Complex Lesions with Dr. Nicolas Shammas:

https://www.backtable.com/shows/vi/podcasts/408/laser-btk-study-insights-navigating-complex-lesions

Safety and efficacy of radial artery access for peripheral vascular intervention: a single center experience:

https://www.ajconline.org/article/S0002-9149(24)00461-2/abstract

Comparative Outcomes of Interventions for Femoropopliteal Chronic Total Occlusion Versus Non-Chronic Total Occlusion Lesions From the Multicenter XLPAD Registry:

https://pubmed.ncbi.nlm.nih.gov/37318023/

Prospective, Multi-center, Single-Arm Study of the Auryon Laser System for Treatment of Below-the-Knee Arteries in Patients With Chronic Limb-Threatening Ischemia: 30-Day Results of the Auryon BTK:

https://pubmed.ncbi.nlm.nih.gov/38458581/

Prospective, Multicenter Registry to Assess Safety and Efficacy of Radial Access for Peripheral Artery Interventions:

https://www.jscai.org/article/S2772-9303(23)00813-X/fulltext

Solid state, pulsed-wave 355 nm UV laser atherectomy debulking in the treatment of infrainguinal peripheral arterial disease: The Pathfinder Registry:

https://pubmed.ncbi.nlm.nih.gov/38566525/

SCAI Expert Consensus Statement Update on Best Practices for Transradial Angiography and Intervention:

https://scai.org/publications/clinical-documents/scai-expert-consensus-statement-update-best-practices-transradial

Dr. Ally Baheti interviews interventional radiologist Dr. Steven Smith about his insights into venous orthostatic flow dysfunction and its association with multisystem disorders.

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RADPAD® Radiation Protection

https://www.radpad.com/

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SYNPOSIS

Dr. Smith details his clinical career and his surprising findings that connect pelvic congestion syndrome with a range of other conditions, such as postural orthostatic tachycardia syndrome (POTS), chronic fatigue syndrome, Ehlers-Danlos syndrome, irritable bowel syndrome (IBS), vulvodynia, interstitial cystitis, and fibromyalgia. For patients with venous manifestations, he pursues treatment with stents or embolization, taking a proactive approach to targeting any abnormal vasculature that he identifies.

Additionally, the podcast delves into the physiological basis of POTS and related disorders, which mainly stems from blood pooling in the lower body, leading to sympathetic overactivation. Overall, Dr. Smith emphasizes the significance of collaborating with specialists across different disciplines to advance understanding and treatment of these complex syndromes.

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TIMESTAMPS

00:00 - Introduction

03:11 - Symptom Constellation of Venous Orthostatic Flow Syndrome

12:08 - Pelvic Vein Treatment Algorithm

21:08 - Physiology of Orthostatic Intolerance and Sympathetic Overdrive

27:11 - Patient Selection

33:27 - Need for Research and Collaboration

36:07 - Advocacy for Patients

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RESOURCES

BackTable VI Ep. 337- Management of Vulvar Varices with Dr. Brooke Spencer

https://www.backtable.com/shows/vi/podcasts/337/management-of-vulvar-varices

BackTable VI Ep. 33- Building a Comprehensive Vein Practice with Dr. Brooke Spencer & Dr. Isabel Newton

https://www.backtable.com/shows/vi/podcasts/33/building-a-comprehensive-vein-practice

An online survey of pelvic congestion support group members regarding comorbid symptoms and syndromes (Smith et al, 2022):

https://journals.sagepub.com/doi/abs/10.1177/02683555221112567

Distension of central great vein decreases sympathetic outflow in humans (Cui et al, 2013):

https://journals.physiology.org/doi/full/10.1152/ajpheart.00019.2013

Orthostatic intolerance and chronic fatigue syndrome: New light on an old problem (Rowe, 2002):

https://www.jpeds.com/article/S0022-3476(02)53209-1/fulltext

Dr. Jafar Golzarian shares his experiences with co-founding an outpatient-based lab (OBL), obtaining the right equipment, handling staffing, negotiating with insurance companies, and marketing his new practice. Dr. Golzarian is an interventional radiologist at his OBL in Minneapolis, Minnesota and he is the former Division Head and Program Director for the interventional radiology program at the University of Minnesota.

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CHECK OUT OUR SPONSOR

GE Healthcare Allia Image Guided Systems

https://www.gehealthcare.com/products/interventional-image-guided-systems/allia

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SYNPOSIS

Dr. Golzarian emphasizes the importance of having independence and adopting a patient-centered approach. He also offers practical advice for physicians considering similar moves into the private practice sphere. Additionally, Dr. Golzarian talks about the challenges and rewards of focusing on specific embolization procedures and collaborating with industry partners to build a successful practice.

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TIMESTAMPS

00:00 - Introduction

06:06 - Setting Up a New Practice

14:27 - Tips for Marketing

23:40 - Finding the Right Business Partner

30:44 - OBL vs. ASC Status and Reimbursement

32:59 - Industry Support and Device Costs

37:58 - Staffing and Culture

45:25 - Advice for New Practitioners

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RESOURCES

BackTable VI Episode #85 - Genicular Artery Embolization for OA with Dr. Jafar Golzarian:

https://www.backtable.com/shows/vi/podcasts/85/genicular-artery-embolization-for-oa

BackTable VI Episode #361 - Intra-Arterial & Percutaneous Treatment of Giant Hepatic Hemangiomas with Dr. Jafar Golzarian:

https://www.backtable.com/shows/vi/podcasts/361/intra-arterial-percutaneous-treatment-of-giant-hepatic-hemangiomas

BackTable VI Episode #447 - Exploring GAE: Clinical Insights & Outcomes with Dr. Mark Little:

https://www.backtable.com/shows/vi/podcasts/447/exploring-gae-clinical-insights-outcomes

GEST MSK Annual Meeting:

https://www.gestmsk.com/

Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: AUA Guideline:

https://www.auanet.org/guidelines-and-quality/guidelines/benign-prostatic-hyperplasia-(bph)-guideline

Dr. Aditya Bagrodia sits down with Elie Toubiana, founder and CEO of ScribeMD.ai, to discuss the transformative potential of artificial intelligence (AI) in medical documentation.

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SYNPOSIS

Their conversation covers the capabilities and benefits of using an AI-driven medical scribe that ensures HIPAA compliance, reduces physician burnout, and enhances patient interactions. Elie also shares his insights about the technology’s adaptability across various medical fields. Finally, Dr. Bagrodia and Elie discuss ethical considerations surrounding applications of AI in other aspects of healthcare, such as medical workup and diagnosis.

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TIMESTAMPS

00:00 - Introduction

06:00 - How ScribeMD AI Works

14:14 - Integration with EMR

20:31 - Legal Considerations with AI Technology

26:34 - Cost Implications of AI Scribes

38:46 - Future of AI in Medical Diagnosis

41:45 - Conclusion and Final Thoughts

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RESOURCES

ScribeMD.ai

https://www.scribemd.ai/