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.---This podcast is supported by:RADPAD® Radiation Protectionhttps://www.radpad.com/---SYNPOSISDr. 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.---TIMESTAMPS00:00 - Introduction02:04 - Provocative Angiography for Lower GI Bleeds04:09 - Detailed Protocol for Provocative Angiography11:13 - Technical Details and Best Practices20:07 - Challenges in GI Bleeding Studies22:40 - Selective Embolization Techniques27:44 - Handling Negative Angiograms32:56 - Real-World Case Studies35:15 - Final Thoughts---RESOURCESThiry et al. Provocative Mesenteric Angiography: Outcomes and Standardized Protocol for Management of Recurrent Lower Gastrointestinal Hemorrhagehttps://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. --- This podcast is supported by an educational grant from Johnson & Johnson and Varian. --- 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. --- TIMESTAMPS 00:00 - Introduction04:12 - Cryobiopy vs. Non-Cryobiopsy08:43 - Biopsy and Ablation: Strategies and Considerations15:31 - Post-Therapy Imaging and Follow-Up25:18 - Treatment Options and Patient Decisions27:08 - Evaluating Ablation Techniques28:59 - Managing Lung Cancer Recurrence39:41 - Case Study: Young Male with Ground Glass Nodule43:15 - 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. --- 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. --- 00:00 - Introduction02:09 - Specialization in Neuroendocrine Tumors06:32 - Patient Selection and Treatment Criteria10:40 - Grading and Treatment of Neuroendocrine Tumors16:09 - Systemic Therapy Options22:22 - Rebiopsy and Its Importance28:01 - Technical Aspects of Local Regional Therapies39:14 - Radioembolization: When and How43:33 - Segmentectomy and Multimodal Approaches45:22 - CapTemY90 Trial and Promising Results49:52 - Hormone Release During Local Regional Therapies53:12 - Combining Radioembolization with PRT56:12 - Thermal Ablation in Neuroendocrine Tumor Patients58:06 - Follow-Up Imaging and Tumor Markers01:02:40 - Updates from Nanets Conference01:05:08 - Collaborating Across Specialties01:07:56 - Managing High Tumor Burden Patients01:13:59 - Treating Carcinoid Heart Disease01:19:37 - Closing Remarks and Acknowledgments --- RESOURCES NETTER-1 Trialhttps://www.nejm.org/doi/full/10.1056/NEJMoa1607427 REMINET Trialhttps://ascopubs.org/doi/10.1200/JCO.2016.34.15_suppl.TPS4148 CapTemY90 Trialhttps://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. --- 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. --- TIMESTAMPS 00:00 - Introduction 01:08 - The Importance of Revenue Cycle Management09:29 - The No Surprises Act and Data Transparency12:03 - Professional Societies and Continuing Education17:50 - Credentialing and Taxonomy Codes40:28 - Impact of Insurance Credentialing on Patient Care42:08 - Revenue Cycle Management Walkthrough48:18 - Challenges with Medicare Advantage and Coordination of Benefits54:20 - Covered vs. Non-Covered Services59:03 - Medical Necessity and Insurance Policies01:01:04 - Prior Authorization and Payment Issues01:13:11 - Payment Plans and Compliance01:23:10 - Practice Management Software01:31:10 - AI in Healthcare and Compliance01:38:57 - Final Thoughts --- 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. --- 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. --- TIMESTAMPS 00:00 - Introduction05:09 - Computer Science and Medicine09:37 - AI Fundamentals for IRs17:59 - Practical Applications of AI in IR28:14 - The Value and Risks of Patient Data31:22 - Developing Advanced Imaging Techniques34:16 - Maskless Subtraction Angiography40:29 - AI in Clinical Problem Solving45:55 - The Future of AI in IR49:51 - Getting Involved with AI and Volunteering53:01 - Final Thoughts and Resources --- 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. --- This podcast is supported by an educational grant from Johnson & Johnson and Varian. --- 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. --- TIMESTAMPS 00:00 - Introduction and Overview of Lung Ablation07:01 - Microwave Ablation and Ground Glass Attenuation17:53 - Artificial Pneumothorax Techniques27:09 - Technical Aspects and Innovations32:35 - Bronchial Brachytherapy Techniques37:47 - Conclusion and Credits --- RESOURCES 2021 Central Lesion Studyhttps://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). --- This podcast is supported by an educational grant from Varian. --- 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. --- TIMESTAMPS 00:00 - Introduction05:54 - Patient Workup for GAE10:42 - Setting Patient Expectations for GAE16:24 - Procedure Approaches and Techniques30:41 - Understanding Artery Targeting Strategies34:56 - Approaches to Microcatheter Selection38:18 - Choosing the Right Embolic Agents47:43 - Managing Complications and Follow-Ups51:23 - Challenges with Post-TKA Patients54:16 - 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. --- This podcast is supported by an educational grant from Johnson & Johnson and Varian. --- 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. --- TIMESTAMPS 00:00 - Tumor Ablation and Recurrence Rates12:53 - Advancements in Ablation Technologies23:31 - Bronchoscopic Approaches in Lung Cancer Treatment38:46 - Challenges in Radiation Dose and Delivery49:21 - Ablation and Radiation Margins01:07:19 - Final Thoughts --- 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. --- 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. --- TIMESTAMPS 00:00 - Introduction03:53 - Thrombin Injection Procedural Overview08:14 - Procedure Setup and Execution16:13 - Needle Positioning and Ultrasound Evaluation18:47 - Handling Complex Pseudoaneurysms19:20 - Balloon Occlusion Thrombin Injection19:59 - Case Studies and Practical Insights26:21 - Post-Procedure Care and Follow-Up29:17 - Final Thoughts and Reflections --- 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

How do leading oncologists interpret the abundance of molecular tests, genomic data, and biomarkers to create a lung cancer patient’s treatment plan? In this episode of the 2025 NSCLC Creator Weekend™ series, our tumor board discusses the complexities of lung cancer treatment, including new systemic therapies, lung cancer staging, and the role of molecular diagnostics and liquid biopsies. --- This podcast is supported by an educational grant from Johnson & Johnson and Varian. --- SYNPOSIS The panel, featuring specialists from various institutions, discusses the specifics of sequencing therapies, the impact of targeted and immunotherapies, and the nuances of treating different patient profiles, including non-smokers and those with specific genetic mutations. The conversation also touches on the integration of new staging systems, the benefits of multidisciplinary clinics, and the ongoing evolution of cancer treatment trials. The discussion aims to provide clarity on the latest advancements and future directions in managing lung cancer, emphasizing the importance of tailored treatment plans and the potential of emerging technologies. --- TIMESTAMPS 00:00 - Introduction05:16 - Molecular Diagnostics and Liquid Biopsy21:43 - Targeted Therapy Options27:29 - Managing Toxicities and Treatment Strategies33:13 - Challenges with Immunotherapy in Special Cases34:07 - Lung Transplantation in Cancer Patients48:38 - Multidisciplinary Clinics and Collaboration01:06:29 - Future Directions --- RESOURCES ADAURA Trialhttps://www.nejm.org/doi/full/10.1056/NEJMoa2027071 Gomez NSCLChttps://pmc.ncbi.nlm.nih.gov/articles/PMC5143183/

Are you up to date with the latest guidelines on deep venous thrombosis (DVT) management? Dr. Steven Abramowitz, vascular surgeon at MedStar Health, joins host Dr. Chris Beck for a deep dive into emerging clinical data in DVT management, where they review the evolving indications for mechanical thrombectomy and the implications of studies like the ATTRACT trial, the CLOUT registry, and the ongoing DEFIANCE trial. --- This podcast is supported by: Inari Medicalhttps://www.inarimedical.com/artix-system --- SYNPOSIS Dr. Abramowitz reviews recent data comparing outcomes of mechanical intervention versus lytic-based therapy, outlining how each approach fits into current practice. He underscores the critical role of IVUS in determining treatment endpoints, while noting the ongoing challenge of an absent standardized definition. The conversation also offers practical insights on procedural techniques and the evolving role of anticoagulation, emphasizing the importance of close collaboration and open communication with referring physicians. --- TIMESTAMPS 00:00 - Introduction00:45 - Overview of DVT Management02:50 - New Guidelines for DVT Treatment07:30 - Technical Endpoints in DVT Treatment13:26 - Clout Registry and Its Findings17:57 - Anticoagulation and DVT23:05 - Defining Acute DVT Management27:00 - Evolving Approaches to Acute DVT28:19 - Patient Experience and Quality of Life31:08 - Referring Providers and Data Impact37:01 - Single Session Treatments and Stenting41:07 - Chronic Venous Disease Management --- RESOURCES (ATTRACT) Weinberg I, Vedantham S, Salter A, et al. Relationships between the use of pharmacomechanical catheter-directed thrombolysis, sonographic findings, and clinical outcomes in patients with acute proximal DVT: Results from the ATTRACT Multicenter Randomized Trial. Vasc Med. 2019;24(5):442-451. doi:10.1177/1358863X19862043https://pubmed.ncbi.nlm.nih.gov/31354089/ (CLOUT) Shaikh A, Zybulewski A, Paulisin J, et al. Six-Month Outcomes of Mechanical Thrombectomy for Treating Deep Vein Thrombosis: Analysis from the 500-Patient CLOUT Registry. Cardiovasc Intervent Radiol. 2023;46(11):1571-1580. doi:10.1007/s00270-023-03509-8https://pubmed.ncbi.nlm.nih.gov/37580422/ (DEFIANCE) Abramowitz SD, Marko X, D'Souza D, et al. Rationale and design of the DEFIANCE study: A randomized controlled trial of mechanical thrombectomy versus anticoagulation alone for iliofemoral deep vein thrombosis. Am Heart J. 2025;281:92-102. doi:10.1016/j.ahj.2024.10.016https://pubmed.ncbi.nlm.nih.gov/39491572/

What should you know before applying to an interventional radiology residency program? Get 70 minutes of free advice in this week's episode of BackTable featuring Georgetown IR fellow Dr. Neil Jain and host Dr. Chris Beck, covering everything from building your IR resume to crushing your interviews. SYNPOSIS The conversation starts by covering the essential steps that medical students can take to build their resume prior to the application cycle, including involvement in the medical student sections of SIR, CIRSE, and local symposiums. Dr. Jain highlights the importance of mentorship and research, strategies for obtaining strong letters of recommendation, and effectively navigating both home and away rotations. The discussion also extends to interview preparation, program selection, signaling updates, and the rank list construction. The episode also touches on the SOAP process for unmatched applicants and the avenues to secure a match. Importantly, Dr. Jain emphasizes the significance of fit over prestige and finding a program that aligns with your values and professional goals. --- TIMESTAMPS 00:00 - Introduction03:07 - Building Your Resume for IR10:43 - Away Rotations and Letters of Recommendation 23:54 - Personal Statements: Importance and Tips30:07 - Application Strategies: IR and DR Programs41:48 - Utilizing Signaling in the Application Process44:19 - Evaluating Programs During Interviews49:58 - Letters of Interest and Intent54:33 - The Interview Day Experience01:04:47 - Building Your Rank List01:08:56 - The SOAP Process01:12:50 - Final Advice and Closing Remarks --- RESOURCES 2025 NRMP Match Data https://www.nrmp.org/wp-content/uploads/2025/03/Advance_Data_Tables_2025.pdfSociety of Interventional Radiology Trainee Websitehttps://www.sirweb.org/in-training/ VI 372 - IR Pathways Unveiled: Matching, Training & Beyond https://www.backtable.com/shows/vi/podcasts/372/ir-pathways-unveiled-matching-training-beyond VI 554: Optimizing the IR/DR Curriculum & Experiencehttps://www.backtable.com/shows/vi/podcasts/554/optimizing-the-ir-dr-curriculum-experience

With the range of interventional modalities that are available for metastatic liver tumors, when should you advocate for thermal ablation at the tumor board? In this episode of BackTable, host Dr. Sabeen Dhand welcomes back Dr. Jason Hoffman, an interventional radiologist from New York University, to discuss tools, techniques, and multidisciplinary collaboration around microwave ablation for liver metastases. --- This podcast is supported by: Varian --- SYNPOSIS The physicians discuss the decision-making process behind using microwave ablation for metastatic liver disease, and strategies for advocating for the technology in tumor boards. Dr. Hoffman especially emphasizes the value of educating patients about their options and using thoughtful clinical judgement as an IR. The discussion delves into the benefits and advancements in microwave ablation, including his experience with the Varian system in light of NeuWave’s discontinuation. Dr. Hoffman shares the utility of software guidance, system fusion with CT machines, temperature monitoring, and the ability to achieve a more spherical ablation zone. --- TIMESTAMPS 00:00 - Introduction04:39 - Practice Growth11:10 - Microwave Ablation Technology12:43 - Multidisciplinary Approach to Liver Metastases26:48 - Microwave Technology and Probe Placement28:42 - Guidance Software and Technological Integration30:40 - Planning and Intraoperative Decisions40:28 - Future of Microwave Ablation48:35 - Conclusion and Final Thoughts

When cancer spreads to the brain, what is the best approach: immediate local treatment or systemic immunotherapy first? Part two of the 2025 NSCLC Creator Weekend™ series focuses on a complex case involving a 75-year-old woman with a history of breast malignancy, presenting with new dyspnea and a large mass in the left lower lobe. --- This podcast is supported by an educational grant from Johnson & Johnson and Varian. --- SYNPOSIS Our mock tumor board consists of surgeons, medical oncologists, and radiation oncologists to deliberate and determine the best treatment plan. The specialists explore diagnostic and treatment options, including neoadjuvant chemoimmunotherapy, invasive mediastinal staging, and the potential for surgical resection or radiation therapy. --- TIMESTAMPS 00:00 - Introduction05:01 - Approach to Isolated Brain Metastasis09:09 - Radiation Therapy Considerations12:06 - Imaging and Follow-Up Strategies14:39 - Resectability and Surgical Decisions19:10 - Conclusion --- RESOURCES PACIFIC Clinical Trialhttps://www.nejm.org/doi/full/10.1056/NEJMoa1709937

When conventional revascularization fails, can deep venous arterialization offer a new lifeline to limb salvage? Dr. Lucas Ferrer Cardona, vascular surgeon at Ascension and Dr. Miguel Montero Baker, vascular surgeon and medical director at HOPE Clinical Innovation Center join host Dr. Sabeen Dhand for an insightful discussion on deep venous arterialization (DVA). --- This podcast is supported by: RADPAD® Radiation Protectionhttps://www.radpad.com/ --- SYNPOSIS The doctors discuss the progression of deep venous arterialization, highlighting the benefits of open, endovascular, and hybrid approaches. They draw on their personal experiences to share key technical nuances and explore new devices such as the Aveera Boomerang device. They emphasize the critical role of patient selection, family support, and close postoperative surveillance, including weekly wound assessments and monthly ultrasound evaluations. Although currently FDA-approved for no-option chronic limb-threatening ischemia (CLTI), Dr. Baker notes that deep venous arterialization may hold promise even for patients earlier in the disease course.The episode concludes by exploring future directions for deep venous arterialization, highlighting the ongoing need for research to advance limb preservation. --- TIMESTAMPS 00:00 - Introduction03:15 - The Inspiration Behind Their Podcast10:05 - Challenges and Success Stories in Vascular Surgery10:29 - Exploring Deep Venous Arterialization (DVA)25:16 - Hybrid Approaches and Patient Outcomes32:06 - Evolution of Endovascular Techniques37:33 - Patient Selection and Criteria38:52 - Understanding the Biology of Procedures43:57 - Exploring New Techniques and Devices58:52 - Challenges and Considerations01:01:51 - Final Thoughts --- RESOURCES Hybrid superficial venous arterialization and endovascular deep venous arterializationhttps://pubmed.ncbi.nlm.nih.gov/37404577/ Transcatheter Arterialization of Deep Veins in Chronic Limb-Threatening Ischemiahttps://www.nejm.org/doi/full/10.1056/NEJMoa2212754

As lung cancer treatments become more complex, is a collaborative tumor board more essential than ever? We’re kicking off the 2025 NSCLC Creator Weekend™ series with an in-studio panel discussion on the multidisciplinary management of lung cancer. The panel includes experts from medical oncology, thoracic surgery, radiation oncology, and interventional pulmonology from major institutions in Los Angeles. --- This podcast is supported by an educational grant from Johnson & Johnson and Varian. --- SYNPOSIS They discuss the operation of tumor boards at their respective institutions, the impact of virtual meetings, optimal strategies for mediastinal staging, the management of early-stage lung cancer, and the emerging role of ablation therapy. The conversation dives into the complexities of treating patients with recurrence or metastatic disease, highlighting the importance of collaborative decision-making in navigating these challenging scenarios. The episode emphasizes the critical role of multidisciplinary tumor boards in providing informed, patient-centered care. --- TIMESTAMPS 00:00 - Introduction06:59 - Role of Pulmonologists in Tumor Boards12:08 - Importance of Tissue Diagnosis24:52 - Lung Cancer Screening and Stigma34:01 - Interventional Radiology and Biopsies46:21 - Challenges with Immunotherapy and Radiation53:44 - The Importance of Multidisciplinary Teams54:24 - Final Thoughts --- RESOURCES American Lung Association 2024 Datahttps://www.lung.org/getmedia/12020193-7fb3-46b8-8d78-0e5d9cd8f93c/SOLC-2024.pdf National Lung Screening Trialhttps://www.nejm.org/doi/full/10.1056/NEJMoa1102873 Checkmate 816https://www.nejm.org/doi/full/10.1056/NEJMoa2202170 PACIFIC Trialhttps://www.nejm.org/doi/full/10.1056/NEJMoa1709937

As breast imaging is becoming increasingly sensitive, is cryoablation the next frontier for treating small cancers or patients who are poor surgical candidates? Learn from expert Dr. Robert Ward, associate professor and program director of the Breast Imaging Fellowship at Brown University as he provides a contemporary overview of the innovative field of breast cryoablation. --- SYNPOSIS Dr. Ward shares his journey to becoming an expert in breast cryoablation, from his start in residency to his well-developed service line today. He details his experience enrolling patients in the FROST Trial, which is investigating the role of breast cryoablation as an alternative for surgery in patients with early stage invasive breast cancer. The conversation also covers the intricacies of the procedure, patient selection criteria, pre- and post-procedural care, and the significance of receptor positivity and clinical markers in treatment choices. Dr. Ward talks through the challenges in needle positioning prior to ice ball formation and the possibility of treating tumors close to the skin surface given appropriate wound care. The discussion concludes with a future look at how cryoablation could change the current paradigm of breast cancer care. --- TIMESTAMPS 00:00 - Introduction 01:39 - The Rise of Breast Cryoablation06:40 - Challenges and Considerations in Cryoablation07:59 - Patient Referral and Evaluation Process13:35 - Equipment and Techniques for Cryoablation23:29 - Procedure Steps and Needle Positioning26:11 - Post-Procedure Thawing and Patient Expectations28:35 - Post-Procedure Care and Follow-Up34:20 - Future of Cryoablation in Breast Cancer Treatment38:01 - Conclusion --- RESOURCES FROST Trialhttps://clinicaltrials.gov/study/NCT01992250 Brown et al., Strategies to Optimize Success in Breast Cancer Cryoablation, Journal of Vascular and Interventional Radiologyhttps://pubmed.ncbi.nlm.nih.gov/41083146/

What role does thyroid artery embolization play in contemporary thyroid cancer care? Dr. Juan Camacho, an interventional radiologist from Sarasota, Florida, joins host Dr. Sabeen Dhand to discuss how this emerging technique is reshaping the management of thyroid malignancies. --- SYNPOSIS Dr. Camacho shares his experiences establishing a multidisciplinary team at Memorial Sloan Kettering Cancer Center dedicated to the management of thyroid malignancies, highlighting the critical role of collaboration in the successful implementation of this emerging treatment. He details key procedural techniques, emphasizing the importance of recognizing anatomic variations that can influence technical success. He also examines how arterial supply and lesion location inform procedural planning and decision-making, and outlines his technical approach to thyroid artery embolization, including the use of a radial artery access, catheter selection strategies, and the application of cone-beam CT for procedural optimization. Finally, he reviews his pre- and post-procedural management strategies, including the role of beta blockers in optimizing patient outcomes. The discussion concludes with illustrative case studies demonstrating substantial reductions in thyroid volume and symptomatic relief, notably achieved without post-procedural hypothyroidism. --- TIMESTAMPS 00:00 - Introduction03:31 - Pioneering Thyroid Ablation at Sloan Kettering06:53 - The Need for Thyroid Artery Embolization25:08 - Pre-Procedural Planning32:41 - Embolization Technique and Procedure44:48 - Choosing the Right Catheter for the Job45:43 - Ensuring Patient Comfort and Safety47:09 - High-Stakes Imaging and Safety Protocols47:55 - Innovative Techniques and Case Studies51:02 - Post-Procedure Management and Follow-Up56:30 - Engaging with Endocrinology and Surgeons01:00:00 - Case Studies and Practical Applications

A patient presents to the ER with hemoptysis. When is bronchial artery embolization (BAE) the right call, and what can you do to tip the odds of procedural success in your favor? In this episode of the BackTable Podcast, interventional radiologist Dr. Alexander Lam of UCSF shares his approach to bronchial artery embolization with host Dr. Ally Baheti.---This podcast is supported by:RADPAD® Radiation Protectionhttps://www.radpad.com/---SYNPOSISThe conversation covers why patients are referred for this procedure, the typical causes of bronchial artery hypertrophy, and Dr. Lam's preferred techniques for embolization, including the use of glue over traditional particles. Dr. Lam emphasizes the importance of multidisciplinary collaboration, detailed pre-procedure preparations, and recognizing potential complications.---TIMESTAMPS00:00 - Introduction01:45 - Patient Evaluation04:22 - Causes of Bronchial Hypertrophy09:03 - Procedure Setup10:35 - Catheter Selection and Techniques13:35 - Embolic Choices and Techniques19:39 - Understanding Different Types of Glue22:48 - Continuous Push Technique24:38 - Managing Complications and Success Rates28:14 - Postoperative Instructions and Follow-Up29:00 - Handling Difficult Bronchial Artery Selections34:02 - Final Thoughts

With the annual trend of fluctuating reimbursement rates, have you been on the fence about turning your OBL into an ASC? Make sure your OBL is prepared for the surprising changes in coding coming in 2026. In this episode, Dr. Mary Costantino partners with fellow OBL owner Dr. Goke Akinwande and revenue cycle management expert Laurie Bouzarelos to review the new CPT code changes and how they translate to OBL and ASC reimbursement.---SYNPOSISDr. Akinwande discusses many positive takeaways after diving into the recent Medicare documents, and highlights key shifts. He believes these changes to add-on codes and territories means one thing: CLI is being heard. The upcoming code changes improve delineation of vascular territories, differentiating between "simple" (stenosis) and "complex" (CTO) procedures. These changes are aimed at rewarding physicians performing the difficult CLI work while decreasing reimbursement for more straightforward cases.Beyond the CPT code specifics, the conversation also covers real-world implications for OBL owners. Dr. Akinwande explains why these changes might narrow the reimbursement gap between OBLs and ASCs, prompting him to warn against ASC conversion. Laurie Bouzarelos provides guidance on implementation, stressing the importance of updating charge masters, reviewing payer contracts for "gap fill" clauses, and monitoring payments once the new codes go live. The episode ends with a discussion on obstacles in billing, collections, and the need for physicians to master the business side of their practice to ensure financial success.---TIMESTAMPS00:00 - Introduction04:37 - 2026 CPT Changes Overview07:18 - Simple vs. Complex Codes13:16 - Key Add-on Codes19:52 - OBL vs. ASC Conversion?24:56 - IVL Reimbursement Trends29:18 - Update Your Charge Master41:41 - Pricing & Medicare Year46:39 - Billing & Collections Reality