BackTable Vascular & Interventional

Dr. Douglas Beall, an interventional radiologist, shares his expertise on groundbreaking techniques in vertebral augmentation. He dives into screw-assisted vertebral augmentation and advanced tools like vertebral body stents and shaped balloons, all aimed at improving patient outcomes. The discussion highlights how to prevent complications, particularly cement extravasation, and the importance of precise techniques. Dr. Beall emphasizes a shift toward minimally invasive procedures for better results in treating vertebral compression fractures.

In this episode, host Dr. Jacob Fleming interviews Dr. Douglas Beall about current osteoporosis diagnosis criteria, his treatment algorithm, and recent data showing efficacy of osteoanabolic agents and vertebroplasty.---CHECK OUT OUR SPONSORDI4MDsProtect your most valuable asset, the skill and ability to practice your medical specialty. Be prepared by establishing a specialty specific disability insurance policy from the experts at DI4MDs. Contact them today at www.Di4MDS.com or call 888-934-4637.---EARN CMEReflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/oQMiwe---SHOW NOTESIn this episode, host Dr. Jacob Fleming interviews Dr. Douglas Beall about current osteoporosis diagnosis criteria, his treatment algorithm, and recent data showing efficacy of osteoanabolic agents and vertebroplasty. This is the second installment of our 4-part BackTable VI series on osteoporosis treatment.As we continue our conversation from Ep. 208, Dr. Beall outlines his typical follow up protocol for his patients. This includes DEXA scans in the first and second years, prescriptions for antiresorptive and/or osteoanabolic agents, and possible Romosozumab injections. Dr. Beall emphasizes that thoroughness is key to treating the disease process, and each encounter is a reimbursable event that can benefit both the patient and the practice.Next, we shift to talking about the American Association of Clinical Endocrinologists (AACE) diagnostic criteria for osteoporosis. Dr. Beall highlights the fact that there are 4 categories that encompass information about DEXA (T-scores), FRAX scores, and fragility fractures. Sole reliance on DEXA score cutoffs can lead to under-diagnosis and increased mortality risk for patients. Notably, any past fragility fracture in a postmenopausal woman is sufficient for an osteoporosis diagnosis. Dr. Beall shares that 82% of patients with fragility fractures do not have T-scores in the osteoporotic range. On the other hand, there are confounding factors that can give a falsely elevated T-score.As we shift to discussing medications for osteoporosis, Dr. Beall emphasizes the need to consider the order in which they are prescribed. He advocates for initially using osteo anabolics (specifically a PTH analog) for 2 years to build up bone mineral density, and then maintaining that density with antiresorptives afterwards. He notes that with the risk of bisphosphonate side effects like osteonecrosis of the jaw and atypical femur fracture, it is unwise to prescribe these antiresorptives as an initial treatment.Finally, we begin the conversation about vertebroplasty and recent trials proving its efficacy in reducing pain and improving function for patients. Tune in to our next 2 installments to learn about Dr. Beall’s clinical pearls for vertebral augmentation!---RESOURCESDr. Douglas Beall Twitter:@DougBeallBackTable VI Episode 94, Innovation in Spine Interventions with Dr. Douglas Beall:https://www.backtable.com/shows/vi/podcasts/94/innovation-in-spine-interventionsComparison of thoracolumbosacral orthosis and no orthosis for the treatment of thoracolumbar burst fractures: interim analysis of a multicenter randomized clinical equivalence trial (2009):https://pubmed.ncbi.nlm.nih.gov/19769510/Comparative study of the treatment outcomes of osteoporotic compression fractures without neurologic injury using a rigid brace, a soft brace, and no brace: a prospective randomized controlled non-inferiority trial (2014):https://pubmed.ncbi.nlm.nih.gov/25471910/The efficacy of conservative treatment of osteoporotic compression fractures on acute pain relief: a systematic review with meta-analysis (2015):https://pubmed.ncbi.nlm.nih.gov/25725810/Clinical effect of balloon kyphoplasty in elderly patients with multiple osteoporotic vertebral fracture (2019):https://pubmed.ncbi.nlm.nih.gov/30837413/

In this episode, host Dr. Jacob Fleming interviews Dr. Douglas Beall about the importance of interventional radiologists stepping up to address the entire picture of osteoporosis and taking the initiative to treat the underlying cause of the disease.---CHECK OUT OUR SPONSORLaurel Road for Doctorshttps://www.laurelroad.com/healthcare-banking/---EARN CMEReflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/xVGPFx---SHOW NOTESIn this episode, host Dr. Jacob Fleming interviews Dr. Douglas Beall about the importance of interventional radiologists stepping up to address the entire picture of osteoporosis and taking the initiative to treat the underlying cause of the disease. This is the first installment of our 4-part BackTable VI series on osteoporosis treatment.Dr. Beall starts by stating his mission: he not only performs vertebral augmentation; he also offers DXA scans and T-score analysis, prescribes osteoanabolic agents, and follows up with patients over time. Dr. Beall cites data showing that both vertebral augmentation and osteoporosis medications can improve patients’ quality of life and significantly reduce mortality.Even with newer osteoanabolic agents like Teriparatide, Abaloparatide, and Romosozumab being approved for treatment, osteoporosis screening rates have dropped in recent years. This is a pressing concern, since osteoporosis is a growing societal burden, given the increasing population of elderly patients. Furthermore, treatment of osteoporosis allows patients to regain mobility, which reduces comorbidities. We finish this episode by discussing how IRs have the potential to learn about osteoanabolic medications, counsel patients, and take ownership of this disease process.---RESOURCESDr. Douglas Beall Twitter:@DougBeallBackTable VI Episode 94, Innovation in Spine Interventions with Dr. Douglas Beall:https://www.backtable.com/shows/vi/podcasts/94/innovation-in-spine-interventionsNumber Needed to Treat with Vertebral Augmentation to Save a Life:http://www.ajnr.org/content/early/2019/12/19/ajnr.A6367Risk of Mortality Following Clinical Fractures:https://pubmed.ncbi.nlm.nih.gov/11069188/Prospective and Multicenter Evaluation of Outcomes for Quality of Life and Activities of Daily Living for Balloon Kyphoplasty in the Treatment of Vertebral Compression Fractures: The EVOLVE Trial:https://journals.lww.com/neurosurgery/Fulltext/2019/01000/Prospective_and_Multicenter_Evaluation_of_Outcomes.20.aspx

En este episodio de BackTable, Dra. Gina Landinez habla con el Dr. Alejandro Mejia, cirujano trasplante de Methodist Dallas, y la Dra. Pilar Bayona, radiologista intervencionista de UT Southwestern, sobre la colaboración entre los cirujanos trasplantes y los radiólogos intervencionistas durante los trasplantes de hígados. Hablan sobre el papel de los radiólogos intervencionistas durante los periodos críticos de trasplante: el preoperatorio, el perioperatorio, y el postoperatorio.The CME experience for this Podcast is powered by CMEfy - click here to reflect and unlock credits & more: https://earnc.me/rkKX8a---CHECK OUT OUR SPONSORLaurel Road for Doctorshttps://www.laurelroad.com/healthcare-banking/

We talk with interventional cardiologist Dr. Gary Ansel about his career in medical device innovation, including the development of the Ansel Guiding Sheath and the Pounce Thrombectomy System (which was recently acquired by Surmodics, Inc.).---EARN CMEReflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/3y4ysO---SHOW NOTESIn this episode, our host Dr. Bryan Hartley interviews interventional cardiologist Dr. Gary Ansel about his career in medical device innovation, including the development of the Ansel Guiding Sheath and the Pounce Thrombectomy System (which was recently acquired by Surmodics).Dr. Ansel describes his early career and how he identified a clinical need within the realm of renal stenting. His collaboration with Cook Medical evolved into a guiding sheath that has now become widely popular. Dr. Ansel stresses the importance of ensuring that a device has a value proposition for all stakeholders– patients, doctors, hospitals, and payers. The added cost of a new device must provide overall benefits to the procedure.Next, we discuss Dr. Ansel’s development of a percutaneous thrombectomy system over the course of twelve years, multiple patent applications, and various obstacles. Throughout this process, Dr. Ansel highlights the benefits of having the expertise of a knowledgeable business team. He also tells new entrepreneurs to focus on de-risking their ideas with patents and early sales, in order to make their offerings more attractive to potential investors and acquirers.---RESOURCESAnsel Guiding Sheath:https://www.cookmedical.com/products/dfdfc483-b37b-49f2-8a78-937bf16ae831/Pounce Thrombectomy System:https://pouncesystem.com/

As part of our Health Equity Series Dr. Vishal Kumar talks with Shane Snowdon about current challenges in healthcare for LGTBQ+ patients, how we can improve communication, reduce fear and misunderstanding, and be a true patient advocate, starting with our own education.The CME experience for this Podcast is powered by CMEfy - click here to reflect and unlock credits & more: https://earnc.me/moP2eJ---SHOW NOTESIn this episode, guest host Dr. Vishal Kumar and educator/advocate Shane Snowdon discuss unique barriers to care for LGBTQ+ individuals, as well as strategies for healthcare providers can create nonjudgemental environments for this community.Shane starts by outlining the history of LGBTQ+ healthcare in the United States, noting that it first came to public attention in the midst of the HIV/AIDS epidemic of the 1980s. In the 2020s, the major concerns for LGBTQ+ health access have been centered around gender-affirming care for youths and adults. Shane emphasizes that the process of coming out to healthcare providers empowers LGTBQ+ individuals to “claim an identity that they had been taught to dispense and conceal.” The concern is that when they become known as LGBTQ+, will the provider and system treat them and their families with the respect and care with which they treat people who do not identify as LGBTQ+? Shane says that discrimination in healthcare makes it more likely for patients to delay their screenings and follow up appointments, leading to less engagement in care and worse medical outcomes.Next, we shift to discuss specific patient-provider communication techniques. Shane addresses the fact that there will be moments when providers make the mistake of misgendering patients. Shane advises providers to acknowledge the mistake in the moment, apologize, and affirm the patient’s self identity. This well-meaning approach can help build trust and give the provider an opportunity to specify the patient’s preferred identifiers in the electronic health record. Furthermore, we discuss the unique role of the radiologist in providing LGBTQ+ care, as it is often radiologists who learn that someone is transgender, through imaging. Radiologists can reach out to the patient in a sensitive and respectful way and notify their colleagues of the need for clarification in the electronic medical record.Finally, we discuss healthcare systems and the need for foundational policies, integrated education about LGBTQ+ patients across all healthcare topics, and adequate resources for LGBTQ+ staff and patients. Shane highlights the Healthcare Equality Index, a specific tool that healthcare systems can use to self-assess their level of health equity and learn additional strategies to make their care more LGBTQ+-friendly.---RESOURCESHealthcare Equality Index:https://www.hrc.org/resources/healthcare-equality-indexTransgender Patients: What Radiologists Need to Know:https://pubmed.ncbi.nlm.nih.gov/29629811/Physicians as Political Pawns– The Texas Directive on Gender-Affirming Care and Other Moves:https://www.nejm.org/doi/full/10.1056/NEJMp2203746Affordable Care Act, Section 1557:https://www.hhs.gov/civil-rights/for-individuals/section-1557/index.htmlThe Trevor Project:https://www.thetrevorproject.org/Gender Spectrum:https://genderspectrum.org/The Joint Commission’s LGBTQ+ Field Guide:https://www.jointcommission.org/-/media/tjc/documents/resources/patient-safety-topics/health-equity/lgbtfieldguide_web_linked_verpdf.pdf?db=web&hash=FD725DC02CFE6E4F21A35EBD839BBE97&hash=FD725DC02CFE6E4F21A35EBD839BBE97Transgender and Gender Diverse Health Care: The Fenway Guide:https://www.amazon.com/Transgender-Gender-Diverse-Health-Care-ebook/dp/B09648R5HG

Dr. Karen Brown, Section Chief for Interventional Radiology at the University of Utah, discusses how she improved paracentesis workflow, shortened procedure time, decreased hospital length of stay, and improved patient and referring provider satisfaction. By using the Renova pump, they could cut the procedure time down by almost half. Hiring an advanced practice provider (APP) designated to paracentesis was key to improving daily IR workflow.

In this episode Vascular Surgeon Jim Melton and Interventional Radiologist Blake Parsons give us the lay of the land on recent reimbursement cuts in the OBL/ASC space, including peripheral artery disease treatments and embolization procedures, as well as projections of what to expect in the next few years.---CHECK OUT OUR SPONSORBoston Scientific Eluvia Drug-Eluting Stenthttps://www.bostonscientific.com/en-US/medical-specialties/vascular-surgery/drug-eluting-therapies/eluvia/eluvia-clinical-trials.html?utm_source=oth_site&utm_medium=native&utm_campaign=pi-at-us-de_portfolio-hci&utm_content=n-backtable-n-backtable_site_eluvia_1&cid=n10008043---SHOW NOTESIn this episode, host Dr. Aaron Fritts interviews interventional radiologist Dr. Blake Parsons and vascular surgeon Dr. Jim Melton about navigating recent Medicaid reimbursement cuts in their hybrid Office Based Lab (OBL) and Ambulatory Surgery Center (ASC), CardioVascular Health Clinic. This episode largely follows a question and answer format, where our guests respond to previously-submitted audience questions.The guests start by outlining recent vascular surgery and interventional radiology reimbursement cuts from 2022, as well as sharing information on future cuts through 2026. Most cuts are PAD-focused, but they also include pain management procedures like kyphoplasty. Dr. Parsons advises IRs to think about diversifying their practices to encompass procedures outside of PAD. He summarizes the average profits generated in various types of IR cases. He also predicts that there will be more reimbursement cuts on embolization cases, as prostate and geniculate embolizations become more popular. To protect profit margins by means of cost reduction, the doctors negotiate with vendor pricing and try to leverage disposables against capital.Dr. Melton describes the current political landscape and physician advocacy efforts. While industry has started to position themselves to help advocate for OBLs and ASCs, Dr. Melton believes that industry and physicians should be more politically active. He encourages physicians to get involved with their medical societies and reach out to local representatives and senators in order to highlight the benefits of patient care in an OBL/ASC setting– faster recovery, lower risk of infection, and overall lower cost for the healthcare system.---RESOURCESCardioVascular Health Clinic:https://cvhealthclinic.com/SIRPAC:https://www.sirweb.org/advocacy/sirpac/OEIS:https://oeisociety.com/

We talk with interventional radiologist Dr. Stephen Wang about building an IVC filter retrieval program, the current guidelines on filter placement, and how to minimize the complications of filters.The CME experience for this Podcast is powered by CMEfy - click here to reflect and unlock credits & more: https://earnc.me/nBihBQ---CHECK OUT OUR SPONSORDI4MDsProtect your most valuable asset, the skill and ability to practice your medical specialty. Be prepared by establishing a specialty specific disability insurance policy from the experts at DI4MDs. Contact them today at www.Di4MDS.com or call 888-934-4637.---SHOW NOTESIn this episode, host Dr. Christopher Beck interviews interventional radiologist Dr. Stephen Wang. They discuss building an IVC filter retrieval program, the current guidelines on filter placement, and the long-term risks of IVC filters.We start by discussing the joint consensus published in JVIR in 2020, a collaboration between vascular, cardiology, and IR societies. Dr. Wang notes that the main indication for placement of an IVC filter is an acute deep venous thrombosis (DVT) or pulmonary embolism (PE) in someone with a contraindication to anticoagulation. He says that they often collaborate with hematology to provide the best patient care, and they have even collaborated with hematology to set up a filter clinic.Next, they touch on the long-term risks of IVC filters. They discuss the PREPIC-1 and PREPIC-2 studies which were studies looking at mortality and risk reduction in patients with IVC filters. These studies demonstrated a low level of evidence that IVC filters being placed were actually working. Even more compelling, the risk of putting in filters often outweighs the benefit. Dr. Wang says that for a filter that is in for longer than five years, there is a 13% risk of partial or complete inferior vena cava (IVC) thrombosis. Additionally, at five years, 70% of filters perforated outside of the IVC and were touching or perforating a retroperitoneal structure.Finally, they discuss the filter retrieval program that Dr. Wang built at Kaiser. Important aspects of the process were educating primary care doctors, coordinating with critical care and hematology, and involving the anticoagulation clinic. He says he created a current procedural terminology (CPT) code-based list and hired a physician extender as filter lead to monitor and update the list. He was able to get his EPIC team on board by creating a safety net based on a procedural code. Ultimately, he raised the IVC filter retrieval rate from 38% in Northern California to 54% after his grand rounds and up to 80% after integrating his program into EPIC which allowed a provider to click a single button that would notify the patient that they were due to come in for their IVC filter retrieval.---RESOURCESSIR Clinical Practice Guidelines for IVC Filters:https://www.jvir.org/article/S1051-0443(20)30531-5/fulltextPREPIC-1:https://www.nejm.org/doi/full/10.1056/NEJM199802123380701PREPIC-2:https://jamanetwork.com/journals/jama/fullarticle/2279714Dr. Wang’s paper: Long-term complications of inferior vena cava filters:https://www.jvsvenous.org/article/S2213-333X(16)30148-2/fulltext

Eric J. Keller talks with Isabel Newton, Susan Jackson and Margaret Simor from the Interventional Initiative about informed consent and helping patients make informed choices with newly developed Patient Decision Aids!---CHECK OUT OUR SPONSORDI4MDsProtect your most valuable asset, the skill and ability to practice your medical specialty. Be prepared by establishing a specialty specific disability insurance policy from the experts at DI4MDs. Contact them today at www.Di4MDS.com or call 888-934-4637.---EARN CMEReflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/HzAYsS---SHOW NOTESIn this episode, our host Dr. Eric Keller interviews a panel of leaders from the Interventional Initiative, a not-for-profit organization devoted to raising awareness of minimally invasive image-guided procedures (MIIPs) among patients and referring clinicians. Our guests are interventional radiologists Drs. Susan Jackson and Isabel Newton and nurse and hospital administrator Margaret Simor.We start by discussing the origins of the Interventional Initiative, which started in 2015. After recognizing the public’s knowledge gap within interventional radiology procedures, the team decided to embark on a docuseries project to capture the impact that the field of IR could have on patients’ lives. This docuseries, entitled “Without a Scalpel,” is available on many streaming platforms. The series follows interventional radiologists and their patients in a variety of procedures and medical settings. Presenting new information within a film format has created a welcoming introduction to the field for both patients and physicians.Next, we shift to discussing the Interventional Initiative’s most recent project, a collection of patient decision aids. These materials are unique because they are specifically crafted to meet health literacy levels in the general public. They also provide statistics and graphics that clearly communicate benefits, risks, and alternatives to IR procedures. Ms. Simor, speaking from the experience of an IR nurse, recognizes the knowledge gaps that patients struggle with when giving informed consent. She looks forward to sharing the decision aids with other providers. Dr. Jackson advocates for presenting the decision aids in a variety of formats (paper, online, app-based, EHR-accessible) so that they are most available to as many people as possible.Dr. Newton describes the success of early clinical trials, which show that using the patient decision aids enriches physician-patient conversations, enhances patient autonomy, and even makes patients perceive that they spent more time with the physician. She encourages anyone who is interested in helping beta test the decision aid to reach out to the Interventional Initiative.---RESOURCESThe Interventional Initiative:https://www.theii.org/The Interventional Initiative Twitter:@Interventional2Without a Scalpel Docuseries:https://www.theii.org/the-docuseries