The IR specialty has a come a long way from Charles Dotter’s day, and though it still embodies his innovative spirit, innovating is a lot harder these days—but it’s still possible if you know where to look, according to 2025 Charles T. Dotter lecturer Lindsay Machan, MD, FSIR.
Through his time as an innovator and entrepreneur—first co-founding Angiotech Pharmaceuticals, Inc, and then Ikomed Technologies Inc.—Dr. Machan has discovered several key lessons of innovation: observe, honor every opportunity to learn something new, work with people who have other skill sets, timing is everything, and work on a problem someone will pay for.
Dr. Machan shared the story of how Dr. Dotter took his ideas, refined them and then found ways to bring them to market, such as the time he met with Bill Cook at a convention, which resulted in his catheters being sold within days at the same convention.
However, because technology is more advanced, regulations are tighter and IRs are committed to evidence-based solutions, innovation doesn’t move that quickly anymore, Dr. Machan said. When the balloon catheter was introduced in the 1970s, it took 9 months to go from idea to patient-use, and cost approximately $5 million, Dr. Machan said. In 2000, drug-covered stents took 52 months to come to the market and cost $800 million.
"Despite how things have changed, the same cascade steps of innovation have stayed the same,” Dr. Machan said. “You cannot change the landscape, but you can change where you look for opportunities.”
So where do you look? Dr. Machan advises that you follow the money.
In the current healthcare landscape, the money is pointing at several key opportunities, Dr. Machan said: efficiency, disruption, digitization and AI.
Healthcare spending, especially in the United States and Canada, has increased, while performance has decreased, he said. Concurrently, outpatient revenue has increased, while inpatient service revenue has gone down and the ambulatory surgical center market grows.
Innovation that provides solutions to efficiency concerns, especially ones that tap into growing markets, may be key opportunities for exploration, Dr. Machan said.
Additionally, the digitalization of healthcare has brought high-tech expertise into the patient’s home, such as with cardiovascular care.
“Patients can get insight into their heart health at any time, on their wrist,” Dr. Machan said.
And these solutions are being delivered by technology “disrupters” who are not a part of the traditional healthcare landscape, such as Google or Apple.
Dr. Machan shared several examples of digital innovations, such as an AI-powered digital stethoscope which can share real-time interpretations of heart and lung sounds, thereby providing general practitioners with the expertise of specialized cardiologists and reducing unnecessary referrals.
Another example Dr. Machan pointed to is how biologics are meshing with smart devices, such as with renal artery pacemaker interrogation before denervation.
“Using a pacemaker can help you identity and find nerves and good responders, and verifies the completeness of the procedure,” Dr. Machan said.
Similarly, medical implants can converge with the information technology that comes standard in most phones now, to create new solutions like smart knee replacements. According to Dr. Machan, smart devices can be used to track dozens of things, even deep vein thrombosis.
The largest opportunity, however, may be in the evolution and integration of artificial intelligence into the healthcare system. It has multiple benefits, Dr. Machan said, such as enhanced imaging analysis, procedure planning and simulation, real-time decision support, patient outcome prediction, and continuous learning and improvement. And AI is even joining the workforce this year with Hippocratic AI, via AI “agents” that can be hired by heath systems to conduct low-risk, non-diagnostic, patient-facing services.
Dr. Machan was actually joined on stage by an AI doctor—not one of the Hippocratic AI agents, but an AI simulation trained on Dr. Dotter’s voice and image. After telling some jokes and answering a few questions, the AI-Dr. Dotter concluded his lecture with advice for the crowd.
“If you mix audacity with a bit of tubing and a dream of doing better for the patient, you can set the world on fire,” Dr. AI-Dotter said. “And if you find a better way to do something, publish it.”
