Episodes
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In this episode, Dr. Aron Chary provides an in-depth look into endovascular and minimally invasive treatments for pain management, specifically focusing on cryoneurolysis. He shares his experience of implementing the technology for both benign and malignant conditions in an independent private practice setting.
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Boston Scientific Visual ICE Cryoablation System
https://www.bostonscientific.com/en-US/products/cryoablation/visual-ice.html
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SYNPOSIS
The discussion covers various aspects, including collaboration with Boston Scientific for the VISUAL ICE cryoablation system, Dr. Chary’s personal journey from academics at Emory to private practice in Memphis, the effectiveness of cryoneurolysis in different areas such as genicular nerve and palliative care, and the operational dynamics between hospital and outpatient settings. The doctors delve into the procedural specifics, patient response, and outcomes with cryoneurolysis, including Dr. Chary’s efforts to navigate insurance and reimbursement challenges.
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TIMESTAMPS
00:00 - Introduction
07:04 - Evolution of Pain Intervention Techniques
11:08 - Building a Pain Intervention Service
16:16 - Versatility of Cryoablation in Pain Management
23:54 - Expectations and the Future of Pain Management Research
31:41 - Cryoneurolysis Insights and Patient Management
42:10 - Techniques in Celiac Cryoneurolysis
52:33 - Pain Management in the Outpatient Setting
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RESOURCES
Percutaneous CT-Guided Cryoablation of the Celiac Plexus: A Retrospective Cohort Comparison with Ethanol:
https://www.jvir.org/article/S1051-0443(20)30349-3/abstract
BT VI Episode 199 - Advanced Minimally Invasive Pain Interventions with Dr. David Prologo:
https://www.backtable.com/shows/vi/podcasts/199/advanced-minimally-invasive-pain-interventions
BT VI Episode 433 - Kyphoplasty Evolution: Steering Toward Targeted Therapy with Dr. David Prologo:
https://www.backtable.com/shows/vi/podcasts/433/kyphoplasty-evolution-steering-toward-targeted-therapy
Boston Scientific, VISUAL ICE:
https://www.bostonscientific.com/en-US/products/cryoablation/visual-ice.html -
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.
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CHECK OUT OUR SPONSOR
Reflow Medical
https://www.reflowmedical.com/
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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
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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/ -
Missing episodes?
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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.
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CHECK OUT OUR SPONSOR
Reflow Medical
https://www.reflowmedical.com/
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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
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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.
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CHECK OUT OUR SPONSOR
RADPAD® Radiation Protection
https://www.radpad.com/
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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
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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.
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CHECK OUT OUR SPONSOR
RADPAD® Radiation Protection
https://www.radpad.com/
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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
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RESOURCES
Dr. Bryan Hartley’s email:
[email protected]
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.
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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/
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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
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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.
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CHECK OUT OUR SPONSOR
Nevro HFX Spinal Cord Stimulator
https://www.hfxforpdn.com
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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
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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.
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RADPAD® Radiation Protection
https://www.radpad.com/
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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
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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.
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CHECK OUT OUR SPONSOR
Merit Spine
https://www.merit.com/merit-spine/
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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
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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.
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CHECK OUT OUR SPONSOR
Reflow Medical
https://www.reflowmedical.com/
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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
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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.
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CHECK OUT OUR SPONSOR
Reflow Medical
https://www.reflowmedical.com/
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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
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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.
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CHECK OUT OUR SPONSORS
Varian, a Siemens Healthineers company
https://www.siemens-healthineers.com/
Reflow Medical
https://www.reflowmedical.com/
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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
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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.
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CHECK OUT OUR SPONSOR
Boston Scientific Obsidio Embolics
https://www.bostonscientific.com/obsidio
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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
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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
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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
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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.
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CHECK OUT OUR SPONSOR
Varian, a Siemens Healthineers company
https://www.siemens-healthineers.com/
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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
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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 -
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/
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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
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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
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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/
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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 - Show more
