BackTable Vascular & Interventional BackTable

In this episode, host Dr. Bryan Hartley takes us on a deep dive into the origin story and mission of Pulmera, a medtech company dedicated to transforming the field of bronchoscopic lung cancer diagnosis by retrofitting existing fluoroscopy machines into cone beam CT-like scanners. Dr. Hartley is a vascular and interventional radiologist and co-founded Pulmera, alongside interventional pulmonologist Dr. Harmeet Bedi at Stanford.

Pulmera is developing a novel approach to enhance physicians’ ability to diagnose lung nodules accurately through innovative technology. Dr. Hartley shares insights into the challenges of existing diagnostic methods, the inspiration behind Pulmera, and the technology’s potential to combine the best of 3D imaging and endoscopy techniques. Dr. Hartley discusses the benefits for both patients and physicians, such as improved diagnostic yields and patient outcomes, and introduces an investment opportunity for the BackTable community to be part of this revolutionary project. The episode also explores the broader implications of this technology across various medical specialties beyond pulmonology.

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RADPAD® Radiation Protection
https://www.radpad.com/

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SHOW NOTES

00:00 - Introduction
02:18 - Personal Journey: From Vanderbilt to Stanford Biodesign
06:11 - Pulmera’s Mission: Enhancing Diagnostic Accuracy in Lung Biopsies
15:02 - Introducing a Game-Changing Technology for Bronchoscopic Procedures
22:09 - Challenges and Breakthroughs in Portable CT Imaging
27:44 - Economic Impact of Enhanced Diagnostic Procedures
29:48 - Building a Team and Securing Funding for Innovation
31:30 - Understanding Investment Opportunities and Equity Financing

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RESOURCES

Dr. Bryan Hartley’s email:
bryan.hartley@pulmera.com

Dr. Bryan Hartley’s cell:
423-432-0612

Pulmera:
http://www.pulmera.com/

Stanford Biodesign Fellowship:
https://biodesign.stanford.edu/programs/fellowships/innovation-fellowships.html

BackTable Innovation Episode #1 - Needs Driven Innovation with Dr. Todd Brinton (Stanford BioDesign):
https://www.backtable.com/shows/innovation/podcasts/1/needs-driven-innovation

BackTable Innovation Episode #30 - Host Stories with Dr. Bryan Hartley and Dr. Eric Gantwerker (Stanford BioDesign):
https://www.backtable.com/shows/innovation/podcasts/30/host-stories

BackTable VI Episode #422 - Pathology 101: Solid Advice for Percutaneous Biopsies with Dr. Andrew Sholl:
https://www.backtable.com/shows/vi/podcasts/422/pathology-101-solid-advice-for-percutaneous-biopsies

In this episode, Dr. Jos van den Berg discusses the benefits of joining the Critical Limb Ischemia (CLI) Global Society, including discounts on Amputation Prevention Symposium (AMP) meetings, access to a specialized journal, and participation in Multidisciplinary CLI Network (MCLIN) discussion boards.

Dr. van den Berg is an interventional radiologist at University of Bern in Switzerland and Europe Office Chairman and Member of Board of Directors for CLI Global Society. Dr. van den Berg also serves as a reviewer and editorial board member of multiple high-impact scientific journals.

With members across the globe, the CLI Global Society emphasizes a multidisciplinary approach to combat CLI, aiming to prevent amputation and death through education, patient advocacy, and awareness about CLI. Dr. van den Berg also sheds light on the complexity of CLI management in Europe due to varied reimbursement systems among countries and the society’s efforts to tackle these challenges. The episode also touches on the society’s future goals, including expanding its global presence and continuing to offer extensive resources and networking opportunities to its members.

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CHECK OUT OUR SPONSORS

BD Advance Clinical Training & Education Program
https://page.bd.com/Advance-Training-Program_Homepage.html

Reflow Medical
https://www.reflowmedical.com/

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SHOW NOTES

00:00 - Introduction
02:08 - Meet Our Guest: Dr. Jos van den Berg
05:42 - Deep Dive into CLI Global Society
07:53 - Exploring the Impact and Initiatives of CLI Global Society
14:42 - Challenges and Differences of CLI Management in Europe
21:08 - Innovations and Future Endeavors in CLI Treatment
23:45 - Closing Thoughts and the Importance of Membership

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RESOURCES

CLI Global Society:
https://www.cliglobalsociety.org/

Multidisciplinary CLI Network (MCLIN) Global CLI LIVE Meeting (every 2nd Friday of the month, 7am EST):
https://www.cliglobalsociety.org/education/mclin/#myaccount

AMP CLI Meeting:
https://www.hmpglobalevents.com/amptheclimeeting

In this episode, Dr. Blake Parsons talks through the role of spinal cord stimulation in treating vascular issues and diabetic neuropathy. He also discusses the growing presence of vascular specialists in clinics, the transition from procedural work to clinical involvement, and the significance of building a strong patient-doctor relationship.

The doctors highlight the effectiveness of Nevro 10 kHz therapy in providing long-term pain relief and sensory improvements for patients struggling with painful diabetic neuropathy, even after conventional treatments fail. Additionally, they touch upon reimbursement updates, the rise of outpatient care, and the future of spinal cord stimulation - emphasizing its potential beyond just pain relief to include improvements in patients’ overall quality of life, reducing risks related to diabetic foot wounds, and incidental falls. The need for a multidisciplinary approach in treating vascular and neuropathic conditions is also discussed, along with the role of interventional radiologists in managing these complex cases.

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CHECK OUT OUR SPONSOR

Nevro HFX Spinal Cord Stimulator
https://www.hfxforpdn.com

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SHOW NOTES

00:00 - Introduction
06:00 - Demystifying Spinal Cord Stimulation for Pain Management
17:11 - Optimizing Patient Care: Trials, Techniques, and Insurance
26:03 - Leveraging Telehealth and Support Teams for Patient Success
30:22 - Challenges and Solutions in Managing Peripheral Neuropathy
35:19 - Collaboration and Referral Dynamics in Vascular and Interventional Radiology
39:19 - Exploring the Future of Neuropathy Treatment and Quality of Life Improvements
43:46 - Addressing the Challenges of Permanent Implant Procedures
48:46 - Role of Technology and AI in Patient Management
56:31 - Concluding Thoughts on Neuropathy Treatment and Practice Dynamics

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RESOURCES

Nevro 10 kHz Therapy:
https://nevro.com/English/en/providers/HFX-Advanced-Therapies/default.aspx

Effect of High-frequency (10-kHz) Spinal Cord Stimulation in Patients With Painful Diabetic Neuropathy: A Randomized Clinical Trial (JAMA Neurology RCT 2021):
https://pubmed.ncbi.nlm.nih.gov/33818600/

Long-term efficacy of high-frequency (10 kHz) spinal cord stimulation for the treatment of painful diabetic neuropathy: 24-Month results of a randomized controlled trial (SENZA-PDN RCT 2023):
https://pubmed.ncbi.nlm.nih.gov/37536514/

Electrical spinal-cord stimulation for painful diabetic peripheral neuropathy (Lancet RCT 1996):
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(96)02467-1/abstract

In this episode, Dr. Mark Lessne and Dr. John Martinie discuss the importance of multidisciplinary collaboration, patient-centered care, and the role of interventional radiology and surgery in treating benign and malignant biliary diseases. Dr. Lessne is an interventional radiologist at Charlotte Radiology and Dr. Martinie is a hepatobiliary surgeon at Carolinas Medical Center, both located in North Carolina.

The doctors explore various scenarios including challenges in biliary decompression, the decision-making process behind choosing the right intervention, and the impact of such diseases on patient care plans and outcomes. Dr. Lessne and Dr. Martinie emphasize the importance of viewing interventional radiologists and gastroenterologists as physicians who not only perform procedures, but also provide comprehensive care and follow-up for their patients. Through their dialogue, it becomes clear that successful treatment of biliary diseases requires a combination of technical skill, thoughtful patient engagement, and collaborative practice among specialists.

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CHECK OUT OUR SPONSOR

RADPAD® Radiation Protection
https://www.radpad.com/

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SHOW NOTES

00:00 - Introduction
02:19 - Multidisciplinary Approach to Patient Care
05:31 - Navigating the Complexities of Biliary Disease Workups
10:13 - Collaboration Between Hepatobiliary Surgery and Interventional Radiology
19:33 - Balancing Minimally Invasive Techniques with Surgical Options
30:29 - The Importance of Compassionate Consent and Patient-Centered Care
32:16 - Exploring Advanced Interventions and Team Discussions
36:31 - Considerations and Challenges in Biliary Stenting
45:46 - Role of Interventional Radiology in Patient Care
56:57 - Final Thoughts on Teamwork and Patient Care

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RESOURCES

BackTable Ep. 203- Making Informed Consent an Informed Choice with the Interventional Initiative:
https://www.backtable.com/shows/vi/podcasts/203/making-informed-consent-an-informed-choice-with-the-interventional-initiative

In this episode of the BackTable MSK Podcast, Dr. Dana Dunleavy interviews Dr. David Prologo about his perspective on current advancements in MSK interventions, including steerable spine needles, thermocouples for radiofrequency ablation, and the growing importance of advocacy and longitudinal follow up for patients with chronic pain. Dr. Prologo is an interventional radiologist at Emory University.

Dr. Prologo starts by describing the evolution of interventional radiology’s role in MSK interventions. He explains that establishing solid referral networks is crucial to building this service line, and he gives examples of how new interventionalists can highlight their skills to others. Then, he describes a new steerable needle that allows operators to safely enter the vertebral body with a transpedicular approach and subsequently navigate directly to the location of interest. This device is especially useful when lesions are located in tricky areas where the trajectory of a straight needle would have difficulty reaching. He also discusses different devices for bone tumor ablation and his preferred methods for targeting lesions that are located at varying locations in the spine. For lesions below T5, he uses fluoroscopy for better visualization of the axial plane. For lumbar lesions, he emphasizes the importance of correlating and cross-checking vertebral levels with pre-procedural MRI.

Dr. Prologo also discusses lessons learned from his extensive experience in spine interventions, especially from prior complications. He explains how thermocouple monitoring can give real time feedback on internal temperature during radiofrequency ablation, the necessity of understanding the ablation zone, and the importance of longitudinal follow up. He cites specific cases of patients struggling with chronic pain and how he advocated for each case.

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Merit Spine
https://www.merit.com/merit-spine/

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SHOW NOTES

00:00 - Introduction
02:09 - Dr. Prologo’s Career and Leadership Roles
09:52 - Interventional Radiology’s Role in MSK Interventions
13:37 - A Primer for Steerable Vertebral Needles
21:40 - Increasing Standardization and Accessibility of Bone Tumor Ablation
26:37 - Advanced Pain Management in Interventional Radiology’ Book
30:24 - Thermocouples in Radiofrequency Ablation
35:45 - Prior Complications and Importance of Longitudinal Care
44:24 - SIR EDGE 2024
52:31 - Accessing Targets for Basivertebral Nerve Ablation
1:01:17 - The Role of Advocacy in Patient Care

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RESOURCES

Osseoflex Steerable Needle:
https://www.merit.com/product/osseoflex-sn-steerable-needle/

STAR Tumor Ablation System:
https://www.merit.com/product/star-tumor-ablation-system/

Osteocool OsteoCool Radiofrequency Ablation System:
https://www.medtronic.com/us-en/healthcare-professionals/products/spinal-orthopaedic/tumor-management/osteocool-ablation-system-rf.html

OptaBlate Bone Tumor Ablation System:
https://providers.strykerivs.com/products/optablate

‘Advanced Pain Management in Interventional Radiology’ by J. David Prologo and Charles E. Ray Jr:
https://shop.thieme.com/Advanced-Pain-Management-in-Interventional-Radiology/9781684201402

Ablation zones and weight-bearing bones: points of caution for the palliative interventionalist:
https://pubmed.ncbi.nlm.nih.gov/24745905/

SIR EDGE 2024:
https://www.sirweb.org/learning-center/meetings/sir-edge/

‘The Catching Point Transformation’ by J. David Prologo:
https://www.catchingpoint.com/

In this episode, Dr. Matthew Lungren discusses the transformative potential of Artificial Intelligence (AI) in healthcare, sharing insights into large language models, deep learning, and machine learning in improving patient care, enhancing clinical workflows, and optimizing medical research.

Dr. Lungren is a pediatric diagnostic and interventional radiologist, and the Chief Data Science Officer at Microsoft Health and Life Sciences. He advocates for a future where AI acts as a tool for healthcare professionals, allowing them to devote more time to patient care rather than administrative tasks. Additionally, the discussion explores concerns such as AI’s impact on employment and interactions with insurance companies, while presenting resources for healthcare professionals to engage with and learn about AI technologies actively.

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CHECK OUT OUR SPONSOR

Reflow Medical
https://www.reflowmedical.com/

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SHOW NOTES

00:00 - Introduction
03:00 - The Journey to AI Expertise: Dr. Lungren’s Story
05:48 - Decoding AI: From Basics to Large Language Models
13:07 - AI’s Impact on Healthcare and Beyond
15:57 - Exploring AI’s Potential in Content Creation and Clinical Efficiency
20:22 - The Future of AI in Healthcare: Opportunities and Challenges
25:27 - Leveraging AI for Diagnostic Radiology and Beyond
27:42 - The Transformative Potential of Generative AI in Healthcare
33:40 - Addressing Concerns: AI’s Role in Insurance and Patient Advocacy
36:41 - Empowering Healthcare Professionals with AI: Practical Applications and Future Outlook

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RESOURCES

Fundamentals of Machine Learning for Healthcare - Stanford University Coursera Course: https://www.coursera.org/learn/fundamental-machine-learning-healthcare

Dr. Matt Lungren’s LinkedIn Learning Course on Generative AI:
https://www.linkedin.com/learning/an-introduction-to-how-generative-ai-will-transform-healthcare/introduction-to-generative-ai-in-healthcare

DeepLearning.AI Website (Professor Andrew Ng):
https://www.deeplearning.ai/

Fast.AI Website (Professor Jeremy Howard):
https://www.fast.ai/

Professor Jeremy Howard YouTube:
https://www.youtube.com/@howardjeremyp/featured

Healthcare Information and Management Systems Society (HIMMS) Meeting:
https://www.himssconference.com/en/homepage.html