In this episode, Dr. David Guez discusses the advancements in contrast enhanced ultrasound, its application in detecting endoleaks, and his journey of learning and applying this modality from residency to his current practice. Dr. Guez emphasizes ultrasound’s utility in lesion characterization, endoleak monitoring, and sparing patients from more invasive diagnostic procedures. The doctors delve into the specifics of using ultrasound contrast agents, particularly LUMASON and its intravascular utility for real-time monitoring of disease states with superior resolution compared to CT or MRI. Dr. Guez also discusses the potential for contrast enhanced ultrasound in interventional radiology, including diagnosing vascular lesions and augmenting tumor treatments. The conversation highlights the technique’s advantages, its high sensitivity for endoleaks, and potential areas for future research and application. The episode underscores the underutilized potential of contrast enhanced ultrasound in both diagnostic and interventional radiology settings. --- CHECK OUT OUR SPONSOR Reflow Medical https://www.reflowmedical.com/ --- SHOW NOTES 00:00 - Introduction 03:54 - Exploring the Basics of Contrast Enhanced Ultrasound 06:49 - Clinical Applications and Advantages of Contrast Enhanced Ultrasound 09:15 - Contrast Enhanced Ultrasound in Action: Diagnosing Endoleaks 23:52 - Future of Contrast Enhanced Ultrasound in Interventional Radiology 27:02 - Closing Thoughts --- RESOURCES Bracco LUMASON: https://lumason.com/ Nontraditional Uses of US Contrast Agents in Abdominal Imaging and Intervention: https://pubs.rsna.org/doi/full/10.1148/rg.220016 Book written by Andrej Lyshchik, MD, PhD (Thomas Jefferson) - Specialty Imaging: Fundamentals of CEUS: https://www.amazon.com/Specialty-Imaging-Fundamentals-Andrej-Lyshchik/dp/0323625649 Contrast-enhanced Ultrasound Identifies Patent Feeding Vessels in Transarterial Chemoembolization Patients With Residual Tumor Vascularity: https://pubmed.ncbi.nlm.nih.gov/32890324/ Contrast-enhanced ultrasound (CEUS) versus computed tomography angiography (CTA) in detection of endoleaks in post-EVAR patients. Are delayed type II endoleaks being missed? A systematic review and meta-analysis: https://pubmed.ncbi.nlm.nih.gov/26191109/

In this episode, guest host Dr. Krishna Mannava interviews Dr. Bob Tahara about the significant multilevel impacts, ripple effects, and fallout of cyberattacks on the healthcare industry, specifically covering the recent cyberattack that targeted major clearinghouse, Change Healthcare. Dr. Tahara is a vascular surgeon practicing in rural northwest Pennsylvania and President of Outpatient Endovascular Interventional Society (OEIS). Dr. Tahara shares his experiences as a solo vascular surgeon in rural Pennsylvania, highlighting the complexities of modern billing systems, the advantages of hiring a quality billing company, and the challenges posed by the consolidation of clearinghouses. The conversation also delves into the alarming ransomware attack on Change Healthcare, where 6 terabytes of patient data were compromised. This incident exposed vulnerabilities across the healthcare sector, from payment processes to electronic medical and prescription records. The doctors underscore the importance of cybersecurity preparedness, diversification of clearinghouses, and the role of physicians in advocating for more secure and efficient healthcare systems. They also touch on personal hobbies like Kendo to manage stress. --- CHECK OUT OUR SPONSOR Reflow Medical https://www.reflowmedical.com/ --- SHOW NOTES 00:00 - Introduction 02:02 - Cyberattack on Change Healthcare: An Overview 06:37 - Impact of the Cyberattack on Healthcare Practices 09:50 - Understanding Clearinghouses in Healthcare Billing 14:30 - Fallout from the Cyber Attack: A Personal Account 16:40 - Navigating the Aftermath: Strategies and Solutions 22:54 - Value of Medical Records and Cybersecurity Measures 29:18 - Action Items and Advocacy for Physicians 35:00 - OEIS 2024 Meeting and Final Thoughts --- RESOURCES OEIS Annual Meeting Schedule 2024: https://oeisweb.com/wp-content/uploads/2024/04/2024-AM-attendee-brochure-v4-FINAL-proof-lowres.pdf BackTable Episode 349 - Cybersecurity for Physicians with Jason Newton, Esq: https://www.backtable.com/shows/vi/podcasts/349/cybersecurity-for-physicians

In this episode, Dr. Omar Saleh and Dr. Mike Watts discuss the challenging aspects of vascular interventions in the OBL setting, focusing on ‘oh $#!%’ moments and how to address various complications. Both Dr. Saleh and Dr. Watts are vascular and interventional radiologist, practicing in Southern California and New Jersey, respectively. The doctors share specific, challenging cases they’ve encountered, including device malfunctions and unexpected outcomes during procedures. Additionally, Dr. Saleh and Dr. Watts discuss the advantages of having hybrid OBL and hospital practices, the importance of being prepared for complications by having the right tools and strategies at hand, and interdisciplinary collaboration. The conversation also touches on the value of certain devices and techniques in managing complications effectively and ensuring patient safety. --- CHECK OUT OUR SPONSOR RADPAD® Radiation Protection https://www.radpad.com/ --- SHOW NOTES 00:00 - Introduction 04:53 - Creative Solutions for Complex Vascular Cases 16:47 - Hybrid Practice: Balancing OBL and Hospital Work 21:39 - The Pros and Cons of Hybrid OBL-Hospital Practices 30:34 - Navigating Complex Medical Procedures 35:09 - Importance of Preparedness and Resourcefulness in Medical Emergencies 44:38 - Advice for Handling Complicated Medical Cases 49:26 - Concluding Thoughts and Looking Ahead to Future Conferences --- RESOURCES BackTable VI Episode 384 - New Innovations in Closure Devices with Dr. Omar Saleh and Dr. Syed Hussain: https://www.backtable.com/shows/vi/podcasts/384/new-innovations-in-closure-devices BackTable VI Episode 121 - Office-Based Labs (OBLs) & What You Can Do in Them with Dr. Mike Watts: https://www.backtable.com/shows/vi/podcasts/121/office-based-labs-obls-what-you-can-do-in-them BackTable VI Episode 37 - Treating PAD in the OBL with Dr. Mike Watts and Dr. Omar Saleh: https://www.backtable.com/shows/vi/podcasts/37/treating-pad-in-the-obl

In this episode, host Dr. Bryan Hartley takes us on a deep dive into the origin story and mission of Pulmera, a medtech company dedicated to transforming the field of bronchoscopic lung cancer diagnosis by retrofitting existing fluoroscopy machines into cone beam CT-like scanners. Dr. Hartley is a vascular and interventional radiologist and co-founded Pulmera, alongside interventional pulmonologist Dr. Harmeet Bedi at Stanford. Pulmera is developing a novel approach to enhance physicians’ ability to diagnose lung nodules accurately through innovative technology. Dr. Hartley shares insights into the challenges of existing diagnostic methods, the inspiration behind Pulmera, and the technology’s potential to combine the best of 3D imaging and endoscopy techniques. Dr. Hartley discusses the benefits for both patients and physicians, such as improved diagnostic yields and patient outcomes, and introduces an investment opportunity for the BackTable community to be part of this revolutionary project. The episode also explores the broader implications of this technology across various medical specialties beyond pulmonology. --- CHECK OUT OUR SPONSOR RADPAD® Radiation Protection https://www.radpad.com/ --- SHOW NOTES 00:00 - Introduction 02:18 - Personal Journey: From Vanderbilt to Stanford Biodesign 06:11 - Pulmera’s Mission: Enhancing Diagnostic Accuracy in Lung Biopsies 15:02 - Introducing a Game-Changing Technology for Bronchoscopic Procedures 22:09 - Challenges and Breakthroughs in Portable CT Imaging 27:44 - Economic Impact of Enhanced Diagnostic Procedures 29:48 - Building a Team and Securing Funding for Innovation 31:30 - Understanding Investment Opportunities and Equity Financing --- RESOURCES Dr. Bryan Hartley’s email: bryan.hartley@pulmera.com Dr. Bryan Hartley’s cell: 423-432-0612 Pulmera: http://www.pulmera.com/ Stanford Biodesign Fellowship: https://biodesign.stanford.edu/programs/fellowships/innovation-fellowships.html BackTable Innovation Episode #1 - Needs Driven Innovation with Dr. Todd Brinton (Stanford BioDesign): https://www.backtable.com/shows/innovation/podcasts/1/needs-driven-innovation BackTable Innovation Episode #30 - Host Stories with Dr. Bryan Hartley and Dr. Eric Gantwerker (Stanford BioDesign): https://www.backtable.com/shows/innovation/podcasts/30/host-stories BackTable VI Episode #422 - Pathology 101: Solid Advice for Percutaneous Biopsies with Dr. Andrew Sholl: https://www.backtable.com/shows/vi/podcasts/422/pathology-101-solid-advice-for-percutaneous-biopsies

In this episode, Dr. Jos van den Berg discusses the benefits of joining the Critical Limb Ischemia (CLI) Global Society, including discounts on Amputation Prevention Symposium (AMP) meetings, access to a specialized journal, and participation in Multidisciplinary CLI Network (MCLIN) discussion boards. Dr. van den Berg is an interventional radiologist at University of Bern in Switzerland and Europe Office Chairman and Member of Board of Directors for CLI Global Society. Dr. van den Berg also serves as a reviewer and editorial board member of multiple high-impact scientific journals. With members across the globe, the CLI Global Society emphasizes a multidisciplinary approach to combat CLI, aiming to prevent amputation and death through education, patient advocacy, and awareness about CLI. Dr. van den Berg also sheds light on the complexity of CLI management in Europe due to varied reimbursement systems among countries and the society’s efforts to tackle these challenges. The episode also touches on the society’s future goals, including expanding its global presence and continuing to offer extensive resources and networking opportunities to its members. --- CHECK OUT OUR SPONSORS BD Advance Clinical Training & Education Program https://page.bd.com/Advance-Training-Program_Homepage.html Reflow Medical https://www.reflowmedical.com/ --- SHOW NOTES 00:00 - Introduction 02:08 - Meet Our Guest: Dr. Jos van den Berg 05:42 - Deep Dive into CLI Global Society 07:53 - Exploring the Impact and Initiatives of CLI Global Society 14:42 - Challenges and Differences of CLI Management in Europe 21:08 - Innovations and Future Endeavors in CLI Treatment 23:45 - Closing Thoughts and the Importance of Membership --- RESOURCES CLI Global Society: https://www.cliglobalsociety.org/ Multidisciplinary CLI Network (MCLIN) Global CLI LIVE Meeting (every 2nd Friday of the month, 7am EST): https://www.cliglobalsociety.org/education/mclin/#myaccount AMP CLI Meeting: https://www.hmpglobalevents.com/amptheclimeeting

In this episode, Dr. Blake Parsons talks through the role of spinal cord stimulation in treating vascular issues and diabetic neuropathy. He also discusses the growing presence of vascular specialists in clinics, the transition from procedural work to clinical involvement, and the significance of building a strong patient-doctor relationship. The doctors highlight the effectiveness of Nevro 10 kHz therapy in providing long-term pain relief and sensory improvements for patients struggling with painful diabetic neuropathy, even after conventional treatments fail. Additionally, they touch upon reimbursement updates, the rise of outpatient care, and the future of spinal cord stimulation - emphasizing its potential beyond just pain relief to include improvements in patients’ overall quality of life, reducing risks related to diabetic foot wounds, and incidental falls. The need for a multidisciplinary approach in treating vascular and neuropathic conditions is also discussed, along with the role of interventional radiologists in managing these complex cases. --- CHECK OUT OUR SPONSOR Nevro HFX Spinal Cord Stimulator https://www.hfxforpdn.com --- SHOW NOTES 00:00 - Introduction 06:00 - Demystifying Spinal Cord Stimulation for Pain Management 17:11 - Optimizing Patient Care: Trials, Techniques, and Insurance 26:03 - Leveraging Telehealth and Support Teams for Patient Success 30:22 - Challenges and Solutions in Managing Peripheral Neuropathy 35:19 - Collaboration and Referral Dynamics in Vascular and Interventional Radiology 39:19 - Exploring the Future of Neuropathy Treatment and Quality of Life Improvements 43:46 - Addressing the Challenges of Permanent Implant Procedures 48:46 - Role of Technology and AI in Patient Management 56:31 - Concluding Thoughts on Neuropathy Treatment and Practice Dynamics --- RESOURCES Nevro 10 kHz Therapy: https://nevro.com/English/en/providers/HFX-Advanced-Therapies/default.aspx Effect of High-frequency (10-kHz) Spinal Cord Stimulation in Patients With Painful Diabetic Neuropathy: A Randomized Clinical Trial (JAMA Neurology RCT 2021): https://pubmed.ncbi.nlm.nih.gov/33818600/ Long-term efficacy of high-frequency (10 kHz) spinal cord stimulation for the treatment of painful diabetic neuropathy: 24-Month results of a randomized controlled trial (SENZA-PDN RCT 2023): https://pubmed.ncbi.nlm.nih.gov/37536514/ Electrical spinal-cord stimulation for painful diabetic peripheral neuropathy (Lancet RCT 1996): https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(96)02467-1/abstract

In this episode, Dr. Mark Lessne and Dr. John Martinie discuss the importance of multidisciplinary collaboration, patient-centered care, and the role of interventional radiology and surgery in treating benign and malignant biliary diseases. Dr. Lessne is an interventional radiologist at Charlotte Radiology and Dr. Martinie is a hepatobiliary surgeon at Carolinas Medical Center, both located in North Carolina. The doctors explore various scenarios including challenges in biliary decompression, the decision-making process behind choosing the right intervention, and the impact of such diseases on patient care plans and outcomes. Dr. Lessne and Dr. Martinie emphasize the importance of viewing interventional radiologists and gastroenterologists as physicians who not only perform procedures, but also provide comprehensive care and follow-up for their patients. Through their dialogue, it becomes clear that successful treatment of biliary diseases requires a combination of technical skill, thoughtful patient engagement, and collaborative practice among specialists. --- CHECK OUT OUR SPONSOR RADPAD® Radiation Protection https://www.radpad.com/ --- SHOW NOTES 00:00 - Introduction 02:19 - Multidisciplinary Approach to Patient Care 05:31 - Navigating the Complexities of Biliary Disease Workups 10:13 - Collaboration Between Hepatobiliary Surgery and Interventional Radiology 19:33 - Balancing Minimally Invasive Techniques with Surgical Options 30:29 - The Importance of Compassionate Consent and Patient-Centered Care 32:16 - Exploring Advanced Interventions and Team Discussions 36:31 - Considerations and Challenges in Biliary Stenting 45:46 - Role of Interventional Radiology in Patient Care 56:57 - Final Thoughts on Teamwork and Patient Care --- RESOURCES BackTable Ep. 203- Making Informed Consent an Informed Choice with the Interventional Initiative: https://www.backtable.com/shows/vi/podcasts/203/making-informed-consent-an-informed-choice-with-the-interventional-initiative

In this episode of the BackTable MSK Podcast, Dr. Dana Dunleavy interviews Dr. David Prologo about his perspective on current advancements in MSK interventions, including steerable spine needles, thermocouples for radiofrequency ablation, and the growing importance of advocacy and longitudinal follow up for patients with chronic pain. Dr. Prologo is an interventional radiologist at Emory University. Dr. Prologo starts by describing the evolution of interventional radiology’s role in MSK interventions. He explains that establishing solid referral networks is crucial to building this service line, and he gives examples of how new interventionalists can highlight their skills to others. Then, he describes a new steerable needle that allows operators to safely enter the vertebral body with a transpedicular approach and subsequently navigate directly to the location of interest. This device is especially useful when lesions are located in tricky areas where the trajectory of a straight needle would have difficulty reaching. He also discusses different devices for bone tumor ablation and his preferred methods for targeting lesions that are located at varying locations in the spine. For lesions below T5, he uses fluoroscopy for better visualization of the axial plane. For lumbar lesions, he emphasizes the importance of correlating and cross-checking vertebral levels with pre-procedural MRI. Dr. Prologo also discusses lessons learned from his extensive experience in spine interventions, especially from prior complications. He explains how thermocouple monitoring can give real time feedback on internal temperature during radiofrequency ablation, the necessity of understanding the ablation zone, and the importance of longitudinal follow up. He cites specific cases of patients struggling with chronic pain and how he advocated for each case. --- CHECK OUT OUR SPONSOR Merit Spine https://www.merit.com/merit-spine/ --- SHOW NOTES 00:00 - Introduction 02:09 - Dr. Prologo’s Career and Leadership Roles 09:52 - Interventional Radiology’s Role in MSK Interventions 13:37 - A Primer for Steerable Vertebral Needles 21:40 - Increasing Standardization and Accessibility of Bone Tumor Ablation 26:37 - Advanced Pain Management in Interventional Radiology’ Book 30:24 - Thermocouples in Radiofrequency Ablation 35:45 - Prior Complications and Importance of Longitudinal Care 44:24 - SIR EDGE 2024 52:31 - Accessing Targets for Basivertebral Nerve Ablation 1:01:17 - The Role of Advocacy in Patient Care --- RESOURCES Osseoflex Steerable Needle: https://www.merit.com/product/osseoflex-sn-steerable-needle/ STAR Tumor Ablation System: https://www.merit.com/product/star-tumor-ablation-system/ Osteocool OsteoCool Radiofrequency Ablation System: https://www.medtronic.com/us-en/healthcare-professionals/products/spinal-orthopaedic/tumor-management/osteocool-ablation-system-rf.html OptaBlate Bone Tumor Ablation System: https://providers.strykerivs.com/products/optablate ‘Advanced Pain Management in Interventional Radiology’ by J. David Prologo and Charles E. Ray Jr: https://shop.thieme.com/Advanced-Pain-Management-in-Interventional-Radiology/9781684201402 Ablation zones and weight-bearing bones: points of caution for the palliative interventionalist: https://pubmed.ncbi.nlm.nih.gov/24745905/ SIR EDGE 2024: https://www.sirweb.org/learning-center/meetings/sir-edge/ ‘The Catching Point Transformation’ by J. David Prologo: https://www.catchingpoint.com/

In this episode, Dr. Matthew Lungren discusses the transformative potential of Artificial Intelligence (AI) in healthcare, sharing insights into large language models, deep learning, and machine learning in improving patient care, enhancing clinical workflows, and optimizing medical research. Dr. Lungren is a pediatric diagnostic and interventional radiologist, and the Chief Data Science Officer at Microsoft Health and Life Sciences. He advocates for a future where AI acts as a tool for healthcare professionals, allowing them to devote more time to patient care rather than administrative tasks. Additionally, the discussion explores concerns such as AI’s impact on employment and interactions with insurance companies, while presenting resources for healthcare professionals to engage with and learn about AI technologies actively. --- CHECK OUT OUR SPONSOR Reflow Medical https://www.reflowmedical.com/ --- SHOW NOTES 00:00 - Introduction 03:00 - The Journey to AI Expertise: Dr. Lungren’s Story 05:48 - Decoding AI: From Basics to Large Language Models 13:07 - AI’s Impact on Healthcare and Beyond 15:57 - Exploring AI’s Potential in Content Creation and Clinical Efficiency 20:22 - The Future of AI in Healthcare: Opportunities and Challenges 25:27 - Leveraging AI for Diagnostic Radiology and Beyond 27:42 - The Transformative Potential of Generative AI in Healthcare 33:40 - Addressing Concerns: AI’s Role in Insurance and Patient Advocacy 36:41 - Empowering Healthcare Professionals with AI: Practical Applications and Future Outlook --- RESOURCES Fundamentals of Machine Learning for Healthcare - Stanford University Coursera Course: https://www.coursera.org/learn/fundamental-machine-learning-healthcare Dr. Matt Lungren’s LinkedIn Learning Course on Generative AI: https://www.linkedin.com/learning/an-introduction-to-how-generative-ai-will-transform-healthcare/introduction-to-generative-ai-in-healthcare DeepLearning.AI Website (Professor Andrew Ng): https://www.deeplearning.ai/ Fast.AI Website (Professor Jeremy Howard): https://www.fast.ai/ Professor Jeremy Howard YouTube: https://www.youtube.com/@howardjeremyp/featured Healthcare Information and Management Systems Society (HIMMS) Meeting: https://www.himssconference.com/en/homepage.html

In this episode of the BackTable Podcast, Teri Yates explores the nuances of choosing between an Office-Based Lab (OBL) and Ambulatory Surgery Center (ASC) for private practices. Teri is the CEO of Accountable Physician Advisors, a consulting firm which specializes in OBLs, ASCs, and hybrid models for private-practice physicians. She is also President of DocCentric, a company focused on supporting physicians building and leading their own ASCs. The discussion includes a comprehensive analysis of the financial, regulatory, and operational considerations for physicians contemplating this decision. This includes insights into reimbursement models, Medicare regulations, and the strategic advantages of each model. The episode also touches on the importance of feasibility studies, partnerships with other specialties, and real estate strategies when developing these facilities. The conversation provides valuable advice for navigating the complexities of ASC development and emphasizes the value of maintaining independence and leveraging physician-owned models for long-term success. --- CHECK OUT OUR SPONSOR Reflow Medical https://www.reflowmedical.com/ --- SHOW NOTES 00:00 - Introduction 04:19 - Deep Dive into OBL and ASC: Definitions, Differences, and Decisions 07:26 - Financial Implications of ASC vs. OBL 10:56 - Hybrid Model: Combining OBL and ASC for Flexibility 15:14 - Navigating the Complexities of ASC Development 20:03 - Real Estate Strategies for OBL and ASC Projects 22:50 - Staffing Considerations and Physician Entrepreneur Insights 35:17 - Future of OBL and ASC: Trends and Predictions 39:43 - Closing Thoughts and Resources for Further Learning --- RESOURCES Ambulatory Surgery Center Association: https://www.ascassociation.org/home OEIS Annual Meeting 2024 Las Vegas: https://oeisweb.com/meetings/2024-annual-meeting/ Accountable Physician Advisors (Teri’s consulting firm): http://www.accountablephysicianadvisors.com/services DocCentric: https://doccentricasc.com/ NOON Development Company: https://noondevelopment.com/ BT VI Episode #366 - Navigating OBL & ASC Business: Pitfalls to Avoid with Teri Yates: https://www.backtable.com/shows/vi/podcasts/366/navigating-obl-asc-business-pitfalls-to-avoid BT VI Episode #202 - Staffing the OBL with Dr. Krishna Mannava and Kristin Longwell: https://www.backtable.com/shows/vi/podcasts/202/staffing-the-obl BT VI Episode #129 - OBL / ASC Business Pearls with Dr. Jim Melton: https://www.backtable.com/shows/vi/podcasts/129/obl-asc-business-pearls BI VI Episode #121 - Office-Based Labs (OBLs) & What You Can Do in Them with Dr. Mike Watts: https://www.backtable.com/shows/vi/podcasts/121/office-based-labs-obls-what-you-can-do-in-them BT VI Episode #42 - Building an Outpatient UFE Practice with Dr. Mary Costantino: https://www.backtable.com/shows/vi/podcasts/36/building-an-outpatient-ufe-practice

In this episode of the BackTable Podcast, host Dr. Ally Baheti interviews Dr. Deepak Sudheendra and Laurie Bouzarelos about the complexities of navigating insurance for procedures performed in vascular and interventional radiology outpatient-based labs (OBLs). Dr. Sudheendra is an interventional radiologist at 360 Vascular Solutions in Dublin, Ohio and Laurie Bouzarelos is the founder and owner of Provider Solutions, a small business which focuses on coaching private practice and business-owning physicians on payor contracting. The conversation illuminates common challenges faced by physicians when negotiating insurance contracts, and it emphasizes the lack of awareness among insurance companies about the roles of IRs and the significance of OBLs. Laurie Bouzarelos shares her expertise on insurance contracting, highlighting the importance of education, strategy, and patient-focused care in achieving favorable contract terms. The episode delves into tactics for contract negotiation, leveraging data for better rates, and the critical role of in-house billing for financial transparency and control. Dr. Sudheendra shares his personal journey and the tenacity required to educate insurance providers about IR and OBLs. He underscores the broader need for healthcare professionals to advocate vigorously for their both patient care standards and their financial interests. The episode also includes practical insights for setting up a fee schedule, understanding market dynamics, and the potential pitfalls in standard contracts. --- CHECK OUT OUR SPONSORS Varian, a Siemens Healthineers company https://www.siemens-healthineers.com/ Reflow Medical https://www.reflowmedical.com/ --- SHOW NOTES 00:00 - Introduction 03:14 - Journey of Insurance Contracting: From Confusion to Clarity 10:08 - Art of Negotiation: Laurie’s Unique Coaching Model 19:53 - Leveraging Data for Effective Insurance Negotiations 25:17 - Power of Negotiation: Changing the Game in Insurance Contracting 28:09 - Exploring the Challenges of Physician Negotiations with Insurance Companies 31:54 - Power of Personal Advocacy and Site Visits in Negotiations 36:45 - Navigating Contract Renegotiations and Understanding Fee Schedules 40:56 - Importance of In-House Billing and Vigilant Fee Management 52:16 - Final Advice: The Importance of Negotiation and Understanding Your Business --- RESOURCES Provider Solutions (Laurie Bouzarelos’ company): https://www.providersolutionsconsulting.com/about

In this episode of the BackTable Podcast, host Dr. Aaron Fritts interviews Dr. Osman Ahmed about treatment algorithms and new technologies for upper gastrointestinal (GI) bleed embolization. Dr. Ahmed is an interventional radiologist at the University of Chicago. The doctors dive into various embolization techniques, microcatheters, and embolic materials that are ideal for managing upper GI bleeds. Dr. Ahmed highlights the importance of understanding the etiology of bleeding, differences between arterial vs. venous bleeding, and first-line therapies such as endoscopy. Dr. Ahmed also discusses the utilization of new embolic materials like Obsidio Embolic, which is designed specifically for peripheral use, and its advantages in achieving rapid and complete vessel occlusion. Additionally, the doctors cover pre-procedural imaging, procedural techniques, and operator preferences for microcatheters and embolic devices. They emphasize the procedural nuances, operator comfort, and evolving technologies in the management of GI bleeds. --- CHECK OUT OUR SPONSOR Boston Scientific Obsidio Embolics https://www.bostonscientific.com/obsidio --- SHOW NOTES 00:00 - Introduction 03:29 - Discussion on Upper GI Bleeds 06:35 - Pre-Procedure Imaging for Upper GI Bleeds 11:16 - Procedure Walkthrough for Upper GI Embolization 19:51 - Understanding Mesenteric Anatomy 22:50 - Embolization Devices: Coils and More 25:31 - Exploring Obsidio: A New Embolic 32:55 - Post-Procedure Care 34:17 - Case Discussions and Final Thoughts --- RESOURCES Navigating Early Cases with the Obsidio™ Conformable Embolic - GEST 2023 Webinar with Dr. Ahmed: https://thegestgroup.com/webinar-featuring-obsidio/ BackTable VI Episode #179 - Happiness is a Warm Coil: Treating GI Bleeds with Dr. Donald Garbett: https://www.backtable.com/shows/vi/podcasts/179/happiness-is-a-warm-coil-treating-gi-bleeds BackTable VI Episode #216 - Stick It: Glue Embo with Dr. Ziv Haskal: https://www.backtable.com/shows/vi/podcasts/216/stick-it-glue-embo BackTable VI Episode #321 - New Innovations in Lower GI Bleed Embolization with Dr. Kevin Henseler: https://www.backtable.com/shows/vi/podcasts/321/new-innovations-in-lower-gi-bleed-embolization Obsidio - Conformable Embolic: https://www.bostonscientific.com/obsidio

In this episode of the BackTable Podcast, host Dr. Michael Barraza interviews guest Dr. Marcelo Guimaraes about the advantages and implementation of radial access in interventional radiology. Dr. Guimaraes is a vascular and interventional radiologist from the Medical University of South Carolina (MUSC). Dr. Guimaraes shares insights on the adoption of radial access over femoral access, emphasizing its simplicity, safety, and the clear benefits recognized by younger interventionalists. He elaborates on the importance of education, partnership with the industry, and following a standard protocol to build a successful radial access program. The doctors also cover specific topics like the RAVI Registry outcomes, patient preferences for radial access based on a study, the cost-benefit analysis, and handling various challenges such as artery spasms and loops. Dr. Guimaraes advocates for radial access as the default method for embolization therapies, highlighting its efficacy across a range of procedures and patient conditions. --- CHECK OUT OUR SPONSOR Medtronic Concerto https://mobile.twitter.com/mdtvascular --- SHOW NOTES 00:00 - Introduction 02:56 - Insights into MUSC’s Interventional Radiology Program 04:44 - Emergence of Radial Access in Interventional Procedures 07:04 - Challenges and Solutions in Setting Up a Radial Access Program 10:14 - Essential Equipment for Radial Access 22:20 - Addressing Spasm Challenges in Radial Access 30:11 - Patient Preference: Radial vs Femoral Access 32:46 - Safety and Efficacy of Radial Access: The Data 41:11 - Post-procedure Hemostasis Protocol 43:51 - Optimal Radial Artery Access Point and Best Practices --- RESOURCES How To Do The Barbeau Test - BackTable Demo: https://www.backtable.com/shows/vi/demos/how-to-do-the-barbeau-test Comparison of transradial coronary procedures via right radial versus left radial artery approach: A meta-analysis: https://pubmed.ncbi.nlm.nih.gov/27037544/ Transradial Versus Transfemoral Arterial Access in Liver Cancer Embolization: Randomized Trial to Assess Patient Satisfaction (Dr. Guimaraes paper): https://pubmed.ncbi.nlm.nih.gov/29150395/ An Update on Radial Artery Access and Best Practices for Transradial Coronary Angiography and Intervention in Acute Coronary Syndrome: A Scientific Statement From the American Heart Association: https://www.ahajournals.org/doi/full/10.1161/HCV.0000000000000035 The RAVI registry: prospective, multicenter study of radial access in embolization procedures – 30 days follow up: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10828405/

In this episode of BackTable Podcast, host Dr. Sabeen Dhand interviews guest Dr. Aaron Fischman about the TREAT Symposium and its evolution into TREAT Live, a platform for broadcasting live endovascular cases. Dr. Fischman is a vascular and interventional radiologist at Mount Sinai in New York. Dr. Fischman details the journey from TREAT’s inception as a conference focused on radial interventions to its current form, which includes a monthly live case streaming setup aimed at providing continuous medical education. The discussion covers the strategic shift from annual conferences to monthly live streams due to the pandemic, the logistical challenges and solutions for setting up live broadcasts, and the educational benefits of showcasing live cases, including the potential for offering CME credits. Dr. Fischman also shares insights into the selection of cases and operators, emphasizing the diversity of cases and the future direction of the program. The doctors also underscore the importance of innovation in medical education and the potential of live case broadcasts to enhance learning and improve patient care. --- CHECK OUT OUR SPONSOR Varian, a Siemens Healthineers company https://www.siemens-healthineers.com/ --- SHOW NOTES 00:00 - Introduction 01:53 - Meet Dr. Aaron Fischman: A Pioneer in Transradial Interventions 02:19 - Evolution of TREAT Symposium: From Concept to Live Cases 06:06 - TREAT Live’s Monthly Case Broadcasts 10:28 - Future of Medical Education: Live Cases and CME Credits 16:32 - Impact and Expansion of TREAT Live --- RESOURCES TREAT Live: https://treatsymposium.com/ BackTable VI Episode #30 - Transradial Access: Basic to Advanced with Dr. Aaron Fischman: https://www.backtable.com/shows/vi/podcasts/30/transradial-access-basic-to-advanced

The BackTable Podcast is a resource for interventional radiologists, vascular surgeons, interventional cardiologists, and other interventional and endovascular specialists to learn tips, techniques, and the ins and outs of the devices in their cabinets. Listen on BackTable.com or on the streaming platform of your choice. You can also visit www.BackTable.com to browse our open access, physician-catered knowledge center for all things vascular and interventional; now featuring practice tools, procedure walkthroughs, and expert guidance on more than 40 endovascular procedures.

In this episode of the BackTable Podcast, host Dr. Aaron Fritts interviews guest Dr. Ramsey Al-Hakim about the inception and journey of Auxetics, a med-tech company innovating in the vein stent market. Dr. Al-Hakim is the co-founder of Auxetics and the Section Chief of the Division of Interventional Radiology at Scripps Hospital in San Diego, CA. Dr. Al-Hakim covers the initial challenges of understanding the market and securing capital, the clinical significance of addressing stent-adjacent stenosis, and the process of developing a stent with a negative Poisson effect to counteract it. Dr. Al-Hakim highlights Auxetics' approach to combining cutting-edge interventional technologies with world-class imaging tools for enhanced procedural efficiency in venous interventions. The company’s progress through benchtop work, animal testing, and plans for first-in-human studies outside the U.S., aiming for commercialization within the next four to five years, is also outlined. Contributions from key figures in the vascular community and the role of mentorship and perseverance in navigating the complexities of medical device innovation are discussed as well. --- CHECK OUT OUR SPONSORS Varian, a Siemens Healthineers company https://www.siemens-healthineers.com/ Reflow Medical https://www.reflowmedical.com/ --- SHOW NOTES 00:00 - Introduction 03:11 - The Market and Problem Solving 12:13 - Journey of Creating a Stent 22:28 - Birth of Auxetics 26:53 - Learning Process and Support from the University 29:16 - Building the Dream Team 33:01 - Starting a Company 36:42 - Challenges and Triumphs of Fundraising 37:44 - Current Status and Future Plans 45:32 - Importance of Community and Mentorship --- RESOURCES Auxetics: https://www.auxeticsinc.com In-stent restenosis and stent compression following stenting for chronic iliofemoral venous obstruction: https://pubmed.ncbi.nlm.nih.gov/34174500/ Venous Stenosis Animal Model Utilizing Endovenous Radiofrequency Ablation: https://pubmed.ncbi.nlm.nih.gov/30717966/ The Messy Middle: Finding Your Way Through the Hardest and Most Crucial Part of Any Bold Venture: https://www.amazon.com/Messy-Middle-Finding-Through-Hardest/dp/0735218072

In this episode of the BackTable Podcast, host Dr. Chris Beck interviews guest Dr. Dean Ferrera about treating acute limb ischemia with mechanical thrombectomy. Dr. Ferrera is an interventional cardiologist at Community Care Network in northwestern Indiana. Dr. Ferrera emphasizes the importance of interdisciplinary collaboration, early detection, and selection of appropriate intervention techniques. He also discusses threading issues, bleeding complications, use of lysis, and understanding the nature of clots. He recommends thrombectomy systems such as the Pounce Thrombectomy System for removing thrombus and embolus. Furthermore, Dr. Ferrera highlights the significance of continued learning and mentorship in managing these complex conditions. --- CHECK OUT OUR SPONSOR Surmodics Pounce Thrombectomy https://pouncesystem.com/ --- SHOW NOTES 00:00 - Introduction 04:21 - Patient Presentation and Workup 09:23 - Treatment Options for Acute Limb Ischemia 17:48 - Crossing the Clot and Treatment Options 25:18 - Device Capabilities and Limitations 28:43 - Procedure Steps and Reusability 31:26 - Device Selection and Aspiration Devices 37:07 - Post-Procedure Considerations and Follow-Up 43:16 - Complications and Risk Management --- RESOURCES Pounce Thrombectomy System: https://pouncesystem.com/ Thrombus Structural Composition in Cardiovascular Disease: https://pubmed.ncbi.nlm.nih.gov/34261330/

In this episode of the BackTable Podcast, host Dr. Aaron Fritts interviews guest Dr. John Qiao about exploration of physicians’ role in medical innovation, particularly among interventional radiologists. Dr. Qiao shares insightful information about the origin of RadioClash and details his journey as an entrepreneur. Through this discussion, Dr. Qiao covers the challenges encountered during the startup phase, the invention of a single-probe electroporation device, and the future applications of this novel medical technology. The episode concludes with broader advice on how to manage the demands of professional work, entrepreneurship, and personal life. --- CHECK OUT OUR SPONSORS Reflow Medical https://www.reflowmedical.com/ Medtronic Concerto https://mobile.twitter.com/mdtvascular --- SHOW NOTES 00:00 - Introduction 02:39 - Dr. Qiao’s Journey into Medicine and Entrepreneurship 11:40 - Birth of Radioclash: A Unique Solution for Cancer Treatment 17:58 - Future of RadioClash: Targeting Metastatic Cancer 25:20 - Future of Electroporation Therapy 35:21 - Challenges of Building a Company 44:37 - Path to Market and Future Plans 47:28 - Balancing Clinical Practice and Entrepreneurship --- RESOURCES RadioClash website: https://www.radioclash.co/ News Article on Dr. John Qiao: https://voyagehouston.com/interview/meet-john-qiao-m-d-of-radioclash-ltd-co/ Radiation Therapy as a Modality to Create Abscopal Effects: Current and Future Practices: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7086111/ The Abscopal Effect: A Reemerging Field of Interest: https://ascopost.com/issues/november-25-2018/the-abscopal-effect-a-reemerging-field-of-interest/ BackTable VI Episode #402 - Immunotherapy in HCC: Evolving Treatment Paradigms: https://www.backtable.com/shows/vi/podcasts/402/immunotherapy-in-hcc-evolving-treatment-paradigms Tavo and Pembrolizumab in Patients With Stage III/​IV Melanoma Progressing on Either Pembrolizumab or Nivolumab Treatment (Keynote-695): https://clinicaltrials.gov/study/NCT03132675 PANFIRE-3 Trial: Assessing Safety and Efficacy of Irreversible Electroporation (IRE) + Nivolumab + CpG for Metastatic Pancreatic Cancer: https://classic.clinicaltrials.gov/ct2/show/NCT04612530 Radiofrequency Ablation for the Palliative Treatment of Bone Metastases: Outcomes from the Multicenter OsteoCool Tumor Ablation Post-Market Study (OPuS One Study) in 100 Patients: https://pubmed.ncbi.nlm.nih.gov/33129427/ The improvement of irreversible electroporation therapy using saline-irrigated electrodes: a theoretical study (Northwestern study): https://pubmed.ncbi.nlm.nih.gov/21728392/ Irreversible electroporation reverses resistance to immune checkpoint blockade in pancreatic cancer: https://www.nature.com/articles/s41467-019-08782-1

In this episode of the BackTable Podcast, host Dr. Chris Beck interviews guest Dr. Andrew Sholl, who demystifies the ins and outs of percutaneous biopsies and their impact on diagnoses. Dr. Scholl is a pathologist at LCMC Health in New Orleans, Louisiana. Dr. Sholl emphasizes the importance of understanding substantial clinical history, as well as obtaining adequate and correctly processed samples. The doctors discuss the varying scenarios faced in pathology, such as instances when larger samples are beneficial and the nuances of differentiating malignancies in certain organs. They also cover detailed tips for conducting biopsies and the process of how pathologists assess patient samples. The overarching message is the importance of communication and collaboration between interventional radiologists and pathologists to ensure the best patient outcomes. --- CHECK OUT OUR SPONSOR Argon BioPince Ultra https://www.argonmedical.com/product/biopince-ultra-full-core-biopsy-instrument/ --- SHOW NOTES 00:00 - Introduction 02:38 - Understanding Pathology Training and Practice 06:07 - Role of Pathology in Medical Diagnosis 18:57 - Importance of Sample Size and Quality in Pathology 26:34 - Next Gen Sequencing and Molecular Markers 29:44 - Biopsy Devices and Their Impact on Diagnosis 37:21 - Using Clinical History in Pathology 43:16 - Challenges and Considerations in Diagnosing Renal and Hepatic Tumors 50:25 - Importance of Communication Between Pathologists and Interventional Radiologists

In this episode of the BackTable Podcast, host Dr. Michael Barraza interviews guest Dr. Brian Holly about different surgical scenarios relating to biliary interventions. Dr. Holly is a practicing interventional radiologist and Assistant Professor of Radiology and Radiological Sciences at Johns Hopkins University. The doctors delve into various techniques including the usage of ultrasound, managing non-dilated and dilated systems, as well as handling specific clinical scenarios such as malignant obstructions, benign biliary strictures, and postoperative bile leaks. The podcast also briefly discusses the controversial topic of placing internal biliary stents and the challenges faced with managing biliary strictures and leaks. --- CHECK OUT OUR SPONSOR RADPAD® Radiation Protection https://www.radpad.com/ --- SHOW NOTES 00:00 - Introduction 01:53 - Discussion on IR Training at Johns Hopkins 04:09 - Overview of Biliary Interventions 08:31 - Challenges and Techniques in Biliary Access 19:28 - Approach to Non-Dilated Collecting System 28:07 - Dealing with Dilated Systems and Obstructions 32:56 - Biopsy Techniques for Malignant CBD Strictures 39:30 - Approach to Benign Biliary Strictures 41:48 - Use of Internal Stents in Biliary Procedures 44:51 - Managing Bleeding in Biliary Procedures --- RESOURCES The Hepaticojejunostomy Technique with Intra-Anastomotic Stent in Biliary Diseases and Its Evolution throughout the Years: A Technical Analysis: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4846744/ Percutaneous Transhepatic Cholangiography and Intraductal Radiofrequency Ablation Combined with Biliary Stent Placement for Malignant Biliary Obstruction: https://www.jvir.org/article/S1051-0443(15)00166-9/abstract