SIO 2024 Preview: A Conversation With Conference Chair Vijay Ramalingam

In this episode of the IOL Radio Podcast, Kavi Krishnasamy, MD, interventional radiologist at Columbia University Irving Medical Center, and his guest Vijay Ramalingam, MD, IR professional at Beth Israel Deaconess Medical Center, discuss the upcoming SIO 2024 Annual Scientific Meeting.

Welcome to IOL Radio, the podcast for IO Learning, a digital publication that covers the latest advancements in interventional oncology. This podcast episode is part of the SIO Corner, a collaboration between IO Learning and the Society of Interventional Oncology.  Today’s podcast features Dr Kavi Krishnasamy, an interventional radiologist at Columbia University Irving Medical Center, and his guest Dr Vijay Ramalingam, an IR professional at Beth Israel Deaconess Medical Center. They will discuss the upcoming SIO 2024 Annual Scientific Meeting and some of the unique sessions of interest interventional oncologists should mark on their calendars for the event. 

Dr. Krishnasamy:

I'm Kavi Krishnasamy. I'm an interventional radiologist at Columbia University, and welcome to the December edition of the SIO Corner podcast. We're very happy to welcome Vijay Ramalingam. Vijay, why don't you introduce yourself, please? 

Dr. Ramalingam:

Thanks for having me. As mentioned, my name is Vijay Ramalingam. I'm an interventional radiologist in Boston at Beth Israel Deaconess Medical Center. I've been here for a few years now. And, I'm also acting as the annual meeting chair for the 2024 Annual Scientific Meeting for the Society of Interventional Oncology. 

Dr. Krishnasamy:

Thanks again for being here, Vijay. Tell us a little bit more yourself. Where'd you train? How many years into practice are you? What's your predominant focus—or foci, I should say—in the IO realm? And, what's your passion in oncology? 

Dr. Ramalingam:

I did my residency at Boston Medical Center and my fellowship at Emory and graduated from fellowship in 2014. So, I've been out for just under 10 years at this point, and I would say that I've been pretty fortunate in that I've had a wide variety of experiences in interventional radiology in general. My first job was at Boston Medical Center. 

Boston Medical Center is really a tertiary care center that focuses on marginalized populations. As a result, we did a little bit of everything; interventional oncology, peripheral arterial disease, and I got really good experience there and I was fortunate to have really good mentorship there. After a few years, my wife and I made the decision to move to Louisiana for her career, and I was at the Ochsner Clinic where, I don't know how much you know about the program there, but at the time, it was the largest transplant center in the United States. 

And that really peaked my interest in getting involved in IO, and particularly liver IO and also portal hypertension, which was one of my focus areas in both my first job and one of my first mentors in fellowship. Obviously, being in the south and being at a transplant institute like Ochsner, I was able to become surrounded by great people such as Juan Jimenez and Tyler Sandow. 

I also had the opportunity to grow my practice and get a lot of professional fulfillment out of that. Fast forward to where I am now at Beth Israel Deaconess, where the section head here is actually the president of the Society of International Oncology, Muneeb Ahmed. A few years ago, my wife and I were looking to move back to the northeast, and an opportunity came up here where I was able to build out the portal hypertension practice and work with liver transplant, which are 2 of my interests, and then also grow out my ablation practice. I would say in the IO realm specifically, my real interest right now is thermal ablation. My biggest focus is in GU and prostate ablation. I do ablation everywhere in the body there, whether it's liver ablation or MSK ablation or soft tissue ablation. But, I would say the real area that we've been doing a lot of is prostate ablation. 

Dr. Krishnasamy:

Thanks for sharing and it seems like a lot of aspects to your practice are leading the evolution within the IO space, so that's that's really wonderful to hear. So, tell us more about SIO. How long have you been involved with SIO? What's the process of putting the annual meeting together like? 

Dr. Ramalingam:

I got involved in the Society of Interventional Oncology in 2013, at which point it was actually the World Congress of Interventional Oncology. I don't know if you remember that, at that time, WCIO was their annual meeting, and they did it every year in midtown Manhattan. 

I got involved as a fellow when I myself went to the resident and fellow program. And then, a few years later, they established their own society, which is now the Society of Interventional Oncology. So, I've been involved —I don't wanna say since the beginning—but towards the beginning. But then in 2017, when I was living in New Orleans, and at that time, the annual meeting was slated to be in New Orleans, I got recruited to act as the annual meeting representation for the local rep, basically. 

Every year, the annual scientific committee acquires somebody local who really knows the space and the people in the area, and it helps give an idea of what people nationally and around the world want to know. You want to make a meeting that really fits the area that you're holding the meeting in, and that's where that local rep gets involved. I got recruited on that and I've been on the annual meeting committee since. 

In terms of the society, I would say the thing that drew me to the Society of Interventional Oncology is the fact that I love the space and the work that we're doing within it. I really do believe that even though we hear so much about the liver, we're gonna see changes in interventional oncology and more procedures evolve in every part of the body in the next 10 years of our career. 

I think the society has really phenomenal people who have been at the cutting edge of IO care from the beginning. I also like the fact that SIO is a volunteer-driven organization and everybody is involved, from leadership, you know, in Muneeb's case as president of the society, all the way to the board of directors and committees. It's all volunteer-driven. People really just want to do a good job and push IO care and push the frontiers of the science in IO to see what we as a specialty can do for patients who oftentimes have no other options. 

Dr. Krishnasamy:

That's very well said. Incidentally, I was having a conversation about this yesterday. When it comes to SIR and SIO volunteering and the impact we have as IRs in a space where traditionally, you may not have people that are interested or available, right? So kudos to you for getting so involved and helping us progress and evolve over time. What are you most excited for for this year's annual meeting? 

Dr. Ramalingam:

I think for me, the hands-on Y90 dosimetry program is the piece I’m most excited for. It's a toss-up. There are several things I'm excited about. The breast cryoablation masterclass is gonna be cool. The private practice dedicated programming is gonna be interesting, but I think the Y90 dosimetry is the thing that I'm most interested in seeing and just seeing how it goes, I'm excited.

Dr. Krishnasamy:

And this master class is incorporated into the SIO meeting this year, right? That's a new thing for the annual meeting, correct? So, how did that happen? Why did that happen? 

Dr. Ramalingam:

This kind of goes back to your first question, and I've been talking so much that I apologize if these answers are a little too long—

Dr. Krishnasamy:

No. That's great. 

Dr. Ramalingam:

The interesting thing about the annual meeting is we rotate the committee so that people climb through and do every piece of it. And so, a couple years ago, I did the resident and fellow section, and then the next year, you do the workshop programming, and then you kinda climb through. And every year, the challenge is, how do you keep people interested, but then also how do you put new content out there that is relevant to the attendees? How do you incorporate the survey data after the event as well? We really take interest in talking to people at the meeting and listening to the surveys and seeing what people want.

Consistently, a theme has been more hands-on stuff. We want the ability to hear these world-renowned speakers talk about these things, but also how do you apply it? So, the masterclass evolved out of that. Traditionally, SIO has always done a masterclass on the Thursday before the meeting. A couple years ago, it was a Y90 masterclass. The initial masterclass was the musculoskeletal ablation masterclass, and now those have popped up everywhere. And then, this year, I decided on a breast ablation master class. The reasoning is that it's something that is established and it's something that we know works, but it's not yet in a place where it needs to be. There's just a lot of opportunity to push it forward in the next 5 or 10 years. 

The dosimetry program, on the other hand, while it's not technically a master class, is what I would say is hands-on programming. What that came out of was, if you look at our survey data—and I would say the same about myself, I'm pretty experienced in Y90 as you are, and we have done a lot of 90, but when I go to the meetings, the Y90 space is evolving so fast, particularly around dosimetry, that I would go hear some amazing speakers give these talks, and I would walk away and be like, “Well, that's great. But I have no idea how to do this.”

So, what the committee and myself came up with this year was to get 30 workstations set up in a room with 5 expert faculty. We got our industry partners to help us get 15 stations with a MIM setup and 15 stations with a Simplicit90Y setup. We're limiting it to 2 people per station. And there's actually gonna be 6 faculty who I believe are 6 of the top people in the world for dosimetry. They're gonna do very little didactic lecture because the didactic lectures will be during the day, but it'll be an opportunity for them to say, “Here's in 10 minutes what we think you need to know about dosimetry,” and then everything else will be case-based. 

So, somebody will present a case and then the attendees in the room will actually get to do their own dosimetry at a workstation and ask questions to rotating faculty so that you'll actually get a chance to do it. Now, whether this works or whether this blows up in our faces, we don't know yet, but it is a different way to teach Y90 dosimetry than what I've seen at some of the other meetings. 

Dr. Krishnasamy:

Well, that's a pretty amazing endeavor. I mean, you know as well as I do, there's a huge disparity in standard of care dosimetry, or what we consider standard of care dosimetry across the country and worldwide, really. And, there's All the way from BSA to MERG to partition to voxel base, right? 

As we go forward, I think that firstly, standardization is important. But then also getting everybody on the same page in terms of how to dose is important as well. So kudos to you guys for that. That's an amazing endeavor. I'm very excited to see that play out. Tell us more about the private practice symposium and the breast cryoablation master class. 

Dr. Ramalingam:

So the breast cryoablation masterclass is gonna be on the Thursday before the meeting. It's exciting. It's an exciting time in breast cryoablation. We're gonna be the first radiologic society to do this. The Society of Breast Surgery did something last year that was pretty good with breast ablation and they're getting involved in what we're doing as a  multidisciplinary program. Ours is very comprehensive for our colleagues in breast imaging who may have stepped away from ablation for a few years since they were in residency to somebody who is an interventional radiologist who is saying, “Well, you know, I do ablation in every other part of the body. I just need to know how to get involved in this space.” 

So, we tailored the master class—and by ‘we,’ I have to give credit to Rob Ward from Brown, who is the course co-director on that—to cover everything you need to know from A to Z. It's a 6-hour course. We cover tumor boards. We have surgeons and radiation oncologists speaking about the basics of breast cancer, what tumors should be ablated, what tumors really belong in either radiation or surgical treatment. And we're gonna cover how to get started in this space. The basic terminology and things you need to know about breast cancer, whether it's staging, and then the imaging pieces involved, and what we're hoping for is a 6 to 7-hour course where people can walk away and say, “You know, maybe I don't know everything about this, but I know enough to get started.” 

The private practice symposium, that really came out of what the entire committee felt was a need to engage our colleagues in practices that I would say the SIO, traditionally, haven't gotten as much viewership or as many attendees in the private practice space or in some of the OBL spaces. 

I think you and I both know there is a ton of great interventional oncology work being done outside of academic centers. And as a society, we're pushing education and we're pushing what we think is the leading edge of interventional oncology. We need to have people that are in those spaces doing this work, telling us what's working, what's not working, and how to build a practice in a setup that may not be the same as my setup or the same as your setup. And that was consistently reflected in the post-meeting surveys. 

One of the things that I noticed was oftentimes, the way this was alleviated is there would be one talk on a Saturday in the middle of the meeting which would be a private practice IO session. And, you know, if I'm sitting in a private practice session, and I asked a bunch of my friends who were in these different practices as well, it's like, well, a 12-minute talk is really not gonna make me pick up and go register for a meeting and go to it, which actually makes sense. 

So, why don't we just dedicate the whole Monday to it where it's 6 hours of dedicated programming from people who I think are pioneers in the space, the Sandeep Baglas and the Charlie Nuttings of the world. You can talk about the revenue considerations of doing IO work in an OBL or in a private practice space. How do you deal with some of the turf issues that may be different or the ability to get a tumor board together? And so, I think it's an exciting symposium. I think the program is outstanding, and I'm curious to see how it goes and what happens next, what'll be the next evolution of this program. 

Dr. Krishnasamy:

That's pretty phenomenal. And quite honestly, I know there are a lot of IRs and IOs out there that dabble in both spaces, right? And definitely, our IR/IO colleagues in private practice can teach us many things in academics and vice versa hopefully. So that's a great networking opportunity and educational opportunity all the way around. 

Now, I wanna go back to the master class format for breast cancer and I wanna pick your brain on something. I think one of the challenges that I see in these types of formats is you get 6 or 7 hours of programming, you learn a lot, and then you're trying to figure out how to apply it to your practice, and sometimes, you just need to have the ability to phone a friend, right? So how does SIO put IRs and IOs around the country in touch with each other with different levels of expertise, specifically related to breast cryoablation. How do you envision that working?

Dr. Ramalingam:

I think that's a great question. It is a question that I'm still figuring out myself, even in our daily practice, where you'll come across something and you'll be like, “Man, I know I saw this somewhere before, but how do I do it?” 

One of the things that I think is really nice about SIO which attracted me to them—and this is partially my personality—is that it is a really tight-knit society. There are a lot of social events during the meeting. We set it up this year so that there's a meet and greet networking social event where there'll be drinks and food, etcetera, on every night. Starting Thursday night, and going through Friday, Saturday, and Sunday, all event nights have something where people can go and meet their colleagues.

I think one of the advantages of the SIO is that you'll have residents literally walking up to people like Muneeb, who's the president of the SIO, and just saying, “Hey, I heard you give this talk. Can I introduce myself to you?” There's a lot of opportunities for that. The program is published with the names of our speakers and our colleagues who are doing this. And that's the other piece of it. There is also an element, like you're saying, where we need to make sure that as a society, we're putting out our educational materials in a manner in which people who are saying, “Well, I've sat at the master course, now I wanna be able to do it,” have access to these resources and the speakers who are in this space. 

Dr. Krishnasamy:

That's great. I'm sure everybody also tunes into this podcast on IO Learning, and then, everybody that joins or comes to SIO will definitely benefit from that as well. So, it's fantastic. Now, you already alluded to this a little bit on why you got involved with SIO. For somebody who is not involved with SIO, for somebody who's never been to the annual meeting, why should they get involved with SIO? How do they get involved with SIO? And then, why should they start going to the annual meeting as well? 

Dr. Ramalingam:

For the annual meeting, that's an easy one. I want everybody to go to the annual meeting. I think that, beyond my self interest in it, we've really—and by ‘we,’ I mean, the program committee and the board of directors—have really gone out of their way over the last several years to make sure the meeting has something for everybody. And that's what I would say. I think anybody that's doing IO can go to the meeting even for a day or 2 and get something out of it. You know? 

I'm passionate about prostate ablation. I'm well aware that there's like 5 of us in the country that do it. But somebody else who is like, “Hey, I do a ton of liver work.” You can go just on Friday and Saturday and really get a pretty comprehensive update on what you need to be doing. You can do some hands-on liver work, and there are a lot of opportunities to just get something out of it. Not to mention that, in general, I think that the societal members are all really nice people and it's just a great opportunity to network with colleagues around the world. 

This year, we have people coming from Europe, South America, Asia, continental Africa, and, of course, the United States. I'm sure I'm also forgetting some other places. But, I mean, it's a widespread group of great people to meet and network with on top of the content. 

In terms of the other piece of it, I think societal involvement is a good thing, and I think what you need to figure out is which society interests you. Not every place is gonna be for everybody, and I totally get that, we're all adults and have different interests in different things. But I've enjoyed the SIO because it's a place where you can volunteer starting day 1. 

Find a place where you'll really feel included and really feel like you'll have a voice in shaping the next several years of that society. With that, you know, there are several added benefits. You meet people, through my involvement in the society, I met my current boss. We met at the annual meeting and we kept in contact. And when the right opportunity came up, It worked out. There are a lot of those opportunities and that's why I think it is nice to be involved in something where you can shape the future of it. 

And if you wanna get involved, it's actually quite easy. You can go to the website and just fill out one of the volunteer forms. You can literally email anybody who's involved with the society now and you'll get a response back as well. If somebody emailed me today and was like, “Hey. I wanna get involved.” At minimum, I could get them to the right people and say, “This is who you should talk to.” And there's so much exciting work being done within the society right now that there are just a ton of opportunities to get involved and help push the society forward. 

Dr. Krishnasamy:

I know you alluded to it earlier, but there are so many new technologies coming as well, right? The algorithms are very rapidly changing for how we treat these patients and where the IR/IO involvement actually is. So it's an exciting time.One other thing I'll add, and you can tell me that this is way out there, but I feel like you need a competition at SIO, and the winner can get a 1-year dosimetry software MIM membership or whatever it's called. 

Dr. Ramalingam:

Interestingly enough, we do have trivia night on Saturday night of the meeting, it's pretty fun. You're living in New York, so, you know when you go to one of the local pubs and you play trivia? Well, it's set up just like that, and usually 2 people on the program committee host it. And we all put questions in, and it's actually very little IO. There is some IO in there, but it's more just like random trivia. There's also a prize for the winning team. I don't actually know what the prize is this year. It might be a free annual membership, but I don't wanna say that because I'm not sure, but there are opportunities for free prizes. The competitions are there. 

Dr. Krishnasamy:

I love it. That's even better. I'm glad you brought that up. Well, you know, Vijay, it's been a pleasure. Is there anything else that you want to add about SIO, the annual meeting, or volunteering?

Dr. Ramalingam:

Thank you for having me. This has been amazing just to talk through the annual meeting. I would say the only thing I would add is if you're interested and you wanna get involved or if you have any more questions, feel free to reach out to me. I'm happy to talk about it, but I think it's gonna be a great meeting. I can truly say there's something for everybody doing IO, there will be something there that they'll get something out of. 

That wraps up another insightful podcast discussion for IO Learning. To listen to more conversations on topics of interest to interventional oncologists, please visit the podcast page at iolearning.com. 

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