BackTable Vascular & Interventional BackTable

Dr. Aditya Bagrodia sits down with Elie Toubiana, founder and CEO of ScribeMD.ai, to discuss the transformative potential of artificial intelligence (AI) in medical documentation.

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SYNPOSIS

Their conversation covers the capabilities and benefits of using an AI-driven medical scribe that ensures HIPAA compliance, reduces physician burnout, and enhances patient interactions. Elie also shares his insights about the technology’s adaptability across various medical fields. Finally, Dr. Bagrodia and Elie discuss ethical considerations surrounding applications of AI in other aspects of healthcare, such as medical workup and diagnosis.

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TIMESTAMPS

00:00 - Introduction
06:00 - How ScribeMD AI Works
14:14 - Integration with EMR
20:31 - Legal Considerations with AI Technology
26:34 - Cost Implications of AI Scribes
38:46 - Future of AI in Medical Diagnosis
41:45 - Conclusion and Final Thoughts

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RESOURCES

ScribeMD.ai
https://www.scribemd.ai/

In this episode of the Back Table MSK podcast, Dr. Jacob Fleming and Dr. Douglas Beall dive into the intricacies of sacroplasty, including considerations for selecting cement volume, efficacy of small versus large needles, and biomechanics of the pelvis.

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CHECK OUT OUR SPONSOR

Stryker Interventional Spine
https://www.strykerivs.com

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SYNPOSIS

The doctors review evidence from the SAKOS trial on pain relief and highlight the complexities of billing. They also emphasize proactive treatments for aging populations suffering from fractures and the need for more training and propagation of sacroplasty techniques. Listeners are encouraged to stay informed about new educational opportunities and advancements in sacroplasty through ongoing updates and courses.

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TIMESTAMPS

00:00 - Introduction
02:33 - Expanding Sacroplasty Training and Curriculum
04:50 - Walkthrough of Sacroplasty Technique
10:36 - Mechanical Stabilization and Cement Volume
21:41 - Choosing Hardware and Needle Size
27:37 - Industry-Sponsored Trials and Bias
32:47 - Navigating Billing and Reimbursement
38:05 - Closing Thoughts on Sacroplasty and Osteoporotic Fractures

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RESOURCES

BackTable VI Ep. 51- Sacroplasty: Principles & New Data in the Treatment of Sacral Insufficiency Fractures:
https://www.backtable.com/shows/msk/podcasts/51/sacroplasty-i-principles-new-data-in-the-treatment-of-sacral-insufficiency-fractures

Seattle Science Foundation Annual Image Guided Interventional Spine Procedures Course:
https://ssf.cloud-cme.com/course/courseoverview?P=5&EID=1149

Dr. Doug Beall’s Twitter: @dougbeall

Vertebral Augmentation: The Comprehensive Guide to Vertebroplasty, Kyphoplasty, and Implant Augmentation:
https://www.amazon.com/Vertebral-Augmentation-Comprehensive-Vertebroplasty-Kyphoplasty/dp/1684200156

An Interim Analysis of the First 102 Patients Treated in the Prospective Vertebral Augmentation Sacroplasty Fracture Registry (Beall, 2023):
https://www.jvir.org/article/S1051-0443(23)00356-1/fulltext

Dr. Jacob Fleming and Dr. Douglas Beall discuss the challenges and advancements in treating sacral insufficiency fractures (SIF), the importance of real-world data in evaluating treatment efficacy, and the need to increase awareness of sacral fractures and sacroplasty.

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CHECK OUT OUR SPONSOR

Stryker Interventional Spine
https://www.strykerivs.com

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SYNPOSIS

Dr. Beall emphasizes the underrecognition and undertreatment of sacral insufficiency fractures, pointing out the high mortality and chronic pain rates associated with non-treatment. He urges providers to consider this diagnosis, especially if the patient is describing symptoms of pain with position changes with standing, sitting, and laying, has pubic rami fractures, or reports a history of pelvic radiation. Even with imaging, the diagnosis can remain elusive, since it is not commonly recognized on x-ray and may not show obvious cortical disruption on CT or MRI.

We also review the current literature on sacroplasty efficacy in lowering patient-reported pain scores and adverse events associated with treatment versus conservative management. Dr. Beall speaks about the importance of real-world data collection in the form of patient registries and the insight that these resulting studies have on applications of sacroplasty in specific patient populations.

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TIMESTAMPS

00:00 - Introduction
03:01 - Sacral Fractures and Sacroplasty
15:17 - Treatment Options for Sacral Fractures
17:34 - Consequences of Untreated Sacral Fractures
28:32 - Sacroplasty Registry and Current Research
38:08 - Imaging Modalities: CT vs. Fluoroscopy
40:49 - Complications of Sacroplasty: Extravasation
43:21 - Bone Quality and Fracture Healing
45:42 - Growing Awareness of Sacral Fractures and Treatment Options

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RESOURCES

Spontaneous osteoporotic fracture of the sacrum. An unrecognized syndrome of the elderly (Lourie, 1982):
https://pubmed.ncbi.nlm.nih.gov/7097924/

Percutaneous cementoplasty for pelvic bone metastasis (Marcy, 2000):
https://pubmed.ncbi.nlm.nih.gov/11094996/

Safety and Efficacy of Sacroplasty for Sacral Fractures: A Systematic Review and Meta-Analysis (Chandra et al, 2019):
https://pubmed.ncbi.nlm.nih.gov/31587952/

Percutaneous sacroplasty for osteoporotic sacral insufficiency fractures: a prospective, multicenter, observational pilot study (Frey et al, 2008):
https://pubmed.ncbi.nlm.nih.gov/17981097/

Sacroplasty: A Ten-Year Analysis of Prospective Patients Treated with Percutaneous Sacroplasty: Literature Review and Technical Considerations (Frey et al, 2017):
https://pubmed.ncbi.nlm.nih.gov/29149151/

Vertebral Augmentation: The Comprehensive Guide to Vertebroplasty, Kyphoplasty, and Implant Augmentation (Beall, 2020):
https://www.thieme-connect.de/products/ebooks/book/10.1055/b000000226

An Interim Analysis of the First 102 Patients Treated in the Prospective Vertebral Augmentation Sacroplasty Fracture Registry (Beall et al, 2023):
https://pubmed.ncbi.nlm.nih.gov/37207812/

Clinical Effect of Balloon Kyphoplasty in Elderly Patients with Multiple Osteoporotic Vertebral Fracture (Liu et al, 2019):
​https://journals.lww.com/njcp/fulltext/2019/22030/clinical_effect_of_balloon_kyphoplasty_in_elderly.1.aspx

Dr. Dylan Suttle and Dr. Harris Chengazi delve into recent advancements in transjugular intrahepatic portosystemic shunt (TIPS) procedures, highlighting the significant reduction in procedural time and improvements in outcomes due to the introduction of Intracardiac Echo (ICE) and the Scorpion Portal Vein Access Series.

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CHECK OUT OUR SPONSOR

Argon Medical
http://www.argonmedical.com/

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SYNPOSIS

The doctors share their experiences, techniques, and the evolution of their approaches. They emphasize benefits such as high-resolution imaging, cost-effectiveness, and new technologies that make TIPS cases more approachable.

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TIMESTAMPS

00:00 - Introduction
06:17 - Portal Hypertension Clinics
13:17 - Technical Aspects of TIPS Procedures
35:17 - Challenges in Selecting the Right Hepatic Vein
38:48 - Pre-Procedure Planning
39:36 - Puncture Techniques
50:04 - Stent Deployment and Placement
55:35 - Learning Curve of ICE & Advantages
01:07:58 - The Future of TIPS Procedures

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RESOURCES

BackTable VI Episode #123 - TIPS University Freshman Year: Referrals and Pre-op Workup with Dr. Emmett Lynskey:
https://www.backtable.com/shows/vi/podcasts/123/tips-university-freshman-year-referrals-pre-op-workup

BackTable VI Episode #124 - TIPS University Sophomore Year: Basic Procedure Technique
with Dr. Emmett Lynskey:
https://www.backtable.com/shows/vi/podcasts/124/tips-university-sophomore-year-basic-procedure-technique

BackTable VI Episode #125 - TIPS University Junior Year: Advanced Techniques, ICE, and Splenic Access with Dr. Emmett Lynskey:
https://www.backtable.com/shows/vi/podcasts/125/tips-university-junior-year-advanced-techniques-ice-splenic-access

BackTable VI Episode #126 - TIPS University Senior Year: Gunsight Technique & Splenic Closure with Dr. Emmett Lynskey:
https://www.backtable.com/shows/vi/podcasts/126/tips-university-senior-year-gunsight-technique-splenic-closure

Dr. Suttle TIPS Technique Video:
https://www.youtube.com/watch?v=jYfr_rWe5Ck

TIPS prevents further decompensation and improves survival in patients with cirrhosis and portal hypertension in an individual patient data meta-analysis:
https://www.journal-of-hepatology.eu/article/S0168-8278(23)00314-8/abstract

Intracardiac Echocardiography–Guided TIPS: A Primer for New Operators:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7540636/

In this episode, Dr. Paul Lewis discusses best practices for thoracentesis. He shares insights on using image guidance, managing complex effusions, and managing complications such as pneumothorax and hemothorax. Dr. Lewis is an interventional radiologist at the University of Pittsburgh Medical Center.

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CHECK OUT OUR SPONSOR

Laborie RenovaRP Centesis System
https://www.laborie.com/product/renovarp-products/

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SYNPOSIS

Dr. Lewis also speaks on patient selection, procedural techniques, equipment choices, and other troubleshooting tips. Additionally, the doctors cover procedural nuances such as bilateral thoracentesis and patient positioning and highlight the efficiency of the RenovaRP Centesis System.

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TIMESTAMPS

00:00 - Introduction
06:07 - Thoracentesis Procedure Walkthrough
16:49 - Equipment Used
22:14 - Troubleshooting
30:56 - Post-Procedural Care
36:12 - Complications
48:07 - Helpful Resources

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RESOURCES

Prospective comparison between a peristaltic pump and vacuum containers for paracentesis: Time, resources and safety:
https://pubmed.ncbi.nlm.nih.gov/38042055/

Paracentesis: Faster and easier using the RenovaRP® pump:
https://pubmed.ncbi.nlm.nih.gov/35548901/

Society of Interventional Radiology Consensus Guidelines for the Periprocedural Management of Thrombotic and Bleeding Risk in Patients Undergoing Percutaneous Image-Guided Interventions—Part II: Recommendations:
https://www.jvir.org/article/S1051-0443(19)30407-5/fulltext

The Impact of Gravity vs Suction-driven Therapeutic Thoracentesis on Pressure-related Complications: The GRAVITAS Multicenter Randomized Controlled Trial:
https://pubmed.ncbi.nlm.nih.gov/31711990/

In this episode, Dr. Paul Lewis discusses best practices for thoracentesis. He shares insights on using image guidance, managing complex effusions, and managing complications such as pneumothorax and hemothorax. Dr. Lewis is an interventional radiologist at the University of Pittsburgh Medical Center.

---

CHECK OUT OUR SPONSOR

Laborie RenovaRP Centesis System
https://www.laborie.com/product/renovarp-products/

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SYNPOSIS

Dr. Lewis also speaks on patient selection, procedural techniques, equipment choices, and other troubleshooting tips. Additionally, the doctors cover procedural nuances such as bilateral thoracentesis and patient positioning and highlight the efficiency of the RenovaRP Centesis System.

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TIMESTAMPS

00:00 - Introduction
06:07 - Thoracentesis Procedure Walkthrough
16:49 - Equipment Used
22:14 - Troubleshooting
30:56 - Post-Procedural Care
36:12 - Complications
48:07 - Helpful Resources

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RESOURCES

Prospective comparison between a peristaltic pump and vacuum containers for paracentesis: Time, resources and safety:
https://pubmed.ncbi.nlm.nih.gov/38042055/

Paracentesis: Faster and easier using the RenovaRP® pump:
https://pubmed.ncbi.nlm.nih.gov/35548901/

Society of Interventional Radiology Consensus Guidelines for the Periprocedural Management of Thrombotic and Bleeding Risk in Patients Undergoing Percutaneous Image-Guided Interventions—Part II: Recommendations:
https://www.jvir.org/article/S1051-0443(19)30407-5/fulltext

The Impact of Gravity vs Suction-driven Therapeutic Thoracentesis on Pressure-related Complications: The GRAVITAS Multicenter Randomized Controlled Trial:
https://pubmed.ncbi.nlm.nih.gov/31711990/