BackTable Vascular & Interventional

Can the right dosimetry approach turn palliative Y90 into a curative therapy? In this episode of the BackTable 2026 HCC Creator Weekend™, Interventional oncologists Dr. Riad Salem, Dr. Nima Kokabi, and Dr. Zach Berman examine modern Y90 dosimetry, from the decline of body-surface-area calculations to newer strategies that tailor treatment intensity to tumor burden, liver reserve, and clinical intent.

---

Get the BackTable app
https://www.backtable.com/app

---

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

---

Timestamps

00:00 - Introduction
03:16 - MIRD and Dosing Considerations
06:20 - BSA Is Dead
09:26 - Early Stage Segmentectomy
13:04 - Sphere Density Questions
18:12 - CPN as the Goal
18:41 - BCLC B Multifocal Strategy
22:56 - Radiation Lobectomy Explained
25:49 - Surgery and Adhesions
28:59 - Advanced PVT Patients
30:22 - Dosisphere and Biomarkers
34:29 - Wrap Up

---

More about this episode

The doctors discuss how to choose how much radiation treatment to give and why “activity” (what you order) is different from “dose” (what tissue receives). The episode goes on to compare one-area calculations with more nuanced methods that distinguish tumor from healthy tissue, and explains why advanced 3D planning is often simpler after treatment than before. The discussion also covers treatment goals for various clinical scenarios, such as when to aim for complete ablation versus palliation, managing radiation lobectomy, and tailoring therapy in cases with portal vein tumor thrombus. The episode concludes with insights on how imaging informs treatment intensity and how local and systemic therapies work together in the latest Y90 approaches.

---

Resources

Combination treatment with transarterial chemoembolization, radiotherapy, and hyperthermia (CERT) for hepatocellular carcinoma with portal vein tumor thrombosis: Final results of a prospective phase II trial
https://pmc.ncbi.nlm.nih.gov/articles/PMC5581058/

A global evaluation of advanced dosimetry in transarterial radioembolization of hepatocellular carcinoma with Yttrium-90: the TARGET study
https://pubmed.ncbi.nlm.nih.gov/35394152/

Y90 Radioembolization Significantly Prolongs Time to Progression Compared With Chemoembolization in Patients With Hepatocellular Carcinoma
https://pubmed.ncbi.nlm.nih.gov/27575820/

Long-Term Overall Survival After Selective Internal Radiation Therapy for Locally Advanced Hepatocellular Carcinomas: Updated Analysis of DOSISPHERE-01 Trial
https://jnm.snmjournals.org/content/early/2024/01/10/jnumed.123.266211

---

BackTable Vascular & Interventional (VI) is the go-to podcast for interventional radiologists, vascular surgeons, and interventional cardiologists.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

► https://www.backtable.com/app

How do you build a pipeline for passionate, well-prepared interventional radiologists from day one of med school? In this episode of the BackTable Podcast, Dr. Aaron Rohr, interventional radiologist and associate professor at the University of Kansas, joins guest host Dr. Jessica Yoon to discuss how IR is accessed, taught, and experienced by medical students throughout their early education.

---

Get the BackTable app
https://www.backtable.com/app

---

Timestamps

00:00 - Introduction
02:49 - Finding IR: Then and Now
06:54 - Challenges of Teaching IR in Core
10:07 - How IR Thinks Through Problems
14:40 - MAVIRIC Symposium
20:09 - Engaging Teaching Models
27:26 - Increasing Clinical Presence of IR
30:17 - Leadership in Educational Initiatives
35:57 - Reflections and Advice for Educators
39:15 - Final Thoughts and Closing Remarks

---

More about this episode

The physicians explore ways in which the transition from traditional fellowship models to integrated IR training pathways has increased the specialty’s visibility for early learners while also pointing out obstacles that continue to hinder greater integration of IR into the core medical curriculum. They discuss how IR’s involvement in diverse systems and disease processes offers valuable opportunities for comprehensive clinical learning, but simultaneously makes the specialty challenging for students with structured rotations to engage within a longitudinal fashion. Dr. Rohr goes on to highlight the Mid-America Vascular and Interventional Radiology Initiative Collegium (MAVIRIC), a student-led, faculty-supervised program hosted by KUMC that aims to introduce medical students to clinical, technical, and industry-related aspects of IR. He reflects on the effectiveness of hands-on interaction with devices and physicians’ demonstration of passion for their practice in piquing student interest. While acknowledging the burden of labor beyond work hours that such initiatives often demand of doctors and students alike, the physicians express their optimism for the growth of IR’s presence both in the hospital ecosystem and in the medical curriculum.

---

Resources

MAVIRIC
https://www.maviric.org/

---

BackTable Vascular & Interventional (VI) is the go-to podcast for interventional radiologists, vascular surgeons, and interventional cardiologists.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

► https://www.backtable.com/app

Pulmonary AVM may be rare, but missing them can lead to lifelong complications, especially in patients with hereditary hemorrhagic telangiectasia (HHT). How do you choose the right device and strategy to ensure long-term success with embolization? In this episode of the BackTable Podcast, host Dr. Kavi Krishnasamy is joined by Dr. Brian Funaki and Dr. Nima Kokabi to unpack the evolving treatment landscape for pulmonary arteriovenous malformations (PAVM). Through imaging breakdown, review of challenging real-world cases, and a discussion on advanced treatment strategies, the conversation tackles a key debate in pulmonary embolization: are plugs replacing coils as the new standard?

---

Get the BackTable app
https://www.backtable.com/app

---

This podcast is supported by

Okami
https://okamimedical.com/

---

Timestamps

00:00 - Introduction
01:43 - Defining HHT and PAVM
05:53 - Democratizing Interventions for HHT Patients
08:83 - Recommendations to Embolize PAVM
13:19 - Imaging Specificity and Procedural Preferences
23:29 - Persistence Rates with Plugs and Coils
25:59 - Lag in Utilization of Plugs
29:18 - Comparison of LOBO to Alternative Vascular Plugs
34:26 - Post Embolization Symptoms and Troubleshooting Methods
39:04 - PAVM Cases and Treatments
54:26 - Wrap Up and Credits

---

More about this episode

The discussion begins by defining HHT and PAVM, highlighting the risks associated with untreated PAVM and the critical need for genetic screening and multi-organ evaluation. Drs. Funaki and Kokabi review current treatment recommendations, surveillance imaging, and follow-up protocols, with special considerations for pediatric and high-risk patients. They explore practical tips for optimizing embolization performance, focusing on device selection and the evolving role of vascular plugs. By comparing different plug designs, such as wire count and pore size, and sharing lessons from challenging cases, including persistent lesions, tortuous anatomy, and pseudoaneurysm management, they provide advanced troubleshooting and decision-making strategies to achieve more durable, successful PAVM treatments.

---

BackTable Vascular & Interventional (VI) is the go-to podcast for interventional radiologists, vascular surgeons, and interventional cardiologists.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

► https://www.backtable.com/app

Why are some GJ tubes more prone to failure, and what can you actually do about it? In this episode of the BackTable Podcast, Dr. Chris Beck hosts Dr. Kevin Wong, a pediatric interventional radiologist at the University of South Alabama, to discuss the complexities of gastrojejunostomy (GJ) tube management in hospital-based IR, especially in pediatric patients. The discussion offers clinically relevant guidance on troubleshooting, device selection, and multidisciplinary approaches to enhance GJ tube care and improve patient outcomes.

---

Get the BackTable app
https://www.backtable.com/app

---

Timestamps

00:00 - Introduction
05:40 - Etiologies of GJ Tube Dislodgement and Placement Considerations
12:17 - Spiral Upsizing Solutions
14:30 - Parent Education Playbook
19:34 - Indications for GJ Conversion
21:55 - Criteria for GJ Removal
24:12 - Preferred Low-Profile Tube Designs
27:15 - Addressing Suboptimal Angles and Guidewire Selection
31:26 - Strategies to Prevent Tube Occlusion
33:34 - Wish List for Industry
36:12 - Balloon Assisted Placement Techniques
37:58 - Wrap Up and Credits

---

More about this episode

The doctors explore why GJ tubes fail and how to manage common complications, such as balloon failures, vomiting-induced dislodgement, stoma enlargement, and recurrent malfunction due to poor gastrostomy angle or architecture, often seen with surgically placed G-tubes. Dr. Wong shares prevention strategies, including parent education on balloon-volume checks and refills, sending patients home with a backup G-tube, minimizing upsizing, and addressing traction and granulation tissue (including the use of silver nitrate). He also covers approaches to clog management such as warm water, Coke, aggressive flushing, and avoiding routing medications through the G port. The episode wraps up with a discussion on device preferences (AMT G-JET versus MIC-KEY), tips for wire and catheter exchanges, and the need for industry improvements in materials and lumen design.

---

BackTable Vascular & Interventional (VI) is the go-to podcast for interventional radiologists, vascular surgeons, and interventional cardiologists.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

► https://www.backtable.com/app

A high-functioning HCC tumor board can turn complex transplant decisions into coordinated treatment plans that account for liver reserve, tumor biology, and evolving biomarkers. In this episode of the BackTable Podcast 2026 HCC Creator Weekend™, abdominal transplant surgeon Dr. Ari Cohen (Ochsner Health) and transplant hepatologist Dr. Neil Mehta (UCSF) join host Dr. Kavi Krishnasamy to map out strategies for effective multidisciplinary treatment and transplantation planning in HCC.

---

Get the BackTable app
https://www.backtable.com/app

---

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

---

Timestamps

00:00 - Introduction
00:51 - Starting a Tumor Board
06:39 - Building Referral Streams
09:03 - Academic and Community Practice Integration
14:31 - Treatment Selection Criteria
20:38 - Modern HCC Biomarkers
25:24 - Role of ctDNA and Biopsy
29:37 - Bridging Therapy on Transplant Waitlist
32:34 - Downstaging Strategy and Risks
39:25 - Final Thoughts and Closing Remarks

---

More about this episode

The physicians discuss what it takes to build a robust tumor board, from fostering hospital buy-in to engaging leaders across specialties and utilizing virtual formats for consistent participation. The conversation explores clinical decision-making, emphasizing the integration of AFP-L3 and DCP biomarkers alongside AFP to better understand tumor biology and predict post-transplant recurrence. Dr. Mehta and Dr. Cohen also share their patient selection criteria, discussing how bilirubin, liver disease etiology, and INR influence decisions. While radiographic guidance remains central to HCC management, they highlight the growing potential of reliable ctDNA analysis and other biomarkers. The specialists conclude by emphasizing that an integrated, communicative tumor board is the most effective way to navigate the nuances of liver reserve and HCC biology to achieve the best possible patient outcomes.

---

Resources

Sustained AFP-L3 or DCP expression is associated with progression risk and inferior outcomes in unresectable hepatocellular carcinoma.
https://doi.org/10.1007/s10238-025-01877-8

---

BackTable Vascular & Interventional (VI) is the go-to podcast for interventional radiologists, vascular surgeons, and interventional cardiologists.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

► https://www.backtable.com/app

Can arterial closure devices transform your OBL workflow and get patients moving sooner? In this episode of the BackTable Podcast, Dr. Mike Barraza sits down with Interventional Radiologist Dr. Dave Johnson to discuss the ins and outs of launching and running an office-based lab (OBL) in Florida. While covering startup logistics, staffing, regulatory requirements, and cost-saving strategies, the conversation centers on how the use of arterial closure devices can streamline workflow, speed post-procedure recovery, and enhance both efficiency and patient care in the OBL setting.

---

Get the BackTable app
https://www.backtable.com/app

---

Terumo
https://www.terumo.com/

---

Timestamps

00:00 - Introduction
01:31- Launching The OBL
04:41- Logistics And Staffing
07:14 - Standardizing Supplies
11:57 - OBL vs. Hospital Cases
15:30 - Patient Experience Benefits
17:41 - Efficiency And Throughput
20:49 - Closure Devices For Flow
23:28 - Early Ambulation With AngioSeal
26:14 - Anticoagulation Decisions
28:31 - AngioSeal Access Technique
30:20 - Avoiding Hostile CFA Access
32:19 - Choosing SFA or Radial
34:04 - Do You Need Groin Runs
36:14 - Closure Device Fundamentals
38:53 - Ultrasound Guided AngioSeal
45:11 - Post Op Monitoring Checklist

---

More about this episode

Dr. Johnson explains that some procedures, such as Prostate Artery Embolization (PAE), may still require a hospital setting due to insurance coverage, patient preference, or unique clinical needs. He compares patient experiences in OBLs versus hospitals, emphasizing the advantages of privacy, convenience, and personalized communication in the OBL environment. A major challenge discussed is managing post-procedure recovery and patient throughput with limited holding beds, where femoral arterial closure devices like Angio-Seal are essential for early ambulation and efficient turnover. The discussion highlights best practices for access site selection, ultrasound guidance, and post-closure assessment, providing actionable insights for IR physicians aiming to optimize office-based procedures.

---

Resources

Cost Comparison of Prostatic Artery Embolization Between In-Hospital and Outpatient-Based Lab Settings
https://pubmed.ncbi.nlm.nih.gov/39310461/

Prostate Artery Embolization: Indication, Technique and Clinical Results
https://pubmed.ncbi.nlm.nih.gov/29975976/

Ultrasound-guided angio-seal deployment
https://pubmed.ncbi.nlm.nih.gov/25735527/

---

BackTable Vascular & Interventional (VI) is the go-to podcast for interventional radiologists, vascular surgeons, and interventional cardiologists.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

► https://www.backtable.com/app

With recent updates to the Barcelona Clinic Liver Classification (BCLC), how should multidisciplinary teams adapt their treatment strategies to accommodate the newest evidence? In this episode of the BackTable Podcast 2026 HCC Creator Weekend™, Dr. Neil Mehta of UCSF and Dr. Riad Salem of Northwestern Medicine join host Dr. Tyler Sandow to explore the complexities of hepatocellular carcinoma (HCC) therapies and the practical application of the latest global algorithms in balancing standardized therapeutic algorithms with individual patient factors.

---

Get the BackTable app
https://www.backtable.com/app

---

Timestamps

00:00 - Introduction
01:54 - HCC Case Discussion
08:05 - Guest Introductions
10:37 - BCLC Committee and 2025 Update
15:54 - CUSE and Tumor Board Goals
17:46 - Bridging vs Curative Y90
22:37 - Patient Factors in Treatment Algorithms
26:41 - Liver Function and Hyperbilirubinemia Trends
30:25 - HCC Treatment Decision Ownership
34:36 - Radiation Segmentectomy vs Surgical Resection
37:35 - BCLC B Heterogeneity
41:51 - Improving HCC Risk Stratification
43:48 - Final Thoughts and Closing Remarks

---

More about this episode

The discussion begins with an inside look at the consensus process behind the 2025 BCLC updates, highlighting the official inclusion of Y90 radioembolization as a recognized therapeutic option. The experts introduce the "CUSE" (Complexity, Uncertainty, Subjectivity, and Emotion) framework to provide a structured approach to the subjective considerations that modulate purely data-based algorithms in multidisciplinary decision-making. Dr. Salem and Dr. Mehta speak on the nuances of surgical resection versus radiation segmentectomy in a case-based discussion, highlighting how factors such as portal hypertension, patient age, and etiology of cirrhosis should influence treatment pathways. Finally, they underscore the paradigm shift toward pursuing complete pathonecrosis (CPN) as a primary curative goal, regardless of bridging status, and reiterate that success in HCC care is driven by continuous communication and collaboration between physicians and patients.

---

Resources

BCLC 2026 Update
https://doi.org/10.1016/j.jhep.2025.10.020

---
BackTable Vascular & Interventional (VI) is the go-to podcast for interventional radiologists, vascular surgeons, and interventional cardiologists.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

► https://www.backtable.com/app

When a liver tumor is hard to see, the limits of conventional image guidance can become the limits of treatment. In this episode of the BackTable Podcast, Netherlands interventional oncologist Dr. Maarten (M.L.J.) Smits shares a step-by-step walkthrough of the new hepatic arteriography and C-arm CT–guided ablation (HepACAGA) technique, punctuated with a real-world case series at the end. Find out how intra-arterial contrast, cone-beam CT, and 3D needle guidance can improve tumor conspicuity, targeting accuracy, and ablation margin assessment within a single angiography suite.

---

Get the BackTable app
https://www.backtable.com/app

---

Timestamps

00:00 - Introduction
02:55 - Netherlands Tech Access
04:31 - Origin of HepACAGA
07:14 - Why Use a Catheter?
11:24 - Tools and Setup
13:13 - Catheters and Devices
17:06 - Contrast Protocol Basics
22:51 - Targeting and Needle Guidance
31:09 - Patient Selection
35:56 - Extra Benefits and Multimodal
39:58 - Workflow and Outcomes
46:14 - Evidence and Early Studies
51:41 - Rethinking Size Cutoffs
57:54 - HCC Case Walkthrough
01:02:27 - Hard-to-See Metastasis
01:06:22 - Margin Driven Reablation
01:11:04 - Bleeding and Embolization
01:16:05 - Renal ACAGA Expansion
01:23:31 - Adoption and Next Steps

---

More about this episode

Dr. Smits explains the origins of HepACAGA and why catheter-based contrast delivery can meaningfully change ablation planning, particularly for small lesions, poorly visualized tumors, and cases where ultrasound or conventional CT guidance may be insufficient. He walks through the practical setup, including catheter positioning, contrast dilution, timing protocols, needle navigation, apnea/end-expiration technique, and built-in fusion for immediate ablation verification. He also describes how the angio suite environment supports multimodal treatment, including intraprocedural embolization when bleeding occurs or when additional transarterial therapy is needed.

The episode also examines early outcomes from Dr. Smits’ group, including a reported reduction in local recurrence from approximately 25% to 5%, with a modest increase in procedure time. Case examples include HCC, small colorectal liver metastases, margin-driven re-ablation, hemorrhage management, and extension of the ACAGA concept to renal tumors (RenACAGA).

---

Resources

Hepatic Arteriography and C-Arm CT-Guided Ablation (HepACAGA) to Improve Tumor Visualization, Navigation and Margin Confirmation in Percutaneous Liver Tumor Ablation
https://pubmed.ncbi.nlm.nih.gov/37704863/

Renal Arteriography and C-arm CT-Guided Ablation (RenACAGA) for Thermal Ablation of Challenging Renal Tumors
https://pubmed.ncbi.nlm.nih.gov/40295401/

---

BackTable Vascular & Interventional (VI) is the go-to podcast for interventional radiologists, vascular surgeons, and interventional cardiologists.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

► https://www.backtable.com/app

Vascular trauma care looks a lot different when the OR is improvised, supplies are limited, and limb salvage decisions cannot wait. On this episode of the BackTable Podcast, host Dr. Sabeen Dhand interviews vascular surgeon Dr. Ahmad Hussain, a Southern California private-practice “hired gun” who volunteered on a WHO/UN-coordinated humanitarian mission to Gaza after an orthopedic colleague requested vascular surgeons due to widespread limb loss.

---

Get the BackTable app
https://www.backtable.com/app

---

Timestamps

00:00 - Introduction
04:02 - Why Volunteer In Gaza?
07:41 - Logistics and Crossing Into Gaza
10:45 - Hospital as Refugee Camp
13:34 - First Vascular Trauma Case
18:24 - Mass Casualty Triage
23:20 - Kids Guiding Doctors
27:09 - Evacuation Uncertainty
32:03 - Would You Go Back?
37:55 - How to Volunteer
39:30 - Show Wrap Up and Credits

---

More about this episode

Dr. Hussain describes entering through the Rafah border with suitcases of medical supplies, working in a hospital functioning as a refugee camp for tens of thousands, and treating shrapnel-related vascular trauma with limited imaging (mainly ultrasound and X-ray), scarce anesthesia, and minimal surgical resources, relying heavily on skilled local medical students and residents. He recounts mass-casualty triage, the emotional impact of caring for injured children, bonding with the children who assisted the volunteers, and the dangerous, militarized evacuation via Israel with U.S. embassy assistance. He says he wants to return, but notes tightened restrictions and dwindling aid, and he recommends other organizations, noting any specialty of medical professionals should consider volunteering.

---

Resources

Gift of Disability Alleviation (GODA)
https://indushospital.ca/appeal/gift-of-disability-alleviation-goda/

---

BackTable Vascular & Interventional (VI) is the go-to podcast for interventional radiologists, vascular surgeons, and interventional cardiologists.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

► https://www.backtable.com/app