BackTable Vascular & Interventional

Dr. Ezana Azene M.D., Ph.D. talks with us about how he found his side gig reviewing insurance claims, and shares tips on how to avoid insurance claim denials for procedures.---EARN CMEReflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/OHtkwE---SHOW NOTESIn this episode, Dr. Ezana Azene joins Dr. Christopher Beck to discuss reviewing medical cases for insurance claims. Dr. Azene tells us how often he reviews insurance claims for IR procedures, and he explains what the step-by-step process looks like once he gets a case to review.We discuss how to search for information to show a procedure was done in extenuating circumstances by looking at clinic notes and labs, in addition to previous reviews from other physicians. We review some mistakes that physicians make that could keep an insurance claim from being approved, and we discuss why documenting all previous interventions is important.We explain why it is helpful to understand the patient’s insurance policy and how citing articles and references can support an insurance claim. Dr. Azene shares how reviewing medical cases has improved his documentation, and we give some advice on how to get involved in this process.---RESOURCESIR Quarterly article featuring Dr. Azenehttps://connect.sirweb.org/e-irq/participate/viewirqarticle?DocumentKey=ec2b47d8-e067-4628-a40a-ab19021ab36a

In Part 2 of their Pelvic Congestion Syndrome discussion, Dr. Mark Meissner and Dr. Michael Cumming get into their specific techniques, tips and tricks for embolization, and follow up care.---SHOW NOTESIn this episode, Dr. Mark Meissner and Dr. Michael Cumming join Dr. Michael Barraza to discuss techniques for treating Pelvic Congestion Syndrome. We examine their goals for therapy and why to approach the internal iliac veins first. We discuss which catheters they use and how to approach venograms in a therapeutic way, rather than diagnostic.We share a new technique for coiling that reduces procedure time and pain for the Pelvic Congestion Syndrome patient. We discuss the challenges of embolization and why we often rely on the sclerosant when using an occlusion balloon. Dr. Meissner and Dr. Cumming tells us about the post-procedure management, why to follow-up after the first menstrual period, and why to make foam using CO2 when a patient has a history of migraines.We examine the verbiage of the name “Pelvic Congestion Syndrome” and how it leads to misconceptions about its etiology. Dr. Meissner shares his process for treating Nutcracker Syndrome, and we discuss the potential problems of renal vein stenting.

Vascular Surgeon Dr. Mark Meissner and Interventional Radiologist Dr. Michael Cumming discuss diagnosis and treatment planning for Pelvic Congestion Syndrome. This is Part 1 of 2 on Pelvic Congestion Syndrome.---SHOW NOTESIn this episode, Dr. Mark Meissner and Dr. Michael Cumming join Dr. Michael Barraza to discuss Pelvic Congestion Syndrome. We discuss the pathophysiology of Pelvic Congestion Syndrome and the fundamentals of pelvic venous hypertension. Dr. Meissner and Dr. Cumming tell us how patients end up in their clinic.We discuss why it is important to distinguish primary and secondary causes of Pelvic Congestion Syndrome and the dangers of an incomplete embolization. We review some techniques for ultrasounds, why not to rely on cross-sectional imaging, and the advantages of getting a CT for the Pelvic Congestion Syndrome patient.We discuss how to adapt treatment plans for women that have never been pregnant or women that are post-menopausal. Dr. Meissner and Dr. Cumming explain how they frame their goals and expectations for each patient’s treatment process, and we examine when it is appropriate to use a multi-modality approach to treat Pelvic Congestion Syndrome.---RESOURCESCheck out our other episode featuring Dr. Michael Cumming:https://www.backtable.com/shows/vi/podcasts/52/ivus-for-iliac-vein-compression

Bryan Hartley talks with Lawrence "Rusty" Hofmann MD about his experiences in device and digital health innovation, including the inspiring story behind building Grand Rounds, a digital health company helping patients get better access to expert healthcare.---EARN CMEReflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/hA0kx3---SHOW NOTESIn this episode, Dr. Randy Hofmann joins Dr. Bryan Hartley to discuss his path to creating an innovative digital health company. Dr. Hofmann tells us how he became an IR and discusses his start in medical devices. We share some advice on how to get started on a new project.We discuss Dr. Hofmann’s health technology company, Grand Rounds, which offers clinical and financial guidance. Dr. Hofmann explains why he came up with the idea for a digital health company and how his experiences as a father and husband influenced his advocacy for patient education.

Dr. Jason Levy, an interventional radiologist in Atlanta, and Dr. Amir Lavaf, a radiation oncologist in Palm Springs, delve into innovative treatment strategies for spinal metastases. They discuss groundbreaking findings from the OPUS-1 study, revealing the benefits of radiofrequency ablation. Collaboration between specialties is emphasized, highlighting how coordinated care can enhance patient outcomes. The duo shares insights on managing pain, improving survival rates, and reducing treatment-related risks, showcasing the importance of teamwork in complex cancer care.

In this episode, Dr. Ameer Hassan joins Dr. Sabeen Dhand to discuss the use of artificial intelligence (AI) to improve stroke care. We explain the hub and spoke model and how the primary stroke centers communicate in the hub. Dr. Hassan describes how the system determines which center a stroke patient will go to. We discuss how the system optimizes the transfer from spoke to hub and how comparing trends in stroke patients allowed them to speed up the process. We explain how AI is used in stroke care using decision trees and deep learning. We discuss the benefits of using AI to remove steps and sending push notifications to phones, allowing radiologists to review imaging quicker.Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs here: https://earnc.me/IhN6NWRESOURCES MENTIONED: SAGE journals; Interventional Neuroradiology https://journals.sagepub.com/doi/full/10.1177/1591019920953055 Early experience utilizing artificial intelligence shows significant reduction in transfer times and length of stay in a hub and spoke model

In this episode, Dr. David Field joins Dr. Aaron Fritts to discuss nephrostomy tube placement. We talk about the most common indications for this procedure, and Dr. Field explains why he prefers the single stick technique over the double stick technique. We discuss why it is important to scan the patient with ultrasound before preparing them for the nephrostomy tube placement. We give some tips for trainees on the process of inserting the needle, and we review the dangers of over-pressurizing. We discuss how much blood in the urine is worrisome, managing anticoagulation meds, and which labs to run prior to the nephrostomy tube placement. Dr. Field tells us about using guidance software and how to properly direct the needle, once inside the patient. We discuss why you might inject air rather than contrast. We emphasize the importance of working with urology ahead of time and what post-op care looks like for different types of patients. Dr. Field gives some advice when dealing with the challenges of nephrostomy tube placement, and we give trainees some general advice on this procedure.Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs here: https://earnc.me/r2AlYcRESOURCES MENTIONED: Nephrostomy Tube Placement Procedure https://www.backtable.com/app-procedure/nephrostomy-tube-placement

In this episode, Dr. Matt Raynor and Dr. Ari Isaacson join Dr. Michael Barraza to discuss their prostatic artery embolization (PAE) program. They tell us about their new book and how they worked with IR and urology to build their program. We discuss how they got started with their first patient and explain when to follow up with PAE patients. We talk about the initial challenges of starting the PAE program, and we discuss what type of patients would be good candidates for the procedure. Dr. Raynor and Dr. Isaacson give us some advice on how to make a pitch to Urology practices that treat benign prostatic hyperplasia (BPH) patients. We discuss how IR and urology departments can collaborate and how to work with physicians who are skeptical. We examine how they approach the market for this procedure and why word-of-mouth from previous patients is so important. We emphasize learning the technique of the prostatic artery embolization, but also why interventional radiologists should learn about BPH disease process in detail. RESOURCES MENTIONED: Prostatic Artery Embolization https://www.amazon.com/Prostatic-Artery-Embolization-Ari-Isaacson/dp/3030234703/ref=sr_1_1?dchild=1&keywords=prostatic+artery+embolization&qid=1606166571&sr=8-1 This is the book by Dr. Raynor and Dr. Isaacson about PAE in IR. BackTable Podcast episode 17: Prostate Artery Embolization with Dr. Ari Isaacson and Dr. Sandeep Bagla https://www.backtable.com/podcast/17/prostate-artery-embolization Check out another episode about PAE with Dr. Isaacson!

In this episode, Dr. Brinton tells us how he started as a biomedical engineer and why he eventually went to medical school. We discuss how important mentorship can be, and we talk about how he was able to balance residency with building a company. Dr. Brinton shares some of the biggest lessons he has learned while being an innovator, and he discusses the goals of his company, Shockwave. We talk about the importance of understanding the patient population and some of the technical challenges of creating solutions to healthcare problems. We speak about Dr. Brinton’s position as the Fellowship Director of BioDesign at Stanford, and how he worked to train the next generation of innovators. We review the importance of needs driven innovation in medicine and how to keep the patient at the center of the innovation process. We discuss the importance of having a creative, multidisciplinary team behind an invention. We share some advice for physicians wanting to get started in needs driven innovation and explain when to file for intellectual property. Dr. Brinton explains why it can be important to “fail often and fail fast.” Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs here: https://earnc.me/oaB26u

In this episode, Dr. Douglas Beall joins Dr. Michael Barraza to discuss innovation in spine interventions. Dr. Beall tells us how he got his training in spine interventions and shifted to a more clinical approach. We talk about how following patients longitudinally can help determine the true source of pain, and the benefit of implementing new methods into a practice. We discuss what the term interventional radiologist really means and the importance of diagnostic input. We discuss an example of an out of the box spine intervention that helped a patient. Dr. Beall speaks about his new book that came out earlier this year and how it is different from other textbooks and how he has been using Twitter to give tips and tricks. We talk about how this inspired Dr. Beall to re-start a fellowship training program for spine intervention. We discuss studies and trials that were done on vertebral augmentation, and we examine the relationship between the name and value of interventional radiology. We touch on some goals for AI use in spine interventions and its impact on diagnosis and treatment.Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs here: https://earnc.me/BiMwPvRESOURCES MENTIONED: Book by Dr. Beall: Vertebral Augmentation: The Comprehensive Guide to Vertebroplasty, Kyphoplasty, and Implant Augmentation https://www.amazon.com/gp/product/B0856PWC7G/ref=dbs_a_def_rwt_hsch_vapi_tkin_p1_i0 Check out Dr. Beall on Twitter @dougbeall