Dr. Alan Matsumoto, Chair of the Department of Radiology at the University of Virginia, discusses his career in interventional radiology, including his initial interest and journey into the field. He highlights the importance of uniformity and training in clinical IR, as well as the challenges faced in transitioning to independent practice. Dr. Matsumoto reflects on the experiences and differences between private practice and academia, and shares insights into transitioning from a fellow to an attending. He also discusses his path to becoming chief and chair of his department, and offers advice for upcoming interventional radiologists.

Dr. Kush Desai and Dr. Steven Abramowitz discuss iliofemoral venous stenting, including referral patterns, work-up of patients, procedural approach, best practices, and post-operative follow up. They also touch on the impact of venous disease, tools for complex crossings, stent selection, recognizing problems during procedures, and the rapid evolution of venous stenting.

Interventional radiologists discuss the spectrum of patient sedation for IR procedures, emphasizing the fluidity between local anesthesia, moderate sedation, and deep sedation. They highlight the need for trauma-informed care and comprehensive patient education. The decision for anesthesia is influenced by factors such as the procedure type, patient's condition, and provider preference. The game-changing concept of having an anesthesia team present for real-time monitoring is explored. The podcast also touches on topics like G2 tubes, lidocaine toxicity, patient-centered care, and the importance of separate roles for sedation and procedure.

In this episode, host Dr. Ally Baheti interviews vascular surgeon Dr. Steven Abramowitz and interventional radiologist Dr. Angelo Marino on managing venous stent rethrombosis with the RevCore device. Steven is the Chair of Vascular Surgery at MedStar Washington Hospital and Angelo is an Assistant Professor of Interventional Radiology at Yale School of Medicine.---CHECK OUT OUR SPONSORInari Medical RevCorehttps://www.inarimedical.com/revcore/---SHOW NOTESWe start this episode with Steven and Angelo’s experience in venous interventions and how venous stent rethrombosis presents. The doctors then tell us more about how stent failure can precipitate, inflow and landing zone considerations, and stenting location. Angelo then goes onto introduce the RevCore device.Both Steven and Angelo share their experience in using the RevCore device in venous stent rethrombosis, and their preferred access site(s) when using this tool. They also discuss specific maneuvers, troubleshooting, and other tools they use alongside the RevCore system. We conclude this episode with the doctor’s overall treatment algorithm for venous stent rethrombosis and follow-up plans.---RESOURCESInari Medical RevCore Device:https://www.inarimedical.com/revcore/

Interventional radiologists Dr. Juan Gimenez and Dr. Tyler Sandow discuss managing hepatocellular carcinoma (HCC) in this episode. They delve into topics like lobar treatment vs. radiation segmentectomy, ablation and Y-90 combination, preoperative mapping, cone-beam CT, complex cases, treatment plans, and current research pursuits. Important points include new developments in tumor markers and the role of albumin in HCC. They also touch upon combination therapies, collaboration with oncologists, and the use of segmentectomy for metastatic disease.

Dr. Bruno Odisio and Dr. Constantinos Sofocleous discuss the history and advancements in tumor ablation, emphasizing the importance of establishing larger margins for improved outcomes. They also explore the challenges in conducting comprehensive studies due to the presence of multiple ablation technology vendors. The significance of ablation margin confirmation and the use of software for optimal treatment planning is highlighted. The speakers also touch upon the background, design, and industry sponsors of a renowned liver ablation trial, as well as the challenges in assessing ablation confirmation margin.

Dr. Juan Gimenez and Dr. Tyler Sandow, experienced interventional radiologists, discuss the management of hepatocellular carcinoma (HCC). They cover topics such as building strong relations with transplant surgeons, working-up patients with HCC, effective interventional oncology services, and factors that guide their treatment plan using the Barcelona Clinic Liver Cancer (BCLC) staging algorithm. Stay tuned for Part 2 of this discussion.

In this episode, host Dr. Jacob Fleming interviews Dr. Dana Dunleavy about spinal tumor ablation and vertebral augmentation. Dana is an interventional radiologist and Director of Windsong Interventional & Vascular Services.---CHECK OUT OUR SPONSORStryker Interventional Spinehttps://www.strykerivs.com---SHOW NOTESDana begins the discussion by reflecting on his upbringing in a small country town. His parents, his mother a midwife and his father a contractor, shaped his early experiences. His exposure to medicine began through his mother, particularly in witnessing childbirths. As he navigated his way through medical school, he contemplated various specialties, including orthopedic surgery, interventional radiology, and neurosurgery. He discovered incredible mentors in radiology and ultimately found his place in the field of interventional radiology. During his residency at Johns Hopkins, he sought externships in interventional spine and had the opportunity to immerse himself in this field for one month.He underscores the significance of participating in tumor boards and being a valuable contributor to the team in terms of diagnosis and treatment. He also emphasizes the value of calling consults when performing biopsies and the importance of meeting with the patient face-to-face and engaging in a thorough discussion of the treatment plan.Next, Dana delves deeper into the topics of bone tumor ablation and mechanical augmentation. He notes the importance of having a comprehensive understanding of the patient's anatomy and being well-versed in interventional tools. Cement extravasation is a feared complication of vertebral augmentation, so Dana discusses the role of implants as a means to establish structural support and mitigate the risk of cement leakage. In addition, he talks about his approach in combining ablation with mechanical augmentation so that the augmentation provides a structure after the ablation.Lastly, he discusses the use of advanced technology such as cone beam CT in trajectory planning. He shares his hybrid approach to performing bone biopsies, utilizing fluoroscopy during access and cone beam CT to ascertain accurate trajectory.

In this episode, host Dr. Ally Baheti interviews Dr. Bill Julien about strategies to secure independent IR hospital privileges. Bill is an experienced vascular interventional physician at South Florida Vascular Associates.---CHECK OUT OUR SPONSORSBD Advance Clinical Training & Education Programhttps://page.bd.com/Advance-Training-Program_Homepage.htmlSiemens Healthineershttps://www.siemens-healthineers.com/Reflow Medicalhttps://www.reflowmedical.com/---SHOW NOTESBill starts the episode by telling us why it is crucial for vascular and interventional physicians to have hospital privileges. We learn about Bill’s career progression. He discusses the growing pains he faced, how he effectively tackled these challenges, and how he became staff at a number of hospitals.Bill and Ally then unfold Bill’s detailed roadmap for how IRs can join hospital staff. They explore different pathways, and Bill shares his anecdotes and advice throughout. The doctors discuss how many contracts leave little opportunity to build longitudinal care practice, since the majority of time can be dedicated to large volumes of diagnostic reading time and consults for non-complex cases.At the conclusion of this episode, Bill emphasizes the need for SIR and other societies to step in and usher change. He also shares his 13-point action list for what SIR can do to accomplish this and help IRs secure hospital privileges (linked in Resources section).---RESOURCESSIR Strategic Plan:https://tinyurl.com/SIRstrategicplanSIR Policy Statement:https://tinyurl.com/SIRpolicystatementDr. Bill Julien’s Clinical Practice Position:https://tinyurl.com/clinicalpracticeposition2ACR Policy Statement:https://tinyurl.com/ACRpolicystatement

In this episode, host Dr. Dana Dunleavy engages in a thought-provoking discussion about independent interventional radiology practice with two esteemed IRs, Dr. Kavi Devulapalli and Dr. Ian Wilson. Together, they discuss the complexities and opportunities in the ever-evolving landscape of IR.---CHECK OUT OUR SPONSORPhilips SymphonySuitehttps://www.philips.com/symphonysuite---SHOW NOTESWe start off the discussion with Kavi expanding on early experiences in working a standard DR / IR split that most IRs tend to work in. He elaborates on how this split was not what he, as well as most IRs, intended to practice in when they entered the field. Thus, he then shifted over to the OBL space, a gratifying journey, but one he notes was difficult to navigate due to the intricacies. As Kavi finally transitioned to locum tenens work, he reflects on its appeal, despite the scarcity of opportunities. He notes that locum tenens work is usually in areas with an extreme dearth of IRs, such as rural areas. This conversation also explores the topic of exclusive contracts. Their impact on independent IR practices' access to hospital privileges is also explored, shedding light on the challenges faced by IRs seeking to expand their reach.Ian then notes that his locum tenens work was also in a rural setting, and how he had served this location for an extended period of time due to their lack of retention of IRs. The discussion then reveals a growing trend among physicians, as more and more are turning to locum work due to its exclusive focus on the IR aspect of the job that initially attracted them to this field. It's a mutual demand, as physicians seeking to specialize in IR find locum work to be a well-suited avenue, while areas of healthcare dearth are equally eager to tap into the expertise of these specialists.Both guests emphasize the urgent need for sustainable solutions to address this growing public health crisis in rural areas. This is precisely where organizations like Travelier come into play. Travelier was established by IRs, one of whom is Kavi, with a mission to bridge this critical gap by offering world-class IR services to communities with unmet needs. Their approach involves assembling dedicated physician teams and creating interventional radiology practices that generate revenue while providing viable work solutions for radiologists. This discussion is a testament to the adaptability and innovation that drive the field of IR, characterized by the commitment to improving healthcare access in areas where it is needed the most. It's also a testament to the increasing mutual demand for specialized IR services and the unique opportunities that come with it.---RESOURCESTravelier:https://travelierir.com