BackTable Vascular & Interventional

In this episode, host Dr. Dana Dunleavy engages in a thought-provoking discussion about independent interventional radiology practice with two esteemed IRs, Dr. Kavi Devulapalli and Dr. Ian Wilson. Together, they discuss the complexities and opportunities in the ever-evolving landscape of IR.

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Philips SymphonySuite

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SHOW NOTES

We start off the discussion with Kavi expanding on early experiences in working a standard DR / IR split that most IRs tend to work in. He elaborates on how this split was not what he, as well as most IRs, intended to practice in when they entered the field. Thus, he then shifted over to the OBL space, a gratifying journey, but one he notes was difficult to navigate due to the intricacies. As Kavi finally transitioned to locum tenens work, he reflects on its appeal, despite the scarcity of opportunities. He notes that locum tenens work is usually in areas with an extreme dearth of IRs, such as rural areas. This conversation also explores the topic of exclusive contracts. Their impact on independent IR practices' access to hospital privileges is also explored, shedding light on the challenges faced by IRs seeking to expand their reach.

Ian then notes that his locum tenens work was also in a rural setting, and how he had served this location for an extended period of time due to their lack of retention of IRs. The discussion then reveals a growing trend among physicians, as more and more are turning to locum work due to its exclusive focus on the IR aspect of the job that initially attracted them to this field. It's a mutual demand, as physicians seeking to specialize in IR find locum work to be a well-suited avenue, while areas of healthcare dearth are equally eager to tap into the expertise of these specialists.

Both guests emphasize the urgent need for sustainable solutions to address this growing public health crisis in rural areas. This is precisely where organizations like Travelier come into play. Travelier was established by IRs, one of whom is Kavi, with a mission to bridge this critical gap by offering world-class IR services to communities with unmet needs. Their approach involves assembling dedicated physician teams and creating interventional radiology practices that generate revenue while providing viable work solutions for radiologists. This discussion is a testament to the adaptability and innovation that drive the field of IR, characterized by the commitment to improving healthcare access in areas where it is needed the most. It's also a testament to the increasing mutual demand for specialized IR services and the unique opportunities that come with it.

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RESOURCES

Travelier:

https://travelierir.com

Dr. Ally Baheti interviews interventional radiologist Dr. Steven Smith about his insights into venous orthostatic flow dysfunction and its association with multisystem disorders.

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RADPAD® Radiation Protection

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SYNPOSIS

Dr. Smith details his clinical career and his surprising findings that connect pelvic congestion syndrome with a range of other conditions, such as postural orthostatic tachycardia syndrome (POTS), chronic fatigue syndrome, Ehlers-Danlos syndrome, irritable bowel syndrome (IBS), vulvodynia, interstitial cystitis, and fibromyalgia. For patients with venous manifestations, he pursues treatment with stents or embolization, taking a proactive approach to targeting any abnormal vasculature that he identifies.

Additionally, the podcast delves into the physiological basis of POTS and related disorders, which mainly stems from blood pooling in the lower body, leading to sympathetic overactivation. Overall, Dr. Smith emphasizes the significance of collaborating with specialists across different disciplines to advance understanding and treatment of these complex syndromes.

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TIMESTAMPS

00:00 - Introduction

03:11 - Symptom Constellation of Venous Orthostatic Flow Syndrome

12:08 - Pelvic Vein Treatment Algorithm

21:08 - Physiology of Orthostatic Intolerance and Sympathetic Overdrive

27:11 - Patient Selection

33:27 - Need for Research and Collaboration

36:07 - Advocacy for Patients

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RESOURCES

BackTable VI Ep. 337- Management of Vulvar Varices with Dr. Brooke Spencer

https://www.backtable.com/shows/vi/podcasts/337/management-of-vulvar-varices

BackTable VI Ep. 33- Building a Comprehensive Vein Practice with Dr. Brooke Spencer & Dr. Isabel Newton

https://www.backtable.com/shows/vi/podcasts/33/building-a-comprehensive-vein-practice

An online survey of pelvic congestion support group members regarding comorbid symptoms and syndromes (Smith et al, 2022):

https://journals.sagepub.com/doi/abs/10.1177/02683555221112567

Distension of central great vein decreases sympathetic outflow in humans (Cui et al, 2013):

https://journals.physiology.org/doi/full/10.1152/ajpheart.00019.2013

Orthostatic intolerance and chronic fatigue syndrome: New light on an old problem (Rowe, 2002):

https://www.jpeds.com/article/S0022-3476(02)53209-1/fulltext

In this episode of the BackTable Podcast, host Dr. Chris Beck interviews guest Dr. Gary Tse about the innovative technique of thyroid ablation and its role in treating benign thyroid nodules. Dr. Tse is a practicing interventional radiologist at UCLA Health.

Dr. Tse highlights the procedural details, patient experiences, potential complications, and follow-up protocols of thyroid ablation. He emphasizes the importance of consistent communication with patients during these procedures, given that the patients are under minimal anesthesia. He explains how interventional radiologists can benefit from embracing this procedure due to their expertise in ultrasound usage, as it leads to reduction in recovery times and complications for patients. Dr. Tse also briefly discusses the future potential of thyroid embolization for larger goiters. He encourages other IR specialists to consider adopting this procedure, which he believes should become a standard of care.

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Siemens Healthineers

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Varian, a Siemens Healthineers company

https://www.varian.com/products/interventional-solutions/embolization-solutions

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SHOW NOTES

00:00 - Introduction

04:03 - Dr. Tse’s Career Journey and Transition to Academics

06:32 - Discussion on Thyroid Interventions

09:15 - Building Referral Patterns for Thyroid Interventions

11:50 - Thyroid Ablation Procedure Overview

21:23 - Post-Ablation Outcomes and Goals

25:52 - Avoiding Complications

32:55 - Post-Procedure Follow-Up

36:14 - Exploring Thyroid Embolization

42:23 - Final Thoughts and Future Prospects

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RESOURCES

2017 Thyroid Radiofrequency Ablation Guideline: Korean Society of Thyroid Radiology:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6005940/

Recurrent Laryngeal Nerve Injury in Thermal Ablation of Thyroid Nodules-Risk Factors and Cause Analysis:

https://pubmed.ncbi.nlm.nih.gov/35311971/

Effectiveness of Injecting Cold 5% Dextrose into Patients with Nerve Damage Symptoms during Thyroid Radiofrequency Ablation:

https://doi.org/10.3803/EnM.2020.35.2.407

Revisiting Rupture of Benign Thyroid Nodules after Radiofrequency Ablation: Various Types and Imaging Features:

https://doi.org/10.3803/EnM.2019.34.4.415

Thyroid arterial embolization to treat Graves' disease:

https://pubmed.ncbi.nlm.nih.gov/17354140/

Thyroid Embolization for Nonsurgical Treatment of Nodular Goiter: A Single-Center Experience in 56 Consecutive Patients:

https://www.jvir.org/article/S1051-0443(21)01212-4/fulltext#%20

In this episode, host Dr. Aaron Fritts interviews interventional radiologist Dr. Eric DePopas about digital marketing strategies for physicians. Eric is the Co-Founder and Chief Medical Officer of Helped, a company designed to connect patients to IR physicians.

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Siemens Healthineers

https://www.siemens-healthineers.com/

Medtronic Ellipsys Vascular Access System

https://www.medtronic.com/ellipsys

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SHOW NOTES

To begin the episode, Eric shares his motivations behind starting Helped and the unique story of sharing this undertaking with his brother and co-founder Kevin DePopas. He discusses his uphill battle of marketing IR services and building a strong patient base.

Eric also covers differences between digital versus in-person marketing. He emphasizes that the digital world is not a substitute for boots on the ground, and he underscores the importance of building word of mouth through strong clinical work and regularly interacting with referring physicians. Eric also shares valuable digital marketing takeaways and questions to ask marketing agencies.

Then, Eric breaks down paid-search (Google), paid-social (Facebook, Instagram, TikTok), and radio marketing strategies. Aaron and Eric discuss how to approach the bottom of the marketing funnel (where potential patients become treated patients), and how to engage and guide patients with interactive online quizzes.

Finally, the doctors examine the value of customer relation management systems (CRMS). Eric explains how CRMS is a high fidelity approach to assessing patient knowledge and how it is a key component in building a truly robust funnel. The episode concludes with Eric giving parting advice and encouragement for physicians in the marketing world.

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RESOURCES

Helped Website:

https://www.tryhelped.com/patient-home

In this episode, guest host Dr. Sean Tutton interviews Dr. Bill Rilling and Dr. Sarah White about the history of the Society of Interventional Oncology (SIO), their current research and volunteer involvement, and future directions of the society.

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Varian, a Siemens Healthineers company

https://www.varian.com/

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SHOW NOTES

We begin by discussing how the Society of Interventional Oncology (SIO) began. It started as the World Conference of Interventional Oncology (WCIO), but was formed into an official society with the goal to become the fourth pillar of oncology care, in addition to surgical oncology, medical oncology and radiation oncology. At the time of its inception, the group asked themselves whether interventional oncology would be bettered by the addition of a professional membership society, and there was a thoughtful and unified decision that it would be.

Next, we discuss what goes into forming a society? When asking people to become members, pay money and give their time, they will expect some return on their investment. It's important to have a formal society, as it greatly advances the field forward. The ability to focus resources and effort completely on what you're passionate about is what having SIO allows. At SIO, we want people to be members of both SIR and SIO, it should be both, not one or the other.

Finally, we talk about some of the current research funded by SIO. SIO fulfills the research aspect of the society by creating data, currently via the Ablation with Confirmation of Colorectal Liver Metastasis (ACCLAIM) Trial. This trial uses software to determine post-treatment margins in percutaneous microwave ablation for colorectal metastasis of the liver. With this trial, they hope to prove that this procedure results in high rates of clear margins, which will make it a minimally invasive alternative to surgical resection. Future research efforts will likely focus on coupling locoregional therapy with targeted immunotherapy. They aim to start treating new cancers, develop further partnerships with industry and pharma, and continue to produce quality data on response rates to promote interventional oncology as the well respected and accepted fourth pillar of oncology.

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RESOURCES

SIO:

www.sio-central.org

ACCLAIM Trial:

www.sio-central.org/p/cm/ld/fid=809