I want to thank everybody for having me here I'm really not as big a deal on Twitter as everybody thinks I am but I have had some fun on Twitter and hopefully we'll have a little bit of fun with this this is advanced IVC filter retrieval and if any of you all have

ever been on these cases they can have some pretty scary moments and but it's always satisfying when you get this piece of metal out of the patient no matter how mangled it may see and so I said this is really where a lot of my

tweets have come from is because I usually take a picture afterwards because the patient's always want to see what they look like when they come out unless I actually have data to be able to present and so this is kind of what

I've learned from Twitter about difficult IVC filter treatable so it all kind of I gotten invited to help out with this article and not only is this article about Twitter and Twitter are which is kind of our little hashtag we

use for the more active members in Twitter and Internet radiology it's a molarity - hashtag irad but we really wanted to understand the the ecosystem behind twitter for anniversary ology that practice and what I want to

say is that if you look at the names on here none of us are from the same institution this entire article was crowdsource through Twitter and through email we never met we wrote the paper all separate and then put it all

together and the board really just did a phenomenal job of keeping us on task to do this so what did we really come up with in this number one is the potential for public awareness of our specialty through several different communication

travels channels and Mishelle kind of talked about this a little bit but there's there's all different channels that are a parent on the social media and this is Twitter specific but it is all of the

social medias but you know I are too patient I aren't a patient advocacy groups I've learned a lot of the handles for things such as the I do a lot of pulmonary AVMs and so that society and and the hht society targeting them when

I put a quote about put a tweet in there IRD ir kumar can talk about that a little bit but that's really key I heard other specialties and this is not trolling this is actually inviting them and I'll show some examples of some

cross-pollination that's happened and then of course I our two trainees I really probably should put in there I our two texts or IRA nurses that that that community is growing as well we didn't have it in on our paper but and

then innovative uses in academics education and there was a abstract presented SAR that groups solely out of a call for help on Twitter and then if you've been around we have these Twitter chats around a certain topic and these

are really great ways of presenting questions and then have people answer those questions from all different backgrounds and this really has grown to all aspects of of health care Babri you who really is the the king of Twitter in

my mind if you he's at Denver he wrote this paper this is back in in 2000 and I believe when he wrote this article and he he actually came up with this whole idea of filter out and it's kind of funny because he he admits that he

started off writing fake tweets posing as Bob vogelzang when he was at Northwestern but he came up with this idea of creating a hashtag for a very specific procedure to bring awareness if you guys remember in 2010 was when the

CDC put out the information saying we need to start removing filters and this was a ground grassroots effort to kind of get the word out and and it had the it had the the benefits of getting this message out but also had benefits of

connecting people to specialties or centers where they could really get this done you can use a lot of different types of analytical devices this comes from hashtag fi comm and this is a analysis of the filter out and what

these lines and circles are or what is associated with filter out so you have PE as a big one you have I rat as a big one without a scalpel the gtfo which is one that I like to use it's not what you think it is it's get the filter out and

then what's what's really interesting is Vancouver had a we kind of had a high point of tweets in Vancouver and that surf 16 Vancouver actually made it to the big big leads so if you then take irad and take that out and say what what

is connected to IRAD you have cancer as the biggest one which i think is really interesting without a scalpel radiology NIP grad res again vancouver filter out just a little bit part of that in the thing and then I kind of thought I'd do

GTFO see what's associated with that and this was right around when Mariah Carey did her music video about it Trump resigned so that's the other gtfo not this gtfo is one of my tweets whoops and there it

is again

alright so hashtag filter Friday so this is kind of another fun way where you can post a true tweet we I don't know why they seem to always come on Friday for me maybe because there are a lot of

elective cases but we kind of throw in hashtag filter Friday so here's one of our colleagues and you can see from his tweets kinda hard for me to read here but the other thing he's done is you notice he's tagged everybody down below

that that does this here's one of mine which I just showed you from from there and I actually had I thought that my fellow had a hashtag but I had a handle but as you can see it didn't show up there Kim Kowski I found that one later

here's another filter Friday and then added the filter out to it problem is is that if you actually google or look for filter Friday you get stuff like this that this honey barbecue chicken strip that looks like a turd I have no idea

where the filter Friday came from but he got filter Friday this one is kind of interesting so it starts off Kumar did this one where he had a medical student he's reaching out the medical students did the filter out on the first try it's

got a nice picture of her on there and the the case you know tagged a bunch of us but what's just interesting is the positive affirmation that comes from this so it becomes almost like a little cheerleading so here's the as we go down

you can start to read some of these we got some some nice things here I was trying to say you know congratulations graduate everybody just kind of getting behind this person saying yeah and then you keep going and I mean this just kept

going and going and if you can read here is another Bob Vogel saying thing later I found out it's because it's hard to push the syringe beads through a micro catheter but hey it's still amazing and of course

another positive information the others

baking breaking boundaries so one thing that we all like to do is brag right we took this filter out that's been in for 50 years and you know all that sort of stuff so here's a Greenfield that was

in for over 25 years green fields as you know as a permanent filter in this patient it's a Friday so it's got to go another shout out to filter Friday but here's a you know incredible case where he was able to

remove a filter that had been in for 25 years so here's here's one of my cases where I have this filter that I threw out there and I had seen this 16 year old truck be shredded and this is another Bob reuse case and so I kind of

got excited about actually doing this case that I don't know if I would have felt comfortable doing that but I see that here's another one from Manny that had another op DS filter that was that was able to be removed so by getting

this filter out I would post this picture and say how you know how would other people attach that so this is that IR to IR part here's another one that Agnes Solberg put out real nice thing I think I have a video here can you run

that video where she has this is more almost like an Instagram type post whoops go back there play that little video there so she has some live pictures of what's going on in the case and she's put some nice graphics and

things like that but this is you know it was like the Pinterest of Twitter of Twitter complex IVC filter retrievals so anyway so I had this case and I actually did the case and tweeted about it afterwards and then I got a reply from

Christopher Ballman who's a said nice to see it come out in one place I personally like laser sheathe as for this filter because I've had nonmetal sheaths tear on me and cause filter fracturing embolism looks like this

plastic sheath was close to the same so he's actually looking at my text and commenting on fact that he would have done something a little bit differently which i think is wonderful here's another one where the fracture embedded

10-year old filter if you look on the on the right they're removed with the laser here's one on the left where the same sort of case was removed with a laser so we're all kind of cross pollinating there there's tips and tricks so here's

somebody that Bradley Thomas who's actually a master surgeon what was that what would your stress the community what would your strategy be if you referred this from outside Hospital after a failed first 1/10 of course he

said hashtag asking for a friend I'd say CT if not redone forceps and wire loop any other thoughts so I saw this and I had this exact same case in the past before if you see this this is a 3d reconstruction of a filter that has

penetrated tilted and penetrated outside the IVC on the top and the bottom side I was able to snare that from above using a loop snare and I pulled hard enough that I actually bent the the head of the filter over and was able to remove it

through the sheath and so a couple weeks later Babri you posts his exact same filter that's bent over like this he called it the ragdoll filter which I really like I think I've replied to him and said it look like a solvent or dolly

picture with the filter draped across the tree and then a follow-up from Brad Thomas says there it goes it's out and he did the exact same thing he couldn't bent the filter over so none of us talked or anything like this this is all

posted on social media you learn a lot about emerging technologies you learn about filters that are coming down the road Peter Horner a good friend of mine from from Denver who I correspond with

probably a year on Twitter before we met at a conference and just met up and had a drink so he talks about this filter that opens up after a period of time it can it converts to a stent with six months

96% within six months and then you have the absorb alive EC filter coming out of Indiana again with links to the publication's on it just all sorts of really cool things where you can learn about these new emerging technologies I

can't wait to get my hands on this device is the Aptus device that are the captives device sorry I kind of doing that Bob Ryu has been involved with which is a different way of of grabbing the top of the filter that doesn't

require a snare doesn't require a loop it actually kind of molds over the top of it and grabs and pulls it out here's another picture of it and I love this one where where Bob if you got a if you don't follow Bob you gotta follow him

he's got the greatest sense of humor but he says I was filter out with my brand-spanking-new Colorado filter a fellow Demetri with the cap to spice ho-hum he says to me kids today I say to him and then now the penultimate which

is the captives plus the laser and then this is how Luke Skywalker likes to do is filter out there are parody accounts as well and this is my favorite if you guys don't know Scott tree atoll he's been at Penn forever he's the chief and

chair there and vehemently opposed to social media so somebody put this together and if you don't know this he he has strong opinions first of all and two he wears these sneakers and he only does his cases in these white sneakers

and he's been using the same pair of sneakers for like 25 years so here's a tweet where Bill Strava law post said I wore those shows with the case once in the better filter jumped off patients on its own so that's

another way to get a filter out I guess you just wear those sneakers so thank you for your attention [Applause]

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