Ep. 107 Keeping Up With The Field in Interventional Radiology with Dr. Gregg Khodorov

yeah i mean i've always

seen at least from the exterior that i mean almost all of medicine is very much like an apprenticeship field where you have to learn from other people you know like you said you can you can't really do a lot of in a textbook you got to do it hands-on but also from other people and what other what other so you you must have had lectures in residency too

yeah we had like Three to four days a week, I would say we had lectures plus a couple of tumor boards.

I mean, obviously those are great learning opportunities as well, especially the repetition of the weekly tumor boards like HEC conference.

Jefferson does a lot of uveal melanoma.

So there's a weekly mum conference, metastatic uveal melanoma.

And we treat those patients like three to four days a week at Jefferson.

So just a strange niche interventional oncologic practice that I had a lot of exposure to.

And those tumor boards really do a good job, I think, of making you appreciate just how nuanced the care of those patients are and the many clinical trials that are available to them.

What

happens for you in the tumor board? Like how is it set up that it was useful for you? And what are you really gleaning from those?

Yeah, so in the diagnostic years, we had the opportunity to kind of participate in tumor boards, meaning sort of drive the imaging throughout the tumor board and really go through the findings and stuff.

In the IR years, it was a little more passive.

We were just kind of tuning in to hear our attendings kind of discuss multidisciplinary management of those patients.

Like HCC conference, obviously transplant surgery, you know, hepatology, IR, kind of the big three, and then obviously oncology, making lots of decisions for those patients and just understanding like the full spectrum and where we kind of fit in.

If you just go to work every day as an IR fellow and show up and do procedures on patients, you will miss the big picture of like where you fall in the spectrum of care for these patients and when it's appropriate, when it's not appropriate to intervene.

So I think that was an important part of my learning.

And why is that important for an IR, like when to intervene and when not? I mean, don't you get called by the med-onc basically to say, hey, you know, Greg, we got to do this? Or do you have some say in whether to do

the procedure? A lot of times people don't fully understand the nuances of interventional work, right? Like you have a high lesion up by the dome of the liver and if you go to ablate it, you may risk damage to the diaphragm and things like that that just aren't really...

thought about by the folks who aren't doing the procedure.

It's important to understand those nuances.

And, you know, there's all these guidelines out there for when you should ablate, when you should treat with Y90.

But at the end of the day, you have to review the imaging every time and review the patient's history, right? Like maybe their Billy's sky high and they're not a candidate anymore for anything.

Unless you have those conversations and you're kind of attuned to those discussions, you're going to kind of miss that part of the whole spectrum of the disease that we manage.

Now, obviously, I'm going to a practice where I'm not going to be doing much interventional oncology work, but I felt that that was really important for my learning and for eventually passing the oral boards and understanding that sort of continuum.