BackTable Vascular & Interventional

Dr. Christopher Beck talks with Dr. Driss Raissi about his approach to Microwave Ablation of Liver Lesions, including workup, technique, and tips and tricks for a successful ablation treatment.---CHECK OUT OUR SPONSORMedtronic Emprint Ablation Systemhttps://www.medtronic.com/covidien/en-gb/products/ablation-systems/emprint-ablation-system.html---SHOW NOTESIn this episode, Dr. Driss Raissi and our host Dr. Chris Beck discuss the planning, technique, and follow-up considerations for microwave ablation of liver lesions.First, they talk through the process of mapping out the tumor. Dr. Raissi often attends tumor boards to contribute to the variety of treatment perspectives and gain consensus for microwave ablation from colleagues in different specialties. He also discusses the differences between cirrhotic and steatotic livers because the latter can limit the efficiency of microwave energy delivery.During the procedure, Dr. Raissi appreciates the simplicity of a one-needle device. He offers advice for maneuvering near critical organs: direct the tip of the needle towards the critical structure to gain control. Additionally, he prefers to align the long axis of the needle with the long axis of the tumor and to minimize the number of new liver punctured by overlapping ablation zones.The doctors also discuss the need to balance clean margins with preservation of liver tissue, noting that lesions in different lobes can be treated in different sessions. Finally, they cover telehealth follow-ups and MRI follow-up during the subsequent month.Throughout this episode, we refer to findings about microwave ablation from previous publications, which are linked below.---RESOURCESComparison of microwave ablation and radiofrequency ablation for hepatocellular carcinoma: a systematic review and meta-analysis: https://pubmed.ncbi.nlm.nih.gov/30676100/Liver microwave ablation: a systematic review of various FDA-approved systems:https://pubmed.ncbi.nlm.nih.gov/30506218/Early Outcomes with Single-antenna High-powered Percutaneous Microwave Ablation for Primary and Secondary Hepatic Malignancies: Safety, Effectiveness, and Predictors of Ablative Failure:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7110402/

In Part II of our Lung Biopsy Series Dr. Fred Lee and Dr. Christopher Beck discuss Pleural and Parenchymal Blood Patching to prevent Pneumothorax, including results of the recent JVIR article from Sept 2021.---CHECK OUT OUR SPONSORRADPAD® Radiation Protectionhttps://www.radpad.com/---EARN CMEReflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/0lTQ87---SHOW NOTESIn this episode, Dr. Fred Lee and our host Dr. Chris Beck discuss the use of parenchymal and pleural blood patches to reduce the rate of lung biopsy re-interventions.First, Dr. Lee describes why he has incorporated parenchymal blood patching at the end of most biopsies, noting that it is a straightforward procedure that only adds on a few extra minutes to the overall biopsy, and it can reduce the rate of re-intervention. Both doctors agree that minimizing the need for chest tubes can greatly improve the patient experience.Pleural blood patches are used as a salvage technique in the event of a pneumothorax. Dr. Lee walks through his process of re-inflating the lung, finishing the biopsy, and using a three-way stopcock to inject blood onto the pleural surface and along the needle track. He notes that there are other valid ways of treating intraprocedural pneumothoraces (saline, fibrin plug, etc); however, he prefers the pleural blood patch because of its liquid-to-solid clotting transition, minimal time, minimal cost, and relatively low risk.Throughout this episode, we cite data from Dr. Lee’s previous publications, which are cited below.---RESOURCESPercutaneous Lung Biopsy with Pleural and Parenchymal Blood Patching: Results and Complications from 1,112 Core Biopsies:https://www.jvir.org/article/S1051-0443(21)01202-1/fulltextCT-Guided Lung Biopsies: Pleural Blood Patching Reduces the Rate of Chest Tube Placement for Postbiopsy Pneumothorax: www.ajronline.org/doi/full/10.2214/AJR.10.6324Pulmonary Intraparenchymal Blood Patching Decreases the Rate of Pneumothorax-Related Complications following Percutaneous CT–Guided Needle Biopsy: www.jvir.org/article/S1051-0443…6)32178-9/fulltext

We start off Part 1 of a 2 part series with Dr. Fred Lee discussing Percutaneous Lung Biopsy Technique, with tips and tricks to help your daily practice.---CHECK OUT OUR SPONSORRADPAD® Radiation Protectionhttps://www.radpad.com/---EARN CMEReflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/QD39HM---SHOW NOTESIn this episode, Dr. Fred Lee and our host Dr. Chris Beck discuss tips for achieving safe and successful percutaneous lung biopsies.They start by discussing the increasing popularity of core biopsy (as opposed to fine needle aspiration), since an adequate amount of specimen is needed for genetic testing and personalized medicine. Dr. Lee emphasizes that knowing the goals of lung biopsy for each individual patient helps him decide how much specimen to collect and how the specimen should be handled.Next, Dr. Lee walks through his lung biopsy technique. He outlines the difference between conventional CT and CT with fluoroscopy. While CT with fluoroscopy can be more efficient, it poses radiation risk to the patient and the physician. To minimize radiation risks, he advises IRs to intermittently tap the foot pedal and stand lateral to the CT scanner. The doctors also discuss some of the trickiest lung regions to biopsy and ways to avoid pneumothorax.Finally, Dr. Lee comments on the choice between percutaneous lung biopsies and electromagnetic navigation bronchoscopy, noting that each procedure has different advantages and risks. He encourages interventional radiologists and interventional pulmonologists to explore these options and take evidence-based approaches.Throughout this episode, we cite data from Dr. Lee’s previous publications, which are cited below.---RESOURCESPercutaneous Lung Biopsy with Pleural and Parenchymal Blood Patching: Results and Complications from 1,112 Core Biopsies:https://www.jvir.org/article/S1051-0443(21)01202-1/fulltext

We talk with Vascular Surgeon John Martin about his entrepreneurial journey to becoming CMO of Butterfly Network, Inc., and their mission to revolutionize medical imaging and medical education.---CHECK OUT OUR SPONSORMedtronic AV DCBhttps://www.medtronic.com/avdcb---SHOW NOTESIn this installment of the BackTable Innovation Series, Dr. John Martin, Chief Medical Officer of Butterfly Network, and our host Dr. Bryan Hartley discuss Dr. Martin’s work in clinical software development, nonprofit efforts, and the revolutionary Ultrasound-on-Chip technology.Dr. Martin traces his entrepreneurial journey back to his vascular surgery fellowship years, when he developed software programs to automate risk stratification and track patient outcomes. He emphasizes that it is important to take risks and “bet on yourself” when you know that your product can bring benefits to patients and physicians.Dr. Martin also advises listeners to be open to partnerships with larger companies who can bring their ideas to fruition. This collaborative mindset brought him into the nonprofit world, where he worked with industry and government leaders to found a free cardiovascular screening initiative called Dare to CARE.In his current role at Butterfly Network, Dr. Martin aims to make bedside ultrasound care affordable and accessible to all patients across the globe. He highlights the fact that the portable Butterfly probe has been successfully employed in contexts such as medical education, the COVID response, and his own cancer diagnosis. Overall, Dr. Martin believes that ultrasound access will benefit all medical specialties and help physicians make more efficient and informed clinical decisions.---RESOURCESThe Butterfly Network: https://www.butterflynetwork.com/Dare to CARE: http://www.daretocare.us/

The BackTable hosts get together to discuss the results of the recent complications survey, including some stories from the audience as well some of their own experiences.---EARN CMEReflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/beC0Z4---SHOW NOTESTwo months ago, we invited our listeners to participate in an anonymous Complications Survey. Our goal was to encourage open and honest conversations about procedural complications and what we can learn from them. In this episode, our BackTable hosts conduct a roundtable discussion about the results of the survey and share their personal experiences with complications.The hosts start with distinguishing between complications from high-risk procedures and unexpected complications that arise in healthy individuals, noting that the latter type takes a larger toll on an IR. They emphasize the important role of case selection in minimizing complications and how each of them presents complication risks to patients during the informed consent process.Next, the hosts read through complication stories that respondents submitted. Each host also shares stories about the aftermath of their own complications and how to communicate these to patients, families, and referring doctors.Finally, we highlight an important survey finding: 76% of respondents do not think that complications are discussed enough among endovascular and interventional specialists. In the future, we hope to bring more attention to procedural complications and share advice on how we can collectively minimize risks for our patients and support each other in dealing with complications.We would like to give special thanks to all of our BackTable community members who submitted their insights on complications! If you have a show topic or guest suggestion on the subject of dealing with or preventing complications, reach out to us on our website or social media.---RESOURCESBackTable Ep. 54: Coping with Procedure Complications:https://www.backtable.com/shows/vi/podcasts/45/coping-with-procedure-complications“Doctors and Litigation: The L Word” Podcast:https://podcasts.apple.com/us/podcast/doctors-and-litigation-the-l-word/id1469155084

Dr. Christopher Beck and Dr. Aaron Fritts discuss the Mediport placement procedure, including differences in technique (tie-down vs snug pocket), tips and tricks, and avoiding complications.The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/X2qOIH---CHECK OUT OUR SPONSORMedtronic VenaSealhttps://www.medtronic.com/impact---SHOW NOTESIn this episode, our co-hosts Dr. Chris Beck and Dr. Aaron Fritts share their tips and techniques to make Mediport placement more efficient and comfortable for both IRs and patients.They start by discussing common reasons for port placement, noting that the majority of patients need them for chemotherapy, but they can also be helpful for patients who need access for frequent blood transfusions. As for contraindications, it is best to wait on patients who are currently experiencing active infections. Radiation burns, mastectomies, and bleeding disorders are not absolute contraindications, but these conditions can present challenges to port placement that might require extra planning.Next, they walk through a port placement procedure, giving insights to their personal preferences. Dr. Beck uses the micropuncture needle to administer lidocaine along the track that he will be tunneling, to reduce the number of sticks. Both doctors aim to create a “snug pocket” for the Mediport, which reduces to suture it into place. As for avoiding complications, they prescribe antibiotics depending on the hospital protocols and exercise caution with patients who are sensitive to arrhythmias. Finally, they discuss the satisfaction of port removal and emotional significance for patients.This episode is also available in video format on our BackTable YouTube channel (linked below).---RESOURCESWatch the Video Podcast: https://youtu.be/PwDqG3av3eE

We talk with Dr. Alex Barnacle about her approach to the workup of Vascular Anomalies, including the importance of correct nomenclature and multidisciplinary teams for accurate diagnosis and long-term success.---CHECK OUT OUR SPONSORRADPAD® Radiation Protectionhttps://www.radpad.com/---EARN CMEReflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/f2yvd6---SHOW NOTESIn this episode, Dr. Alex Barnacle and our host Dr. Chris Beck discuss the diagnosis and treatments of different vascular anomalies, as well as considerations in treating a pediatric population.We start by reviewing the terminology of vascular anomalies, noting that the terms can be complicated and misleading for providers and for patients. Dr. Barnacle explains categories delineated by the ISSVA (International Society for the Study of Vascular Anomalies). She emphasizes the importance of combining imaging and physical examination to correctly differentiate between capillary, venous, lymphatic, and arterial malformations.Next, Dr. Barnacle highlights the interdisciplinary nature of her joint clinics, which involve a variety of specialties (dermatologists, orthopedic surgeons, plastic surgeons, and others) and physical therapists. All play a role in diagnosing, treating, and following up with patients.When discussing sclerotherapy, we cover considerations such as sedation, sclerosing agent, two needle technique, and potential complications. Dr. Barnacle talks about managing patient and family expectations, emphasizing that large lesions may require multiple interventions. We conclude by reflecting on the current state of pediatric IR and the future growth of the field.---RESOURCESCommentary on Electrosclerotherapy as a Novel Treatment Option for Hypertrophic Capillary Malformations:https://pubmed.ncbi.nlm.nih.gov/31574036/ISSVA Classification for Vascular Anomalies:https://www.issva.org/UserFiles/file/ISSVA-Classification-2018.pdfISSVA website: https://www.issva.org/

We talk with Dr. David Liu about the life cycle of innovation projects, developing ideas strategically, and his mentorship work with Creative Destruction Lab.---CHECK OUT OUR SPONSORRADPAD® Radiation Protectionhttps://www.radpad.com/---EARN CMEReflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/F02n8o---SHOW NOTESIn this episode, Dr. David Liu and our host Dr. Bryan Hartley discuss the intersections of medicine, engineering, and business in innovation.Dr. Liu describes his background in computer science and how it helped him develop a problem-solving mindset. Within the IR space, he believes that innovation can be divided into three categories: disease management, technical refinement of procedures, and transformational technologies. Dr. Liu outlines his projects that fall into these categories, including an app for Y90 dosimetry, gesture based control for the angio suite, and collaboration through virtual reality.We also discuss how innovation and execution are processes that require diverse perspectives. Dr. Liu summarizes important business concepts such as the various stages of a company’s evolution (start up, small cap, mid cap, and large cap) and two different types of investment (accretive vs. dilutive). Bringing a product to the marketplace involves multiple milestones such as establishment of intellectual property rights, proof of concept, first in human clinical trials, and regulatory approval. Achieving these milestones helps a company “de-risk” itself and become more attractive to investors.---RESOURCESNZ Technologies: https://nztech.ca/Imaging Reality: https://www.imagingreality.com/Creative Destruction Lab: https://www.creativedestructionlab.com/

Nuestro primer episodio de Backtable en español está aquí. Las doctoras Gloria Salazar y Gina Landinez discuten COVID, las demandas médicas y endovasculres de nuestra población Iberoamericana y como convertir un ”no” en un “si".Our first episode of BackTable en Español is here! With a growing demand for outreach in the Latin American community, Drs. Gloria Salazar, MD, FSIR and Gina Landinez MD talk about COVID, growing medical needs of our Spanish speaking community, and how to find opportunity when turning a “no” to a “yes”.---EARN CMEReflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/Cdf5S1---SHOW NOTESEn este episodio de BackTable, la radióloga intervencionista Dra. Gina Landinez entrevista a la Dra. Gloria Salazar, la jefa de división de radiología vascular e intervencionista de UNC Chapel Hill , sobre las desigualdades de salud en las comunidades minoritarias, su camino médico, y sus consejos para los aprendices médicos latinos.Nacida por padres chilenos, la Dra. Salazar creció en Brasil. Desde su niñez, tuvo aspiraciones de ser doctora en los Estados Unidos y por eso, tuvo la motivación para aprender inglés a una temprana edad. Como alumna médica de la Universidad Federal de Sāo Paulo, tuvo excelentes mentores quienes fomentaron una curiosidad de pesquisa en ella. Fue ahí que nació su deseo de participar en el desarrollo del campo de la medicina.La Dra. Salazar explica cómo su perspectiva sobre la salud cambió a través de sus experiencias como fellow y attending en el Hospital de Massachusetts General, donde el treinta por ciento de los pacientes eran latinos. Durante la pandemia, ella se dio cuenta que los pacientes latinos con COVID-19 enfrentaban retos únicos, como la barrera lingüística y dificultades económicas que impactan su recuperación. Ella recalca la relación entre las comunidades inmigrantes y el acceso a salud básica y describe como esta pandemia funciona como un despertar y llamada de conciencia tanto como para ella como para todos sus compañeros médicos, al enfatizar las divisiones existentes en nuestro sistema de salud. Sin embargo, cree que la competencia cultural y la colaboración internacional entre radiólogos puede mejorar las vidas de pacientes estadounidenses y latinos.Finalmente, refleja en los factores más importantes en su éxito hoy en día. Reconoce que la persistencia inculcada por sus padres desde joven le proveía la fuerza de superar los retos profesionales y personales. Adicionalmente, destaca la importancia de los buenos mentores quienes pudieron iniciar sus intereses médicos y clarificar sus caminos. Finalmente, explica el fenómeno del “síndrome impostor” y anima a los médicos en formación a creer en sí mismos.

We talk with Dr. Robert Ryu about Imposter Syndrome. What is it, why is it so common in medicine, and how do we effectively deal with it?---CHECK OUT OUR SPONSORRADPAD® Radiation Protectionhttps://www.radpad.com/---EARN CMEReflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/MWOHi5---SHOW NOTESIn this episode, Dr. Robert Ryu and our host Dr. Michael Barraza discuss the prevalence and implications of imposter syndrome. They open up about personal experiences with imposter syndrome and share strategies for overcoming feelings of inadequacy.Dr. Ryu distinguishes between self-examination (critically assessing the situation and figuring out if you have the resources to succeed) and imposter-like feelings (constantly questioning yourself and unwillingness to acknowledge your achievements), noting that there is a whole spectrum of thoughts and feelings in between the two terms.As a new department chair, Dr. Ryu acknowledges that he had experienced some insecurities with adjusting to the role. After learning about imposter syndrome, he has become interested in how it affects the medical community. He also emphasizes the important role of medical schools and residency programs in raising awareness of this topic to prevent burnout.The doctors wrap up the episode by discussing their personal strategies for managing self doubt. For Dr. Barraza, extensive preparation brings confidence. For Dr. Ryu, reaching out to others for support and keeping a larger goal in mind has proven to be beneficial.---RESOURCESThe Imposter Phenomenon in High Achieving Women: Dynamics and Therapeutic Intervention:https://psycnet.apa.org/doiLanding?doi=10.1037%2Fh0086006How to Deal with Imposter Syndrome (TIME article):https://time.com/5312483/how-to-deal-with-impostor-syndrome/