BackTable Vascular & Interventional

The key to personalizing Y90 may not just be treating the tumor, but understanding how much radiation a patient can tolerate, where to deliver it, and when to safely push the dose. In this episode of the BackTable Podcast, Drs. Tyler Sandow and Ryan Hickey join host Dr. Kavi Krishnasamy to explore strategies for using Y90 in hepatocellular carcinoma and liver metastases. They combine real-world data from a study of nearly 1,000 patients with insights into methodology and the many variables that influence these procedures.

---

Get the BackTable apphttps://www.backtable.com/app

---

This podcast is supported by an educational grant from Boston Scientific TheraSphere Y-90.

---

Timestamps

00:00 - Introduction02:36 - Resection After Radioembolization06:07 - Personal Practices Between HCC and Liver Metases07:26 - Bridging Radiation Segmentectomy 11:22 - Understanding Portal Vein Tumor Thrombus14:21 - Preferences in Dosimetry Software17:57 - Liver Reserve Limits25:11 - Microsphere Activity and Density29:16 - Diving into PROACTIF33:32 - RCTs and Trial Challenges36:57 - Patient Diversity in PROACTIF41:42 - Extrahepatic Disease43:03 - Data Gaps and Takeaways45:32 - Defining Personalized Dosimetry and Bridging Software50:15 - Mixed Delivery Approaches and Dose Thresholds01:01:36 - Response and Local Control01:04:26 - Treating PVT Subgroups01:09:03 - Comparison Between Dosing and Survival01:15:03 - Differences in Patients Quality of Life After Transplantation01:26:34 - Wrap-Up and Credits

---

More about this episode

The discussion covers radiation segmentectomy and selective delivery, the nuances of portal vein tumor thrombus levels, and how multidisciplinary collaboration differs between resection and transplant. The doctors dive into the PROACTIF study, focusing on personalized dosimetry, dose escalation, trial challenges, tumor response, and survival outcomes across disease stages. Drs. Sandow and Hickey also explain the limits of Y90, such as lung shunts, liver reserve, and treated liver volume, and highlight how decision-making and tailored techniques are essential for improving outcomes in liver cancer care.

---

BackTable Vascular & Interventional (VI) is the go-to podcast for interventional radiologists, vascular surgeons, and interventional cardiologists.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

► https://www.backtable.com/app

What characteristics make bone biopsies unique in both presentation and procedure? In this episode of the BackTable Podcast, Drs. Junjian Huang and Majid Khan join host Dr. Neil Jain to break down the complexities of bone biopsy technique. They discuss key strategies for tackling difficult cases, from understanding referral patterns and pre-procedure planning to selecting the best guidance modality and anticipating complications.

---

Get the BackTable apphttps://www.backtable.com/app

---

This podcast is supported by

Varian OmniBonehttps://cancercare.siemens-healthineers.com/products/interventional-oncology/musculoskeletal/omnibone

---

Timestamps

00:00 - Introduction08:06 - Referrals And Pre-Procedure Planning12:35 - Triaging and Managing Difficult Cases17:06 - Measuring and Improving Diagnostic Yield18:58 - Knowing Boundaries Behind Difficult Cases22:37 - Choosing the Best Guidance Modality26:16 - The Future with Augmented Reality28:11 - Tough Case Scenarios and Setup41:27 - Preventing and Managing Complications47:49 - Technical Tips for Future IRs51:40 - Wrap-up and Credits

---

More about this episode

The conversation covers how to triage complex cases, adjust technique for smaller or hard-to-reach lesions, and benchmark diagnostic success. Drs. Huang and Khan share their preferred imaging guidance, from CT to fluoroscopy, and explore new frontiers like augmented reality. Case scenarios highlight practical problem-solving, and the episode wraps up with technical pearls and complication-prevention tips gained from years of experience in targeted bone biopsy.

---

BackTable Vascular & Interventional (VI) is the go-to podcast for interventional radiologists, vascular surgeons, and interventional cardiologists.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

► https://www.backtable.com/app

Once your PERT is assembled, how do you navigate the evolving pulmonary embolism (PE) literature to improve patient outcomes at all risk levels? In this episode of the BackTable Podcast, interventional radiologist Dr. Robert Lookstein (Mount Sinai) and pulmonary critical care specialist Dr. Timothy Fernandes (UC San Diego) join host Dr. Harris Chengazi to examine the latest evidence and multidisciplinary strategies for managing acute pulmonary embolism. The discussion highlights the complexities of catheter-directed therapies in intermediate- to high-risk PE, evolving guidelines in the face of new trial data, and prioritization of improving patients’ clinical trajectories.

---

Get the BackTable apphttps://www.backtable.com/app

---

This podcast is supported by

Penumbra

https://www.penumbrainc.com/

Timestamps

00:00 - Introduction03:57 - PERT Structure and Activation08:24 - PE Risk Stratification Tools12:02 - Patient Selection for IR Intervention15:21 - Assessing Clot Chronicity21:03 - Standardizing Workup26:38 - Managing Unstable PE28:31 - STORM-PE and HI-PEITHO Trial Data35:49 - Guidelines vs. New Evidence40:12 - Determining Therapeutic Endpoints45:05 - Upcoming Trials and Future Directions51:46 - Final Thoughts and Closing Remarks

---

More about this episode

The physicians explore the nuances of validated PE risk stratification tools, assessing the relationship between various PE scoring systems and the 2026 ACC/AHA classification for acute PE. They emphasize that the integration of clinical assessment, serial lab work, and patient history must take precedence over static imaging alone in guiding care. The doctors go on to review new trial data, including the improved RV-to-LV ratio and 90-day functional gains seen with mechanical thrombectomy in STORM-PE and reduced clinical deterioration observed with ultrasound-assisted catheter-directed thrombolysis in HI-PEITHO. The conversation concludes with a call for collaborative, safety-first management that focuses on the patient’s clinical status and long-term post-PE functional recovery.

---

Resources

2026 AHA/ACC/ACCP/ACEP/CHEST/SCAI/SHM/SIR/SVM/SVN Guideline for the Evaluation and Management of Acute Pulmonary Embolism in Adultshttps://doi.org/10.1161/CIR.0000000000001415

Composite Pulmonary Embolism Shock (CPES) Scorehttps://doi.org/10.1161/CIRCINTERVENTIONS.124.014088

FOCUS studyhttps://doi.org/10.1093/eurheartj/ehac206

STORM-PE trialhttps://doi.org/10.1161/CIRCULATIONAHA.125.077232

HI-PEITHO trialhttps://doi.org/10.1056/nejmoa2516567

PE-TRACT studyhttps://petractstudy.org/homepage

PEERLESS II studyhttps://clinicaltrials.gov/study/NCT06055920

PERSEVERE trialhttps://clinicaltrials.gov/study/NCT06588634

---

BackTable Vascular & Interventional (VI) is the go-to podcast for interventional radiologists, vascular surgeons, and interventional cardiologists.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

► https://www.backtable.com/app

Why do nearly half of IR residents consider leaving the specialty, and what can be done to change that? On this episode of the BackTable Podcast, Dr. Neil Jain interviews Dr. David Mittelstein, an integrated IR resident at UC San Diego and co-chair of the SIR RFS Recruitment Committee, about the findings of a national SIR survey on interventional radiology resident attrition. They discuss what drives uncertainty, from lifestyle and call burden to job market fears, and highlight the program features that encourage retention, such as structured training, high case volume, and a culture of camaraderie.

---

Get the BackTable apphttps://www.backtable.com/app

---

This podcast is supported by

RADPAD® Radiation Protectionhttps://www.radpad.com/

---

Timestamps

00:00 - Introduction04:31 - From Biomedical Engineering to IR07:41 - Recruitment Committee Mission12:37 - Match Trends Warning Sign15:12 - Survey Design Demographics20:21 - What Factors Matter25:04 - Why Residents Consider Switching30:23 - Recommendation 1 IR Curriculum32:32 - Recommendation 2 More IR Rotation34:10 - Recommendation 3 Build Camaraderie38:30 - Advice for Residents Who Are Doubting41:00 - What’s Next for RFS Recruitment43:20 - Wrap Up

---

More about this episode

The conversation explores free-response themes from the survey, where 78 percent of residents cited lifestyle concerns, 31 percent pointed to job market uncertainty, and 22 percent mentioned call experience as reasons for questioning IR. Retention was linked to structured training (38 percent), high case volume and procedural experience (35 percent), and program camaraderie (18 percent). Dr. Mittelstein and Dr. Jain review three concrete recommendations to improve retention, examine early changes at programs like Georgetown, and offer practical advice to residents who may be quietly doubting their path in IR.

---

Resources

Episode # 554 Optimizing the IR/DR Curriculum & Experience

https://www.backtable.com/shows/vi/podcasts/554/optimizing-the-ir-dr-curriculum-experience

---

BackTable Vascular & Interventional (VI) is the go-to podcast for interventional radiologists, vascular surgeons, and interventional cardiologists.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

► https://www.backtable.com/app

How are new aspiration thrombectomy systems and real-time hemodynamic monitoring enabling safer, more effective pulmonary embolism treatment? On this episode of the BackTable Podcast, Dr. Ally Baheti welcomes Dr. Maya Serhal and Dr. David Dexter for a deep dive into modern pulmonary embolism (PE) management, with a focus on advances in large-bore aspiration thrombectomy. They discuss evolving PE triage algorithms, real-world procedural strategies, and the clinical impact of next-generation aspiration systems on safety, efficiency, and patient recovery.

---

Get the BackTable apphttps://www.backtable.com/app

---

This podcast is supported by

Imperative Care https://imperativecare.com/

---

Timestamps

00:00- Introduction02:03- PE Response Workflow05:32- Symphony Device07:07- Sizing and Blood Loss10:00- Multi-Port Hemodynamics14:45- Procedure Endpoints17:01- IVUS Guided Strategy20:02- ProHelix and Lollipopping25:48- Case Studies34:12- Closing Thoughts

---

More about this episode

The conversation explores multidisciplinary PE response workflows, lab and imaging triggers for escalation, and technical considerations in catheter sizing, blood loss management, and real-time hemodynamic monitoring. Dr. Dexter reviews his use of intravascular ultrasound for precise clot localization, and Dr. Serhal shares practical tips for adjusting aspiration power to avoid complications. Together, they discuss procedural endpoints, mechanical assist devices for difficult clots, and present case examples demonstrating rapid improvement in hemodynamics and oxygenation. The episode emphasizes the importance of teamwork, patient selection, and ongoing innovation in optimizing PE care.

---

Resources

American Society of Hematology 2020 Guidelines for Management of Venous Thromboembolism: Treatment of Deep Vein Thrombosis and Pulmonary Embolismhttps://ashpublications.org/bloodadvances/article/4/19/4693/463998/American-Society-of-Hematology-2020-Guidelines-for

Prospective Multicenter IDE Study of the Next-Generation Precision Aspiration Thrombectomy System for Intermediate-Risk Pulmonary Embolism: The SYMPHONY-PE Trialhttps://www.ahajournals.org/doi/full/10.1161/CIRCINTERVENTIONS.125.015815

Is There a Golden Hour for Thrombectomy in Intermediate-Risk Pulmonary Embolism? Insights From SYMPHONY-PEhttps://www.ahajournals.org/doi/full/10.1161/CIRCINTERVENTIONS.126.016573---

BackTable Vascular & Interventional (VI) is the go-to podcast for interventional radiologists, vascular surgeons, and interventional cardiologists.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

► https://www.backtable.com/app