Clinical Focus

  • Interventional Radiology and Diagnostic Radiology

Academic Appointments

Professional Education

  • Residency: University of Texas Southwestern Radiology Residency (1996) TX
  • Board Certification: American Board of Radiology, Interventional Radiology and Diagnostic Radiology (2017)
  • Board Certification: American Board of Radiology, Pediatric Radiology (2017)
  • Fellowship: UT Southwestern Pediatric Radiology Fellowship (2014) TX
  • Fellowship: UTHSC San Antonio Vascular and Interventional Radiology Fellowship (1997) TX
  • Medical Education: University of Texas Southwestern Medical School Registrar (1992) TX

All Publications

  • Sociodemographic Disparities in the Diagnostic Management of Pediatric Thyroid Nodules. JAMA otolaryngology-- head & neck surgery Moon, P. K., Qian, Z. J., Noel, J. E., Orloff, L. A., Seeley, H., Hartman, G. E., Josephs, S., Meister, K. D. 2022


    Importance: Thyroid cancer is the most common pediatric endocrine malignant neoplasm. Disparities in the workup of thyroid nodules may be significantly associated with thyroid cancer outcomes.Objective: To determine the association of sociodemographic factors with the odds of receiving a biopsy, timeliness of the procedure, and risk of nodule malignancy.Design, Setting, and Participants: This was a retrospective cross-sectional study using insurance claims data from the Optum Clinformatics Data Mart database. The study cohort comprised pediatric patients diagnosed with single thyroid nodules between 2003 and 2020. Data analysis was performed from January 1, 2003, to June 30, 2020.Main Outcomes and Measures: Multivariable logistic regression models were used to identify demographic variables associated with biopsy and nodule malignant neoplasm. A multivariable linear regression model was used to assess the time between thyroid nodule diagnosis and biopsy.Results: Of 11 643 children (median [IQR] age at diagnosis or procedure, 15 [12-17] years; 8549 [73.2%] were female and 3126 [26.8%] were male) diagnosed with single thyroid nodules, 2117 (18.2%) received a biopsy. Among the patients who received a biopsy, 304 (14.4%) were found to have a malignant nodule. Greater parental education was associated with a shorter diagnosis-to-biopsy interval (mean difference, -7.24 days; 95% CI, -13.75 to -0.73). Older age at nodule diagnosis (odds ratio [OR], 1.11; 95% CI, 1.09-1.13) and female gender (OR, 1.25; 95% CI, 1.11-1.40) were associated with increased odds of receiving a biopsy, while Black/African American (OR, 0.80; 95% CI, 0.65-0.99) and Hispanic (OR, 0.84; 95% CI, 0.72-0.99) patients had lower odds of receiving a biopsy compared with White patients. Finally, female gender (OR, 1.08; 95% CI, 0.80-1.47) was not associated with lower odds of nodule malignant neoplasm.Conclusions and Relevance: Findings of this cross-sectional study highlight disparities in the diagnostic management of pediatric thyroid nodules. These results call for future work to ensure equitable access to thyroid care for all children.

    View details for DOI 10.1001/jamaoto.2022.3167

    View details for PubMedID 36227590

  • Update on Pediatric Interventional Radiology. Radiographics : a review publication of the Radiological Society of North America, Inc Young, V. A., Thakor, A. S., Josephs, S. C. 2022; 42 (6): 1580-1597


    The field of pediatric interventional radiology encompasses the treatment of a broad range of patients. Whether treating a premature infant who weighs less than 1 kg or treating an adult-sized teenager who weighs more than 100 kg, the innovative skills of the interventional radiologist are required to adapt equipment designed for adult patients, to meet the needs of children. Moreover, children cannot be treated simply as small adults owing to a number of factors, including differences in physiology, disease processes, and treatment techniques between pediatric and adult patients. In this article, the unique medical needs of children are highlighted, noting specific areas the interventional radiologist should be aware of when treating patients of all ages. Specific focus is placed on the unique considerations related to children in terms of their periprocedural needs and the procedural modifications required for routine pediatric procedures, with specific diseases of the liver, chest, and musculoskeletal system highlighted. The broader topic of vascular anomalies, although an important part of pediatric interventional radiology, was intentionally excluded to highlight some of the lesser-known procedures performed. ©RSNA, 2022.

    View details for DOI 10.1148/rg.220019

    View details for PubMedID 36190845

  • Kidney Replacement Therapy in Low Birth Weight Preterm Newborns. Pediatrics Sutherland, S. M., Davis, A. S., Powell, D., Tanaka, J., Woo, M., Josephs, S., Wong, C. J. 2022


    Managing newborns with kidney failure is a complex undertaking; even under ideal circumstances, dialysis is technically challenging and available therapies are designed for adults. These issues are exacerbated in smaller newborns, and intervention has traditionally not been offered in those below a certain weight threshold. Ethical concerns abound and patients deemed too small for dialysis are typically transitioned to comfort or palliative care. However, many of these neonates are otherwise healthy and would be considered survivable if kidney replacement therapy were available. To challenge the existing paradigm, we present 7 preterm, low birth weight neonates with end-stage kidney disease who were successfully managed using an innovative approach to kidney replacement therapy. These newborns had a median gestational age of 32 weeks (interquartile range [IQR], 32-35) and a median birth weight of 1.58 kg (IQR, 1.41-2.01). Kidney replacement therapy was initiated at a median age of 16 days (IQR, 1.5-40) and a weight of 1.85 kg (IQR, 1.57-2.1). Five of the 7 newborns (71%) survived to hospital discharge. Kidney replacement therapy was provided using 3F and 4F single lumen catheters and a modified ultrafiltration device. Patients experienced excellent metabolic control, and fluid homeostasis was achieved in the first week of life. Furthermore, survivors experienced physiologic weight gain and linear growth throughout their hospitalization. These findings, although preliminary, are encouraging for our smallest patients with kidney failure and suggest that survivability thresholds should be reexamined. At a minimum, neonatologists should be aware that novel approaches exist and may be considered for these challenging patients.

    View details for DOI 10.1542/peds.2022-056570

    View details for PubMedID 35945293

  • Pediatric trauma and the role of the interventional radiologist. Emergency radiology Annam, A., Josephs, S., Johnson, T., Kulungowski, A. M., Towbin, R. B., Cahill, A. M. 2022


    PURPOSE: While interventional radiologists occupy a critical role in adult trauma management, the role of interventionalist in pediatric trauma continues to evolve. The indications for transarterial embolization (TAE) are significantly different in pediatric patients in whom non-operative management (NOM) has a much more prominent role than in adults. Contrast extravasation on imaging may not require acute surgical or interventional management as it would in an adult. There are also areas in which pediatric interventional radiology is increasingly useful such as pelvic TAE in failed management, or splenic embolization to treat bleeding without the loss of splenic function inherent to surgical splenectomy. The rapid evolution of techniques and devices in pediatric patients is also changing what interventions are possible in pediatric trauma management which necessitates frequent reassessment of the guidelines and interventional radiology's role in caring for these patients.CONCLUSION: This review seeks to consolidate the recent literature to describe the evolving role of the interventional radiologist in pediatric trauma management.

    View details for DOI 10.1007/s10140-022-02067-9

    View details for PubMedID 35678950

  • Radiological management of traumatic lymphatic injuries in children JOURNAL OF PEDIATRIC SURGERY CASE REPORTS Khan, M. S., Casson, C., Bergman, G., Mokdad, A., Josephs, S., Qureshi, F. G. 2021; 74
  • Multidisciplinary management of newly diagnosed pediatric large cell neuroendocrine carcinoma of the lung causing hemoptysis. Pediatric blood & cancer Marquez, C. P., Violari, E. G., Sodji, Q., Jiang, A. L., Donaldson, S. S., Josephs, S., Hiniker, S. M. 2021: e29182

    View details for DOI 10.1002/pbc.29182

    View details for PubMedID 34125484

  • Society of Interventional Radiology Quality Improvement Standards for Percutaneous Nephrostomy in the Pediatric Population. Journal of vascular and interventional radiology : JVIR Cahill, A. M., Annam, A., Baskin, K. M., Caplin, D., Cramer, H. R., Connolly, B., Crowley, J., Heran, M., Himes, E. A., Hogan, M. J., Josephs, S., Pabon-Ramos, W., Prajapati, H., Shivaram, G., Towbin, R., Vaidya, S. S. 2021; 32 (1): 146–49

    View details for DOI 10.1016/j.jvir.2020.07.029

    View details for PubMedID 33388108

  • Return to Native Drainage: Duodenal Biliary Fistula Formation Following Pediatric Hepatobiliary Surgery with Roux-en-Y Reconstruction. Digestive diseases and sciences Barakat, M. T., Josephs, S., Gugig, R. 2020

    View details for DOI 10.1007/s10620-020-06372-6

    View details for PubMedID 32533541

  • Dynamic Hydrodissection for Skin Protection during Cryoablation of Superficial Lesions. Journal of vascular and interventional radiology : JVIR Sandberg, J. K., Shoaf, K. R., Lungren, M. P., Young, V. A., Josephs, S., Thakor, A. S. 2020

    View details for DOI 10.1016/j.jvir.2020.01.025

    View details for PubMedID 32418774

  • Achieving Speaker Gender Equity at the SIR Annual Scientific Meeting: The Effect of Female Session Coordinators. Journal of vascular and interventional radiology : JVIR Ghatan, C. E., Altamirano, J., Fassiotto, M., Perez, M. G., Maldonado, Y., Josephs, S., Sze, D. Y., Kothary, N. 2019


    PURPOSE: To examine the impact of targeted efforts to increase the number of female speakers at the Society of Interventional Radiology (SIR) Annual Scientific Meeting (ASM) by reporting gender trends for invited faculty in 2017/2018 vs2016.MATERIALS AND METHODS: Faculty rosters for the 2016, 2017, and 2018 SIR ASMs were stratified by gender to quantify female representation at plenary sessions, categorical courses, symposia, self-assessment modules, and "meet-the-expert" sessions. Keynote events, scientific abstract presentations, and award ceremonies were excluded. In 2017, the SIR Annual Meeting Committee issued requirements for coordinators to invite selected women as speakers. Session coordinators are responsible for issuing speaker invitations, and invited speakers have the option to decline.RESULTS: Years 2017 and 2018 showed increases in female speaker representation, with women delivering 13% (89 of 687) and 14% (85 of 605) of all assigned presentations, compared with 9% in 2016 (46 of 514; P= .03 and P= .01, respectively). Gender diversity correlated with the gender of the session coordinator(s). When averaged over a 3-year period, female speakers constituted 7% of the speaker roster (112 of 1,504 presentations) for sessions led by an all-male coordinator team, compared with 36% (108 of 302) for sessions led by at least 1 female coordinator (P < .0001). Results of the linear regression model confirmed the effect of coordinator team gender composition (P < .0001).CONCLUSIONS: Having a woman as a session coordinator increased female speaker participation, which suggests that the inclusion of more women as coordinators is one mechanism for achieving gender balance at scientific meetings.

    View details for DOI 10.1016/j.jvir.2019.07.006

    View details for PubMedID 31587951

  • Untapped Resources: Attaining Equitable Representation for Women in IR JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY Perez, M. G., Fassiotto, M., Altamirano, J., Hwang, G. L., Maldonado, Y., Josephs, S., Sze, D. Y., Kothary, N. 2019; 30 (4): 579–83
  • Untapped Resources: Attaining Equitable Representation for Women in IR. Journal of vascular and interventional radiology : JVIR Perez, M. G., Fassiotto, M., Altamirano, J., Hwang, G. L., Maldonado, Y., Josephs, S., Sze, D. Y., Kothary, N. 2019


    PURPOSE: To investigate the current state of gender diversity among invited coordinators at the Society of Interventional Radiology (SIR) Annual Scientific Meeting and to compare the academic productivity of female interventional radiologists to that of invited male coordinators.MATERIALS AND METHODS: Faculty rosters for the SIR Annual Scientific Meetings from 2015 to 2017 were stratified by gender to quantify female representation among those asked to lead and coordinate podium sessions. To quantify academic productivity and merit, H-index, publications, and authorship by females over a 6-year period (2012-2017) were statistically compared to that of recurring male faculty.RESULTS: From 2015 to 2017, women held 7.1% (9/126), 4.3%, (8/188), and 13.7% (27/197) of the available coordinator positions for podium sessions, with no representation at the plenary sessions, and subject matter expertise was concentrated in economics and education. Academic productivity of the top quartile of published female interventional radiologists was statistically similar to that of the invited male faculty (H-index P= .722; total publications P= .689; and authorship P= .662).CONCLUSIONS: This study found that senior men dominate the SIR Annual Scientific Meeting, with few women leading or coordinating the podium sessions, despite their established academic track record.

    View details for PubMedID 30772166

  • Successful Medical Management of Life-threatening Hepatic Hemangioma in Neonates. Pediatrics Lekwuttikarn, R. n., Josephs, S. n., Teng, J. M. 2019


    Hepatic hemangioma (HH) is a common asymptomatic, self-limiting benign vascular tumor of the liver in neonates. Although complicated HHs are rare, they have significant risks of morbidity and mortality, especially during the perinatal period. Because of the high risks of complications from surgical interventions, there is an unmet need for effective medical therapy. We report 2 neonates with life-threatening HH who were evaluated for a liver transplant before being treated successfully with combined medical therapy, which included sirolimus, corticosteroids, and propranolol.

    View details for DOI 10.1542/peds.2019-1339

    View details for PubMedID 31511312