Nishant Patel

@t_intheleadcoat @kmadass @AmputationSuck @LessneVIR @vascularIR @YsaAugust @linemonkeymd @monteromiguel @FadiSaab17 @drcostantino1 @MisraMD @keithppereira @SDhandMD @laronecampbell @jmills1955 @canuc_57 @westleyohman @sternvascular @butrosIR @baobui99 Feel like I do this more often than not 😂

This trick when going antegrade helped me out countless times! When WIRE prefers Profunda,this can save time! What’s UR trick, beyond direct SFA stick! @kmadass @AmputationSuck @LessneVIR @vascularIR @YsaAugust @linemonkeymd @monteromiguel @FadiSaab17 @drcostantino1 @MisraMD

@IR_Doctor See if AI can top THAT, boom!

Seen today in "outside" radiology report: "Mildly increased fecal load. Correlate with history of constipation." Stay classy, everyone.

@rkryu As one of the first IR residency graduates in a “100% IR” job, I fully appreciate the value of DR. MANY great cases, rapport with my DR partners, moonlighting opps come from reading. Theres a difference between an “endovascular surgeon” and an IR; DR skills make us better IRs.

@dr_cellini That’s a lot for sure but on diagnostic shifts I regularly break 200 RVUs so would hit nearly 40k for the year. Luckily I mostly do IR though :)

@MikeJHsu @SDhandMD Essentially never. In that scenario for me it’s tPA then CTA. You’ll find either another cause for the clinical decompensation, or often distal PE, which probably lysed because of the tPA. But you could avoid patient coding on your table too…

So I pushed 100 mg TPA and took emergently to angio and found these PEs. Lightning 16 got them out but I wonder how many times I’ll be wrong in the future if I skip the CTA. #irad #twittIR

@Warren_IR @pparikhxr Totally

@pparikhxr Once you sous vide, you never go back... 🥩

Searing these guys in the holy trinity (Ghee, EVOO and duck fat). What do you think?

@dr_cellini Glad I’m not the only one that feels like this, although I knew I couldn’t be :)

I bet radiologists would be less likely to give a 1.0cm thyroid nodule a TI-RADS 5, if they were the ones doing the biopsy…

@t_intheleadcoat @kmadass @keithppereira @farkomd @RKTvascular @drcostantino1 @drochohan @DrJayMohan @JayMathewsMD @LessneVIR @IRKhalsa @RexRayMD @iRadRock @SDhandMD @westleyohman @vascularIR Usually select with catheter (sometimes Mpa sometimes longer Bern through MPA) then use 035 Rosen to help get the guide Cath in position (sometimes need to advance over a balloon). Then switch for V18 (carefully) for delivery

@IRadNAP @kmadass @keithppereira @farkomd @RKTvascular @drcostantino1 @drochohan @DrJayMohan @JayMathewsMD @LessneVIR @IRKhalsa @RexRayMD @iRadRock @SDhandMD @westleyohman @vascularIR Great! What’s your 018 wire of choice ?

Renal artery stenting in our practice is relatively rare but here are 2 good ones resolved. 1. HTN emergency 2. Difficulty controlling HTN on multiple antihypertensives What’s your stent of choice? 014/018/035 ? @kmadass @keithppereira @farkomd @RKTvascular @drcostantino1

Sometimes a wound needs our help to heal. Be it a celebrated college football coach or a beloved blue-collar neighbor, options exist to prevent unnecessary amputation.

@dr_cellini 60-90 seconds for a normal CT chest or CT AP can easily get you 10 CTs an hour. In PP there are tons of normals (e.g., <2% positive rate PE studies). Add streamlined templates and 80 CT in 8-9 hour shift is easy. I’ve read 280 studies (all modalities) in a day on my best day.

If you are reading 80+ CTs per 8 or 9 hour shift, please explain. I personally don’t think this is possible unless: A. Reads are garbage B. Majority are head CTs C. Have residents pre-dictating D. You are ok with missing incidentals

@dr_cellini Maybe they shouldn’t HAVE to, but volume makes a better radiologist, as long as it comes with the appropriate teaching. If they can’t support that volume, count them out of my group.

No radiology resident should be reading 40-50 CTs per shift.

Here’s one for #RadRes. 80 yo presents with syncope, shock. CT shows hemoperitoneum and splenic artery rupture. No aneurysm on prior CT. No trauma prior, no signs of infection. #justglueit does the trick! Classic presentation. Diagnosis? @SIRspecialists @SIR_ECS @thegestgroup

@SandeepBaglaMD @UHC The highest paid CEO in the US, I believe

The single worst insurance scam is @UHC hence why so many large organizations are dropping them! The city of #Raleigh is doing it en mass. More to come as I hear many other large platforms are doing the same. They just rip off their subscribers and at the same time health care workers for large bonuses to their execs

@kmadass @SIRspecialists @SIR_ECS @CHICKVIR @MamdouhKhayatMD @iRadRaj @medravi @EJJohnsonMD Kissing 14 abres into a 20 abre and right external iliac extension with 12 abre

@IRadNAP @SIRspecialists @SIR_ECS @CHICKVIR @MamdouhKhayatMD @iRadRaj @medravi @EJJohnsonMD Nice work. What stent and size was that

Optease #filterout with iliocaval reconstruction. Patient refused to be admitted because they felt so well afterwards. We can do amazing things while having fun! @SIRspecialists @SIR_ECS

@SriniTummala @SIRspecialists @SIR_ECS @CLIfighters Thanks, and for your advice as I started doing these a few years ago! Podiatrist sees them as wound heals weekly-monthly. Imaging either thru us or vascular surgery minimum 3 months, earlier if there are concerns. Seeing about 30% occlusion, we only reintervene if still wounds.

@IRadNAP @SIRspecialists @SIR_ECS @CLIfighters Great flow rate! What will your surveillance algorithm be to monitor the DVA patency etc?

That feeling when your friendly podiatrist said he had 600 mL blood loss when working on your DVA patient 🩸 👍🏽 @SIRspecialists @SIR_ECS @CLIfighters

@ChengaziMD @SIRspecialists @SIR_ECS @CLIfighters We only have regular balloons, I dilate to 5 mm. Sometimes requires really high pressure. Cutting balloon would be better, or a valvulotome.

@IRadNAP @SIRspecialists @SIR_ECS @CLIfighters Amazing work, did you take any specific steps to open the valves?

@IRadNAP @SIRspecialists @SIR_ECS @CLIfighters Your work is so impressive, @IRadNAP! You’re the DVA expert! @JVIRmedia @CVIR_Journal @SIRspecialists