BackTable Vascular & Interventional BackTable

Bringing more interventional radiology to rural America would benefit many patients who currently do not have access to minimally invasive, image guided medicine. In today's episode, Dr. Frederick Johnson, an interventional radiologist practicing in Thomasville, Georgia joins us to discuss the unique dynamics and challenges of setting up and maintaining a successful rural IR practice.

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Medtronic ClosureFast
https://www.medtronic.com/us-en/c/cardiovascular/closurefast-rfa-system.html

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SYNPOSIS

Dr. Johnson provides insights into the professional service agreement (PSA) model that allows his practice to maintain autonomy while collaborating with the local hospital. The episode explores the complexities of recruiting to a rural setting, maintaining a broad case mix, ensuring financial stability, and fostering professional satisfaction. The conversation highlights the importance of redefining independence and the benefits of integrating collaboration into IR practices.

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TIMESTAMPS

00:00 - Introduction
02:29 - Dr. Johnson’s Background and Journey
11:46 - Professional Service Agreement (PSA) Explained
18:48 - Daily Operations and Structure
24:19 - Teamwork in Rural Healthcare
30:35 - Recruitment and Growth
33:33 - Compensation and Financial Incentives
42:05 - Benefits of Small Town Living
44:34 - Advice for Aspiring Rural Healthcare Practitioners

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RESOURCES

Dr. Fred Johnson’s Practice:
https://www.archbold.org/providers/frederick-d-johnson-jr-md/

Ever wonder what it’s like to practice interventional radiology down under? Dr. Chris Rogan joins us on the BackTable Podcast this week to tell us about his IR practice in Australia, with special emphasis on healthcare system and interventional practice model differences between our two countries.

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SYNPOSIS

We cover a wide range of topics, including the differences in IR training pathways between Australia and the U.S., the impact of healthcare models on IR practice, and the cooperation between public and private healthcare. We also highlight the urgent need for more IR specialists in Australia. Additionally, the doctors explore the challenges of public awareness, interdisciplinary and global collaboration, and the ongoing efforts by the Interventional Radiology Society of Australasia (IRSA) to promote IR through public outreach and educational strategies.

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TIMESTAMPS

00:00 - Introduction
04:08 - Australia vs. US Healthcare Systems
08:21 - Compensation and Career Mobility
16:52 - IR Public Awareness and Marketing
25:56 - Global Collaboration and Conferences
30:53 - Travel Tips for Australia

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RESOURCES

Dr. Chris Rogan’s practice:
https://drrogan.com/

Interventional Radiology Society of Australasia (IRSA):
https://irsa.com.au/

IRSA 2024 Annual Meeting:
https://irsa.com.au/education-events/irsa-annual-scientific-meeting-2024/

Superficial venous disease can pose significant management challenges, particularly after patients have exhausted conservative and invasive therapies. This week, our host, Dr. Sabeen Dhand, interviews Dr. Ali Golshan, an interventional radiologist and the founder of SOLVEIN. Dr. Golshan discusses the latest advancements in treating superficial venous disease, highlighting both the benefits and complexities of thermal and non-thermal ablation techniques.

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

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SYNPOSIS

Dr. Golshin introduces SOLVEIN, his innovative medical device designed to address these challenges. The conversation also includes practical tips for managing patients with venous insufficiencies, along with insights into the entrepreneurial journey involved in developing a new medical device.

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TIMESTAMPS

00:00 - Introduction
02:02 - Defining Superficial Venous Disease
05:43 - Diagnostic Techniques and Imaging
08:29 - Current Treatment Options for Venous Insufficiency
20:07 - Introducing SOLVEIN
29:42 - FDA Approval Pathway
33:37 - Advice for Aspiring Medical Entrepreneurs

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RESOURCES

Dr. Ali Golshan’s Practice:
https://www.beachwellnessmd.com/

Dr. Venkatesh Krishnasamy shares techniques and specific cases for challenging lung biopsies, his insights on mentorship, importance of multidisciplinary tumor boards, and the evolution of lung biopsy practices. Dr. Krishnasamy is an interventional radiologist and Director of Interventional Oncology at the University of Alabama Birmingham.

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CHECK OUT OUR SPONSOR

Merit Biopsy Solutions
https://www.merit.com/solutions/biopsy-solutions/

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SYNPOSIS

The doctors cover practical advice on handling complications like pneumothorax and hemoptysis, and share strategies for optimizing workflows to improve patient outcomes. Dr. Krishnasamy encourages listeners to leverage mentor experience and partake in continued learning to advance their practice.

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TIMESTAMPS

00:00 - Introduction
05:16 - Lung Biopsy Referrals and Multidisciplinary Approach
12:03 - Complex Lung Biopsies
25:43 - Needle Position Verification
27:29 - Importance of Cytopathologist Presence
28:51 - Blood Patching vs. Plug Technique
33:54 - Post-Procedure Protocols
36:15 - Advanced Techniques and Mentorship
44:26 - Handling Hemoptysis During Biopsies
47:50 - Encouragement for Trainees

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RESOURCES

Society of Interventional Oncology:
https://www.sio-central.org/

BackTable VI Podcast Episode #278 - Minimizing Complications for Lung Biopsies with Dr. Robert Suh:
https://www.backtable.com/shows/vi/podcasts/278/minimizing-complications-for-lung-biopsies

BackTable VI Podcast Episode #156 - Percutaneous Lung Biopsies: The Basics with Dr. Fred Lee (Part 1 of 2):
https://www.backtable.com/shows/vi/podcasts/156/percutaneous-lung-biopsies-the-basics

BackTable VI Podcast Episode #157 - Percutaneous Lung Biopsies: Pleural & Parenchymal Blood Patching with Dr. Fred Lee (Part 2 of 2):
https://www.backtable.com/shows/vi/podcasts/157/percutaneous-lung-biopsies-pleural-parenchymal-blood-patching

In this episode, Dr. Alexander Vezeridis discusses advanced biliary interventions; covering stone removal procedures, technical success rates, and practical tips for using Spyglass cholangioscopy, laser lithotripsy, and endobiliary ablation. Dr. Vezeridis is an interventional radiologist, physician-scientist, and Assistant Professor of Radiology at Stanford.

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CHECK OUT OUR SPONSOR

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

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SYNPOSIS

Dr. Vezeridis highlights the importance of continuous learning, collaboration with other specialties, and shares his experiences and tips for optimizing patient outcomes. The doctors also touch on innovative approaches such as photodynamic therapy and the use of various tools in managing benign and malignant biliary diseases.

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TIMESTAMPS

00:00 - Introduction
03:25 - Setting Up Spyglass in Your Practice
10:50 - Patient Selection and Procedure Details
24:27 - Stone Fragmentation Techniques
27:35 - Success Rates and Patient Outcomes
35:06 - Endobiliary Ablation Techniques
47:35 - Laser Treatment for Biliary Obstructions
49:18 - Future Innovations

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RESOURCES

BackTable VI Podcast Episode #146 - Spyglass Interventions with Dr. Jeffrey Chick and Dr. Ravi Srinivasa:
https://www.backtable.com/shows/vi/podcasts/146/spyglass-interventions

Spyglass - Boston Scientific:
https://www.bostonscientific.com/en-US/medical-specialties/gastroenterology/advancements-cholangioscopy.html

Percutaneous Gallstone Removal: Long-term Follow-up (Dr. Hovsepian Paper):
https://www.jvir.org/article/S1051-0443(96)70766-2/pdf

SIR’s Percutaneous Cholangiopancreatoscopy (PCPS) registry:
https://clinicaltrials.gov/study/NCT05210322

StarMed Endoscopic RFA Clinical Articles:
https://www.starmedacademy.com/endoscopic-rfa-clinical-articles-elra

Habib Endobiliary Ablation Catheter:
https://www.bostonscientific.com/en-US/products/rf-ablation/habib-endohpb-bipolar-radiofrequency-catheter.html

Interventional Radiology-Operated Choledochoscopic-Guided Radiofrequency Wire and Holmium Laser Ablations May Facilitate Treatment and Long-Term Patency of Benign Biliary Strictures:
https://www.jvir.org/article/S1051-0443(18)31535-5/abstract

Percutaneous Cholangioscope-Assisted Laser Incision of Severe Benign Hepaticojejunostomy Stenoses:
https://pubmed.ncbi.nlm.nih.gov/35504434/

Percutaneous Endoluminal Benign Biliary Laser (PEBBL) (Clinical Trial):
https://clinicaltrials.gov/study/NCT05567003

In this episode of the Back Table Podcast, interventional radiologist Dr. Noor Ahmad discusses his algorithm for complex inferior vena cava (IVC) filter retrievals and reviews several cases that utilize various retrieval tools.

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CHECK OUT OUR SPONSOR

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

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SYNPOSIS

Dr. Ahmad emphasizes that most patients are referred by physicians with whom he maintains good relationships, and both specialties jointly monitor patients after IVC filters are placed. Generally, it is ideal to remove IVC filters around the 3-month mark, with filters in place for over 6 months posing a higher risk of requiring complex retrieval. For preoperative evaluation, obtaining a history of the filter type and placement date, along with CT scans (non-contrast and venogram), is crucial. Anticoagulation is typically discontinued two days prior to retrieval.

During the procedure, moderate sedation and internal jugular access are used. However, complex retrievals may necessitate general anesthesia and access through the femoral vein or dual sites. The initial device employed is usually the CloverSnare to hook and extract the IVC filter. If unsuccessful, Dr. Ahmad proceeds with techniques such as the hangman (modified loop snare), endobronchial forceps, and finally the ClavaClear laser sheath. He highlights that particularly challenging cases might require collaboration with colleagues, especially when dual access is needed, possibly requiring rescheduling for general anesthesia availability. Patient safety is emphasized in these scenarios. Lastly, Dr. Ahmad presents past cases with imaging to illustrate various retrieval methods.

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TIMESTAMPS

00:00 - Introduction
03:29 - Referrals and Tracking for Filter Removal
08:49 - Working Up Complex Cases
13:19 - Patient Selection
20:14 - Procedure Walkthrough
23:22 - Different Strategies for Filter Removal
31:23 - Laser Techniques
34:47 - Sheath Sizing
36:06 - Enhancing Patient Safety
43:34 - Cheat Sheet for IVC Filters and Case Studies

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RESOURCES

BackTable Ep. 204- Filter Indications and Filter Tracking: Up Your Game with Dr. Stephen Wang:
https://www.backtable.com/shows/vi/podcasts/204/filter-indications-filter-tracking-up-your-game

BackTable Ep. 339- The Importance of a Multidisciplinary Filter Retrieval Program with Dr. Robert Ryu, Dr. Warren Clements, and Dr. Premal Trivedi:
https://www.backtable.com/shows/vi/podcasts/339/the-importance-of-a-multidisciplinary-filter-retrieval-program