BackTable Vascular & Interventional

Chronic limb-threatening ischemia (CLTI) represents the most advanced stage of peripheral artery disease. While many patients can be treated with endovascular or surgical revascularization, a subset of individuals remain ‘no-option’ candidates when conventional therapies fail or distal targets are absent. In this episode of BackTable, host Dr. Ally Baheti speaks with Dr. Mary Costantino, interventional radiologist at Advanced Vascular Centers, and Jill Sommerset, vascular technologist and Director of Clinical Education and Training at Aveera Medical, about the emerging role of spinal cord stimulation (SCS) as a potential therapy for patients with no-option CLTI. --- SYNPOSIS This episode explores where spinal cord stimulation may fit within the treatment landscape for advanced CLTI, particularly for patients who are not candidates for revascularization or deep venous arterialization (DVA). Dr. Costantino describes how interest in the therapy developed through multidisciplinary collaboration and early physiologic observations using pedal acceleration time (PAT) measured with duplex ultrasound alongside angiography. A representative case highlights immediate, setting-dependent improvements in PAT following stimulation, and the group reviews early trends from a small patient cohort suggesting improved distal perfusion in individuals with severe infrapopliteal disease. The conversation also addresses practical barriers to adoption, including site-of-service and reimbursement challenges and the difficulty of implanting permanent stimulators in patients with active wounds. Jill Sommerset adds perspective from the vascular lab, discussing ultrasound-based methods to quantify physiologic changes after DVA and how similar perfusion metrics may help evaluate spinal cord stimulation. The episode concludes with a discussion of the potential role of neuromodulation in this population and the need for larger datasets to better define its clinical impact. --- TIMESTAMPS00:00 - Introduction02:02 - Why CLTI Needs Options06:25 - First No Option Case11:06 - Trial Turns Flow On14:38 - Timing and Reimbursement19:59 - Early Results and Adoption22:45 - How Spinal Cord Stimulation Might Improve Flow26:46 - Patient Selection and Access30:24 - Treatment Algorithm and Timing32:37 - Quality of Life and Mobility37:57 - Implant Delays and Coordination39:41 - Data --- RESOURCES Paper on Maturation after DVAhttps://www.sciencedirect.com/science/article/pii/S1078588426000523

Below-the-knee (BTK) arterial disease remains one of the more challenging areas in vascular care, particularly in patients with chronic limb-threatening ischemia (CLTI), where heavy calcification complicates endovascular treatment. As new calcium-modifying technologies emerge, an important question remains: what evidence supports their use in BTK interventions? In this episode of BackTable Vascular & Interventional, host Dr. Sabeen Dhand speaks with vascular surgeon Dr. Paul Foley of Doylestown Health about the Disrupt BTK II clinical trial from Shockwave Medical, which evaluates the performance of peripheral intravascular lithotripsy (IVL) in heavily calcified BTK disease. --- This podcast is supported by: Shockwave Medicalhttps://shockwavemedical.com/ --- SYNPOSIS Dr. Foley begins by outlining his training and the evolution of his vascular surgery practice, setting the stage for a broader discussion on how BTK interventions have changed over the past decade. The conversation explores shifts in access strategies, procedural approaches, and the unique characteristics of calcification encountered in CLTI. Because BTK calcium differs from calcification seen elsewhere in the peripheral vasculature, imaging and device selection play a particularly important role when planning IVL-based therapies. Dr. Foley reviews the design and outcomes of the Disrupt BTK II trial, where devices such as the Shockwave M5+ and S4 catheters were used to modify calcified plaque, demonstrating encouraging safety and performance signals. The discussion then turns to emerging technologies, including Shockwave’s Javelin catheter, designed to deliver focused pressure waves to fracture dense calcium within peripheral arteries. Dr. Foley describes how the device fits into BTK workflows, including technique considerations and its use alongside adjunctive therapies such as balloon angioplasty. The episode also addresses the ongoing skepticism surrounding IVL in BTK disease, emphasizing the need for careful patient selection, procedural precision, and continued multidisciplinary collaboration as the field works to refine treatment strategies and improve outcomes for patients with peripheral artery disease (PAD). --- TIMESTAMPS 00:00 - Introduction08:20 - Evolution of Below-the-Knee Treatments11:10 - Differences in BTK Calcification13:13 - Imaging and Technology in BTK Interventions15:18 - Disrupt BTK II Trial Data and Results23:17 - Introduction to the Javelin Device26:39 - Technique Considerations with Javelin28:36 - Comparing Javelin and E831:17 - Future Directions for Lithotripsy Technology35:30 - Skepticism Around IVL in BTK Disease38:47 - Final Thoughts --- RESOURCES Disrupt BTK II Trialhttps://www.jvascsurg.org/article/S0741-5214(24)02063-9/fulltext

When standard-of-care checkpoint blockade fails in metastatic melanoma, how can oncologists and interventional radiologists join forces to turn around patient outcomes? In this episode of the BackTable Podcast, medical oncologist Dr. Jennifer McQuade and interventional radiologist Dr. Rahul Sheth join host Dr. Tyler Sandow to discuss the growing evidence for intratumoral oncolytics as a therapeutic strategy for frontline immunotherapy-refractory melanoma and the interdisciplinary work that is required for successful implementation in practice. --- SYNPOSIS The physicians review how engineered viral vectors, particularly RP1, complement checkpoint blockade through direct tumor lysis and immune activation, and summarize the IGNYTE trial data supporting their use in patients with metastatic melanoma refractory to anti-PD-1 and anti-CTLA-4 agents. The discussion then shifts to practical administration, highlighting the central role of interventional radiology in delivering these therapies to visceral and deep-seated lesions under image guidance. The doctors go on to address the nuances of patient and lesion selection, injection technique, and response assessment, including the importance of recognizing pseudo-progression. They place particular emphasis on the need for multidisciplinary collaboration and stakeholder buy-in efforts on the part of IRs seeking to integrate intratumoral oncolytic injections into their scope of practice. The episode concludes with a forward-looking discussion on the potential for expansion of oncolytic platforms into other solid tumors, underscoring this field as a growing, IR-forward frontier in cancer treatment. --- TIMESTAMPS 00:00 - Introduction02:28 - Immunotherapy Basics06:51 - How Oncolytic Viruses Work11:01 - IGNYTE Trials and Why IR Matters18:14 - T-VEC vs RP1 Indications and Logistics21:57 - Physician Communication and Multidisciplinary Treatment23:06 - RP1 Protocol and Administration Techniques30:28 - RP1 Safety Profile32:46 - Follow-Up Imaging and Response Assessment35:44 - Future Applications Beyond Melanoma41:42 - Final Thoughts and Closing Remarks --- RESOURCESWong MK, et al. RP1 Combined With Nivolumab in Advance Anti-PD-1-Failed Melanoma (IGNYTE). J Clin Oncol. 2025;43(33):3589-3599.https://doi.org/10.1200/jco-25-01346 IGNYTE-3 Trialhttps://clinicaltrials.gov/study/NCT06264180

With data increasingly positioning thermal ablation as a viable alternative to surgery for select liver metastases, the demands on the interventional oncologist have never been higher. Mastering the nuances of patient selection and precise margin assessment is now essential for ensuring effective disease control locally. In this episode of the BackTable Podcast, interventional radiologist Dr. Jonas Redmond of UC San Diego Health joins host Dr. Sabeen Dhand to discuss the current state of microwave ablation (MWA) in the management of oligometastatic liver disease, focusing on tumor assessment, preprocedural planning, and the integration of local and systemic therapies. --- This podcast is supported by: Varian IntelliBlatehttps://www.varian.com/products/interventional-solutions/microwave-ablation-solutions --- SYNPOSIS The conversation delves into the complexities of timing systemic versus local ablative therapies and explores questions surrounding adequate treatment margins. Dr. Redmond goes on to emphasize the need for operators to approach procedures with a high level of adaptability, advocating for interdisciplinary preprocedural planning and thoughtful modality selection. Exploring the complications that could arise from injury to adjacent viscera, the physicians speak to the critical importance of rigorous intraprocedural reassessment and discuss how modern software and robotics are transforming procedural precision and safety. Framing these MWA pearls within the context of recent clinical trials like COLLISION and ACCLAIM, the episode underscores the transition of interventional oncology from providing palliative services to increasingly curative solutions that may offer better prospects for patients with metastatic disease. --- TIMESTAMPS 00:00 - Introduction04:30 - Role of Local Therapy in Systemic Disease09:49 - Patient Selection and Treatment Modalities13:15 - Challenging Lesion Characteristics and Locations19:56 - Y-90 Radioembolization versus Microwave Ablation23:04 - Intraoperative Ablation and Combining Locoregional Modalities29:36 - Complications of Microwave Ablation in the Liver36:43 - Future of Ablation and Liver Metastases Treatment39:25 - Final Thoughts and Closing Remarks --- RESOURCES UC San Diego Health. Cryoablation and Arterial Infusion of SD-101 in Combination with Durvalumab and Tremelimumab.https://clinicaltrials.ucsd.edu/trial/NCT06710223 COLLISION trialhttps://clinicaltrials.gov/study/NCT03088150 ACCLAIM trialhttps://clinicaltrials.gov/study/NCT05265169

Better habits start now. Poor ergonomics in the angio suite lead to cumulative neck and back injuries, absenteeism, presenteeism, and even early retirement. This episode of the BackTable Podcast offers a guide on on how to improve your ergonomics in the the cath lab, featuring interventional radiologist Dr. Keith Horton and host Dr. Ally Baheti. --- SYNPOSIS Dr. Horton and Dr. Baheti discuss common setup mistakes (especially monitor and ultrasound placement), practical positioning guidance (neutral posture, monitor height/angle, table height at elbow level), lead considerations (two-piece vs one-piece, refitting with body changes, costs vs. injury), and procedural stressors from longer, more complex cases. Horton also reviews evidence and standards (including SIR guidance), highlights surgical ergonomics programs like Duke’s education-and-leadership model with scheduled microbreaks, and describes emerging mitigations such as augmented reality guidance, robotics, and “zero-gravity” lead systems, emphasizing that strain prevention and intentional setup are essential for career longevity. --- TIMESTAMPS 00:00 - Introduction01:43 - Defining Ergonomics04:52 - Common Setup Mistakes07:31 - Neutral Posture Basics09:02 - Lead Fit And Support12:33 - Fighting Bad Room Design14:46 - Augmented Reality Workflow17:11 - Leadless Shielding Options20:53 - Repetitive Strain Tactics25:06 - Future Tech On Horizon27:56 - Maternity Lead Frustrations30:22 - Why Incentives Misalign32:45 - When Ergonomics Fails33:59 - Duke Program Blueprint37:02 - Tools Monitor Table Setup39:05 - Microbreaks That Stick42:46 - Room Setup Realities47:08 - Reminders and Wrap Up

Prostate artery embolization may be performed by interventional radiologists, but its indications are rooted in urologic evaluation. In the second installment of our 2026 PAE University Series, Dr. Chris Beck is joined by Dr. Art Rastinehad of Northwell Health, a urologist with formal interventional radiology training, to share how his dual background informs both when to offer PAE and how to execute it thoughtfully. --- This podcast is supported by an educational grant from Guerbert. --- SYNPOSIS Dr. Rastinehad discusses his path from urology into IR and how that combined training shapes his current hybrid practice. He outlines a practical BPH consult framework grounded in urologic evaluation, emphasizing appropriate imaging, careful patient selection, and the importance of ruling out malignancy before proceeding with embolization. From his perspective, durable outcomes begin with disciplined workup and clear counseling around expectations, including sexual side effects and alternative treatment options. The conversation then turns to procedural strategy. Dr. Rastinehad reviews anatomic considerations, large-gland and technically challenging cases, and his experience incorporating liquid embolics into PAE. He compares glue and particles, detailing workflow decisions, medication strategy, and post-procedure management. Throughout, he highlights scenarios where PAE may not be the most appropriate intervention and how other BPH tools may better serve the patient. The episode concludes with a discussion of the future of PAE, including questions of training, collaboration between specialties, and reimbursement; underscoring the value of cross-specialty insight in contemporary BPH care. --- TIMESTAMPS 00:00 - Introduction01:26 - Interventional Urologist with IR Roots04:13 - Leaving Urology for IR: Fellowship Life, Case Volume & Mentors08:45 - Building a Hybrid Urology/IR Practice14:32 - PAE Benefits, Sexual Side Effects & Why MRI Matters17:39 - BPH Consult Playbook22:17 - Anatomy Deep Dive24:27 - Edge Cases & Big Glands28:24 - Why Glue?35:39 - Glue vs Particles39:40 - Post-PAE Follow-Up41:28 - Antibiotics and Medications46:18 - Tough Cases50:53 - The Future of PAE --- RESOURCES Early Outcomes of Prostatic Artery Embolization using n-Butyl Cyanoacrylate Liquid Embolic Agent: A Safety and Feasibility Studyhttps://pubmed.ncbi.nlm.nih.gov/39074551/ Dr. Rastinehad’s Websitehttps://drrastinehad.com/

How do experienced operators approach the most technically demanding aspects of Distal Venous Arterialization (DVA)? In this episode of BackTable, host Dr. Sabeen Dhand sits down with Dr. Kumar Madassery for a detailed discussion of procedural strategy, technical decision-making, and real-world troubleshooting in DVA. --- SYNPOSIS Dr. Madassery walks through his approach from pre-procedure planning to final scaffolding. The conversation begins with imaging review, patient selection, and anesthesia considerations, emphasizing how preparation influences technical success. They then examine venous mapping and access strategy, with specific attention to femoral and tibial disease patterns and how these anatomic variables shape crossing techniques.This episode also covers wire and catheter selection, techniques for creating the arteriovenous anastomosis, balloon sizing, valve management, and stent scaffolding. Throughout, Dr. Madassery shares practical solutions to common access challenges and highlights decision points that can determine procedural durability. The discussion closes with reflections on clinical management, operator fatigue, and the value of professional networks when navigating complex limb salvage cases. --- TIMESTAMPS 00:00 - Introduction03:08 - Pre-Procedure Imaging and Setup05:01 - Venous Access and Mapping07:27 - Anesthesia and Patient Preparation12:29 - Femoral and Tibial Disease Considerations23:17 - Crossing Techniques and Tools27:16 - Venous Access Challenges and Solutions35:54 - Creating the Anastomosis37:03 - Balloon Sizing and Scaffolding Techniques38:26 - Navigating Venous Access Challenges39:56 - Wire and Catheter Strategies42:08 - Dealing with Valves and Anastomosis44:16 - Proximal vs. Distal DVA Approaches47:01 - Scaffolding and Stent Techniques50:06 - Clinical Management and Case Fatigue01:01:10 - Networking and Seeking Advice01:05:41 - Concluding Thoughts and Future Directions

Think your medical practice is safe from hackers? Learn why humans, rather than software, are often the weakest link in patient data protection. In this episode of the BackTable Podcast, host Dr. Chris Beck delves into the critical topic of cybersecurity in healthcare with Didier Jourdain, a certified Information Systems Security Professional (CISSP). --- SYNPOSIS Didier discusses his recently approved paper, 'Cybersecurity for Interventional Radiologists: A Clinical Imperative for Protecting Patient Data and Imaging Systems,' and shares his extensive background in software and application security, penetration testing, and cybersecurity risk governance. The conversation covers key issues such as phishing, ransomware, third-party vendor risks, and the vulnerabilities of the Internet of Medical Things (IOMT). Didier emphasizes the importance of education, tabletop exercises, and comprehensive third-party risk management strategies to enhance cybersecurity resilience in both hospital systems and independent physician practices. --- TIMESTAMPS00:00 - Introduction04:03 - Cybersecurity in Healthcare: A Clinical Imperative16:07 - Mitigating Cybersecurity Risks20:23 - Password Management and Best Practices27:33 - The Role of IT in Cybersecurity31:04 - Internet of Medical Things (IoMT) Vulnerabilities39:17 - Top Cybersecurity Recommendations for Physicians

How can patients receive more consistent interventional radiology care amid a national shortage of IR physicians? That question led Dr. Rick Daniels to develop a new outpatient practice model centered on recruiting independent IRs to provide long-term, fractional coverage for groups in need. In this episode of the BackTable Podcast hosted by Dr. Aaron Fritts, Dr. Daniels outlines the thinking behind this approach and how it aims to expand access to IR services in outpatient settings. --- SYNPOSIS The conversation examines the evolving landscape of IR practice, including the challenges associated with transitioning between practice settings and building sustainable outpatient service lines. Dr. Daniels walks through the development of his model, with particular attention to identifying and supporting outpatient embolization opportunities. The discussion also explores the consortium-style structure for independent IRs, emphasizing long-term alignment, professional autonomy, and scalability at a national level. Operational considerations such as technology partnerships, documentation workflows, and targeted marketing strategies offer a practical look at what it takes to make this model work. --- TIMESTAMPS 00:00 - Introduction03:49 - Evolution of an Independent IR Practice05:30 - Challenges and Opportunities in Outpatient IR09:58 - Building Service Lines and Marketing Strategies18:34 - Forming a National IR Group25:21 - Balancing Business and Healthcare25:37 - Evaluating and Correcting Site Performance28:16 - Expanding Geographical Reach30:45 - Recruitment and Retention Challenges38:07 - The Importance of Tech-Doc Teams42:35 - Future Goals and Recruitment Efforts45:58 - Conclusion

As new calcium-modifying technologies expand the repertoire of below-the-knee (BTK) arterial disease interventions, how should your treatment algorithm evolve, and what endpoints matter most? In this episode of the BackTable Podcast, Dr. Constantino Peña of the Baptist Health Miami Cardiac and Vascular Institute joins Dr. Sabeen Dhand to discuss the latest advancements in BTK chronic limb-threatening ischemia (CLTI) therapies and the push to improve on current vessel preparation outcomes. --- This podcast is supported by: Shockwave Medicalhttps://shockwavemedical.com/ --- SYNPOSIS The physicians discuss the evolution of tibial arterial therapies, the challenges presented by heavily calcified lesions, and the impact of new tools, particularly the Shockwave E8 intravascular lithotripsy (IVL) device, on procedural considerations and endpoints. Dr. Peña shares his treatment algorithms and offers practical advice on selecting the right tools for each unique case. The episode closes with speculation on the future of treatment options and technologies for BTK disease, and the growing need for robust data to guide patient-specific treatment. --- TIMESTAMPS 00:00 - Introduction02:11 - Understanding Tibial Disease and Treatment Evolution07:22 - Advancements in Tibial Disease Treatment and the Role of IVL15:31 - Techniques for Effective IVL Sizing and Usage 21:28 - Challenges and Innovations in Tibial Disease Management26:48 - Innovations in Stent Technology30:43 - Combining IVL with Adjunct Therapies32:13 - Addressing Misconceptions in Tibial Treatment37:54 - Advancements in Intravascular Lithotripsy40:59 - Future of Vascular Treatments43:42 - Final Thoughts

Have you ever wondered what it was like to be in the room when the first pelvic embolization was performed or how the TIPS procedure was pioneered? Dr. Ernie Ring, a legendary figure from UCSF and a true forefather of Interventional Radiology, joins host Dr. Peder Horner to recount the early days of the specialty. Dr. Ring shares fascinating stories from his training at Massachusetts General Hospital under Dr. Stanley Baum, where he witnessed the birth of transformative techniques using angiographic catheters to treat life-threatening bleeding. --- SYNPOSIS From improvising the use of autologous blood clot and thrombin to stop massive hemorrhages to his pivotal role in developing the TIPS procedure and specialized biliary catheters, Dr. Ring’s career is loaded with innovation. The conversation explores the "cowboy" era of IR, the evolution of essential tools like the glide wire, and the critical importance of maintaining a "high-touch" clinical practice in the face of emerging technologies like AI. Dr. Ring also reflects on his later transition into hospital leadership as Chief Medical Officer, where he applied his problem-solving mindset to institutional quality and safety. --- TIMESTAMPS 00:00 - Introduction01:58 - Upbringing from Detroit to Mass Gen 06:55 - Early IR with an Embo Case13:50 - Trailblazing Cases in IR16:17 - Penn and Innovation20:00 - Polarizing Procedures24:13 - IR Device Innovation33:00 - Dotter’s Separation from Diagnostics37:30 - Fear Finds Cowboys39:08 - AI and Robotics40:08 - Fun Hobbies

You’re about to biopsy a renal lesion; should you ablate at the same time? In this episode of the BackTable Podcast, host Michael Barraza talks with Dr. Steven Huang from MD Anderson Cancer Center about building an efficient and effective renal biopsy and ablation service line. --- This podcast is supported by: Varian IntelliBlatehttps://www.varian.com/products/interventional-solutions/microwave-ablation-solutions --- SYNPOSIS Dr. Huang first covers referral patterns and the typical pathway that patients take to end up in his clinic. The discussion covers the types of lesions he treats, imaging requirements, and criteria for patient eligibility. He emphasizes the importance of shared decision making when deciding between active surveillance, interventional treatment, and partial nephrectomy. Dr. Huang explains his preferred procedural approach and ablation modalities, including cryo, microwave (MWA), and radiofrequency ablation (RFA). He shares his experiences with challenging cases and integrating new technologies like histotripsy and the Siemens interventional package. They also discuss the possibility of a preoperative embolization for larger lesions that could be susceptible to the heat sink effect. Both experts emphasize the importance of collaboration with urologists and ensuring patient safety and expectations. They also touch on the future of the field, discussing the use of AI and robotics. --- TIMESTAMPS 00:00 - Introduction 02:17 - Training Programs at MD Anderson03:23 - Referral Patterns for Renal Ablations07:25 - Patient Management and Virtual Consultations10:59 - Ablation Techniques and Device Selection26:44 - Challenges and Complications27:25 - Approach to Lesions Near Renal Vasculature28:02 - Patient Expectations and Urologist Collaboration33:26 - Post-Procedure Care and Patient Recovery35:30 - Managing Recurrences and Multiple RCCs47:17 - Closing Remarks

What does day-to-day interventional radiology look like in the military? Here’s a firsthand account. Dr. John York, interventional radiologist at University of California San Diego with 37 years of active duty in the Navy joins host Dr. Ally Baheti to share his experiences and perspectives on being an interventional radiologist in the military. --- SYNPOSIS Dr. York recounts his path to the military and how it ultimately led him to interventional radiology. He reflects on his deployments to Afghanistan and Djibouti, highlighting the clinical complexity, operational challenges, and fulfilling aspects of delivering image-guided care in high-acuity environments. Dr. York recounts several remarkable cases from his deployments, including the management of a vertebral artery aneurysm. He underscores how strong foundational training enables creative problem-solving in resource-limited settings. Dr. York also shares his experience as senior medical officer on the USS Theodore Roosevelt during the initial COVID-19 outbreak, offering insight into the clinical, operational, and administrative challenges he faced. He highlights how adaptability and creative problem-solving are essential to managing complex cases in dynamic environments. --- TIMESTAMPS 00:00 - Introduction02:53 - Journey to Medicine: From Naval Academy to Medical School05:55 - Choosing Interventional Radiology08:11 - Military Medical Experience: Portsmouth and Beyond11:38 - First Deployment: Challenges and Adaptations14:38 - Case Studies: Trauma and Innovation in Afghanistan26:15 - A Unique Procedure in a Combat Zone28:49 - Transitioning Back to Civilian Life31:07 - Challenges in Combat Zones34:22 - Deployment in Djibouti38:25 - COVID-19 on the USS Theodore Roosevelt45:50 - Reflections on Military Service

Are balloon occlusion microcatheters your new best friend for prostate artery embolization (PAE)? In this episode of BackTable, Dr. Raj Ayyagari, interventional radiologist at Boston Medical Center, joins Dr. Ally Baheti to tackle complex clinical and technical challenges in PAE. --- This podcast is supported by an educational grant from Guerbert. --- SYNPOSIS Dr. Ayyagari shares his unique journey from urology to interventional radiology and his experience building successful PAE service lines at multiple institutions. He walks through a series of challenging cases involving intraprostatic penile arteries, perivesicular collaterals, and internal pudendal collaterals used to treat bilateral hemi-prostates. The discussion highlights the role of balloon occlusion microcatheters such as the Sniper, his transition from 100–300 micron particles to glue embolization, and scenarios where coil protection is essential to prevent nontarget embolization. He also covers post-procedural management, the importance of setting expectations around suprapubic tube removal, and why thorough patient and provider counseling is critical for optimal care. --- TIMESTAMPS 00:00 - Introduction 02:14 - Building a Practice in Prostate Artery Embolization08:19 - Case Studies and Techniques in Prostate Artery Embolization23:16 - Challenges in Embolization Techniques23:47 - Step-by-Step Guide to Embolizing a Hemi Prostate25:24 - Choosing the Right Beads for Embolization29:10 - Transitioning to Liquid Embolics35:38 - Setting Patient Expectations and Pre-Procedure Evaluation40:17 - Post-Procedure Care and Medications44:06 - Conclusion and Final Thoughts

Have you ever considered taking a sabbatical to practice Interventional Radiology in the Middle East? In this episode, Dr. Jamal AlKoteesh, the Chairman of Clinical Imaging at SEHA and the "Godfather of IR" in the United Arab Emirates, joins host Dr. Sabeen Dhand to discuss the rapid evolution and current state of IR in the Gulf region. --- SYNPOSIS Dr. AlKoteesh shares his journey from training in the UK to establishing the IR specialty in Abu Dhabi over the last 18 years. He details the unique practice environment in UAE government hospitals, where the lack of strict sub-specialization requires IRs to maintain a versatile skillset—handling everything from thyroid FNAs and UFE to complex neurovascular thrombectomies. The conversation highlights the significant government investment in healthcare technology, which allows physicians access to the latest tools—such as the Siemens Artis Icono with integrated RapidAI for stroke—often before they are widely available in other markets. Dr. AlKoteesh also provides a practical guide for US physicians interested in working abroad, covering the licensing timeline, tax-free income, and the high demand for Western-trained physicians. --- TIMESTAMPS 00:00 - Introduction01:39 - Building IR in UAE05:23 - UAE Healthcare System Overview07:54 - IR Residency and Staffing13:15 - Access to Latest Devices15:15 - Compensation and Lifestyle17:58 - PAIRS Conference Overview20:45 - Licensing and Relocation Guide21:39 - Liability and Language Barriers26:33 - Launching Stroke Interventions

Patient access to interventional radiology services remains highly variable worldwide, reflecting global differences in training opportunities and infrastructure. Drawing on responses from more than 1,260 interventional radiologists worldwide, Dr. Justin Guan and Dr. Constantinos Sofocleous unpack the findings of a large international survey, highlighting where IR is advancing, where it remains fragmented, and what the data suggest about the future direction of the specialty. --- SYNPOSIS Key points of the episode involve the collaborative efforts put into this survey, how data was collected, and major findings from the respondents. These findings involve challenges with IR training, the significance of public awareness, and the need for standardized training programs. The discussion also covers the efforts required to promote IR globally, especially at global summits, and the potential steps to address these findings. Finally, the episode highlights the importance of developing region-specific programs and the ongoing efforts to elevate IR practices worldwide. --- TIMESTAMPS 00:00 - Introduction01:57 - Global IR Network and Survey Introduction10:30 - Survey Insights and Results19:26 - Challenges in IR Training and Awareness23:33 - Future Directions and Initiatives36:06 - Conclusion and Final Thoughts --- RESOURCES Results of a Global Survey on the State of Interventional Radiology 2024: https://pubmed.ncbi.nlm.nih.gov/39793699/

Are you getting paid for the work you do? In this episode of the BackTable Podcast, interventional radiology coding expert Dr. David Zielske joins host Dr. Ally Baheti to share practical tips for billing and coding in interventional radiology, focusing on accurate, efficient, and compliant revenue capture. --- SYNPOSIS Dr. Zielske shares his path to becoming a coding expert, highlighting why precise documentation is essential to accurate medical billing. Drawing from personal experience, he breaks down the most common coding pitfalls physicians face and how to avoid them. He highlights the importance of early training in coding and billing during residency and fellowship, reviews key coding updates effective January 2026, and offers guidance on modifier usage. --- TIMESTAMPS 00:00 - Introduction01:34 - The Importance of Accurate Coding and Documentation04:03 - Common Coding Errors and Compliance Issues07:09 - Detailed Coding Guidelines and Best Practices26:20 - Modifiers and Their Proper Use33:53 - Interventional Radiology vs Diagnostic Radiology35:18 - Discussing ENM Billing and Procedural Focus35:45 - Commonly Missed Codes in Dialysis Circuit Interventions37:04 - Balloon Fibrin Sheath Disruption and Thrombectomy37:51 - Importance of Accurate Documentation for Vascular Access40:55 - Moderate Sedation and Ultrasound Guidance42:33 - Selective Imaging and Urinary Access Coding44:48 - Ablations and Biopsies: Guidance and Coding46:53 - Drainages and Intravascular Lithotripsy50:19 - 2026 Coding Changes and Physician Documentation01:00:29 - Resources and Education for Physicians