BackTable Vascular & Interventional

As new calcium-modifying technologies expand the repertoire of below-the-knee (BTK) arterial disease interventions, how should your treatment algorithm evolve, and what endpoints matter most? In this episode of the BackTable Podcast, Dr. Constantino Peña of the Baptist Health Miami Cardiac and Vascular Institute joins Dr. Sabeen Dhand to discuss the latest advancements in BTK chronic limb-threatening ischemia (CLTI) therapies and the push to improve on current vessel preparation outcomes.

---

This podcast is supported by:

Shockwave Medical
https://shockwavemedical.com/

---

SYNPOSIS

The physicians discuss the evolution of tibial arterial therapies, the challenges presented by heavily calcified lesions, and the impact of new tools, particularly the Shockwave E8 intravascular lithotripsy (IVL) device, on procedural considerations and endpoints. Dr. Peña shares his treatment algorithms and offers practical advice on selecting the right tools for each unique case. The episode closes with speculation on the future of treatment options and technologies for BTK disease, and the growing need for robust data to guide patient-specific treatment.

---

TIMESTAMPS

00:00 - Introduction
02:11 - Understanding Tibial Disease and Treatment Evolution
07:22 - Advancements in Tibial Disease Treatment and the Role of IVL
15:31 - Techniques for Effective IVL Sizing and Usage
21:28 - Challenges and Innovations in Tibial Disease Management
26:48 - Innovations in Stent Technology
30:43 - Combining IVL with Adjunct Therapies
32:13 - Addressing Misconceptions in Tibial Treatment
37:54 - Advancements in Intravascular Lithotripsy
40:59 - Future of Vascular Treatments
43:42 - Final Thoughts

Have you ever wondered what it was like to be in the room when the first pelvic embolization was performed or how the TIPS procedure was pioneered? Dr. Ernie Ring, a legendary figure from UCSF and a true forefather of Interventional Radiology, joins host Dr. Peder Horner to recount the early days of the specialty. Dr. Ring shares fascinating stories from his training at Massachusetts General Hospital under Dr. Stanley Baum, where he witnessed the birth of transformative techniques using angiographic catheters to treat life-threatening bleeding.

---

SYNPOSIS

From improvising the use of autologous blood clot and thrombin to stop massive hemorrhages to his pivotal role in developing the TIPS procedure and specialized biliary catheters, Dr. Ring’s career is loaded with innovation. The conversation explores the "cowboy" era of IR, the evolution of essential tools like the glide wire, and the critical importance of maintaining a "high-touch" clinical practice in the face of emerging technologies like AI. Dr. Ring also reflects on his later transition into hospital leadership as Chief Medical Officer, where he applied his problem-solving mindset to institutional quality and safety.

---

TIMESTAMPS

00:00 - Introduction
01:58 - Upbringing from Detroit to Mass Gen
06:55 - Early IR with an Embo Case
13:50 - Trailblazing Cases in IR
16:17 - Penn and Innovation
20:00 - Polarizing Procedures
24:13 - IR Device Innovation
33:00 - Dotter’s Separation from Diagnostics
37:30 - Fear Finds Cowboys
39:08 - AI and Robotics
40:08 - Fun Hobbies

You’re about to biopsy a renal lesion; should you ablate at the same time? In this episode of the BackTable Podcast, host Michael Barraza talks with Dr. Steven Huang from MD Anderson Cancer Center about building an efficient and effective renal biopsy and ablation service line.

---

This podcast is supported by:

Varian IntelliBlate
https://www.varian.com/products/interventional-solutions/microwave-ablation-solutions

---

SYNPOSIS

Dr. Huang first covers referral patterns and the typical pathway that patients take to end up in his clinic. The discussion covers the types of lesions he treats, imaging requirements, and criteria for patient eligibility. He emphasizes the importance of shared decision making when deciding between active surveillance, interventional treatment, and partial nephrectomy. Dr. Huang explains his preferred procedural approach and ablation modalities, including cryo, microwave (MWA), and radiofrequency ablation (RFA). He shares his experiences with challenging cases and integrating new technologies like histotripsy and the Siemens interventional package. They also discuss the possibility of a preoperative embolization for larger lesions that could be susceptible to the heat sink effect. Both experts emphasize the importance of collaboration with urologists and ensuring patient safety and expectations. They also touch on the future of the field, discussing the use of AI and robotics.

---

TIMESTAMPS

00:00 - Introduction
02:17 - Training Programs at MD Anderson
03:23 - Referral Patterns for Renal Ablations
07:25 - Patient Management and Virtual Consultations
10:59 - Ablation Techniques and Device Selection
26:44 - Challenges and Complications
27:25 - Approach to Lesions Near Renal Vasculature
28:02 - Patient Expectations and Urologist Collaboration
33:26 - Post-Procedure Care and Patient Recovery
35:30 - Managing Recurrences and Multiple RCCs
47:17 - Closing Remarks

What does day-to-day interventional radiology look like in the military? Here’s a firsthand account. Dr. John York, interventional radiologist at University of California San Diego with 37 years of active duty in the Navy joins host Dr. Ally Baheti to share his experiences and perspectives on being an interventional radiologist in the military.

---

SYNPOSIS

Dr. York recounts his path to the military and how it ultimately led him to interventional radiology. He reflects on his deployments to Afghanistan and Djibouti, highlighting the clinical complexity, operational challenges, and fulfilling aspects of delivering image-guided care in high-acuity environments. Dr. York recounts several remarkable cases from his deployments, including the management of a vertebral artery aneurysm. He underscores how strong foundational training enables creative problem-solving in resource-limited settings.

Dr. York also shares his experience as senior medical officer on the USS Theodore Roosevelt during the initial COVID-19 outbreak, offering insight into the clinical, operational, and administrative challenges he faced. He highlights how adaptability and creative problem-solving are essential to managing complex cases in dynamic environments.

---

TIMESTAMPS

00:00 - Introduction
02:53 - Journey to Medicine: From Naval Academy to Medical School
05:55 - Choosing Interventional Radiology
08:11 - Military Medical Experience: Portsmouth and Beyond
11:38 - First Deployment: Challenges and Adaptations
14:38 - Case Studies: Trauma and Innovation in Afghanistan
26:15 - A Unique Procedure in a Combat Zone
28:49 - Transitioning Back to Civilian Life
31:07 - Challenges in Combat Zones
34:22 - Deployment in Djibouti
38:25 - COVID-19 on the USS Theodore Roosevelt
45:50 - Reflections on Military Service

Are balloon occlusion microcatheters your new best friend for prostate artery embolization (PAE)? In this episode of BackTable, Dr. Raj Ayyagari, interventional radiologist at Boston Medical Center, joins Dr. Ally Baheti to tackle complex clinical and technical challenges in PAE.

---

This podcast is supported by an educational grant from Guerbet.

---

SYNPOSIS

Dr. Ayyagari shares his unique journey from urology to interventional radiology and his experience building successful PAE service lines at multiple institutions. He walks through a series of challenging cases involving intraprostatic penile arteries, perivesicular collaterals, and internal pudendal collaterals used to treat bilateral hemi-prostates. The discussion highlights the role of balloon occlusion microcatheters such as the Sniper, his transition from 100–300 micron particles to glue embolization, and scenarios where coil protection is essential to prevent nontarget embolization. He also covers post-procedural management, the importance of setting expectations around suprapubic tube removal, and why thorough patient and provider counseling is critical for optimal care.

---

TIMESTAMPS

00:00 - Introduction
02:14 - Building a Practice in Prostate Artery Embolization
08:19 - Case Studies and Techniques in Prostate Artery Embolization
23:16 - Challenges in Embolization Techniques
23:47 - Step-by-Step Guide to Embolizing a Hemi Prostate
25:24 - Choosing the Right Beads for Embolization
29:10 - Transitioning to Liquid Embolics
35:38 - Setting Patient Expectations and Pre-Procedure Evaluation
40:17 - Post-Procedure Care and Medications
44:06 - Conclusion and Final Thoughts

Have you ever considered taking a sabbatical to practice Interventional Radiology in the Middle East? In this episode, Dr. Jamal AlKoteesh, the Chairman of Clinical Imaging at SEHA and the "Godfather of IR" in the United Arab Emirates, joins host Dr. Sabeen Dhand to discuss the rapid evolution and current state of IR in the Gulf region.

---

SYNPOSIS

Dr. AlKoteesh shares his journey from training in the UK to establishing the IR specialty in Abu Dhabi over the last 18 years. He details the unique practice environment in UAE government hospitals, where the lack of strict sub-specialization requires IRs to maintain a versatile skillset—handling everything from thyroid FNAs and UFE to complex neurovascular thrombectomies.

The conversation highlights the significant government investment in healthcare technology, which allows physicians access to the latest tools—such as the Siemens Artis Icono with integrated RapidAI for stroke—often before they are widely available in other markets. Dr. AlKoteesh also provides a practical guide for US physicians interested in working abroad, covering the licensing timeline, tax-free income, and the high demand for Western-trained physicians.

---

TIMESTAMPS

00:00 - Introduction
01:39 - Building IR in UAE
05:23 - UAE Healthcare System Overview
07:54 - IR Residency and Staffing
13:15 - Access to Latest Devices
15:15 - Compensation and Lifestyle
17:58 - PAIRS Conference Overview
20:45 - Licensing and Relocation Guide
21:39 - Liability and Language Barriers
26:33 - Launching Stroke Interventions

Patient access to interventional radiology services remains highly variable worldwide, reflecting global differences in training opportunities and infrastructure. Drawing on responses from more than 1,260 interventional radiologists worldwide, Dr. Justin Guan and Dr. Constantinos Sofocleous unpack the findings of a large international survey, highlighting where IR is advancing, where it remains fragmented, and what the data suggest about the future direction of the specialty.

---

SYNPOSIS

Key points of the episode involve the collaborative efforts put into this survey, how data was collected, and major findings from the respondents. These findings involve challenges with IR training, the significance of public awareness, and the need for standardized training programs. The discussion also covers the efforts required to promote IR globally, especially at global summits, and the potential steps to address these findings. Finally, the episode highlights the importance of developing region-specific programs and the ongoing efforts to elevate IR practices worldwide.

---

TIMESTAMPS

00:00 - Introduction
01:57 - Global IR Network and Survey Introduction
10:30 - Survey Insights and Results
19:26 - Challenges in IR Training and Awareness
23:33 - Future Directions and Initiatives
36:06 - Conclusion and Final Thoughts

---

RESOURCES

Results of a Global Survey on the State of Interventional Radiology 2024: https://pubmed.ncbi.nlm.nih.gov/39793699/

Are you getting paid for the work you do? In this episode of the BackTable Podcast, interventional radiology coding expert Dr. David Zielske joins host Dr. Ally Baheti to share practical tips for billing and coding in interventional radiology, focusing on accurate, efficient, and compliant revenue capture.

---

SYNPOSIS

Dr. Zielske shares his path to becoming a coding expert, highlighting why precise documentation is essential to accurate medical billing. Drawing from personal experience, he breaks down the most common coding pitfalls physicians face and how to avoid them. He highlights the importance of early training in coding and billing during residency and fellowship, reviews key coding updates effective January 2026, and offers guidance on modifier usage.

---

TIMESTAMPS

00:00 - Introduction
01:34 - The Importance of Accurate Coding and Documentation
04:03 - Common Coding Errors and Compliance Issues
07:09 - Detailed Coding Guidelines and Best Practices
26:20 - Modifiers and Their Proper Use
33:53 - Interventional Radiology vs Diagnostic Radiology
35:18 - Discussing ENM Billing and Procedural Focus
35:45 - Commonly Missed Codes in Dialysis Circuit Interventions
37:04 - Balloon Fibrin Sheath Disruption and Thrombectomy
37:51 - Importance of Accurate Documentation for Vascular Access
40:55 - Moderate Sedation and Ultrasound Guidance
42:33 - Selective Imaging and Urinary Access Coding
44:48 - Ablations and Biopsies: Guidance and Coding
46:53 - Drainages and Intravascular Lithotripsy
50:19 - 2026 Coding Changes and Physician Documentation
01:00:29 - Resources and Education for Physicians

The modes and methods of medical education have changed drastically in the past decade. Social media, podcasts (like this one), and other on-demand learning formats have fundamentally shifted how healthcare professionals stay up to date and advance their practice. So what’s next? Dr. Rusty Hofmann, former chief of interventional radiology at Stanford, current Chief of Industry Partnerships for Stanford Healthcare, and Medical Director of Cardiac and Interventional Services at Stanford, joins host Dr. Aaron Fritts to discuss how he’s redefining the future of personalized learning.

---

SYNPOSIS
Dr. Hofmann shares an update on his company, Grand Rounds—now called Included Health—a personalized healthcare platform delivering virtual primary and specialty care to millions of Americans. Dr. Hofmann reflects on the journey behind Included Health and introduces his latest venture, Wysdom, a next-generation learning platform reimagining medical education through short, TikTok-style videos created by clinicians, for clinicians. He dives into the innovation of building a peer-reviewed, clinician-driven video library centered on real-world clinical cases. He discusses both the challenges and transformative potential of technology in medical education, spanning learners from trainees to seasoned clinicians. The episode concludes with his perspective on what’s next—and where the company is ultimately headed.

---

TIMESTAMPS

00:00 - Introduction
03:23 - Grand Rounds and Included Health
05:29 - Challenges in Healthcare and Entrepreneurship
12:28 - The Evolution of Medical Education
16:37 - Creating and Sharing Medical Content
20:52 - Curation and Organization of Medical Content
27:41 - Morning Rounds: A Social Media Platform for Healthcare Professionals
30:08 - Educational Content and Industry Collaboration
35:08 - Creating Engaging and Practical Medical Videos
40:55 - The Future of Medical Education
48:18 - Final Thoughts and Reflections

---

RESOURCES

VI Episode 100
https://www.backtable.com/shows/vi/podcasts/100/why-dr-rusty-hofmann-built-an-innovative-digital-health-company

Wysdom Website
https://www.medicalwysdom.ai/home