UP TO AMA PRA CATEGORY 1 CREDITS

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1 EXCELLENCE IN EDUCATION FOR INTERVENTIONAL PAIN PHYSICIANS CADAVER WORKSHOP AND ONLINE VIDEO LECTURES BASIC, INTERMEDIATE, AND ABIPP PREPARATION FEBRUARY 1-2, 2014 IMAGING, FLUOROSCOPY, AND RADIATION SAFETY JANUARY 31, 2014 UP TO AMA PRA CATEGORY 1 CREDITS HOTEL & COURSE LOCATION: EMBASSY SUITES PHOENIX NORTH, 2577 WEST GREENWAY ROAD, PHOENIX, AZ CADAVER WORKSHOP: SCIENCE CARE, 2020 WEST MELINDA LANE, PHOENIX, AZ (800) n SPECIAL ROOM RATES THRU JANUARY 1, 2014 n 75% OFF MEETING FEE TO FELLOWS & RESIDENTS. ASIPP American Society of Interventional Pain Physicians THE VOICE OF INTERVENTIONAL PAIN MANAGEMENT SINCE LAKEVIEW DRIVE, PADUCAH, KENTUCKY PHONE: FAX: WEB: asipp@asipp.org

2 FROM THE CHAIRMAN AND CEO On behalf of the Board of the American Society of Interventional Pain Physicians, it is my privilege and pleasure to invite you to attend the Cadaver Workshop (Basic, Intermediate, and ABIPP Preparation), February 1-2, 2014 and the Imaging, Fluoroscopy, and Radiation Safety course on January 31, We have revised our program to meet continuing needs of interventionalists, based on input and needs assessment over the years and created a state-of-the-art educational program of didactic courses covering various interventional techniques under fluoroscopy and a comprehensive hands-on interventional Cadaver Workshop. We have changed the seminar and workshop to accommodate training levels and capacity of participants. On the first day, the comprehensive review course in Imaging, Fluoroscopy, and Radiation Safety is designed to provide interventional pain physicians with the ability to understand fluoroscopic interpretation and appropriate needle placement. This course is an essential component for interventional pain physicians and provides education opportunities to assist you in providing high quality, competent, safe, accessible, and cost-efficient services to your patients. This course, as with all ASIPP courses, focuses on doing the right things, the right way, and for the right reasons. The comprehensive cadaver workshop is also planned to prepare physicians seeking board certification by ABIPP, obtain necessary CME credits and/or as an in-depth review of interventional techniques. Participants will experience a comprehensive and intense learning opportunity focusing either on basic, intermediate or advanced techniques, or non-spinal interventional techniques. Participants will also benefit from the experience of individual physicians across the United States. During the 1½ day cadaver hands-on workshop, physicians can improve existing skills, learn new skills, prepare for the interventional techniques certification examination, or prepare for the board examination. Whether you have been practicing interventional pain management for many years or are new to the field with basic skills, we are confident you will find this Imaging, Fluoroscopy, and Radiation Safety review course and cadaver workshop to be beneficial, as it is essential to learn new and relevant information to survive in the new millennium. Our faculty consists of many experts in the field of interventional techniques. We trust you will be as excited as we are about this exceptional opportunity for professional enhancement. We hope you will make your plans early to attend. We look forward to seeing you in Phoenix. If you have any questions, please feel free to contact me at 2831 Lone Oak Road, Paducah, KY 42003, phone: ext. 101, fax: , or drm@asipp.org Thank you, Laxmaiah Manchikanti, Chairman of the Board and Chief Executive Officer, ASIPP American Society of Interventional Pain Physicians THE VOICE OF INTERVENTIONAL PAIN MANAGEMENT SINCE Lakeview Drive, Paducah, KY Phone: Fax: asipp@asipp.org Web Site: CHAIRMAN OF THE BOARD AND CHIEF EXECUTIVE OFFICER Laxmaiah Manchikanti, MD Paducah, KY PRESIDENT Hans C. Hansen, MD Conover, NC IMMEDIATE PAST PRESIDENT Frank J.E. Falco, MD Newark, DE PRESIDENT-ELECT Ramsin M. Benyamin, MD Bloomington, IL FIRST EXECUTIVE VICE PRESIDENT David L. Caraway, MD, PhD Huntington, WV SECOND EXECUTIVE VICE PRESIDENT Aaron K. Calodney, MD Tyler, TX VICE PRESIDENT STRATEGIC PLANNING Francis Riegler, MD Malibu, CA SECRETARY Peter S. Staats, MD Shrewsbury, NJ TREASURER David Bryce, MD Middleton, WI LIFETIME DIRECTORS Cyrus E. Bakhit, MD Roanoke, VA Laxmaiah Manchikanti, MD Paducah, KY Vijay Singh, MD Niagara, WI DIRECTORS AT LARGE Salahadin Abdi, MD, PhD Houston, TX Mark V. Boswell, MD, PhD Louisville, KY Harold Cordner, MD Sebastian, FL Tim Deer, MD Charleston, WV Sudhir Diwan, MD New York, NY Haroon Hameed, MD Blatimore, MD Mariam Hameed, MD Boston, MA Joshua A Hirsch, MD Boston, MA Alan Kaye, MD, PhD River Ridge, LA Allan T. Parr, MD Covington, LA Gabor B. Racz, MD Lubbock, TX David M. Schultz, MD Minneapolis, MN John R. Swicegood, MD Fort Smith, AR Andrea M. Trescot, MD Eagle River, AK DIRECTORS EMERITUS Standiford Helm II, MD Laguna Hills, CA David S. Kloth, MD Danbury, CT PAIN PHYSICIAN EDITOR-IN-CHIEF Alan David Kaye, MD, PhD New Orleans, LA AMA DELEGATES Lee T. Snook, MD Sacramento, CA Haroon Hameed, MD Baltimore, MD STAFF Melinda Martin, Director of Operations Ray Lane, Director of Public Relations Holly Long, Coordinator of Editorial Services Vidyasagar Pampati, Statistician and Programmer Paula Reynolds Spear, Meeting Coordinator Tom Prigge, Multimedia Specialist Cindy Rogers, Administrative Assistant Summer Moffitt, Administrative Assistant GOVERNMENT AFFAIRS COUNSEL Senator Tim Hutchinson & Randi Hutchinson, Esq., Dickstein Shapiro, LLP, 1825 Eye Street NW Washington, DC hutchinsont@dicksteinshapiro.com Jeff Mortier, Legislative Partner Ryan, Mackinnon, Vasapoli and Berzok, LLP 134 Eye Street NW, Suite 1200 Washington, DC 2000 GENERAL COUNSEL Erin Brisbay McMahon JD, Wyatt, Tarrant & Combs, LLP, 250 West Main Street, Suite 100 Lexington, KY emcmahon@wyattfirm.com 2 AMERICAN SOCIETY OF INTERVENTIONAL PAIN PHYSICIANS

3 IMAGING, FLUOROSCOPY, AND RADIATION SAFETY DESCRIPTION This 1-day review course includes didactics on the topic of fluoroscopy. Participants experience a comprehensive and intense learning opportunity, focusing on interventional pain management techniques. TARGET AUDIENCE/PURPOSE This intensive review course in fluoroscopy is planned as a CME activity for interventional pain physicians for review, skills improvement or to fullfil state board requirements for CME hours in fluoroscopic interpretation and radiation safety. OBJECTIVES After this course, participants should be able to: - Describe the delivery of multiple aspects of interventional pain management. - Review multiple areas of interventional pain management including fluoroscopic interpretation and radiation safety - Demonstrate skills through interactive review of images ACCREDITATION STATEMENT This CME activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education thru the Joint Sponsorship of The Institute for Medical Studies (IMS) and the American Society of Interventional Pain Physicians. IMS is accredited by the ACCME to provide continuing medical education for physicians. CATEGORY I CREDIT The Institute for Medical Studies designates this live activity for a maximum of 7.5 AMA PRA Category 1 Credits. Physicians should only claim credit commensurate with the extent of their participation in the activity. AMERICANS WITH DISABILITIES ACT & SPECIAL SERVICES Organizers fully comply with the legal requirements of the Americans with Disabilities Act and the rules and regulations thereof. If any participant in this educational activity is in need of accommodations, please contact the organizers at (270) at least 10 days prior to the conference. OUTCOME ACCOMMODATIONS Physicians should be able to integrate multiple aspects of fluoroscopy in Embassy Suites Phoenix North interventional pain management in treating their patients so that patients 2577 West Greenway Road, Phoenix, have better outcomes and reduced side effects. AZ Phone: for Medical Studies (IMS) and ASIPP. IMS is accredited by the ACCME to Inform the agent that you are booking provide continuing medical education for physicians. for American Society of Interventional Pain Physicians. We have secured a group room rate of $129. Reserve rooms early all unbooked rooms will be released after January 1, THERE IS NO COMMERCIAL SUPPORT FOR THIS COURSE. NO DUPLICATION OR DISTRIBUTION OF MATERIALS, OR RECORDING OF LECTURES ASSOCIATED. THERE IS NO COMMERCIAL SUPPORT FOR THIS COURSE. COURSE DIRECTORS Laxmaiah Manchikanti, MD Chairman of the Board and CEO, ASIPP Medical Director, Pain Management Center Paducah, KY Clincal Professor of Anesthesiology and Perioperative Medicine, University of Louisville Louisville, KY Hans C. Hansen, MD President, ASIPP Medical Director The Pain Relief Centers, LLC Conover, NC FACULTY Sheri Albers, DO Director of Research Radiology Research and Consultation Sacramento, California Frank J. E. Falco, MD Immediate Past President, ASIPP Medical Director, Midatlantic Spine Newark, DE Clinical Assistant Professor Temple University Medical School Philadelphia, PA David M. Schultz, MD Director-at-Large, ASIPP Medical Director Medical Advanced Pain Specialists Minneapolis, MN Louis K. Wagner, PhD Professor of Radiology Chief Physicist Dept. of Diagnostic and Interventional Imaging University of Texas Medical School Houston, Texas Arthur Watanabe, MD Spinal Diagnostics Spokane, WA AMERICAN SOCIETY OF INTERVENTIONAL PAIN PHYSICIANS 3

4 IMAGING, FLUOROSCOPY, AND RADIATION SAFETY IMAGING, FLUOROSCOPY, AND RADIATION SAFETY FRIDAY JANUARY 31, :00am 8:00am Registration (Complimentary breakfast provided by the Embassy Suites for attendees staying at host hotel) 8:00am 8:30am Introduction Laxmaiah Manchikanti, MD 8:30am 9:00am Evolution, Basic Principles and Mechanics of X-Ray and Fluoroscopy Louis K. Wagner, PhD 9:00m 9:30am Principles of Radiation Safety Louis K. Wagner, PhD 9:30am 10:00am Clinical Aspects of Fluoroscopic Safety in Interventional Pain Management David Schultz, MD 10:00am 10:30 BREAK 10:30am 11:00am Lumbar Spine Fluoroscopy, Needle Placement and Image Interpretation Frank Falco, MD 11:00am 11:30am Cervical Spine Fluoroscopy, Needle Placement and Image Interpretation Arthur Watanabe, MD 11:30am 12:00pm Head and Neck Fluoroscopy, Needle Placement and Image Interpretation Sheri Albers, MD 12:00pm 1:00pm LUNCH - Provided 1:00pm 1:30pm Fluoroscopy, Needle Placement and Image Interpretation: Thorax, Chest and Abdomen Frank Falco, MD 1:30pm 2:00pm Thoracic Spine Fluoroscopy, Needle Placement and Image Interpretation Arthur Watanabe, MD 2:00pm 2:30pm Fluoroscopy, Needle Placement and Image Interpretation of Extremities Sheri Albers, DO 2:30pm 3:00pm BREAK 3:00pm 3:30pm Regulatory Aspects of Fluoroscopy Louis K. Wagner, PhD 3:30pm 4:00pm Complications of Interventional Techniques David Schultz, MD 4:00pm 5:30pm Review of Images and Questions ALL FACULTY 5:30pm ADJOURN 4 AMERICAN SOCIETY OF INTERVENTIONAL PAIN PHYSICIANS

5 CADAVER WORKSHOP DESCRIPTION, PURPOSE AND TARGET AUDIENCE This 1½-day workshop is designed for interventional pain physicians, for a review, skills improvement, or to assist in preparation for Comprehensive Interventional Pain Management Examination qualifications. ASIPP offers the most in-depth, comprehensive, and individualized programs available in interventional pain management, featuring maximum hands-on training with cadavers in a state-of-the-art facility and maximum ability to interact with other participants. Participants will experience a comprehensive and intense learning opportunity, focusing on interventional pain management techniques. Each cadaver station is limited to a maximum of 7 participants. Participants can choose the level of participation: basic, intermediate, or Comprehensive Interventional Pain Management Examination Preparation Course. C-arms and state-of-the-art equipment are utilized in this course. Participants are requested to dress in casual attire or scrubs. Leaded aprons and thyroid shields will be provided. However, participants are advised to bring their own protective eyewear. Participants will be provided with 7 video lectures relevant to the course material The workshop is offered to improve the delivery of multiple aspects of interventional pain management. The desired outcome is to integrate multiple aspects of interventional pain management in treating your patients so that patients have better outcomes and reduced side effects. OUTCOME Physicians should be able to integrate multiple aspects of interventional pain management techniques in patient treatments so that patients have better outcomes and reduced side effects. ACCREDITATION AND CME CREDIT STATEMENTS This live and online CME activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education thru the Joint Sponsorship of the Institute for Medical Studies (IMS) and ASIPP. IMS is accredited by the ACCME to provide continuing medical education for physicians. The Institute for Medical Studies designates this educational activity for a maximum of AMA PRA Category 1 Credits. Physicians should only claim credit commensurate with the extent of their participation in the activity. AMERICANS WITH DISABILITIES ACT & SPECIAL SERVICES Organizers fully comply with the legal requirements of the Americans with Disabilities Act and the rules and regulations thereof. If any participant in these educational activities is in need of accommodations, please contact the organizers at (270) at least 10 days prior to each conference. CADAVER WORKSHOP SITE Science Care sets the standard of excellence for the donation and responsible use of human tissue for medical research, training and professional education. Science Care is the only organization to be accredited by both the American Association of Tissue Banks (AATB) and accredited as a provider by the Accreditation Council for Continuing Medical Education (ACCME). THERE IS NO COMMERCIAL SUPPORT FOR THIS COURSE. NO DUPLICATION OR DISTRIBUTION OF MATERIALS, OR RECORDING OF LECTURES ASSOCIATED. THERE IS NO COMMERCIAL SUPPORT FOR THIS COURSE. CADAVER LAB COURSE LEVELS BASIC INTERMEDIATE COMPREHENSIVE IPM EXAMINATION PREPARATION - ADVANCED 1. Caudal epidural injections 2. Lumbar interlaminar epidural injections 3. Lumbar transforaminal epidural injections 4. Sacroiliac joint interventions 5. Lumbar facet joint nerve blocks. Thoracic facet joint nerve blocks 7. Cervical facet joint nerve blocks 8. Lumbar facet radiofrequency neurotomy 1. Lumbar discography 2. Percutaneous adhesiolysis 3. Lumbar sympathetic blocks and hypogastric plexusblocks 4. Lumbar facet joint nerve blocks and radiofrequency neurotomy 5. Cervical and thoracic interlaminar epidurals. Thoracic facet interventions (medial branch blocks, and radiofrequency neurotomy) 7. Cervical facet joint interventions (medial branch blocks, and radiofrequency neurotomy) 8. Celiac plexus block 1. Caudal, lumbar, thoracic, cervical interlaminar epidural 2. Lumbar transforaminal and discography 3. Lumbar facet joint interventions (facet joint nerve blocks, and radiofrequency neurotomy) 4. Thoracic facet joint interventions (medial branch blocks and radiofrequency neurotomy), intercostal nerve blocks 5. Cervical facet joint interventions (medial branch blocks and radiofrequency neurotomy). Spinal cord stimulation lead placement 7. Sympathetic blockade (stellate ganglion, lumbar sympathetic blocks and celiac plexus blocks) 8. Sacroiliac injections joint injections and adhesiolysis AMERICAN SOCIETY OF INTERVENTIONAL PAIN PHYSICIANS 5

6 CADAVER WORKSHOP COMPREHENSIVE REVIEW COURSE NOTE: THE ONLINE REVIEW COURSE VIDEOS MUST BE VIEWED PRIOR TO ATTENDING THE SATURDAY FEBRUARY 1, 2014 :45am SHUTTLES DEPART FROM EMBASSY SUITES TO THE CADAVER FACILITY - (BREAKFAST ON YOUR OWN) (Complimentary breakfast provided by the Embassy Suites for attendees staying at host hotel) 7:00am 7:30am REGISTRATION 7:30am 8:00am 8:00am 9:00am BASIC and INTERMEDIATE Introduction - Hans Hansen, MD Imaging for Interventionalists Fluoroscopy, Radiation Safety, and Needle Placement - Frank Falco, MD PREPARATION for ABIPP PART II - Laxmaiah Manchikanti, MD 9:15am 1:00pm PARTICIPANTS ROTATE THROUGH MULTIPLE STATIONS 1:00pm 2:30pm WORKING LUNCH - Case Discussions (Lunch Provided) 2:30pm :15pm PARTICIPANTS ROTATE THROUGH MULTIPLE STATIONS :15pm SHUTTLES DEPART FROM CADAVER FACILITY TO THE HOST HOTEL SUNDAY FEBRUARY 2, 2014 :45am SHUTTLES DEPART FROM EMBASSY SUITES TO THE CADAVER FACILITY - (BREAKFAST ON YOUR OWN) (Complimentary breakfast provided by the Embassy Suites for attendees staying at host hotel) 7:00am 7:15am REGISTRATION 7:15am 8:30am Case Discussions - Hans Hansen, MD and Standiford Helm, II, MD 8:45am 11:15am 11:15am ADJOURNMENT WITH SHUTTLES DEPARTING FROM CADAVER FACILITY TO AIRPORT AND HOST HOTEL ACCOMMODATIONS EMBASSY SUITES PHOENIX NORTH 2577 WEST GREENWAY ROAD, PHOENIX, AZ Set in 17 acres of lush private grounds, the Embassy Suites Phoenix North hotel is an amazing place to stay, whether you are here for work or fun. Work from the comfort of your spacious two-room suite with high-speed internet access and a large desk. Inform the hotel that you are booking for ASIPP. We have secured a group room rate of $129. Reserve rooms early all unbooked rooms will be released on January 1, AMERICAN SOCIETY OF INTERVENTIONAL PAIN PHYSICIANS

7 REGISTRATION FORM REGISTRATION INFORMATION Approximately 70 participants will be allowed in the Workshop. Please complete the enclosed registration form and return to ASIPP with payment (your application will not be processed if payment does not accompany registration form). ASIPP reserves the right to cancel this Workshop and/or Review Preparation Course upon reason-able notice and will assume no financial obligation to registrants for cancellation of the course for reasons beyond its control. Registration fees will be refunded. However, costs incurred by the registrants, such as airline or hotel fees or penalties, are the responsibility of the registrants. Registrants who are not accepted into this workshop will receive notice by mail with their returned check. IMPORTANT. Please answer all the questions: Primary Specialty Certification: m Anesthesiology m Physiatry m Neurosurgery m Other: Pain Medicine Subspecialty Certification: m American Board of Anesthesiology m American Board of Pain Medicine m American Board of Interventional Pain Physicians m Fellow of Interventional Pain Practice (FIPP) Specialty Designation: m 09 - Interventional Pain Management m 72 - Pain Management m Other: Percentage of Interventional Pain Management Practice: m 0% m 1-25% m 2-50% m 51-75% m > 75% Years in Interventional Pain Management practice: m 0 m 1-5 m -10 m > 10 Please select one of the following: m Basic m Intermediate m ABIPP Preparation (Advanced) Total number of procedures performed during past year: ASC LOCATION HOPD Office Caudal Epidural Lumbar Interlaminar Epidural Thoracic Interlaminar Epidural Cervical Interlaminar Epidural Lumbar Transforaminal Epidural Lumbar Facet Joint Blocks Sacroiliac Joint Injections Lumbar Facet Radiofrequency Cervical Facet Joint Injections Thoracic Facet Joint Injections Thoracic Facet Radiofrequency Cervical Facet Radiofrequency Lumbar Discography Thoracic Discography Cervical Discography Percutaneous Adhesiolysis Lumbar Sympathetic Blocks Hypogastric Plexus Blocks Stellate Ganglion Blocks T2, T3 Sympathetic Blocks Celiac Plexus Blocks PLEASE PRINT EXACTLY AS YOU WISH YOUR NAME TO APPEAR: NAME (FIRST) (MIDDLE INITIAL) (LAST) (DEGREE) ORGANIZATION ADDRESS CITY STATE ZIP COUNTRY PHONE FAX REVIEW COURSE IN FLUOROSCOPY AND CADAVER WORKSHOP (PHYSICIANS ONLY) Physician: m $2,750 Member m $2,950 Non-Member Fellow: m 75% Discount CADAVER WORKSHOP ONLY (PHYSICIANS ONLY) Physician: m $2,500 Member m $2,800 Non-Member Fellow: m 75% Discount REVIEW COURSE IN FLUOROSCOPY ONLY Physician: m $350 Member m $450 Non-Member Radiology Technician: m $250 Member m $350 Non-Member Fellows: m 75% Discount ***If registering as a fellow, please list below the name of fellowship program, university or hospital and fax or a letter from the program director verifying your status. Your application for registration cannot be processed and you will not receive the 50% discount until ASIPP receives this letter. Fax the letter to or to crogers@asipp.org NAME OF FELLOWSHIP PROGRAM PAYMENT METHOD (Please check one): m MASTERCARD m VISA m AMERICAN EXPRESS m DISCOVER CREDIT CARD NUMBER SECURITY CODE (Back of Card) EXP. DATE NAME ON CARD AUTHORIZED SIGNATURE (required on all credit card orders) (Your application will not be processed if payment does not accompany registration form) RETURN COMPLETED FORM TO: ASIPP, 81 Lakeview Drive, Paducah, KY or Fax to (270) CANCELLATION POLICY: financial obligation to registrants for cancellation for reasons beyond its control. Registration fees will be refunded however, costs incurred by the registrants, such as airline or hotel fees or penalties, are the responsibility of the registrants. ASIPP requires a 30-day notice of cancellation. Cancellations must be submitted in writing by January 1, Cancellations after January 1, 2014 but prior to January 17, 2014, will forfeit 50% of their registration fee. No refunds can be made after January 17, AMERICAN SOCIETY OF INTERVENTIONAL PAIN PHYSICIANS 7

8 American Society of Interventional Pain Physicians PRSRT STD U.S. POSTAGE PAID 81 Lakeview Drive, Paducah, KY PADUCAH, KY PERMIT #44 CADAVER WORKSHOP AND ONLINE VIDEO LECTURES BASIC, INTERMEDIATE, AND ABIPP PREPARATION FEBRUARY 1-2, 2014 IMAGING, FLUOROSCOPY, AND RADIATION SAFETY JANUARY 31, 2014 UP TO AMA PRA CATEGORY 1 CREDITS HOTEL & COURSE LOCATION: EMBASSY SUITES PHOENIX NORTH, 2577 WEST GREENWAY ROAD, PHOENIX, AZ CADAVER WORKSHOP: SCIENCE CARE, 2020 WEST MELINDA LANE, PHOENIX, AZ (800) n SPECIAL ROOM RATES UNTIL JANUARY 1, 2014 n 75% OFF MEETING FEE TO FELLOWS & RESIDENTS EXCELLENCE IN EDUCATION OF INTERVENTIONAL PAIN PHYSICIANS CADAVER WORKSHOP AND ONLINE VIDEO LECTURES BASIC, INTERMEDIATE, AND ABIPP PREPARATION FEBRUARY 1-2, 2014 IMAGING, FLUOROSCOPY, AND RADIATION SAFETY JANUARY 31, 2014 PHOENIX, ARIZONA ASIPP American Society of Interventional Pain Physicians THE VOICE OF INTERVENTIONAL PAIN MANAGEMENT SINCE LAKEVIEW DRIVE, PADUCAH, KENTUCKY PHONE: FAX: WEB: asipp@asipp.org INFORMATION ENCLOSED