BackTable Vascular & Interventional

Is the open thoracotomy becoming outdated as robotic surgery and advanced ablation techniques take center stage in lung cancer treatment? In the final discussion of the 2025 NSCLC Creator Weekend™ series, our virtual tumor board of interventional radiologists and pulmonologists from leading medical institutions discuss recent surgical and interventional advancements in the treatment of lung cancer.

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This podcast is supported by an educational grant from Johnson & Johnson and Varian.

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SYNPOSIS

The conversation covers the contemporary role of PET scans, endobronchial ultrasound (EBUS), mediastinal staging, and the importance of perioperative systemic therapy. The doctors explore surgical and non-surgical methods for treating lung cancer, including lymph node dissection, criteria for resection, and the advantages of minimally invasive approaches such as video-assisted thoracoscopic surgery (VATS) and robotic-assisted surgeries.
A key focus of this episode is the decision-making process for treating multifocal lung cancers while preserving lung function, and the use of combined therapies like ablation and radiation. The episode concludes with a detailed case study illustrating the long-term management of a patient with multiple lung adenocarcinomas over several years, highlighting the multidisciplinary approach required in such complex scenarios.

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TIMESTAMPS

00:00 - Introduction
10:07 - Patient Selection and Comorbid Conditions
27:29 - Surgical Margins and Resection Strategies
42:11 - Understanding Upstaging in Cancer Treatment
53:27 - Technical and Clinical Resectability
56:13 - Case Study: Managing Multifocal Lung Cancer
01:11:41 - Long-Term Outcomes and Treatment Strategies

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RESOURCES

CALGB 140503 Trial
https://www.nejm.org/doi/full/10.1056/NEJMoa2212083

JCOG0802 Trial
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)02333-3/abstract

A negative angiogram in a patient with recurrent lower GI bleeding often calls for provocative angiography. In this episode of the BackTable Podcast, IR hosts Mike Barraza and Sabeen Dhand team up to talk tools, techniques, and tPA dosing for safe and effective treatment of lower GI bleeds with provocative mesenteric angiography.
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This podcast is supported by:
RADPAD® Radiation Protection
https://www.radpad.com/
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SYNPOSIS
Dr. Dhand describes the utility of provocative angiography in recurrent lower GI bleed patients with negative CTA and angiography, addressing common myths and concerns that may contribute to its underutilization. The conversation covers detailed procedure steps for both targeted and untargeted angiography, including access sites, dosing of tPA, and angiographic technique. Dr. Dhand emphasizes the importance of gradual increases in tPA dosage in 2 mg increments, and clear communication with care teams and the patient about the nature of the procedure. He also emphasizes the effectiveness and safety of this procedure by sharing real-world cases.
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TIMESTAMPS
00:00 - Introduction
02:04 - Provocative Angiography for Lower GI Bleeds
04:09 - Detailed Protocol for Provocative Angiography
11:13 - Technical Details and Best Practices
20:07 - Challenges in GI Bleeding Studies
22:40 - Selective Embolization Techniques
27:44 - Handling Negative Angiograms
32:56 - Real-World Case Studies
35:15 - Final Thoughts
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RESOURCES
Thiry et al. Provocative Mesenteric Angiography: Outcomes and Standardized Protocol for Management of Recurrent Lower Gastrointestinal Hemorrhage
https://pubmed.ncbi.nlm.nih.gov/34506023/

Why might simultaneous ablation and biopsy be the new standard for high-probability lung cancer cases where surgery isn’t an option? In the penultimate episode of the 2025 NSCLC Creator Weekend™ series, our multidisciplinary tumor board panel discusses the intricacies and decision-making processes surrounding biopsy and ablation procedures in thoracic oncology.

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This podcast is supported by an educational grant from Johnson & Johnson and Varian.

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SYNPOSIS

Topics include the prioritization of treatment versus tissue acquisition, the nuances of bronchoscopic versus percutaneous biopsies, and the latest advancements in robotic and cryo-biopsy techniques. The experts also share their approaches to managing pneumothorax, the value of multidisciplinary collaboration, and case studies that highlight personalized patient care. Listeners gain valuable insights into the evolving landscape of thoracic oncology procedures and the importance of patient-centered decision-making.

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TIMESTAMPS

00:00 - Introduction
04:12 - Cryobiopy vs. Non-Cryobiopsy
08:43 - Biopsy and Ablation: Strategies and Considerations
15:31 - Post-Therapy Imaging and Follow-Up
25:18 - Treatment Options and Patient Decisions
27:08 - Evaluating Ablation Techniques
28:59 - Managing Lung Cancer Recurrence
39:41 - Case Study: Young Male with Ground Glass Nodule
43:15 - Concluding Thoughts

What considerations drive your decision between bland embolization, TACE, and radioembolization in managing neuroendocrine tumors? In this BackTable episode, Dr. Daniel DePietro, interventional radiologist at the University of Pennsylvania joins host Dr. Kavi Krishnasamy for an in-depth discussion on the interventional management of neuroendocrine tumors.

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SYNPOSIS

The physicians start by discussing the intricacies of primary and metastatic neuroendocrine tumors, focusing on how treatment decisions are shaped by factors such as symptom burden, extent of disease requiring debulking, and symptom progression despite systemic therapy. Dr. DePietro shares insights from his clinical experience and emphasizes the critical role of interdisciplinary collaboration in optimizing patient outcomes.

Dr. DePietro then shares his approach to using Y90 radioembolization in patients with biliary contraindications to TACE or bland embolization—such as those with prior Whipple surgery, sphincterotomy, or biliary stents—where the risk of hepatic abscess with ischemia-based therapies is higher. He also notes that patients who derive less than a year of benefit from prior TACE or bland embolization may be good candidates for radioembolization.

The conversation also covers the role of thermal ablation in select patients with solitary lesions, and also touches on several key trials, including the ongoing CapTemY90 study.

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00:00 - Introduction
02:09 - Specialization in Neuroendocrine Tumors
06:32 - Patient Selection and Treatment Criteria
10:40 - Grading and Treatment of Neuroendocrine Tumors
16:09 - Systemic Therapy Options
22:22 - Rebiopsy and Its Importance
28:01 - Technical Aspects of Local Regional Therapies
39:14 - Radioembolization: When and How
43:33 - Segmentectomy and Multimodal Approaches
45:22 - CapTemY90 Trial and Promising Results
49:52 - Hormone Release During Local Regional Therapies
53:12 - Combining Radioembolization with PRT
56:12 - Thermal Ablation in Neuroendocrine Tumor Patients
58:06 - Follow-Up Imaging and Tumor Markers
01:02:40 - Updates from Nanets Conference
01:05:08 - Collaborating Across Specialties
01:07:56 - Managing High Tumor Burden Patients
01:13:59 - Treating Carcinoid Heart Disease
01:19:37 - Closing Remarks and Acknowledgments

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RESOURCES

NETTER-1 Trial
https://www.nejm.org/doi/full/10.1056/NEJMoa1607427

REMINET Trial
https://ascopubs.org/doi/10.1200/JCO.2016.34.15_suppl.TPS4148

CapTemY90 Trial
https://www.clinicaltrials.gov/study/NCT04339036#contacts-and-locations

The ultimate challenge of operating an OBL is staying profitable. In this episode of BackTable, we bring on healthcare administrator Laurie Bouzarelos and interventional radiologist Dr. Mary Costantino to talk through the intricacies of revenue cycle management as an IR managing an OBL.

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SYNPOSIS

The conversation covers the full lifecycle of getting paid in an IR practice, from initial patient contact through final claim resolution. Key topics include credentialing, determining medical necessity, coordination of benefits, prior authorizations, and the importance of working with billing and practice management teams experienced in interventional radiology. The episode also examines how EHR and practice management platform selection impacts clinical workflows and reimbursement, and closes with a discussion on payment plans and how emerging technologies, including AI, may shape the future of revenue management in IR-led OBLs.

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TIMESTAMPS

00:00 - Introduction
01:08 - The Importance of Revenue Cycle Management
09:29 - The No Surprises Act and Data Transparency
12:03 - Professional Societies and Continuing Education
17:50 - Credentialing and Taxonomy Codes
40:28 - Impact of Insurance Credentialing on Patient Care
42:08 - Revenue Cycle Management Walkthrough
48:18 - Challenges with Medicare Advantage and Coordination of Benefits
54:20 - Covered vs. Non-Covered Services
59:03 - Medical Necessity and Insurance Policies
01:01:04 - Prior Authorization and Payment Issues
01:13:11 - Payment Plans and Compliance
01:23:10 - Practice Management Software
01:31:10 - AI in Healthcare and Compliance
01:38:57 - Final Thoughts

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RESOURCES

Medical Group Management Administration (MGMA)
https://www.mgma.com/

OpenEvidence was founded in 2022. In just 3 short years, it has become a household name amongst aspiring and established healthcare providers. AI-based tools are now being used to augment workflows, improve productivity, streamline busy work, and assist with clinical decision making. Is AI coming for our jobs? Time will tell. But in the meantime, you can (and probably should) use it to enhance yours. In this episode of BackTable, computer scientist and interventional radiologist Dr. Emil Cohen joins Dr. Chris Beck to share how he’s integrated AI tools into his IR practice.

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SYNPOSIS

Dr. Cohen and Dr. Beck discuss both the advantages and key limitations of AI resources and tools like OpenEvidence and ChatGPT. They also explore application of AI in daily workflows, structured reports, procedural guidance, and predicting outcomes. Dr. Cohen dives into integrating AI to solve clinical problems and enhance existing technology, such as maskless subtraction angiography and rotational cone beam CT. Finally, Dr. Cohen speaks on the claim of AI replacing interventional radiology, informing those that are nervous about artificial intelligence.

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TIMESTAMPS

00:00 - Introduction
05:09 - Computer Science and Medicine
09:37 - AI Fundamentals for IRs
17:59 - Practical Applications of AI in IR
28:14 - The Value and Risks of Patient Data
31:22 - Developing Advanced Imaging Techniques
34:16 - Maskless Subtraction Angiography
40:29 - AI in Clinical Problem Solving
45:55 - The Future of AI in IR
49:51 - Getting Involved with AI and Volunteering
53:01 - Final Thoughts and Resources

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RESOURCES

No Mask Subtraction with AI:
https://www.smartangio.com/bone_subtraction/

Collaboration between interventional radiology and radiation oncology has enabled high-dose brachytherapy in central lung lesions that were previously untreatable. This episode of the 2025 NSCLC Creator Weekend™ series offers a deep dive into recent advancements in lung ablation and brachytherapy techniques for primary lung cancer.

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This podcast is supported by an educational grant from Johnson & Johnson and Varian.

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SYNPOSIS

Key discussion points include ablation zone sizes, confirmation methods for effective treatment, and the integration of different modalities such as microwave and cryoablation. Our tumor board panel also explores the practical and logistic challenges of implementing high-dose brachytherapy, especially for central lesions, and its role in palliative care. Despite the intricate processes and potential complications like pneumothorax, these methods show promising local control rates and provide crucial options for non-operative candidates.

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TIMESTAMPS

00:00 - Introduction and Overview of Lung Ablation
07:01 - Microwave Ablation and Ground Glass Attenuation
17:53 - Artificial Pneumothorax Techniques
27:09 - Technical Aspects and Innovations
32:35 - Bronchial Brachytherapy Techniques
37:47 - Conclusion and Credits

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RESOURCES

2021 Central Lesion Study
https://pmc.ncbi.nlm.nih.gov/articles/PMC8186067/

How is genicular artery embolization reshaping our clinical approach to patients with chronic knee pain? Dr. Rachel Piechowiak and Dr. Faraz Khan, interventional radiologists at IR Centers join Dr. Don Garbett in a deep dive into the current state of Genicular Artery Embolization (GAE).

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SYNPOSIS

Dr. Piechowiak and Dr. Khan provide a deep dive on the technical nuances of GAE, covering patient selection, access strategies, and key procedural techniques. The conversation also details complex case scenarios and how to tailor catheters and embolics to navigate challenging anatomy. The doctors then share their structured approach to post-procedure follow-up, underscoring the importance of setting realistic treatment expectations with patients. The episode closes with their perspective on the future of genicular artery embolization, emphasizing the need for robust long-term outcomes data to better define the role of GAE in chronic knee pain management.

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TIMESTAMPS

00:00 - Introduction
05:54 - Patient Workup for GAE
10:42 - Setting Patient Expectations for GAE
16:24 - Procedure Approaches and Techniques
30:41 - Understanding Artery Targeting Strategies
34:56 - Approaches to Microcatheter Selection
38:18 - Choosing the Right Embolic Agents
47:43 - Managing Complications and Follow-Ups
51:23 - Challenges with Post-TKA Patients
54:16 - Future Directions

Why might the standard RECIST criteria fail to accurately track success after tumor ablation, and what should you look for instead? In the 4th installment of the 2025 NSCLC Creator Weekend™ series, hosts Drs. Scott Genshaft and Kavi Krishnasamy are joined by specialists from UCLA and USC to discuss and debate advanced treatment options for primary lung cancer.

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This podcast is supported by an educational grant from Johnson & Johnson and Varian.

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SYNPOSIS

The panel, including interventional radiologists, pulmonologists, and a radiation oncologist, discusses the intricacies of photon versus proton therapies, the physics behind radiation treatment, and the evolving landscape of ablation technologies. The conversation covers the efficacy and limitations of different treatments, patient selection criteria, and the role of newer technologies like electroporation and robotic-assisted bronchoscopy in enhancing precision and outcomes. Additionally, the panel addresses the practical challenges of intraprocedural imaging, the importance of adequate margins, and the complexities of managing local recurrences and radiation-induced toxicities.

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TIMESTAMPS

00:00 - Tumor Ablation and Recurrence Rates
12:53 - Advancements in Ablation Technologies
23:31 - Bronchoscopic Approaches in Lung Cancer Treatment
38:46 - Challenges in Radiation Dose and Delivery
49:21 - Ablation and Radiation Margins
01:07:19 - Final Thoughts

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RESOURCES

Thierry de Baere Paper on Ablation Margins https://pmc.ncbi.nlm.nih.gov/articles/PMC9815739/

Pseudoaneurysms are among the most common complications of vascular access. Here’s a refresher on how to treat them with thrombin injection featuring interventional radiologist Dr. Gabriel Werder from Radiology Associates of Florida. Alongside host Dr. Chris Beck, Dr. Werder outlines both the clinical and procedural approach to thrombin injection for pseudoaneurysms.

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SYNPOSIS

This episode covers best practices for thrombin injection procedures, including preferred needle positioning techniques, sedation protocols, ultrasound evaluation, and follow-up care. The physicians discuss recent evidence supporting needle placement at the center of the sac from an inferior approach, and share specific cases that highlight the utility of balloon-assisted thrombin injections. Dr. Werder provides a detailed walkthrough of his technique, including contralateral femoral access, balloon oversizing, and preferences for a post-procedural run-off angiogram. The episode also touches on complex pseudoaneurysms with multiple sacs and learnings from several other unique cases.

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TIMESTAMPS

00:00 - Introduction
03:53 - Thrombin Injection Procedural Overview
08:14 - Procedure Setup and Execution
16:13 - Needle Positioning and Ultrasound Evaluation
18:47 - Handling Complex Pseudoaneurysms
19:20 - Balloon Occlusion Thrombin Injection
19:59 - Case Studies and Practical Insights
26:21 - Post-Procedure Care and Follow-Up
29:17 - Final Thoughts and Reflections

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RESOURCES

Kim et al. “Optimal thrombin injection method for the treatment of femoral artery pseudoaneurysm” - https://www.jthjournal.org/article/S1538-7836(24)00048-5/fulltext