Episodios

  • Ep. 556 Dosimetry University IV: Optimizing Radiation Segmentectomy with Dr. Nima Kokabi and Dr. Tyler Sandow

    Ep. 556 Dosimetry University IV: Optimizing Radiation Segmentectomy with Dr. Nima Kokabi and Dr. Tyler Sandow
    Jul 8 2025
    Radiation segmentectomy: who, when, how? Interventional oncologists Dr. Nima Kokabi, Dr. Tyler Sandow, and Dr. Kavi Krishnasamy continue their in-studio discussion on all things Y90 in Part 4 of Dosimetry University, focusing on specific applications of radiation segmentectomy. --- This podcast is supported by: Sirtexhttps://www.sirtex.com/ Medtronic Emprinthttps://www.medtronic.com/emprint --- SYNPOSIS This session kicks off with a discussion on the curative potential of Y90, comparing it to other curative modalities like resection. The doctors discuss the importance of achieving a complete pathological necrosis (CPN) with Y90 for better survival outcomes, especially in the context of liver transplantation. The conversation also covers personalized approaches for treating liver-dominant metastatic cancers using Y90, and strategic considerations when choosing between techniques like radiation lobectomy, thermal ablation, and chemoembolization. The interventional oncologists explore the viability of radiation segmentectomy in treating small lesions and discuss data supporting its efficacy. Real-world clinical cases are examined to highlight the practical application of these therapies, their impact on overall survival, and the intricacies of dosimetry and patient selection. --- TIMESTAMPS 00:00 - Introduction01:07 - Ablative Y90 Curative Outcomes and Survival Rates02:16 - Radiation Segmentectomy vs. Ablation09:22 - Case Study: Metastatic Colorectal Cancer18:06 - Tumor Distinction on Cone Beam CT19:58 - Case Study: 77-Year-Old Female with Breast and Colorectal Cancer21:09 - Challenges and Techniques in Selective Radiation Segmentectomy24:28 - Avastin and Y9028:16 - Case Study: 53-Year-Old Male with Metastatic Colorectal Cancer29:40 - Radiation Lobectomy and Hypertrophy Strategies32:37 - Approaches for Metastatic and HCC Patients
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    37 m
  • Ep. 555 Dosimetry University Part III: Optimizing Single-Session Treatments with Dr. Nima Kokabi and Dr. Tyler Sandow

    Ep. 555 Dosimetry University Part III: Optimizing Single-Session Treatments with Dr. Nima Kokabi and Dr. Tyler Sandow
    Jul 1 2025
    Will single session Y90 become the standard of care for HCC and oligo-metastatic disease? Tune in to our third installment of Dosimetry University with interventional oncologists Drs. Tyler Sandow, Nima Kokabi, and Kavi Krishnasamy as they share their experiences and best practices in single session Y90 treatment. --- This podcast is supported by: Sirtexhttps://www.sirtex.com/ Medtronic Emprinthttps://www.medtronic.com/emprint --- SYNPOSIS The doctors discuss the application and workflow of single session Y90 therapy for primary and oligo-metastatic liver tumors. They discuss the latest data from various institutions, emphasizing reduced lung dose, lower time to treatment, improved cost-efficiency, and the advantageous safety profile associated with single session treatment. The discussion also covers ideal patient selection based on tumor location and vascular characteristics, the importance of cone beam CT, and how to identify red-flag features of vascular enhancement. Our panel then reviews key technical considerations for single session success, including the use of flow-modifying microcatheters, gelfoam, and strategies for flow redirection. The episode concludes with a case discussion to explore the best strategy for a large liver tumor, detailing the specifics of each treatment and the potential role of combined therapies to achieve better long-term outcomes. --- TIMESTAMPS 00:00 - Introduction 00:47 - Single Session Y90: Workflow and Benefits03:52 - Patient Selection04:31 - Tumor Location and Preferred Techniques14:31 - Reperfusion and Redirection Techniques 26:16 - Case Study: Large Tumor Treatment37:01 - Long-Term Outcomes and Surgical Considerations
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    52 m
  • Ep. 554 Optimizing the IR/DR Curriculum and Experience with Dr. Gregg Khodorov and Dr. Nicole Lamparello

    Ep. 554 Optimizing the IR/DR Curriculum and Experience with Dr. Gregg Khodorov and Dr. Nicole Lamparello
    Jun 27 2025
    So you’re going to be an IR resident–what exactly did you sign up for? Find out with Dr. Neil Jain, an integrated IR resident at Georgetown as he hosts a discussion on optimizing integrated IR residency programs with Dr. Nicole Lamparello, an Assistant Professor of Clinical Radiology at Weill Cornell Medicine, and Dr. Gregg Khodorov, a PGY-5 resident at Thomas Jefferson University Hospital. The conversation covers a comprehensive range of topics, including optimal rotation schedules, early IR exposure, consult services, and the benefits of structured clinics. --- This podcast is supported by:Medtronic Emprinthttps://www.medtronic.com/emprint --- SYNPOSIS The doctors first discuss the nuances of choosing a surgical, medicine, or transitional intern year, and the electives that best prepare junior trainees for a career in IR. They then discuss the optimal balance between diagnostic and interventional training in DR years, and the best way to keep junior trainees involved in IR throughout their residency. The conversation moves on to the different structures of the consult service at each of the speakers’ programs and what this means for training quality and patient care. The doctors then break down what the last year of IR residency looks like, and the residents detail what they would like to see in order to prepare best for attending life. They explore exposure to private practice, subspecialty clinic, and elective time; sharing innovative practices from their own institutions and emphasizing the importance of mentorship, integration, and resident retention. The episode also addresses the challenges and potential solutions for resident attrition within the integrated IR residency track. --- TIMESTAMPS 0:00 - Host Introductions3:34 - PGY1: Medicine, Surgery or Transitional Intern Year?15:41 - PGY2-PGY4: Diagnostic Radiology Years24:46 - IR Clinic Training Throughout IR/DR Curriculum27:49 - IR Consult Service Structure38:23 - PGY5: Credentialing in Nuclear Medicine and Mammography43:58 - PGY6: Preparing for Attending Life53:00 - Minimizing Attrition Rate
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    1 h y 5 m
  • Ep. 553 Dosimetry University Part II: Understanding Partition and Voxel-Based Approaches with Dr. Tyler Sandow and Dr. Nima Kokabi

    Ep. 553 Dosimetry University Part II: Understanding Partition and Voxel-Based Approaches with Dr. Tyler Sandow and Dr. Nima Kokabi
    Jun 24 2025
    BSA, MIRD, or voxel-based dosimetry? Join us for part 2 of Dosimetry University where interventional oncologists Dr. Tyler Sandow, Dr. Nima Kokabi, and Dr. Kavi Krishnasamy explore and debate the critical nuances of a successful Y90 procedure, covering dosing methods, lung shunt management, and when to incorporate other therapeutic approaches. --- This podcast is supported by: Sirtexhttps://www.sirtex.com/ Medtronic Emprinthttps://www.medtronic.com/emprint --- SYNPOSIS The episode begins with a discussion on methodologies for calculating lung shunt fractions using planar imaging versus SPECT CT. The physicians highlight the implications of various dosimetry models, including BSA (Body Surface Area), MIRD (Medical Internal Radiation Dose), and voxel-based dosimetry for determining prescribed activity. Drawing on their clinical experience, they address the management of high lung shunt fraction cases and the application of therapeutic strategies like TACE (Transarterial Chemoembolization) and SBRT (Stereotactic Body Radiotherapy). The conversation also covers the roles of cryoablation and microwave ablation in treating centrally located lesions. The episode concludes with a case study emphasizing the importance of individualized dosimetry planning. --- TIMESTAMPS 00:00 - Introduction01:05 - Lung Shunt Calculation Methods06:42 - BSA, MIRD, and Voxel-Based Dosimetry16:03 - High Lung Shunt Management30:02 - Case Study: Liver Tumor Treatment34:10 - Cryo vs Microwave: A Safer Option?35:42 - Y-90 Procedure: Imaging and Techniques43:35 - Dosimetry and Dose Calculations51:10 - Post-Treatment Analysis and Outcomes57:51 - Transplant Considerations and Aggressive Treatments58:18 - Conclusion and Final Thoughts
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    1 h y 1 m
  • Ep. 552 Dosimetry University Part I: Treatment Planning with Dr. Tyler Sandow and Dr. Nima Kokabi

    Ep. 552 Dosimetry University Part I: Treatment Planning with Dr. Tyler Sandow and Dr. Nima Kokabi
    Jun 17 2025
    Dosimetry University is now in session! First up—how do you plan your Y90 treatments and what can you do in the planning phase to maximize efficacy? Find out in Part I of BackTable’s Dosimetry University series featuring interventional oncologists Dr. Nima Kokabi from the University of North Carolina Chapel Hill and Dr. Tyler Sandow from Ochsner Health. This episode is hosted by Dr. Kavi Krishnasamy and recorded live in the BackTable studio. --- This podcast is supported by: Sirtexhttps://www.sirtex.com/ Sponsor This podcast is supported by: Medtronic Emprinthttps://www.medtronic.com/emprint --- SYNPOSIS The doctors first discuss the structure of their Y90 service lines, including the impact of multidisciplinary tumor boards and clinics on time to treatment for liver cancer patients. They then talk through their technical preferences—whether to use glass or resin, preferred dosimetry guidelines and apps, and the dosimetry softwares that they use in treatment planning. The doctors also discuss the utility of the T2N ratio, advanced imaging like cone beam CT, and angiographic targeting software—emphasizing how these tools can help achieve the delicate balance of preserving normal tissue while treating as much tumor as possible. This episode also highlights the importance of collaboration between academic and private practices to optimize patient care and treatment outcomes. --- TIMESTAMPS 00:00 - Introduction and Overview02:21 - Multidisciplinary Clinics and Tumor Boards13:12 - Dosimetry Guidelines and Practices27:46 - Nuances in Tumor Dosage and Segmentectomy32:00 - Angiographic Targeting Software33:18 - Cone Beam CT Techniques48:33 - Anesthesia, Access, and Catheters
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    55 m
  • Ep. 551 Independent IR Practice: Opportunities and Challenges with Dr. Waqaar Diwan

    Ep. 551 Independent IR Practice: Opportunities and Challenges with Dr. Waqaar Diwan
    Jun 10 2025
    What would you do if your IR/DR practice underwent major ownership and staffing changes just one week after signing your first attending contract? In this episode of BackTable, Dr. Waqaar Diwan joins host Dr. Michael Barraza to share his experience facing exactly that challenge—and how it led to the eventual development of his own independent IR practice.---This podcast is supported by:RADPAD® Radiation Protectionhttps://www.radpad.com/OBL Marketinghttps://oblmarketing.com/Medtronic Emprinthttps://www.medtronic.com/emprint---SYNPOSISDr. Diwan discusses how he navigated the unexpected transition of ownership and staffing changes, and ultimately secured a hospital contract that allowed him to perform IR procedures full-time. Since then, he has been building an independent IR practice with the support of his partner and a growing team. Dr. Diwan shares his goals for the practice, including staffing and equipment logistics, strategic planning, and patient outreach. He emphasizes the importance of leveraging personal and professional networks to guide his business development. He also outlines key differences between independent IR practices and combined IR/DR models. These include the need for greater investment in the outpatient experience, actively seeking referrals, and navigating hospital politics without the backing of a larger department. His top advice for building a referral base is to first earn trust—by excelling in straightforward cases and ensuring strong outcomes—and to market the practice directly to potential referring providers. Overall, Dr. Diwan encourages early-career interventional radiologists to know their worth. He notes that in the real world, IRs are often seen as providers of “catch-all” services, making it crucial to ensure fair compensation. He stresses the importance of striking a balance between self-advocacy and humility, all while staying focused on serving patients.---TIMESTAMPS00:00 - Introduction 01:42 - Navigating Contracts and Restructuring8:07 - Upcoming Goals for His IR Group14:00 - Strategic Planning and Marketing20:16 - Compensation and Finances of Independent IR27:38 - Future Plans and Market Trends29:48 Advice for New Interventional Radiologists---RESOURCESMinimally Invasive Specialists of Texas: https://www.mist-health.com/
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    36 m
  • Ep. 550 Percutaneous Transesophageal Gastrostomy: Indications and Procedure Insights with Lisa Rotellini-Coltvet and Dr. Alex Wallace

    Ep. 550 Percutaneous Transesophageal Gastrostomy: Indications and Procedure Insights with Lisa Rotellini-Coltvet and Dr. Alex Wallace
    Jun 6 2025
    What do you do when conventional gastric tubes are not an option? In this week’s episode of BackTable, host Dr. Ally Baheti speaks with interventional radiologist Dr. Alex Wallace and physician assistant Lisa Rotellini-Colvet from the Mayo Clinic in Arizona about the percutaneous transesophageal gastrostomy (PTEG) procedure. The discussion explores how PTEG offers a transformative solution for patients who are not candidates for traditional transabdominal gastrostomy access. Suitable candidates for PTEG include individuals with malignancies, peritoneal carcinomatosis, prior gastrectomies, or ascites. --- This podcast is supported by: Medtronic Emprinthttps://www.medtronic.com/emprint --- SYNPOSIS Dr. Wallace and Lisa provide valuable insights on the benefits of early patient selection, thorough pre-procedural evaluation, step-by-step procedural guidance, and key considerations for post-procedural care. They also highlight the critical role of patient and staff education in achieving successful outcomes. The episode features real-world experiences, including a powerful story of a patient who benefited from her PTEG for over 560 days. Our guests advocate for increased awareness of PTEG and its early consideration in patients with advanced abdominal cancers, emphasizing its potential to greatly improve quality of life. --- TIMESTAMPS 00:00 - Introduction01:38 - History and Explanation of PTEG08:12 - Pre-Procedure Evaluation11:48 - Procedural Walkthrough20:46 - Post-Procedure Care and Suction Management24:45 - Exchange Process and Troubleshooting30:11 - Patient Education and Staff Training35:54 - Improved Quality of Life for Patients --- RESOURCES Percutaneous Transesophageal Gastrostomy: Procedural Technique and Outcomes (Rotellini-Coltvet, Wallace et al, 2023):https://pubmed.ncbi.nlm.nih.gov/37419279/
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    42 m
  • Ep. 549 Liquid Embolics: Practical Applications and Techniques with Dr. Gary Siskin

    Ep. 549 Liquid Embolics: Practical Applications and Techniques with Dr. Gary Siskin
    Jun 3 2025
    Liquid embolics are a relatively new addition to the interventional radiology toolkit—how well do you understand the technical considerations that come with using these agents? Get up to speed in this episode of the BackTable Podcast where Dr. Gary Siskin, Chair of Radiology at Albany Medical Center, shares his expertise. --- This podcast is supported by: Sirtexhttps://www.sirtex.com/us/ --- SYNPOSIS Dr. Siskin provides expert insights into the use of liquid embolic agents, including Onyx and LAVA, with a focus on their practical applications, techniques for safe and effective deployment, and the critical role they play in treating complex cases which range from peripheral and traumatic hemorrhage to portal vein embolization. He highlights the importance of understanding the viscosity and flow characteristics of various liquid embolic agents, providing expert guidance on ensuring optimal catheter positioning, case selection, and avoidance of common pitfalls. Additionally, he shares strategies for tailoring injection speed based on vessel caliber to mitigate reflux. The episode ends with final thoughts on best practices and future directions for the technology. --- TIMESTAMPS 00:00 - Introduction02:09 - Historical Perspective on Liquid Embolics06:37 - Practical Applications and Techniques16:14 - Handling Catheters and Reflux Concerns22:38 - Trauma Embolization26:53 - Visibility and Injection Techniques29:06 - Catheter Compatibility and Vessel Size32:53 - Best Practices and Common Mistakes45:55 - Final Thoughts and Advice --- RESOURCES Arslan B, Razavi MK, Siskin G, et al. The LAVA Study: A Prospective, Multicenter, Single-Arm Study of a Liquid Embolic System for Treatment of Peripheral Arterial Hemorrhage. J Vasc Interv Radiol. 2025;36(3):436-445.e2. doi:10.1016/j.jvir.2024.11.005 Onyx Liquid Embolic System: https://europe.medtronic.com/xd-en/healthcare-professionals/products/cardiovascular/peripheral-embolization/onyx-liquid-embolic-system.html LAVA Liquid Embolic System:https://www.sirtex.com/us/products/lava-liquid-embolic-system/product-information/
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    50 m