BackTable Vascular & Interventional

Bryan Hartley talks with physician entrepreneur Dr. Mahmood Razavi about the essential elements of successfully starting a medtech company, as well as pitfalls to avoid.---SHOW NOTESIn this episode, serial entrepreneur Dr. Mahmood Razavi and our host Dr. Bryan Hartley discuss factors to consider when starting a medical technology company, steps of the innovation process, and fundraising strategies.Dr. Razavi recounts his path into entrepreneurship, emphasizing the importance of finding innovative mentors. He advises listeners to go beyond merely observing other successful innovators and instead, actively engaging and asking them questions. The doctors bring up the concept of filing a provisional patent in the early stages of product development, which can allow an entrepreneur to protect their intellectual property as they seek guidance from others.A critical decision point arises when an entrepreneur must decide whether or not they should establish a new product for an existing company or establish a completely new company. If the product is a different iteration of a design that already exists it might be worthwhile to innovate within the structure of an existing company. If you are creating a completely new device class that addresses a new clinical need or disease, there could be potential to start a company.The startup process requires entrepreneurs to recruit team members and raise funds. Dr. Razavi uses equity as a recruiting tool to bring business and engineering experts into the company. He also describes various methods of funding, including venture capital and strategic partnerships and the pros and cons of each.

We talk with Vascular Access Surgeon Ari Kramer about AV Fistula and Graft Maintenance in dialysis patients from creation to long-term care, as well as tips and tricks for treating stenoses.---SHOW NOTESIn this episode, vascular access surgeon Dr. Ari Kramer and our host Dr. Chris Beck discuss the creation, management, and salvage of AV fistulas and grafts.Dr. Kramer describes the referral patterns that lead dialysis patients to his practice, citing the need to coordinate dialysis care around a common surgical practice. He works closely with nephrologists and dialysis centers to ensure quality of care and streamlined patient management. During an initial workup, Dr. Kramer includes a physical assessment and an echocardiogram to establish a baseline.The doctors discuss the pros and cons of using AV fistulas versus grafts. While AV fistulas are autogenic and carry a lower risk of infection, there is a risk that these may not mature. On the other hand, AV grafts are fully matured but they carry a higher risk of infection and require a higher intervention rate. Dr. Kramer emphasizes the importance of understanding a patient’s cardiac performance and history before selecting a method of AV access. He also schedules periodic follow-up appointments to ensure that the access site reaches maturity, which is evaluated by the Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines.Dr. Kramer walks us through devices and procedures for angioplasty, stent placement, and drug coated balloon placement. Finally, he addresses strategies for managing re-stenosis and considerations for patient preferences regarding surgical revision.---RESOURCESKidney Disease Outcomes Quality Initiative (KDOQI) Clinical Practice Guideline for Vascular Access: 2019 Update: https://www.ajkd.org/article/S0272-6386(19)31137-0/fulltext#secsectitle0720American Society of Diagnostic and Interventional Nephrology (ASDIN): https://www.asdin.org/page/A2Kidney Academy (use code “backtable21” for free access): https://www.kidneyacademy.com/

Dr. Sabeen Dhand talks with Dr. Lorenzo Patrone about how to be your best at giving an amazing, engaging presentation.---EARN CMEReflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/rN9SC1---SHOW NOTESIn this episode, interventional radiologists Dr. Lorenzo Patrone and Dr. Sabeen Dhand discuss their best tips for creating and delivering quality presentations.Due to the highly visual nature of interventional radiology, both doctors agree that PowerPoints are a great way to communicate information to audiences. Dr. Patrone recommends learning how to fully utilize PowerPoint functionalities such as embedded videos, animations, and transitions. Specifically, looped videos can help show blood flow. Interspersing dynamic presentation features can better illustrate important points; however, overuse of these can be distracting and unprofessional.As for presentation delivery, both doctors agree that showing authentic personality can engage audiences. They advise listeners to embrace talking about complications and posing questions to the audience. Finally, they discuss considerations to keep in mind for different types of presentation formats, such as online webinars, industry-sponsored events, and debates. Overall, Dr. Patrone advises doctors to only speak on behalf of products that they truly believe in.---RESOURCESVascupedia: https://vascupedia.com/Envato Presentation Templates: https://elements.envato.com/presentation-templates

Dr. Rakesh Ahuja walks us through the Pathway to Becoming a Y-90 Authorized user as a Resident, as well as the standard post-training pathway.---EARN CMEReflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/2JujFM---SHOW NOTESIn this episode, interventional radiologist Dr. Rakesh Ahuja and our host Dr. Michael Barraza continue the BackTable Trainee Series by discussing the meaning, benefits, and pathway for residents to become Y90 Authorized Users (AU).The doctors discuss what it means to be an AU in interventional oncology, a rapidly growing field. The major benefit of Y90 licensing is that AUs can have the freedom to independently prescribe and administer customized doses to patients. Additionally, AU status can make a physician more marketable to private practices and it can allow them to perform cases on their own schedule. AU status is transferable to different sites and states, and it does not expire.Dr. Ahuja speaks about eligibility requirements and emphasizes that trainees do not have to be board certified in radiology to start Y90 training. Supervised clinical training throughout an IR/DR residency will make most PGY-5 residents eligible to start the Authorized User training process. While this alternate pathway of Y90 Authorization can be faster than the traditional pathway (waiting until after board certification from the American Board of Radiology), it is important to work with local radiation safety officers to ensure that all eligibility and training criteria are met.---RESOURCESUS Nuclear Regulatory Commission Y90 Licensing Guidance- https://www.nrc.gov/docs/ML1920/ML19204A272.pdf

We chat with MedSchoolCoach Founder Dr. Sahil Mehta and 1st Year IR Resident Dr. Elias Farah about what inspired them to go into IR, and advice on getting into the specialty via the existing training pathways.---SHOW NOTESIn this episode, interventional radiologist Dr. Sahil Mehta, integrated DR/IR resident Dr. Elias Farah, and our host Dr. Aaron Fritts continue the BackTable Trainee Series by discussing how they each discovered the field of interventional radiology (IR), recent trends in the IR match process, and the importance of raising awareness of the IR specialty.With the recent shift towards integrated IR residencies, medical students now have the opportunity to experience a mix of diagnostic and interventional radiology training from PGY-2 through PGY-4, and then dedicate time to IR training during PGY-5 and PGY-6.As a recent IR applicant and now a resident, Dr. Farah walks us through his process of applying to residency. He outlines the steps that he took to prepare and the number of programs that he applied to. We also address the fact that IR has grown to be one of the most competitive specialties to match into. Dr. Mehta emphasizes that applicants’ average USMLE scores and number of publications have increased in the last few years, so it is important for applicants to demonstrate their genuine interest in the field and be prepared to speak about this during the interview.The doctors close by discussing why increased awareness of IR can benefit both providers and patients. They highlight organizations that advance this mission, including the Society of Interventional Radiology (SIR) and the Interventional Institute.---RESOURCESSociety of Interventional Radiologists (SIR) Online Education Resources: https://www.sirweb.org/learning-center/rfs-landing-page/medical-student-and-resident-educational-resources/SIR Residents, Fellows, and Students (SIR RFS): http://rfs.sirweb.org/The Interventional Initiative: http://www.theii.org/Beth Israel Deaconess IR Residency: https://www.bidmc.org/medical-education/medical-education-by-department/radiology/residencies-in-radiology/interventional-radiology-integrated-pathway-residencyUniversity of Florida IR Residency: https://radiology.med.jax.ufl.edu/interventional-radiology-integrated-residency/MedSchoolCoach: https://www.medschoolcoach.com/

We talk with IR Resident Dr. Jeff Bodner and Emory IR Program Director Dr. Bill Majdalany about the current IR training pathways and what it takes to get in these days!---SHOW NOTESIn this episode, interventional radiology (IR) program director Dr. Bill Majdalany, integrated IR resident Dr. Jeff Bodner, and our host Dr. Chris Beck continue the BackTable Trainee Series by discussing the IR residency application and interview process: different pathways to enter IR, applications that stand out, and interview day tips.As a recent residency applicant, Dr. Bodner walks us through his journey through medical school, applications, and interviews. For students interested in pursuing IR, he recommends demonstrating interest in the field by participating in medical student committees, conferences, and volunteer opportunities. He also advises fourth-year students to apply broadly to both integrated interventional radiology and diagnostic radiology programs, emphasizing that there are multiple pathways to IR.Dr. Majdalany elaborates on these pathways, describing the differences between the Early Specialization in Interventional Radiology (ESIR), the independent IR residency, and the integrated IR residency. He highlights key actions that applicants can take, which include performing well in all clerkships, taking advantage of research opportunities, and composing a personal statement that ties the whole application together.We conclude the episode by offering advice for interview days. Overall, the best practices are to maintain professionalism and come prepared with knowledge about each program.---RESOURCESSociety of Interventional Radiologists (SIR) Online Education Resources: https://www.sirweb.org/learning-center/rfs-landing-page/medical-student-and-resident-educational-resources/SIR Residents, Fellows, and Students (SIR RFS): http://rfs.sirweb.org/Emory University IR Residency: https://med.emory.edu/departments/radiology/education/interventional-radiology-residency/index.html

We talk with Dr. Daryl Goldman, an IR resident at Mount Sinai Health System, about what it takes to "crush" your Interventional Radiology Rotation as a medical student, as well as what makes for a great educational experience from the resident and attending side.---SHOW NOTESIn this episode, interventional radiology resident Dr. Daryl Goldman and our host Dr. Aaron Fritts launch our BackTable Trainee Series by talking about how medical students can perform well on IR rotations, and more broadly, how they can best position themselves to apply for an integrated IR residency. They also discuss actions that program directors can take to ensure that their rotation is effective at teaching and recruiting trainees.Dr. Goldman outlines her path to IR and offers advice to medical students for getting involved in research, networking, and away rotations. For students at sites without IR residency/fellowship programs, she suggests that they reach out to external programs for research opportunities and away rotations. Overall, she encourages interested students to learn how to be good mentees, attend conferences, and get involved with IR interest groups.Dr. Goldman says that a major goal of an IR rotation should be showing students a broad view of the specialty: workups, procedures, inpatient management, clinic time, and follow-up care. She suggests that programs provide students with graduated responsibility, didactic time, and opportunities to give presentations.The doctors advise students to use social media to get connected with their specialty networks. Specifically, they emphasize the collaborative and educational environment of the endovascular community on Twitter.---RESOURCESBackTable’s Twitter: @_BackTableDr. Goldman’s Twitter: @Daryl_GoldmanSIR Residents, Fellows, and Students (SIR RFS): http://rfs.sirweb.org/Mt. Sinai Integrated IR Residency: https://icahn.mssm.edu/education/residencies-fellowships/list/msh-interventional-diagnostic-radiology“Five Ways to Be a Great Mentee” by Dr. Yasha Gupta: https://www.acr.org/Member-Resources/rfs/Resident-and-Fellow-News/2020MAR-Mentorship

We talk with Dr. Christopher Pittman to better understand Management Services Organizations (MSOs) and what they can do for your practice. We also get the 101 on Value-Based Care payment models.---SHOW NOTESIn this episode, interventional radiologist and vein treatment expert Dr. Chris Pittman and our host Dr. Aaron Fritts discuss the structure and benefits of management services organizations (MSOs).As healthcare moves from a fee-for-service model to a fee-for-value model, MSOs have become increasingly popular. Dr. Pittman gives a brief overview of the services that these organizations can provide to independent physicians. These services can encompass billing, human resources, scheduling, contract negotiation, marketing, and any aspect of practice management outside of direct medical care. We discuss the benefits of joining an MSO, which include sharing resources within the network, offloading non-medical functions, controlling costs, learning best business practices, and ultimately, having more time and energy to deliver quality patient care. Additionally, having a network of practices allows each physician to have access to industry data and benchmark themself from operational, clinical, and patient satisfaction standpoints.Dr. Pittman advises all physicians to have due diligence when deciding to join an MSO. He emphasizes the importance of determining the amount of physician autonomy that will be retained, evaluating the organization based on outcomes of past clients, and having an attorney look over agreements. In general, he believes that the most well-run MSO’s are the ones that focus on a single specialty and have physicians on their leadership teams.---RESOURCESHealth Performance Specialists (HSP): https://www.healthperformancespecialists.com/

Bryan Hartley talks with Neurosurgeon Dr. Chris Mansi about the origin story of Viz.ai, a company using Artificial Intelligence to Shorten Time to Treatment and Improve Access to Care for Stroke Patients.---SHOW NOTESIn this episode, neurosurgeon and co-founder/CEO of Viz.ai, Dr. Chris Mansi, and our host Dr. Bryan Hartley discuss the use of AI technology to detect large vessel occlusion (LVO) strokes and increase efficiency of workflow. Dr. Mansi describes his entrepreneurial journey, through the phases of idea formation, funding, growth, and expansion of his company.We start by outlining key advantages that MBA and other graduate degree programs can provide for healthcare entrepreneurs. Both doctors emphasize the value of dedicating space and time, outside of clinical practice, to innovate and test new ideas. Dr. Mansi highlights his collaboration with other disciplines, such as engineering. He also discusses takeaways from his business education-- the importance of patient-centered innovation and having flexible technology that can meet the changing needs of the market.Dr. Mansi gives an overview of Viz.ai’s origins, mission, and product offerings. The company addresses a clinical need for more consistent and efficient stroke care, and aims to move patients from stroke detection to stroke treatment more quickly. Viz.ai employs self-learning technology to provide high-quality imaging, automatic workflow triggers, and HIPAA-compliant communication channels for stroke teams to work together for the benefit of patients. We end this episode by talking about Viz.ai’s plan to expand to more disease states and medical specialties in the near future.---RESOURCESViz.ai Platform: https://www.viz.ai/“Crossing the Chasm” by Geoffrey Moore: Dr. Mansi’s book recommendation for all tech entrepreneurs

Dr. Sabeen Dhand chats with Interventional Radiologist Shankar Rajeswaran from Lurie Children's Hospital in Chicago about a novel minimally invasive treatment of unicameral and aneurysmal bone cysts.---EARN CMEReflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/PzYQjW---SHOW NOTESIn this episode, pediatric interventional radiologist Dr. Shankar Rajeswaran joins host Dr. Sabeen Dhand to discuss a novel minimally-invasive treatment for unicameral and aneurysmal bone cysts.Pediatric interventional radiology is a rapidly growing field, and Dr. Rajeswaran describes how it has evolved in complexity and innovation over the course of his career. Dr. Rajeswaran says that there is a significant challenge that pediatric IRs must overcome-- treating children with IR devices that were originally designed to be used in adults. As a result, he emphasizes the need for creativity and flexibility in this field.Next, we define and differentiate between unicameral and aneurysmal bone cysts. Both can be benign; however, they carry the risk of causing pain, bone fracture, and growth deformities. Dr. Rajeswaran outlines the current standard of care, which includes monitoring and curettage and bone grafting. Then, he describes a new method of treatment, which involves needle injection of doxycycline to burn the walls of the cyst and bone paste to help generate new bone. This method can be applied to unicameral bone cysts and aneurysmal bone cysts, and it leaves no scarring. He also discusses the recurrence rate for various treatment methods.Overall, Dr. Rajeswaran encourages anyone interested in pediatric IR to reach out to doctors in the field for shadowing opportunities and guidance.---RESOURCESSociety for Pediatric Interventional Radiology: https://www.spir.org/Lurie Children’s Hospital blog article over novel treatment of bone cysts: https://www.luriechildrens.org/en/blog/interventional-radiology-cutting-edge-procedure-puts-brooklyn-back-in-the-game/