Episode 79: IR Trailblazers 2

As part of the SIR Resident Fellow and Student Section initiative, this special episode of the Kinked Wire is part of the IR Trailblazers series. 

Host: Joshua Baker, MD, a current research associate with the Miami Cardiac and Vascular Institute and RFS Clinical Education Committee Member

Guest: Alexander Misono, MD, MBA, Chief of Interventional Radiology at Hogue Hospital

The following transcript was AI generated and has been edited for grammar and flow.

[03:50] Dr. Baker: Are there any unsolvable problems perhaps that you've been introduced to that you’ve managed to find a solution to?

[04:00] Dr. Misono: You know, they're so frequent that I feel like it's hard to come up with a specific example. For me—for frame of reference, the number of calls I get from referring clinicians that say “Hey, I don’t know if you can do anything about this,” or “I doubt you can do anything about this, etc.” and then they say, “Can you do X,Y,Z,” and you say yes. Because it’s a core procedure that we’ve already innovated or already do, or maybe it’s something we’ve never done before. Every once in a while, even in community practice I do procedures that are kind of made up, and so it’s that frame of reference. If you ask me if there is an unsolvable problem in IR, my answer is most probably no, because I feel like we can come up with some kind of solution for almost any problem. For our attendings, there’s a lot of things that they think are impossible, and perhaps there’s a gap we need to close together. They shouldn’t be thinking so many things are impossible, they should be educated that there are a plethora of creative ways we can solve their problems.

[05:20] Dr. Baker: I see that you've been extensively involved in medtech development from bench to bedside. Have you been involved in or witnessed any procedural or technological innovations that you think are changing and transforming IR?

[05:45] Dr. Misono: Well IR is ever-changing so that is the one guarantee. And again, it is that is one of the things that draws many of us and clearly has drawn me to it. These days I’m excited about a couple of things. I'm excited about the companies that are working in the imaging side of IR.IR is a very data heavy field because radiology is a very data heavy field; there's quite a bit of imaging data that's being created at any given moment and manipulation of that data has not ever really been performed. It's just displayed on a two dimensional screen. So companies that are working in in VR and augmented, I think, will shape the future of how we interact with imaging data. So I find that to be very exciting.

I also think many companies have tried robotics in endovascular intervention and in interventional radiology and every time we turn around there's somebody else working on some new concept and I believe every iteration is getting a little better, a little bit more usable, more accessible. And while I’m not eager to do PACE procedures on my patients from three thousand miles away, I do realize that access to care is very important. I also believe in the—not reinvention—but evolution of interventional radiology into a field that embraces robotics and augmented reality is inevitable. And our backs are gonna thank us for no more lead eventually. And I think our patients will thank us because we will be able to offer access beyond the walls of physical institutions. That day is not today but without working on it now, we'll never get there.

[06:50] Dr. Baker: I’d love to expound on that a bit more. How did you get involved in augmented reality?

[07:00] Dr. Misono: We actually own an augmented reality system at our facility, and I am constantly, like many young IRs in particularly, looking around. At conferences I walk through the exhibit hall talking to people, and keep an eye on the social medica side of medicine to see what’s being posted there and in trade journals and so forth, to keep abreast of the latest technology. So when augmented reality started to bubble up in IR, and we’ve begun to see VR solutions come through in a variety of surgical intervention worlds, it caught my interest.

For an IR, we need to be able to see our hands, see the room and interact with the room. Doing that while also having augmented capabilities basically makes you a superhuman in terms of visualization. So when I saw that, I said we have to be part of the ground floor for deploying that into practice. I began more or less just experimenting with it at the beginning and then figuring out ways to clinically operationalize it.

There’s a variety of ways to get it into your hands, from using it at conferences to finding funds to acquire that technology in-house and actually operationalize it. I’m frankly still working on it in terms of operationalizing the technology.