BackTable Vascular & Interventional

Join Dr. Howard Chrisman, the President and CEO of Northwestern Medicine, as he shares his inspiring journey from aspiring veterinarian to a leading figure in interventional radiology. He emphasizes the crucial role of mentorship and self-awareness in healthcare leadership. Discover how he navigates the intersection of clinical and administrative worlds, addresses specialty bias, and fosters collaboration. The discussion also explores the transformative impact of AI on radiology and offers insight into the evolving roles of physicians in health systems.

Dr. Vijay Ramalingam, a vascular and interventional radiologist at Beth Israel Deaconess Medical Center, dives into managing portal vein thrombosis (PVT). He discusses the essential multidisciplinary approach to patient care, detailing workflows and decision-making algorithms for both acute and chronic cases. Dr. Ramalingam also shares his step-by-step technique for portal vein recanalization, provides insights into when to use adjunctive therapies like suction thrombectomy, and highlights early clinic data showing impactful shifts in patient management.

This week’s episode is a masterclass on vascular anomaly treatment. Brush up on your malformations with Dr. Cliff Weiss, the Director of the Vascular Anomaly Center at Johns Hopkins. He shares next-level techniques, precision diagnostics, and his 'gold standard' approach to alcohol sclerotherapy. --- This podcast is supported by:RADPAD® Radiation Protectionhttps://www.radpad.com/ --- SYNPOSIS The episode begins with the most vital component of patient care: establishing a correct diagnosis through proper classification. Dr. Weiss shares his philosophy that “MRI is a conversation” - not just an image, detailing the specific MRI protocols to confidently make a diagnosis over 90% of the time. He then shares an overview of the classification system, differentiating vascular tumors like hemangiomas from high-flow and low-flow vascular malformations. Dr. Weiss explores a wide array of treatment strategies tailored to each diagnosis. He walks through his techniques for treating low-flow malformations with sclerotherapy—using agents like alcohol, doxycycline, and bleomycin based on a lesion’s location and characteristics—and his use of cryoablation for vascular tumors. He then dives into the creative and high-stakes approaches for treating AVMs, comparing transvenous and transarterial embolization with agents like Onyx and coils, before concluding with his predictions on the future of IR in the field. --- TIMESTAMPS 00:00 - Introduction 02:36 - Vascular Anomaly Center at Johns Hopkins06:33 - Vascular Anomaly & Malformation Diagnosis with Imaging09:04 - Classifying Vascular Anomalies15:55 - Vascular Tumors18:46 - Low-Flow Malformations27:58 - Needle Placement29:56 - Retro-orbital & ENT Malformations32:44 - AVM Treatment Strategy40:41 - Following up with Patients

What happens when the doctor suddenly becomes the patient? In this episode of the BackTable podcast, host Dr. Ally Baheti interviews Dr. Nicholas Hanson, an interventional and diagnostic radiologist from Oregon, about a life-changing event that dramatically altered his career.---SYNPOSISDr. Hanson describes the circumstances surrounding a severe car accident that resulted in a traumatic brain injury and subsequent medical complications, including the discovery of a heart aneurysm. He shares the challenges of his recovery, his struggle with insurance companies, and the emotional and professional toll of his experiences. Dr. Hanson provides valuable insights into the importance of disability insurance and the often overwhelming process of navigating healthcare systems. The discussion also touches on the ongoing debate about the separation of interventional radiology from diagnostic radiology and how sudden life events can impact one's career in medicine.---TIMESTAMPS00:00 - Introduction01:19 - The Life-Changing Event09:28 - Navigating Insurance and Disability16:39 - The Future of IR and Career Advice21:50 - Struggles with Disconnection28:56 - The Road to Recovery35:20 - Reflecting on the Journey37:42 - Closing Thoughts and Future Hopes

Dr. Driss Raissi, an interventional radiologist and division chief at the University of Kentucky, shares his expertise in microwave ablation techniques. He discusses using innovative strategies to tackle various complex cases, including large liver tumors and challenging fistulas. Dr. Raissi introduces his pre-burn technique to reduce complications and reveals his 'lung seal technique' for lung ablation. He also compares microwave versus cryoablation for different tumor types, emphasizing collaboration and effective communication in optimizing ablation outcomes.

Dr. Ahsun Riaz, an interventional radiologist at Northwestern University, specializes in hepatobiliary services. In this discussion, he shares insights on managing biliary strictures using innovative techniques like endoscopic evaluation and radiofrequency ablation. He emphasizes the importance of distinguishing between benign and malignant conditions and outlines practical tips for biliary drain management. Riaz also highlights collaborative approaches to enhance patient care and improve long-term outcomes, ensuring comprehensive follow-up and minimizing drain duration.

Dr. Ryan Trojan, an interventional radiologist at INTEGRIS Health, discusses his transition from a blended practice to hospital employment, highlighting the financial and administrative challenges involved. He emphasizes the importance of demonstrating interventional radiology's value to hospital leadership, from reducing patient stays to enhancing trauma services. Ryan also explores contract structures, advocating for salary models that support lower RVU work. With insights on job satisfaction and growth in IR services, he offers practical advice for those considering a similar shift.

Join Dr. Clifford Weiss, a pioneering radiologist from Johns Hopkins, and Dr. David Woodrum, an innovative interventional radiologist at Mayo Clinic, as they dive into the future of MRI-guided interventions. They discuss the powerful imaging advantages of MRI, including reduced radiation exposure and superior targeting for ablations. The duo also tackle the significant tech challenges facing adoption and explore the evolving landscape of hybrid MR facilities. With insights for young physicians, they highlight exciting training opportunities in this cutting-edge field.

The hosts dive into innovative techniques shared in a recent tips and tricks competition, showcasing accessibility in interventional radiology. They explore advanced urological catheterization methods, peppered with humor and personal experiences. The discussion on direct portal access for TIPS procedures highlights its benefits over newer approaches. Practical tips to navigate challenging liver procedures are shared, along with creative access techniques to enhance patient comfort and procedural efficiency. Listener engagement is celebrated throughout, enhancing the community spirit.

Join interventional radiologists Dr. Omar Chohan and Dr. Harris Chengazi as they explore the evolving role of mesocaval shunts for managing portal hypertension. They discuss patient selection, highlighting challenging cases like autoimmune hepatitis and pancreatic cancer. The conversation dives into meticulous planning using advanced imaging tools like the 4D CT scanner and emphasizes the importance of compassion in patient care. These experts share insights on overcoming procedural challenges to improve quality of life for their patients.