Wysdom Radio™

In this episode, Dr. Kim Scherer, Assistant Professor of Radiology at Weill Cornell and Associate Program Director, shares her top five pieces of advice for navigating the challenges of an Interventional Radiology residency.

You Get Out What You Put In: Residency isn't medical school; there are no weekly tests. Success requires self-guided learning, reading every night, and showing up early to see as much as possible.

Find Balance: It’s a long six years. Decompressing with hobbies and building relationships with co-residents is vital for sustaining your energy.

Earning Autonomy: Don't expect full autonomy on day one. It is earned by mastering smaller cases first and proving you know your patients inside and out.

The Power of Kindness: IR is a team sport involving nurses, techs, and staff. Being nice isn't just polite; it's a requirement for high-quality patient care.

Stay Engaged: Don't drift away during your diagnostic years. Keep your foot in the door by joining research projects, attending social events, and dropping into the angio suite whenever possible.

Tune in for a roadmap to excelling in your training from a program director who’s been there.

This episode investigates the specific, aggressive liver injury that can follow Y-90 Radioembolization—Radioembolization-Induced Liver Disease (REILD)—defining it not as simple radiation necrosis, but as Hepatic Sinusoidal Obstruction Syndrome (SOS), essentially Veno-Occlusive Disease (VOD).

The Clinical Picture: We identify the hallmark presentation appearing 4-8 weeks post-procedure: significant jaundice (Bilirubin >3) and ascites in the absence of tumor progression.

The "Combined Insult" Theory: The discussion highlights that this injury is often synergistic, occurring when the liver is "primed" by prior systemic chemotherapy, making the tissue far more vulnerable to radiation.

The Safety Limit: We detail the critical safety threshold found in the literature: keeping the dose below 0.8 GBq per liter of targeted liver volume significantly drops the risk.

Protocol for Prevention: The episode outlines a proven modified protocol—including strict patient selection (Bilirubin <2), ursodiol/steroid prophylaxis, and a 2-month chemotherapy-free interval—that reduced the rate of severe toxicity from 13.3% down to 2.2%.

Rescue Therapy: We explore why TIPS is often considered for acute management to decompress the portal hypertension caused by the sinusoidal obstruction.

Tune in to learn the dosimetry limits and patient selection criteria that keep your Y-90 practice safe.

Based on comments from experts, content on Wysdom, and the articles cited below.

Ruutu T, Peczynski C, Houhou M, et al. Current incidence, severity, and management of veno-occlusive disease/sinusoidal obstruction syndrome in adult allogeneic HSCT recipients: an EBMT Transplant Complications Working Party study. Bone Marrow Transplant. 2023;58(11):1209-1214. doi:10.1038/s41409-023-02077-2

Sangro B, Gil-Alzugaray B, Rodriguez J, et al. Liver disease induced by radioembolization of liver tumors: description and possible risk factors. Cancer. 2008;112(7):1538-1546. doi:10.1002/cncr.23339

Gil-Alzugaray B, Chopitea A, Iñarrairaegui M, et al. Prognostic factors and prevention of radioembolization-induced liver disease. Hepatology. 2013;57(3):1078-1087. doi:10.1002/hep.26191

This episode provides a deep dive into the management of Acute Porto-Mesenteric Venous Thrombosis (PVT) in non-cirrhotic patients, a condition with a 30-day mortality rate of up to 32% if the clot extends into the mesenteric veins.

The Limitations of Meds: We discuss why systemic anticoagulation often fails, achieving complete recanalization in only 50% of patients due to the sheer volume of clot.

The "Hidden" Drivers: Learn why an exhaustive workup is mandatory, as up to 52% of these patients have an underlying prothrombotic disorder (like JAK2 mutations) alongside local inflammation.

Interventional Strategy: The conversation highlights the shift toward Mechanical Thrombectomy (MT) combined with Catheter-Directed Thrombolysis (CDT), which data shows can reduce the duration of dangerous thrombolytic infusion from 44 hours to just 22.7 hours.

Critical Safety Caveats: We cover the specific management of VITT (Vaccine-Induced Thrombotic Thrombocytopenia), where heparin is strictly contraindicated, and the three "red flags" (Lactate >2, Marshall score >2, Bowel dilation) that signal irreversible necrosis and the need for surgery.

Tune in to master the decision matrix for saving the bowel when medical therapy fails.

Based on comments from experts, content on Wysdom, and the article cited below.

Lorenz J, Kwak DH, Martin L, et al. Endovascular Management of Noncirrhotic Acute Portomesenteric Venous Thrombosis. J Vasc Interv Radiol. 2025;36(1):17-30. doi:10.1016/j.jvir.2024.09.023

This episode tackles one of the most frustrating clinical challenges in Interventional Radiology: the patient with a recurrent occult GI bleed who has failed endoscopy and standard imaging. We analyze the largest retrospective cohort study to date (22 years of data) on TPA-based Provocative Mesenteric Angiography (PMA) to determine when to use this aggressive diagnostic maneuver.

The Safety Surprise: Despite intentionally provoking bleeding with TPA and Nitroglycerin, the study revealed zero major bleeding adverse events, thanks to "first-pass hepatic metabolism" clearing the drugs before they hit the systemic circulation.

The "Secret Sauce" for Selection: We identify the two independent predictors that increase the odds of a positive study by nearly sevenfold:

Hematochezia (bright red/maroon stool).

A Prior Positive Radiologic Study (CTA or Tagged RBC), even if the bleed appeared to stop.

The Hard Stop: The data provides a clear exclusion criterion: zero patients with Melena (black tarry stool) and negative prior imaging had a positive PMA result, suggesting these procedures are likely futile.

Technical Mastery: Success relies on super-selectivity. Injecting from a distal, third-order vessel yielded a 63.6% positivity rate, compared to just 21.5% from a proximal injection.

Tune in to learn how to safely provoke the bleed on your terms and identify the source when all other methods fail.

Based on comments from experts, content on Wysdom, and the article cited below.

Benvenuti TA, Chisholm M, Cline B, et al. Provocative Mesenteric Angiography for Obscure Gastrointestinal Hemorrhage: An Update on Outcomes, Safety, and Predictors of Success. J Vasc Interv Radiol. 2025;36(10):1558-1566. doi:10.1016/j.jvir.2025.06.022

This episode uncovers the compelling evidence behind Intravascular Ultrasound (IVUS), a technology that is revolutionizing the treatment of Peripheral Artery Disease (PAD) by fixing the fundamental flaw of traditional angiography: its "2D shadow" limitation.

The Problem with Angiography: Standard X-ray imaging forces doctors to guess the size of 3D arteries from 2D pictures, leading to poor device sizing and missed complications like dissections.

The IVUS Advantage: IVUS provides a 360-degree blueprint from inside the artery, allowing for precise sizing and detection of calcified plaque that angiography misses.

Real-World Impact: A massive analysis of 500,000 patients showed that using IVUS is associated with a stunning 27% reduction in Major Adverse Limb Events (MALE) and a significant drop in major amputations.

The "Wow" Stat: In a randomized trial, IVUS findings forced doctors to change their treatment plan in nearly 79% of cases, proving that standard angiography leads to suboptimal decisions four out of five times.

Barriers to Use: Despite this data, IVUS is used in only ~12% of cases due to poor hospital reimbursement policies that penalize better care, highlighting a critical need for systemic reform.

Tune in to learn why IVUS isn't a luxury—it's a necessity for better outcomes and limb preservation.

Based on comments from experts, content on Wysdom, and the article cited below.

Secemsky EA, Aronow HD, Kwolek CJ, et al. Intravascular ultrasound use in peripheral arterial and deep venous interventions: multidisciplinary expert opinion from SCAI/AVF/AVLS/SIR/SVM/SVS. J Soc Cardiovasc Angiogr Interv. 2024;3(1):101205. doi:10.1016/j.jscai.2023.101205

This episode provides a rapid-fire masterclass on the four foundational tools of Interventional Radiology and how to navigate the complex sizing systems that dictate their use.

The Sizing Headache: We demystify the three conflicting measurement systems—Gauge, French, and Inches—that every interventionalist must juggle simultaneously.

Needles (The Gauge Paradox): We explain why lower numbers mean bigger needles (e.g., an 18-gauge is larger than a 21-gauge) and how to use the "Fit Rule" to match needles to wires (e.g., a 0.035" wire needs at least an 18-gauge needle).

Catheters vs. Sheaths (The French Confusion):

Catheters are measured in French by their Outer Diameter (OD), indicating the size of the hole needed in the vessel.

Sheaths are the critical exception; they are measured by Inner Diameter (ID), meaning a 6 French sheath is designed to fit a 6 French catheter inside it.

Safe Access Technique: We walk through the micropuncture exchange, a safety-first method that starts with a small 21-gauge needle and 0.018" wire to create a track before upgrading to standard 0.035" tools.

Tune in to master the essential "grammar" of IR tools for safer, more effective access. 

Based on comments from experts and content on Wysdom.

This episode moves beyond basic instrument knowledge to focus on the subtle physical habits and organizational tricks that distinguish expert operators from novices, aiming to maximize efficiency and safety.

Air Bubble Management: We review the three techniques for removing deadly air bubbles—inversion, flicking, and the "push-pull" vacuum method—and why you must always hold syringes horizontal or tip-up during injection.

Expert Grip: Learn why precise tools (scalpels) need a "pencil grip," while clamps should be "palmed" (avoiding the finger loops) to utilize the thenar eminence for instant 360-degree rotation.

Back Table Hygiene: We cover the cognitive-load-reducing rules of the back table: keeping sharps in the top left corner and ensuring the table stays strictly dry to maintain sterility.

Mastering Wires: We detail specific techniques for handling slippery hydrophilic wires—pinch with fingernails, not pads, keep them wet, and use the "J-tip trick" to straighten curves for easy loading.

Tune in to learn how standardizing these physical habits frees up your brain to focus on high-level clinical decisions.

Based on comments from experts and content on Wysdom.

This episode breaks down the mechanics of two foundational interventional skills—drainage catheter deployment and arterial compression—where proper technique is the only line of defense against complications.

The Pigtail Mechanism: We explain how the "locking loop" secures the catheter to prevent migration and the critical deployment rule: hold the internal stiffener stationary while pushing the catheter off it to ensure it curls correctly inside the fluid collection.

The Anatomy of a Stick: Effective hemostasis requires understanding that the hole in the artery is superior (higher) and deeper than the hole in the skin due to the angle of entry.

Common Pressure Mistakes: Most failures happen because operators press too low (at the skin incision) rather than at the actual arterial puncture site.

The 10-Minute Rule: We detail the strict protocol for manual compression: 10 minutes of consistent pressure followed by a crucial 5-minute weaning period to ensure the clot holds.

Tune in to master the "simple" mechanics that keep patients safe.

Based on comments from experts and content on Wysdom.

This episode is a complete introduction to IVC filters, designed for the IR trainee. We cover all the essentials you need to know from the initial consult to long-term follow-up.

What you'll learn:

What if chronic joint pain from osteoarthritis and tendinopathy isn't just "wear and tear"?

This episode explores the cutting-edge, minimally invasive world of Musculoskeletal Embolization.

Discover the science behind how this procedure targets abnormal blood vessels (angiogenesis) and nerves that contribute to chronic pain.

Tune in to learn about:

This is an essential listen for anyone interested in safe and effective new options for managing musculoskeletal pain and improving quality of life.