BackTable Vascular & Interventional

Is minimally invasive ablation the future of metastatic cancer care? We now have the results of the COLLISION Trial, which investigates the non-inferiority of thermal ablation compared to surgical resection. How will these findings change treatment paradigms and practice patterns around metastatic colorectal cancer? In this week’s episode of BackTable, interventional radiologist Dr. Chris Beck discusses the impact and implications of the COLLISION Trial with principal investigator Dr. Martijn Meijerink from Amsterdam UMC.---SYNPOSISThe doctors explore the COLLISION Trial’s design, results, complication rates, and future directions. They also cover best practices for ablation techniques and the potential for interventional oncology to enter a “golden era.” Finally, Dr. Meijerink highlights the importance of standardizing intervention quality and being present in tumor boards to ensure optimal patient care.---TIMESTAMPS00:00 - Introduction 03:21 - Understanding Metastatic Colorectal Cancer and IR’s Role05:18 - Introduction to the COLLISION Trial07:40 - Radiofrequency vs Microwave Ablation and Technological Advancements09:02 - Trial Design and Patient Eligibility16:20 - Ablation Techniques and Approaches22:05 - Trial Results and Analysis30:19 - Impact on Guidelines and Practice39:44 - Best Practices in Thermal Ablation43:27 - Future Directions in Interventional Oncology---RESOURCES“Surgery versus thermal ablation for small-size colorectal liver metastases (COLLISION): An international, multicenter, phase III randomized controlled trial.” (Meijerink, 2024)https://ascopubs.org/doi/10.1200/JCO.2024.42.17_suppl.LBA3501

Dr. Kavi Devulapalli, a physician at Image Guided Solutions, and Dr. Christopher Zarour, from a private practice in Ann Arbor, dive into the early career landscape of interventional radiology. They discuss the importance of finding the right practice model that aligns with one's skills as either an imager or surgeon. Personal experiences highlight the challenges of job searching, establishing clinical practices, and building strong professional networks. They also offer invaluable insights on the financial fundamentals and the significance of mentorship for new graduates.

Dr. Ben May, an Interventional Radiologist at Weill Cornell Medicine, specializes in hepatobiliary services and shares his expertise on acute portal vein thrombosis. He discusses the need for effective treatment options beyond anticoagulation, especially for younger patients. Dr. May highlights innovative techniques such as suction thrombectomy and the importance of personalized interventions based on clot characteristics. He also emphasizes collaborative practices in managing complex cases and offers practical tips for successful thrombectomy procedures.

Dr. Gloria Salazar, a radiologist and associate professor at the University of North Carolina, dives into the complexities of chronic pelvic pain and pelvic varices in women. She shares her inspiring journey from Brazil, advocating for better women's health. Key topics include the challenges of diagnosing pelvic conditions, the need for interdisciplinary collaboration, and the psychological impacts of underdiagnosis. The conversation also stresses the importance of awareness, education, and responsible treatment options to improve women's health outcomes.

Dr. Saher Sabri, Chief of Interventional Radiology at MedStar Health and future president of the Society of Interventional Radiology, joins Dr. Mark Lessne, an interventional radiologist at Charlotte Radiology. Together, they delve into the evolving relationship between interventional and diagnostic radiology. They discuss the challenges and financial pressures facing interventional specialists while highlighting the need for clearer definitions of their roles. The conversation suggests an impending separation between the two fields, raising critical questions about future identities and sustainability.

Dr. Richard Finn, a medical oncologist at UCLA with expertise in liver cancer clinical trials, and Dr. Julius Chapiro, an interventional radiologist at Yale, delve into groundbreaking treatments for hepatocellular carcinoma. They discuss the synergy between transarterial chemoembolization (TACE) and immunotherapy, revealing how recent studies shift treatment paradigms. The duo emphasizes the need for a multidisciplinary approach, highlights advancements in biopsy techniques, and the importance of robust data in guiding treatment decisions.

What is the key to running an efficient OBL? Dr. Mary Costantino, medical director of Advanced Vascular Centers, joins host Dr. Ally Baheti to share some of the key ingredients in keeping it lean in OBL.---SYNPOSISThe doctors delve into strategies in running a cost-effective OBL while upholding clinical excellence. Dr. Costantino shares her personal insights and experiences in minimizing unnecessary costs while maintaining regulatory compliance, high-performing team, and outstanding patient care. She also underscores the importance of having a clear leadership vision and remaining at the forefront of patient care to proactively identify challenges and develop effective solutions to address them. Lastly, she shares her thoughts on navigating the challenges of balancing personal and professional responsibilities in the growing field of outpatient vascular care.---TIMESTAMPS00:00 - Introduction01:46 - Expanding Practices and Partnerships06:24 - Navigating Regulatory Requirements12:26 - Building a Lean and Valuable Team35:01 - Leadership39:54 - Opportunity Cost in Practice Management44:32 - Employee Growth and Retention Strategies46:49 - Building and Maintaining a Successful Practice01:06:54 - The Financial Wheel and Its Impact on Small Businesses

Join Dr. Louis Hinshaw, a specialist in image-guided procedures for renal tumors, and Dr. Jason Abel, an expert in urologic oncology, as they explore innovative approaches to kidney cancer care. They discuss the evolution from cryoablation to microwave ablation and the role of multidisciplinary teamwork in improving patient outcomes. Their insights on patient selection, the significance of collaboration between urologists and radiologists, and the future of renal cancer treatment are both enlightening and inspiring.

Who is the ultimate candidate for GAE, which technical approach is best, and how do you set your patients up for success? Tune into this week’s episode of BackTable to hear from interventional radiologists Dr. Osman Ahmed (University of Chicago Medicine) and Dr. Siddharth Padia (UCLA Health) as they discuss everything from patient selection to follow-up care, covering pre-procedure imaging, access, embolics, technical challenges, clinical data, and the future of genicular artery embolization.---SYNPOSISDr. Ahmed and Dr. Padia debate their approaches to patient selection criteria, the use of MRI and cone beam CT, permanent vs. resorbable embolic materials, how many arteries to embolize, and the relevance of pain metrics post GAE. They also delve into follow-up considerations and the potential for GAE as a long term treatment.---TIMESTAMPS00:00 Introduction01:08 MRI for Patient Selection in GAE08:53 Access Techniques: Femoral vs. Pedal17:07 Cone Beam CT in GAE Procedures27:20 Embolization Strategies39:30 Challenges and Complications in Embolization44:50 Follow-Up and Pain Metrics in Clinical Practice and Research01:06:30 Repeat GAE Procedures: When and Why?01:11:13 Post-Total Knee Replacement and GAE01:21:01 Advice for IRs Looking to do GAE01:24:32 Conclusion and Final Thoughts---RESOURCESGENESIS Trial: https://pubmed.ncbi.nlm.nih.gov/33474601/Landers et al Trial: https://pubmed.ncbi.nlm.nih.gov/37051829/

Dr. Ned Holman, a Neuroradiologist at Alaska Imaging, and Dr. Mike Romeo, President of West Reading Radiology, dive into the intricacies of the diagnostic radiology job market. They discuss diverse employment models and the importance of job transparency. Tips on compensation structures, contract negotiation, and critical interview questions are shared. They also warn about red flags to look out for and discuss the pros and cons of private equity positions in radiology, making this an essential listen for anyone navigating their career path.