Avsnitt
-
Is there a way to treat liver metastasis secondary to uveal melanoma without introducing systemic, treatment-related toxicity? Dr. Altan Ahmed (interventional radiologist at Moffitt Cancer Center) and Dr. Sid Padia (interventional radiologist at UCLA) join guest-host Dr. Kavi Krishnasamy to discuss HEPZATO, a novel device-based treatment for liver metastases from uveal melanoma.
---
This podcast is supported by:
RADPAD® Radiation Protection
https://www.radpad.com/
---
SYNPOSIS
Dr. Ahmed and Dr. Padia begin by exploring the design and setup of the HEPZATO clinical trials, while also speaking on patient selection criteria. The doctors then talk through the technical aspects of the intervention. After covering workflow and considerations related to procedure timing and coordination, the doctors go on to discuss drug dosing and optimizing treatment cycles. The episode concludes with current gaps in literature, current and future research aims, and potential future applications of the HEPZATO modality in treating other malignancies such as colorectal cancer.
---
TIMESTAMPS
00:00 - Introduction
05:40 - Patient Selection Criteria
09:49 - Workflow
19:17 - Procedure Timing and Coordination
29:39 - Challenges and Considerations in Drug Dosing
32:39 - Optimizing Treatment Cycles and Patient Response
37:56 - Managing Post-Treatment and Adverse Effects
43:43 - Future Research and Gaps in Current Interventions
50:45 - Exploring New Applications for PHP Therapy
55:02 - Conclusion
---
RESOURCES
Hepzato:
https://hepzatokit.com/
FOCUS Trial - Efficacy and Safety of the Melphalan/Hepatic Delivery System in Patients with Unresectable Metastatic Uveal Melanoma: Results from an Open-Label, Single-Arm, Multicenter Phase 3 Study:
https://pubmed.ncbi.nlm.nih.gov/38704501/
FOCUS phase 3 trial results: Percutaneous hepatic perfusion (PHP) with melphalan for patients with ocular melanoma liver metastases (PHP-OCM-301/301A):
https://ascopubs.org/doi/pdf/10.1200/JCO.2022.40.16_suppl.9510
Combining Melphalan Percutaneous Hepatic Perfusion with Ipilimumab Plus Nivolumab in Advanced Uveal Melanoma: First Safety and Efficacy Data from the Phase Ib Part of the Chopin Trial:
https://pubmed.ncbi.nlm.nih.gov/36624292/
Troponin Elevation in Patients Undergoing Percutaneous Hepatic Perfusion for Metastatic Uveal Melanoma:
https://pmc.ncbi.nlm.nih.gov/articles/PMC11010739/
Percutaneous Hepatic Perfusion with Melphalan in Patients with Unresectable Ocular Melanoma Metastases Confined to the Liver: A Prospective Phase II Study:
https://pmc.ncbi.nlm.nih.gov/articles/PMC7801354/
Southampton group - Quality of life after melphalan percutaneous hepatic perfusion for patients with metastatic uveal melanoma:
https://pmc.ncbi.nlm.nih.gov/articles/PMC10906212/
Leiden group - Quality of Life Analysis of Patients Treated with Percutaneous Hepatic Perfusion for Uveal Melanoma Liver Metastases:
https://pubmed.ncbi.nlm.nih.gov/38587534/ -
Is surgery truly the "cure" for hepatocellular carcinoma (HCC), and when is it a viable option? In this episode, Dr. Sabeen Dhand leads a roundtable discussion with interventional radiologist Dr. Siddharth Padia and transplant/hepatobiliary surgeons Dr. John Seal and Dr. Gabriel Schnickel, delving into the complexities of surgical treatments for HCC and the evolving landscape of liver resection and transplantation.
Physicians, nurses, nurse practitioners, and physician assistants can follow this link to earn CME / CE credits for completing an accredited learning activity related to this discussion:
https://www.cmeuniversity.com/course/take/125741
---
This podcast is supported by an educational grant from AstraZeneca Pharmaceuticals and Boston Scientific.
---
SYNPOSIS
The doctors begin by discussing how they manage patient expectations regarding both palliative and curative treatments, highlighting the risk of recurrent HCC as a new lesion. They then outline key factors that influence their recommendations for liver transplant versus resection, such as the extent of underlying liver disease, the function of the future liver remnant, body habitus, overall health, and organ availability. The surgeons also review various surgical approaches to liver resection and recent advancements in liver transplantation, including living donor transplants and the ability to refer patients for downstaging procedures.
Dr. Padia explains the original role of Y90 as a bridging treatment to downstage tumors and promote hypertrophy in the non-diseased liver segments, preparing the organ for surgical resection. However, Y90 treatment can also lead to the formation of adhesions, which may complicate future surgeries. Finally, the doctors discuss strategies to improve care coordination between community physicians and transplant centers to optimize patient outcomes.
---
TIMESTAMPS
00:00 - Curative vs. Palliative Treatment
04:03 - Choosing Between Transplantation and Resection
05:47 - Liver Resection Types
07:27 - Bridging Role of Y90
12:14 - Evolving Landscape of Liver Transplantation
20:59 - Patient Counseling in Minimally Invasive Procedures
28:40 - Considerations for Surgery After Y90
33:32 - Coordination Between Specialists
40:08 - Immunotherapy as a Bridge to Transplant
---
RESOURCES
CME Accreditation Information:
https://f7cae4ec-b69e-490d-9e0f-19b16a6f146d.usrfiles.com/ugd/f7cae4_a7c37ea3cd1b4d3fa53d5edf8dfe255b.pdf -
Saknas det avsnitt?
-
Musculoskeletal embolization is generating significant excitement in the field of chronic pain management. In this episode, Dr. Jacob Fleming hosts a discussion with Dr. Yuji Okuno from Japan, a pioneer in both basic science and clinical practice within the field of musculoskeletal embolization.
---
This podcast is supported by:
Medtronic MVP
https://www.medtronic.com/mvp
---
SYNPOSIS
The conversation delves into Dr. Okuno's groundbreaking work using embolization to treat chronic pain from conditions such as frozen shoulder, knee osteoarthritis, plantar fasciitis, and various sports injuries. Dr. Okuno discusses the development of new temporary embolic agents and compares different approaches to embolization treatments, including the innovative use of antibiotics as embolic material. The doctors also cover the intriguing concept of differential recanalization, where abnormal inflammatory vessels are less likely to recanalize than normal vessels after embolic treatment. Identifying hypervascularity through MRI, ultrasound, or angiogram is a crucial step before attempting embolization.
Overall, Dr. Okuno offers valuable insights into his clinical practice and the potential for groundbreaking advancements in musculoskeletal care worldwide.
---
TIMESTAMPS
00:00 - Introduction
01:54 - Origins of Embolization for Pain
04:15 - Basic Science Research Discoveries and Clinical Trials
09:02 - Temporary Embolic Materials
15:28 - Techniques for Embolization
17:33 - Plantar Fasciitis Treatment
24:04 - Future of Embolization in Sports Injuries
28:11 - Diagnostic Imaging in Embolization
36:10 - Global Expansion and Collaborations -
The process of liver transplantation involves many complexities, and each patient's path to transplant is unique. To offer insider perspectives on this process, Dr. Zachary Berman sits down with transplant and hepatobiliary surgeon Dr. John Seal, as well as transplant hepatologists Dr. Heather Patton and Dr. Steve Young.
Physicians, nurses, nurse practitioners, and physician assistants can follow this link to earn CME / CE credits for completing an accredited learning activity related to this discussion:
https://www.cmeuniversity.com/course/take/125740
---
This podcast is supported by an educational grant from AstraZeneca Pharmaceuticals and Boston Scientific.
---
SYNPOSIS
The panel begins by discussing the multidisciplinary pre-transplant evaluation process, which assesses factors such as liver function, comorbidities, surgical risk, and the availability of psychosocial support. Once a patient is listed for transplant, they enter a system that prioritizes those with the highest Model for End-Stage Liver Disease (MELD) score. During the waiting period, several comorbidities should be carefully monitored. Dr. Seal explores the impact of portal vein hypertension and portal vein thrombosis, explaining how these conditions may necessitate intraoperative thrombectomy or bypass. Dr. Patton and Dr. Young focus on considerations for using anticoagulation in patients with a high baseline bleeding risk and selecting the appropriate anticoagulant for patients listed for transplant.
For patients with hepatocellular carcinoma (HCC), eligibility for MELD exception points may depend on factors such as time spent on the waiting list, adherence to the Milan criteria, and the presence of extrahepatic complications of liver disease. The panel also discusses bridging therapies to transplant, including Y90 and TACE. In the peri-transplant phase, they highlight innovations such as living donor transplants, liver perfusion pumps, and the use of hepatitis C- and HIV-positive organs. Finally, the discussion turns to post-transplant considerations, including surgical complications, organ rejection, immunosuppression, predictors of HCC recurrence, and long-term surveillance.
---
TIMESTAMPS
00:00 - Introduction
01:16 - Current Landscape of Liver Transplantation
03:22 - Transplant Evaluation Process
09:48 - Timeline from Listing to Transplantion
11:16 - Treating Portal Vein Thrombosis and Hypertension
18:44 - MELD Exception Points
22:05 - Bridging Therapies
25:34 - Peri-Transplant Considerations
30:53 - Post-Transplant Period
37:39 - Repeat Transplantation
---
RESOURCES
Model for end-stage liver disease (MELD) and allocation of donor livers (Wiesner et al, 2003):
https://www.gastrojournal.org/article/S0016-5085%2803%2950022-1/fulltext
Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis- Milan Criteria (Mazzaferro et al, 1996):
https://pubmed.ncbi.nlm.nih.gov/8594428/
Validation of the prognostic power of the RETREAT score for hepatocellular carcinoma recurrence using the UNOS database (Mehta et al, 2019):
https://pmc.ncbi.nlm.nih.gov/articles/PMC6445634/
CME Accreditation Information:
https://f7cae4ec-b69e-490d-9e0f-19b16a6f146d.usrfiles.com/ugd/f7cae4_a7c37ea3cd1b4d3fa53d5edf8dfe255b.pdf -
Do we finally have definitive data on the efficacy of prostate artery embolization (PAE)? Dr. Shivank Bhatia (interventional radiologist at University of Miami) joins host Dr. Michael Barraza to discuss the findings from his prospective 1,075 patient study on the long-term outcomes of PAE, the largest longitudinal, single-center, single-operator, prospective study in the United States.
---
This podcast is supported by:
RADPAD® Radiation Protection
https://www.radpad.com/
Medtronic MVP
https://www.medtronic.com/mvp
---
SYNPOSIS
Dr. Bhatia begins by sharing his early years of training, and the steps he took to become an expert in all things PAE. He also covers how he helped build the PAE program at University of Miami, sharing several pearls for young IRs and trainees that are interested in bringing new service lines to their institutions. Dr. Bhatia then talks through the details of the study that he spearheaded, and encourages everyone to tune in - physicians and patients alike.
---
TIMESTAMPS
00:00 - Introduction
05:12 - Building a PAE Program
18:55 - PAE Procedure Technicalities
22:30 - Post-Procedure Meds and Care
25:13 - Study Details and Patient Demographics
27:36 - Procedure Time and Technical Success
28:32 - Safety and Efficacy of PAE
38:06 - PSA Levels and Prostate Cancer
40:42 - Urinary Retention and Treatment Prioritization
45:17 - Re-Intervention Rates and Medication Independence
---
RESOURCES
Pisco et al (2011) - Prostatic arterial embolization to treat benign prostatic hyperplasia:
https://pubmed.ncbi.nlm.nih.gov/21195898/
Bhatia et al (2024) - Prostatic Artery Embolization: Mid- to Long-Term Outcomes in 1,075 Patients:
https://pubmed.ncbi.nlm.nih.gov/39532156/ -
Treatment of hepatocellular carcinoma (HCC), like that of many other cancers, spans a spectrum from curative to palliative intent. To explore the "grey zone" of treatment goals for intermediate-stage HCC patients, Dr. Sabeen Dhand interviews a panel of experts in the field: medical oncologists Dr. Adam Burgoyne and Dr. Lingling Du, along with interventional radiologists Dr. Kirema Garcia-Reyes and Dr. Zachary Berman.
Physicians, nurses, nurse practitioners, and physician assistants can follow this link to earn CME / CE credits for completing an accredited learning activity related to this discussion:
https://www.cmeuniversity.com/course/take/125739
---
This podcast is supported by an educational grant from AstraZeneca Pharmaceuticals and Boston Scientific.
---
SYNPOSIS
The discussion begins with an explanation of the Barcelona-Clinic Liver Cancer (BCLC) staging system. While this system takes into account helpful factors such as liver function, performance status, and tumor burden, it fails to fully capture the true heterogeneity of the HCC patient population. Additional considerations include tumor biology, response to previous treatments, and the location of metastases. The specialists then share their experiences in treating patients with comorbid gastrointestinal cancers and mixed tumors, discuss the benefits of an interventional oncology clinic setting, and highlight virtual opportunities for connecting with tumor boards. They also offer advice on patient education regarding treatment options.
---
TIMESTAMPS
00:00 - Introduction to BCLC Staging
03:02 - Impact of Performance Status
06:29 - Predictors of Survival in HCC
09:51 - Palliative versus Curative Treatment Intent
13:55 - Comorbid and Mixed Gastrointestinal Cancers
16:51 - Adverse Effects of Treatment
20:37 - Interventional Oncology in the Clinic Setting
23:06 - Navigating Multiple Provider Viewpoints
28:01 - Complex Case Examples
---
RESOURCES
BCLC strategy for prognosis prediction and treatment recommendation: The 2022 update (Reig et al, 2022):
https://www.journal-of-hepatology.eu/article/S0168-8278(21)02223-6/fulltext
CME Accreditation Information:
https://f7cae4ec-b69e-490d-9e0f-19b16a6f146d.usrfiles.com/ugd/f7cae4_a7c37ea3cd1b4d3fa53d5edf8dfe255b.pdf -
Given the challenges that our dialysis patients face, how can we as providers stay sharp with the latest access techniques to help ensure the best possible outcomes? Dr. Omar Davis (interventional nephrologist) and Dr. Ari Kramer (general surgeon) join host Dr. Chris Beck to discuss advanced approaches to AV access and share their experiences with the FLEX Vessel Prep device.
---
This podcast is supported by:
VentureMed FLEX Vessel Prep
https://www.venturemedgroup.com/
---
SYNPOSIS
The doctors begin by describing how they create dialysis access and what they account for during the procedure. They then focus on the role of the FLEX VP system, its benefits, and how they use it in practice, touching on the latest clinical data. Dr. Kramer and Dr. Davis also stress the importance of mental health in dialysis care and share ways that we can better support our patients through difficult diagnoses and treatments. In fact, one of their patients, Fred Hill, authored the book “Dialysis Is Not Your Life,” which offers a unique perspective for patients feeling overburdened by dialysis, and the healthcare providers who treat them. The episode concludes with case presentations and practical guidance on when to use the FLEX Vessel Prep system.
---
TIMESTAMPS
00:00 - Introduction
07:00 - AV Access and Procedures
10:58 - Case Walkthrough
14:19 - Balloon Angioplasty and IVUS
24:43 - Flex VP Device and Vessel Prep
35:03 - Algorithm and Reimbursement Challenges
39:51 - Device Usage and Techniques
46:58 - Clinical Data and Outcomes
01:01:59 - Case Studies
---
RESOURCES
Fred Hill, “Dialysis Is Not Your Life” Founder and Author:
https://www.dialysisisnotyourlife.com/meet-founder.php
“Dialysis Is Not Your Life” Book:
https://www.amazon.com/DIALYSIS-NOT-YOUR-LIFE-Redefine/dp/B09L4XGGNX
Novel Device Prior to Balloon Angioplasty for Dysfunctional Arteriovenous Access: Analysis of a Real-World Registry by Race and Sex Cohorts:
https://www.openaccessjournals.com/articles/novel-device-prior-to-balloon-angioplasty-for-dysfunctional-arteriovenousaccess-analysis-of-a-realworld-registry-by-race-and-sex-16852.html
FLEX Vessel Prep 12 Month AV Registry Data and 12 Month Belong PAD Data Shows Benefit to Micro-incisions Before Balloon or DCB Treatment:
https://www.venturemedgroup.com/wp-content/uploads/2022/12/VEITH-Data-FINAL.pdf
Angioplasty with novel, easy-to-use, bladed Flex Vessel Prep system “could replace standard of care”:
https://www.youtube.com/watch?v=iRpkrURx1mc
Surgical AVF Articles Atlas Condensed - sAVF Overview - Creation Maturation and Difficulties:
https://docs.google.com/document/d/1f26FT65s03oZjjeZhBVy8auz0h8PTNvX3CWU5Xi_H5c/edit?usp=share_link
Surgical AVF Articles Asif A, Early Arteriovenous fistula failure:
https://drive.google.com/file/d/1zZEWgxsdBM4MKCQFjw0U04ra_hB9Ey_N/view?usp=share_link
Surgical AVF Articles Asif A - Best Vascular Access in the Elderly - Time for Innovation:
https://drive.google.com/file/d/1IpH-KnZyfN5Rqm_kxLnERnEJD6vcjAO8/view?usp=sharing
Surgical AVF Articles EV Today - Managing Cephalic Arch Stenosis:
https://drive.google.com/file/d/17yVd2M706YCtX-xTK6teesgZqzVIgUoN/view?usp=share_link
VentureMed 2024 FLEX Vessel Prep System Reimbursement Guide:
https://www.venturemedgroup.com/wp-content/uploads/2024/04/MMA-CTO-15690_FlexVesselPrepSystem-BillingGuide_Lv6-003.pdf
BackTable VI Podcast Episode #139 - AV Fistula & Graft Maintenance with Dr. Ari Kramer:
https://www.backtable.com/shows/vi/podcasts/139/av-fistula-graft-maintenance
BackTable VI Podcast Episode #292 - Dialysis Interventions with Drug-Coated Balloons, Covered Stents and More with Dr. Ari Kramer:
https://www.backtable.com/shows/vi/podcasts/292/dialysis-interventions-with-drug-coated-balloons-covered-stents-more -
For hepatocellular carcinoma (HCC) patients who are not candidates for liver transplant or resection, lesion ablation can be a curative treatment. With multiple ablation options available and still under investigation, it can be challenging to navigate the differences between them. In this episode, Dr. Tyler Sandow hosts a discussion with interventional radiologists Dr. Kirema Garcia-Reyes, Dr. Sabeen Dhand, and Dr. Kevin Burns on the various ablation options for HCC and when to use each one.
Physicians, nurses, nurse practitioners, and physician assistants can follow this link to earn CME / CE credits for completing an accredited learning activity related to this discussion:
https://www.cmeuniversity.com/course/take/125738
---
This podcast is supported by an educational grant from AstraZeneca Pharmaceuticals and Boston Scientific.
---
SYNPOSIS
The doctors first discuss Barcelona-Clinic Liver Cancer (BCLC) Stage A patients, where lesion size and location are key factors in deciding between ablation and transarterial therapies. They then compare cryoablation and microwave ablation, highlighting that cryoablation offers better visualization and control of the ablation zone, while microwave ablation is more effective for treating larger lesions.
Dr. Burns introduces histotripsy, a noninvasive treatment that uses ultrasound energy to mechanically ablate tumors. He shares his experiences as an early adopter of this technology and discusses how intraoperative cone beam CT can help treat lesions located near critical structures or those poorly visualized on ultrasound. Finally, Dr. Garcia-Reyes and Dr. Berman provide insights into patient selection, pre-procedural imaging, and technical tips for Y90.
---
TIMESTAMPS
00:00 - Introduction
02:04 - Ablation vs Y90 in BCLC A Patients
05:58 - Same-Day Y90
15:55 - Y90 for Large Tumors
17:51 - Ideal Cases for Cryoablation
19:38 - Explanation of Histotripsy
32:09 - Procedural Specifics for Histotripsy
38:21 - Technical Tips for Y90
---
RESOURCES
Including the Hollow Viscera (Stomach or Bowel) within the Ice Ball during Cryoablation: A Review of Adverse Events (Abramyan et al, 2024):
https://www.jvir.org/article/S1051-0443(24)00681-X/abstract
CME Accreditation Information:
https://f7cae4ec-b69e-490d-9e0f-19b16a6f146d.usrfiles.com/ugd/f7cae4_a7c37ea3cd1b4d3fa53d5edf8dfe255b.pdf -
When deep sedation is required, it can be challenging to implement due to the difficulty of scheduling dedicated anesthesia coverage in the IR suite. Dr. Amy Deipolyi (interventional radiologist and Division Chief at Charleston Area Medical Center, WY) joins host Dr. Ally Baheti to explain an alternative approach to deep sedation through the use of ketamine.
---
This podcast is supported by:
Medtronic Abre Stent
https://www.medtronic.com/en-us/healthcare-professionals/products/cardiovascular/deep-venous-stents/abre-venous-self-expanding-stent-system.html
---
SYNPOSIS
Dr. Deipolyi begins by sharing how she built a dedicated, academic IR program at a level 1 trauma center in West Virginia. The doctors then discuss the advantages of ketamine for deep sedation in the IR suite, and how Dr. Deipolyi gained administrative approval and implemented the change to achieve an alternative approach to deep sedation for interventional procedures. The discussion also includes how ketamine compares to traditional agents such as fentanyl and Versed. The episode concludes with Dr. Deipolyi’s practical advice to fellow IR’s interested in providing their patients deep sedation via ketamine and her ongoing and future research and outreach efforts.
---
TIMESTAMPS
00:00 - Introduction
02:04 - Dr. Deipolyi’s Practice
14:32 - Overcoming Hurdles and Gaining Support
20:12 - Application and Patient Experiences
26:01 - Future of Deep Sedation in IR
28:55 - Conclusion -
In the past five years, the use of immunotherapeutic agents for advanced cancers has emerged as a promising alternative to tyrosine kinase inhibitors and chemotherapy, making it an exciting time to be practicing oncology. In this episode, Dr. Tyler Sandow interviews oncology experts about the landscape of advanced hepatocellular carcinoma (HCC) and the current state of immunotherapy treatments. He is joined by medical oncologists Dr. Jonathan Mizrah, Dr. Lingling Du, and Dr. Adam Burgoyne, as well as interventional oncologist Dr. Zachary Berman.
Physicians, nurses, nurse practitioners, and physician assistants can follow this link to earn CME / CE credits for completing an accredited learning activity related to this discussion:
https://www.cmeuniversity.com/course/take/125737
---
This podcast is supported by an educational grant from AstraZeneca Pharmaceuticals and Boston Scientific.
---
SYNPOSIS
Drs. Burgoyne and Mizrahi provide a primer on immunotherapy and explain how they communicate the principles of this treatment to their patients. Dr. Du discusses the Imbrave clinical trial and how recent studies have shown improved overall survival when immunotherapeutic agents are used, especially when multiple agents targeting various pathways are employed. When choosing between different regimens, the doctors consider factors such as the patient's underlying liver function, symptom burden, and prior treatments.
Importantly, the doctors also discuss contraindications to immunotherapy, including a history of organ transplant, autoimmune disease, and poor performance status—all of which put patients at high risk for deterioration with this treatment. The treatment of patients with poor liver function remains controversial, as underlying cirrhosis may prevent the recovery of liver function. Dr. Berman outlines recent clinical trials studying the effects of transarterial chemoembolization (TACE) combined with immunotherapy. Finally, the doctors discuss the future of HCC treatment and the benefits of continued innovation in both interventional and medical oncology.
---
TIMESTAMPS
00:00 - Introduction to Immunotherapy
04:32 - Notable Clinical Trials
13:39 - HCC Etiology and Immunotherapy Outcomes
18:43 - Contraindications for Immunotherapy
23:05 - Adverse Effects from Treatment
25:14 - Combination Therapy
36:22 - Considerations for Immunotherapy Dosing
40:26 - The Future of HCC Treatment
---
RESOURCES
Atezolizumab plus Bevacizumab in Unresectable Hepatocellular Carcinoma, IMbrave150 Trial (Finn et al, 2020):
https://pubmed.ncbi.nlm.nih.gov/32402160/
Tremelimumab plus Durvalumab in Unresectable Hepatocellular Carcinoma, HIMALAYA Trial (Abou-Alfa et al, 2022):
https://evidence.nejm.org/doi/full/10.1056/EVIDoa2100070
Nivolumab versus sorafenib in advanced hepatocellular carcinoma (CheckMate 459): a randomised, multicentre, open-label, phase 3 trial (Yau, 2022):
https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(21)00604-5/abstract
Nivolumab (NIVO) plus ipilimumab (IPI) vs lenvatinib (LEN) or sorafenib (SOR) as first-line treatment for unresectable hepatocellular carcinoma (uHCC): First results from CheckMate 9DW (Galle, 2024):
https://ascopubs.org/doi/10.1200/JCO.2024.42.17_suppl.LBA4008
Randomized Phase 3 LEAP-012 Study: Transarterial Chemoembolization With or Without Lenvatinib Plus Pembrolizumab for Intermediate-Stage Hepatocellular Carcinoma Not Amenable to Curative Treatment (Llovet, 2022):
https://pubmed.ncbi.nlm.nih.gov/35119481/
EMERALD-1: A phase 3, randomized, placebo-controlled study of transarterial chemoembolization combined with durvalumab with or without bevacizumab in participants with unresectable hepatocellular carcinoma eligible for embolization (Lencioni, 2024):
https://ascopubs.org/doi/10.1200/JCO.2024.42.3_suppl.LBA432
CME Accreditation Information:
https://f7cae4ec-b69e-490d-9e0f-19b16a6f146d.usrfiles.com/ugd/f7cae4_a7c37ea3cd1b4d3fa53d5edf8dfe255b.pdf -
Proximity to innovation often gives rise to further innovation. This trend is especially true in interventional radiology. Dr. Gregg Alzate (interventional radiologist in San Diego, California) joins host Dr. Ally Baheti to share his career pearls for early and mid-career IRs, and how he came to pioneer the Alzate Retrograde Antegrade Maneuver (A-RAM).
---
This podcast is supported by:
Reflow Medical
https://www.reflowmedical.com/
---
SYNPOSIS
Dr. Alzate starts by sharing his early influences, including his time with interventional radiology giant Dr. Harold Coons. The doctors also cover the importance of proper vessel access techniques, innovative approaches to limb salvage, and how to address complex chronic total occlusions (CTOs). Dr. Alzate then goes on to give us a thorough walkthrough of the A-RAM. The episode concludes with Dr. Alzate’s closing thoughts on being open to adopt new techniques, the impact of strong mentorship, and importance for consuming and sharing knowledge.
---
TIMESTAMPS
00:00 - Introduction
03:05 - Dr. Alzate’s Journey
25:52 - A-RAM Technique
34:26 - CTO’s and Heavy Calcium
40:16 - Moral Injury in Medical Practice
43:35 - Honoring Dr. Harold Coons
46:23 - Closing Thoughts and Reflections
---
RESOURCES
Ohki, Takao et al. “Long-term results of the Japanese multicenter Viabahn trial of heparin bonded endovascular stent grafts for long and complex lesions in the superficial femoral artery.” Journal of vascular surgery vol. 74,6 (2021): 1958-1967.e2.
https://www.jvascsurg.org/article/S0741-5214(21)01011-9/fulltext
Kedora, John et al. “Randomized comparison of percutaneous Viabahn stent grafts vs prosthetic femoral-popliteal bypass in the treatment of superficial femoral arterial occlusive disease.” Journal of vascular surgeryvol. 45,1 (2007): 10-6; discussion 16.
https://www.jvascsurg.org/article/S0741-5214(06)01612-0/fulltext -
Of all the topics covered during interventional radiology training, dosimetry education is often delayed until after IRs enter clinical practice. In this episode, Drs. Tyler Sandow and Sabeen Dhand host a roundtable discussion with experts on the dosimetry fundamentals that all Y90 operators should understand. They are joined by interventional radiologists Drs. Zachary Berman, Kirema Garcia-Reyes, and Siddharth Padia, who provide their expert insights.
Physicians, nurses, nurse practitioners, and physician assistants can follow this link to earn CME / CE credits for completing an accredited learning activity related to this discussion:
https://www.cmeuniversity.com/course/take/125736
---
This podcast is supported by an educational grant from AstraZeneca Pharmaceuticals and Boston Scientific.
---
SYNPOSIS
The group agrees that dosimetry is not a one-size-fits-all approach. Dosing strategies depend on factors such as tumor size, perfusion territory, underlying liver function, the choice between glass versus resin spheres, and treatment intent. These considerations are illustrated with real-life case examples. The doctors also explore voxel-based dosimetry, a method for calculating the amount of radiation absorbed by different parts of the tumor. They stress the importance of learning how to perform accurate dosage calculations.
Finally, the conversation touches on data from major Y90 trials, current guidelines, and the evolving perspective on Y90 as a potential curative treatment, rather than merely a bridging therapy.
---
TIMESTAMPS
00:00 - Introduction
01:59 - Dosimetry Education During Training
05:46 - Benefit of Individualized Dosing
11:01 - Complications from High Doses
15:19 - Dosage Calculation Cases
22:51 - Duration of Response to Y90
25:00 - Dosing Based on Treatment Intent
29:11 - Challenging Case Example
42:31 - Voxel-Based Dosimetry
45:15 - Using Dosimetry Software
---
RESOURCES
LEGACY Trial (Salem et al, 2021):
https://pmc.ncbi.nlm.nih.gov/articles/PMC8596669/
Voxel-based tumor dose correlates to complete pathologic necrosis after transarterial radioembolization for hepatocellular carcinoma (Pianka et al, 2024):
https://pubmed.ncbi.nlm.nih.gov/38913189/
RAPY90D Trial (Kappadath et al, 2023):
https://jnm.snmjournals.org/content/64/supplement_1/P268
Clinical, dosimetric, and reporting considerations for Y-90 glass microspheres in hepatocellular carcinoma: updated 2022 recommendations from an international multidisciplinary working group (Salem et al, 2023):
https://pubmed.ncbi.nlm.nih.gov/36114872/
International recommendations for personalised selective internal radiation therapy of primary and metastatic liver diseases with yttrium-90 resin microspheres (Levillain, 2021):
https://link.springer.com/article/10.1007/s00259-020-05163-5)
CME Accreditation Information:
https://f7cae4ec-b69e-490d-9e0f-19b16a6f146d.usrfiles.com/ugd/f7cae4_a7c37ea3cd1b4d3fa53d5edf8dfe255b.pdf -
Robot-assisted technology has revolutionized surgical fields such as general surgery and urology—could interventional radiology be the next frontier? In this episode of the BackTable podcast, host Dr. Jacob Fleming explores the transformative potential of robotic-assisted percutaneous biopsies and ablations with experts Dr. Govindarajan “Raj” Narayanan from the Miami Cancer Institute and Dr. Sean Tutton from UC San Diego.
---
This podcast is supported by:
Quantum Surgical
https://www.quantumsurgical.com/
---
SYNPOSIS
Dr. Narayanan begins by sharing his initial interest in robotic applications for tumor ablations, aiming to maximize efficiency in his practice. Dr. Tutton then highlights the advantages of robotics for probe placement, especially in challenging cases. The two doctors discuss the logistics of the robotic system, including setup, imaging, and access choices. They also reflect on the learning curve associated with robotics and how it gradually enhances procedural efficiency while reducing mental fatigue. This improvement allows them to take on more complex cases with confidence. Overall, both experts agree that robotics has the potential to democratize minimally invasive procedures, offering new opportunities for skill development and advancement within the field of interventional radiology.
---
TIMESTAMPS
00:00 - Introduction to the Podcast
03:30 - Developing an Interest in Robotics
10:44 - Integration of Robotics in the Procedural Suite
13:27 - Logistics of Robot System
18:38 - Planning for Percutaneous Access
22:39 - Future Implications of Robotics on Training Programs
35:51 - Efficiency and Volume Management with Robotics
40:39 - Learning Curves for Robotic Procedures
48:09 - Conclusion and Final Thoughts
---
RESOURCES
Quantum Surgical Epione Robot:
https://www.quantumsurgical.com/epione/
ACCLAIM Trial:
https://www.sio-central.org/ACCLAIM-Trial -
Welcome to the first episode of BackTable Tumor Board, and our first recording session at our new in-person studio! Guest host Dr. Tyler Sandow (interventional radiologist) leads a multidisciplinary discussion about patient care coordination in hepatocellular carcinoma (HCC) diagnosis and treatment, with insights from his colleagues at Ochsner Health– Dr. Steven Young (hepatologist), Dr. Jonathan Mizrahi (medical oncologist), and Deondra Bonds-Adams (patient navigator).
Physicians, nurses, nurse practitioners, and physician assistants can follow this link to earn CME / CE credits for completing an accredited learning activity related to this discussion:
https://www.cmeuniversity.com/course/take/125735
---
This podcast is supported by an educational grant from AstraZeneca Pharmaceuticals and Boston Scientific.
---
SYNPOSIS
The team speaks on the value of having multiple specialties weigh in on treatment conversations that are tailored to each patient’s medical history and risk factors, such as underlying cirrhosis and portal hypertension. Deondra highlights the importance of assessing the patient’s understanding of their disease and the role of physician extenders and schedulers in patient education. Dr. Young discusses the value of outreach clinics and streamlining the transplant evaluation process. Finally, Dr. Mizrahi gives advice on building referral networks and establishing early contact with transplant centers.
---
TIMESTAMPS
00:00 - Introduction
00:46 - Multidisciplinary Tumor Board
06:00 - Patient Experience in Treatment Pathways
10:10 - Barriers to Treatment
16:03 - Benefits of IR Clinic
19:33 - HCC Screening and Risk Factors
24:08 - Building Referral Networks
30:34 - Strategies for Effective Scheduling
35:43 - The Future of HCC Treatment
---
RESOURCES
CME Accreditation Information:
https://f7cae4ec-b69e-490d-9e0f-19b16a6f146d.usrfiles.com/ugd/f7cae4_a7c37ea3cd1b4d3fa53d5edf8dfe255b.pdf -
Welcome to the first episode of BackTable Tumor Board, and our first recording session at our new in-person studio! Guest host Dr. Tyler Sandow (interventional radiologist) leads a multidisciplinary discussion about patient care coordination in hepatocellular carcinoma (HCC) diagnosis and treatment, with insights from his colleagues at Ochsner Health– Dr. Steven Young (hepatologist), Dr. Jonathan Mizrahi (medical oncologist), and Deondra Bonds-Adams (patient navigator).
---
This podcast is supported by an educational grant from:
AstraZeneca
https://www.astrazeneca.com/our-therapy-areas/oncology.html
With additional support from:
Boston Scientific
https://www.bostonscientific.com/en-US/medical-specialties/interventional-radiology/interventional-oncology.html
---
SYNPOSIS
The team speaks on the value of having multiple specialties weigh in on treatment conversations that are tailored to each patient’s medical history and risk factors, such as underlying cirrhosis and portal hypertension. Deondra highlights the importance of assessing the patient’s understanding of their disease and the role of physician extenders and schedulers in patient education. Dr. Young discusses the value of outreach clinics and streamlining the transplant evaluation process. Finally, Dr. Mizrahi gives advice on building referral networks and establishing early contact with transplant centers.
---
TIMESTAMPS
00:00 - Introduction
00:46 - Multidisciplinary Tumor Board
06:00 - Patient Experience in Treatment Pathways
10:10 - Barriers to Treatment
16:03 - Benefits of IR Clinic
19:33 - HCC Screening and Risk Factors
24:08 - Building Referral Networks
30:34 - Strategies for Effective Scheduling
35:43 - The Future of HCC Treatment -
Interventional treatment for pulmonary embolism (PE) has significantly evolved in recent years, largely due to advancements in techniques, knowledge, and device technology. Dr. Zarina Sharalaya (interventional and structural cardiologist) and Dr. Ripal Gandhi (interventional radiologist) join host Dr. Chris Beck to discuss the evolving landscape of PE treatment, comparing large-bore mechanical thrombectomy with catheter-directed thrombolysis and exploring outcomes from the PEERLESS randomized control trial.
---
This podcast is supported by:
Inari Medical
https://cwa.inarimedical.com/inari-learn
---
SYNPOSIS
Dr. Sharalaya and Dr. Gandhi begin by covering risk stratification and treatment algorithms for their patients with PE. The doctors then go onto discuss the procedure in detail, and best practices and techniques for mechanical thrombectomy. The conversation also focuses on the PEERLESS trial, highlighting how the study showed significant benefits of mechanical thrombectomy, including faster symptom improvement, decreased ICU stay, and reduced readmission rates. Dr. Sharalaya and Dr. Gandhi conclude the episode with a series of case presentations.
---
TIMESTAMPS
00:00 - Introduction
08:01 - Pulmonary Embolism Risk Stratification and Treatment Algorithms
14:49 - Procedure Overview
24:25 - Best Practices and Techniques in Thrombectomy
34:31 - Peerless Study Overview and Findings
46:50 - Gender Differences in PE Treatment
47:49 - Future of PE Treatment and Advice
51:55 - Case Presentations and Clinical Insights
---
RESOURCES
2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS):
https://pubmed.ncbi.nlm.nih.gov/31504429/
PEERLESS II: A Randomized Controlled Trial of Large-Bore Thrombectomy Versus Anticoagulation in Intermediate-Risk Pulmonary Embolism:
https://www.jscai.org/article/S2772-9303(24)01053-6/fulltext
Large-bore Mechanical Thrombectomy Versus Catheter-directed Thrombolysis in the Management of Intermediate-risk Pulmonary Embolism: Primary Results of the PEERLESS Randomized Controlled Trial:
https://pubmed.ncbi.nlm.nih.gov/39470698/ -
Interventional radiology is unique in the way that much of what an IR’s practice looks like is extremely contingent upon their practice setting following training - whether it be community, academic, private, or hybrid. Dr. Mark Wilson joins host Dr. Donald Garbett to discuss his own journey of transitioning from a large, physician owned group to forming his own private IR practice in Spokane, Washington following a major hospital contract shift.
---
This podcast is supported by:
Medtronic MVP
https://www.medtronic.com/mvp
---
SYNPOSIS
Dr. Wilson shares the emotional impact of the career shift, and the technical aspects of how he was able to succeed following the change, and the details that went into creating his own private IR-only group and securing contracts with local hospitals. The doctors also spend time on the financial dynamics between DR and IR, as well as the true dollar value and impact IR brings to hospitals. The episode concludes with Dr. Wilson’s practical and thorough guide on how one can go about starting up their own IR-only private practice.
---
TIMESTAMPS
00:00 - Introduction
03:02 - Forming a New IR Group
04:43 - Impact of Practice Changes
11:02 - IR’s Value to Hospitals
30:49 - Independent IR Practice Set-Up
36:38 - Conclusion
---
RESOURCES
Karage, 2024. Attrition Rates in Interventional Radiology Integrated Residency Programs:
https://pubmed.ncbi.nlm.nih.gov/39586539/ -
It might be time to rethink your liver biopsy technique. Transfemoral transcaval core-needle liver biopsy has demonstrated key advantages over the transjugular approach and has become increasingly popular in recent years. Interventional radiologists Dr. Jacob Cynamon and Dr. Kapil Wattamwar join host Dr. Sabeen Dhand to discuss the inception and advantages of their novel approach.
---
This podcast is supported by:
Reflow Medical
https://www.reflowmedical.com/
---
SYNPOSIS
The doctors start with how they began using the transfemoral transcaval approach, along with the literature they published following adoption of this novel technique shortly thereafter. Dr. Cynamon and Dr. Wattamwar then go on to discuss the technique in detail, providing a thorough step-by-step and pausing to mention key considerations. The episode concludes with the doctors emphasizing the safety and efficacy of the transfemoral transcaval approach, citing specific findings and sharing exemplary cases.
---
TIMESTAMPS
00:00 - Introduction
05:47 - Percutaneous vs. Transvenous Biopsies
08:56 - Evolution of Transfemoral Biopsies
12:41 - Comparing Transjugular and Transfemoral Approaches
24:52 - Pre-Procedural Imaging and Sheath Selection
29:23 - Complications and Case Studies
35:46 - Transcaval Biopsy Technique
45:00 - Conclusion
---
RESOURCES
Cynamon, 2016. Transfemoral Transcaval Core-Needle Liver Biopsy: An Alternative to Transjugular Liver Biopsy:
https://pubmed.ncbi.nlm.nih.gov/26723528/
Wattamar, 2020. Transjugular versus Transfemoral Transcaval Liver Biopsy: A Single-Center Experience in 500 Cases:
https://pubmed.ncbi.nlm.nih.gov/32798119/
Wattamar, 2022. The Use of the Transfemoral Transcaval Liver Biopsy Technique for Biopsies of Hepatic Masses:
https://pubmed.ncbi.nlm.nih.gov/36182256/
Wattamar, 2022. Transcaval Creation of a Portal Vein Target for Transjugular Intrahepatic Portosystemic Shunt in a Patient with Portal Vein Thrombosis:
https://pubmed.ncbi.nlm.nih.gov/34448032/ -
En este episodio de BackTable, la Dra. María Luisa Die Trill conversa con la Dra. Sara
Lojo Lendoiro sobre la gestión emocional y la comunicación con los pacientes.
---
SYNPOSIS
Se explora la importancia de integrar el sufrimiento como parte de la vida, la necesidad
de una formación adecuada en comunicación médico-paciente, y las estrategias para
abordar complicaciones y situaciones complejas. Además, se analizan conceptos como
la empatía, la escucha activa, y la introspección, para mejorar la relación con los
pacientes y con el resto de compañeros del hospital. Finalmente, la Dra. Trill enfatiza la
necesidad de centrarse en el bienestar del paciente y en manejar el estrés profesional
para poder ofrecer un cuidado de calidad.
---
TIMESTAMPS
00:00 - Bienvenida y Comprendiendo la Psicología Oncológica
05:06 Habilidades de Comunicación en la Práctica Médica
10:19 Técnicas Prácticas de Comunicación
22:10 La Importancia de Escuchar
28:18 La Insensibilidad en la Sociedad Moderna
30:49 La Importancia de la Salud Mental en los Profesionales
34:24 La Empatía y la Conexión con los Pacientes
36:22 El Manejo del Estrés en el Personal Sanitario
48:35 El Ego y la Dinámica de Grupo en los Hospitales
52:54 Conclusión y Reflexiones Finales -
En este episodio del BackTable, Dr. José Andrés Guirola Ortíz, radiólogo
intervencionista, aborda la embolización como tratamiento para las hemorroides,
mediante la técnica Emborrhoid y comparte su valoración de la embolización como
técnica de futuro.
---
SYNPOSIS
En primer lugar, la Dra. Sara Lojo Lendoiro le invita a explicar qué son las hemorroides
y porqué y cuando hay que tratarlas. Además, el Dr. Guirola Ortíz analiza la historia de
las hemorroides, sus síntomas y opciones de tratamiento. También se discuten las
indicaciones, técnicas y posibles complicaciones de la embolización hemorroidal, así
como el futuro de esta técnica dentro de la radiología intervencionista.
---
TIMESTAMPS
00:00 - Introducción al BackTable y Dr. Ortíz
01:56 - Entendiendo las Hemorroides: Historia y Conceptos Básicos
03:39 - Síntomas y Causas de las Hemorroides
07:36 - Opciones de Tratamiento para las Hemorroides
12:50 - Explicación de la Técnica de Embolización
19:25 - Complicaciones y Seguimiento
29:05 - Futuro de la Embolización y Conclusión - Visa fler
