- Nuclear Medicine
- Pediatric Radiology
Clinical Professor, Radiology - Pediatric Radiology
Director of Pediatric Nuclear Medicine, Lucile Packard Children's Hospital (2018 - Present)
Honors & Awards
Lifetime Achievement Award for contributions to EOSPNM Meeting for 20 years, European Society of Pediatric Nuclear Medicine (EOSPNM) (May 2018)
first place poster- General Clinical Specialties, Society of Nuclear Medicine and Molecular Imaging (June 2018)
RSNA 2016 Educational Exhibit Certificate of Merit: Authors Liang, T, Nadel HR, Bray H, Radiological Society of North America (Dec 2016)
First Place Educational Exhibit: Authors: N Shatani, H Bray, H Nadel, J Potts, Canadian Association of Radiologists (April 2016)
First Place Educational Exhibit: Authors: N Shatani,H Bray,H Nadel, J Potts, Canadian Association of Radiologists (April 2016)
Mickey (Cardiff) Williams Distinguished Service Award, Western Regional Society of Nuclear Medicine and Molecular Imaging. (October 2014)
Board Certification: Diagnostic Radiology, American Board of Radiology (1983)
Board Certification: Nuclear Medicine, Royal College of Physicians and Surgeons of Canada
Board Certification: Diagnostic Radiology, Royal College of Physicians and Surgeons of Canada
Board Certification: Pediatric Radiology, American Board of Radiology (2001)
Board Certification: Nuclear Medicine, American Board of Nuclear Medicine (1989)
Fellowship: University of British Columbia (1989) BC Canada
Fellowship: Hospital For Sick Children (1983) Canada
Residency: University of Toronto (1981)
Internship: Toronto General Hospital (1978) Canada
Medical Education: University of Manitoba Office of the Registrar (1977) Canada
Ifosfamide, gemcitabine, and vinorelbine is an effective salvage regimen with excellent stem cell mobilization in relapsed or refractory pediatric Hodgkin lymphoma.
Pediatric blood & cancer
We describe 12 pediatric patients (8-16 years) with primary refractory (N = 6) or first relapse (N = 6) Hodgkin lymphoma (HL) treated with ifosfamide, gemcitabine, and vinorelbine (IGEV). The overall response rate to IGEV was 100%, with seven (58%) complete responses (CR) and five (42%) partial responses. Successful CD34+ stem cell mobilization was achieved in all patients. Following subsequent autologous stem cell transplantation, 10 patients (83%) achieved CR. At a median follow-up of 71 months, 11 patients had no evidence of disease. Five-year second event-free survival and overall survival were 83% ± 11.0% and 90.0% ± 9.5%, respectively. IGEV is an effective salvage regimen for children with relapsed/refractory HL.
View details for DOI 10.1002/pbc.28167
View details for PubMedID 31925920
Imaging for diagnosis, staging and response assessment of Hodgkin lymphoma and non-Hodgkin lymphoma.
2019; 49 (11): 1545–64
Hodgkin lymphoma and non-Hodgkin lymphoma are common malignancies in children and are now highly treatable. Imaging plays a major role in diagnosis, staging and response using conventional CT and MRI and metabolic imaging with positron emission tomography (PET)/CT and PET/MRI. Cross-sectional imaging has replaced staging laparotomy and splenectomy by demonstrating abdominal nodal groups and organ involvement. [F-18]2-fluoro-2-deoxyglucose (FDG) PET provides information on bone marrow involvement, and MRI elucidates details of cortical bone and confirmation of bone marrow involvement. The staging system for Hodgkin lymphoma is the Ann Arbor system with Cotswald modifications and is based on imaging, whereas the non-Hodgkin staging system is the St. Jude Classification by Murphy or the more recent revised International Pediatric Non-Hodgkin Lymphoma Staging System (IPNHLSS). Because all pediatric lymphomas are metabolically FDG-avid and identify all nodal, solid organ, cortical bone and bone marrow disease, staging evaluations require FDG PET as PET/CT or PET/MRI in both Hodgkin and non-Hodgkin lymphoma. Both diseases have in common issues of airway compromise at presentation demonstrated by imaging. Differences exist in that Hodgkin lymphoma has several independent poor prognostic factors seen by imaging such as large mediastinal adenopathy, Stage IV disease, systemic symptoms, pleural effusion and pericardial effusion. Non-Hodgkin lymphoma includes more organ involvement such as renal, ovary, central nervous system and skin. Early or interim PET-negative scans are a reliable indicator of improved clinical outcome and optimize risk-adapted therapy and patient management; imaging may not, however, predict who will relapse. A recent multicenter trial has concluded that it is usually sufficient for pediatric lymphoma at staging and interim assessment to evaluate children with PET imaging from skull base to mid-thigh. Various systems of assessment of presence of disease or response are used, including the Deauville visual scale, where avidity is compared to liver; Lugano, which includes size change as part of response; or quantitative PET, which uses standardized uptake values to define more accurate response. Newer methods of immunotherapy can produce challenges in FDG PET evaluation because of inflammatory changes that may not represent disease.
View details for DOI 10.1007/s00247-019-04529-8
View details for PubMedID 31620854
- ALK-Positive Lung Adenocarcinoma Arising in an Adolescent Treated for Relapsed Neuroblastoma. Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer 2019; 14 (6): e132–e135
Use of optimized post-contrast enhanced PET/CT to improve diagnostic accuracy, staging, and follow-up of children with cancer
SOC NUCLEAR MEDICINE INC. 2019
View details for Web of Science ID 000473116801206
Assessment of the Reconstructed Pulmonary Circulation With Lung Perfusion Scintigraphy After Unifocalization and Repair of Tetralogy of Fallot With Major Aortopulmonary Collaterals.
World journal for pediatric & congenital heart surgery
2019; 10 (3): 313–20
BACKGROUND: Pulmonary vascular supply in tetralogy of Fallot (TOF) with major aortopulmonary collaterals (MAPCAs) is highly variable. Our approach to surgical management of this condition emphasizes early repair including unifocalization and reconstruction of the pulmonary circulation, incorporating all lung segments and addressing stenoses both proximal to and within the lung, in addition to ventricular septal defect closure. At our institution, we have over 15 years of experience using lung perfusion scintigraphy (LPS) to assess the distribution of pulmonary blood flow after complete unifocalization and repair.METHODS: We reviewed clinical and quantitative LPS data in 310 patients who underwent complete unifocalization and repair of TOF/MAPCAs from 2003 to 2018 at our institution. Postrepair relative lung perfusion distributions were determined from LPS initially obtained at our institution within 60 days after repair and thereafter.RESULTS: Total lung perfusion to the right and left lungs was 58.0% ± 14.2% and 42.0% ± 14.2%, respectively. Perfusion was balanced in 75% of patients and unbalanced in 25%, including 11% in whom it was extremely unbalanced. On multivariable analysis, older age at repair, surgery other than a single-stage complete unifocalization, and native anatomy consisting of unilateral pulmonary blood supply through a ductus arteriosus were associated with unbalanced perfusion.CONCLUSION: We present our experience using LPS as an outcome measure after surgical repair of TOF/MAPCAs. Balanced lung perfusion was present in the majority of patients who had complete repair of TOF/MAPCAs performed at our center.
View details for PubMedID 31084304
Is True Whole-body FDG-PET/CT required in paediatric lymphoma? An IAEA Multicentre Prospective Study.
Journal of nuclear medicine : official publication, Society of Nuclear Medicine
INTRODUCTION: Guidelines recommend true whole body (TWB) FDG-PET/CT scans from vertex to toes in paediatric lymphoma patients, although this suggestion has not been validated in large clinical trials. The objective of the study is to evaluate the incidence and clinical impact of lesions outside the "eyes to thighs" regular field of view (R-FOV) in FDG-PET/CT staging (sPET) and interim (iPET) scans in paediatric lymphoma patients. MATERIALS AND METHODS: TWB sPET and iPET scans were prospectively performed in paediatric lymphoma patients (11 worldwide centres). Expert panel central review of sPET and iPET scans were evaluated for lymphoma lesions outside the R-FOV, and clinical relevance of this findings. RESULTS: A total of 610 scans were performed in 305 patients. The sPET scans did not show lesions outside the R-FOV in 91.8% of the patients, while in 8.2% patients the sPET scans demonstrated lesions also outside the R-FOV (soft tissue, bone, bone marrow and skin); however, the presence of these lesions did not change the clinical stage of any patient and did not impact on treatment decision. Among the 305 iPET scans, there were no new positive FDG-avid lesions outside the R-FOV, when compared to their paired sPET scans. A single lesion outside the R-FOV on iPET occurred in one patient (0.3%) with the primary lesion diagnosed in the femur on sPET that persisted on iPET. CONCLUSION: The identification of additional lesions outside RFOV (eyes to thighs) FDG-PET/CT has no impact in the definition of the clinical stage of disease and minimal impact in the treatment definition of patients with pediatric lymphoma. As so, reduced field of view for both staging and interim FDG-PET/CT scans could be performed.
View details for PubMedID 30683766
Update 2018: 18F-FDG PET/CT and PET/MRI in Head and Neck Cancer.
Clinical nuclear medicine
2018; 43 (12): e439–e452
There are recent advances, namely, a standardized method for reporting therapy response (Hopkins criteria), a multicenter prospective cohort study with excellent negative predictive value of F-FDG PET/CT for N0 clinical neck, a phase III multicenter randomized controlled study establishing the value of a negative posttherapy F-FDG PET/CT for patient management, a phase II randomized controlled study demonstrating radiation dose reduction strategies for human papilloma virus-related disease, and Food and Drug Administration approval of nivolumab for treatment of recurrent head and neck squamous cell carcinoma.
View details for PubMedID 30394934
American College of Radiology and Society of Nuclear Medicine and Molecular Imaging Joint Credentialing Statement for PET/MR Imaging: Body.
Journal of nuclear medicine
This joint statement is intended to guide credentialing bodies that privilege physicians to oversee the performance of and participation in the interpretation of PET/MR imaging in adult and pediatric patients in the United States.
View details for DOI 10.2967/jnumed.117.193524
View details for PubMedID 28473601
Response Assessment Criteria and Their Applications in Lymphoma: Part 2
JOURNAL OF NUCLEAR MEDICINE
2017; 58 (1): 13-22
Interim and end-of-treatment PET/CT have become central to the evaluation of Hodgkin and non-Hodgkin lymphoma. This review article seeks to aid clinical decision making by providing an overview of available data on the diagnostic and prognostic value of PET/CT imaging for response assessment and pretransplant evaluation in lymphoma. The relative strengths and limitations of these techniques in various disease subtypes and clinical scenarios are explored, along with their current standards for reporting and latest developments. Particular attention is given to response-adapted therapy, which is emerging as a cornerstone of clinical management.
View details for DOI 10.2967/jnumed.116.184242
View details for Web of Science ID 000391343400012
View details for PubMedID 27879369
Response Assessment Criteria and Their Applications in Lymphoma: Part 1
JOURNAL OF NUCLEAR MEDICINE
2016; 57 (6): 928-935
The effectiveness of cancer therapy, both in individual patients and across populations, requires a systematic and reproducible method for evaluating response to treatment. Early efforts to meet this need resulted in the creation of numerous guidelines for quantifying posttherapy changes in disease extent, both anatomically and metabolically. Over the past few years, criteria for disease response classification have been developed for specific cancer histologies. To date, the spectrum of disease broadly referred to as lymphoma is perhaps the most common for which disease response classification is used. This review article provides an overview of the existing response assessment criteria for lymphoma and highlights their respective methodologies and validities. Concerns over the technical complexity and arbitrary thresholds of many of these criteria, which have impeded the long-standing endeavor of standardizing response assessment, are also discussed.
View details for DOI 10.2967/jnumed.115.166280
View details for Web of Science ID 000377052400045
View details for PubMedID 27127227
Methotrexate, Doxorubicin, and Cisplatin (MAP) Plus Maintenance Pegylated Interferon Alfa-2b Versus MAP Alone in Patients With Resectable High-Grade Osteosarcoma and Good Histologic Response to Preoperative MAP: First Results of the EURAMOS-1 Good Response Randomized Controlled Trial.
Journal of clinical oncology
2015; 33 (20): 2279-2287
EURAMOS-1, an international randomized controlled trial, investigated maintenance therapy with pegylated interferon alfa-2b (IFN-α-2b) in patients whose osteosarcoma showed good histologic response (good response) to induction chemotherapy.At diagnosis, patients age ≤ 40 years with resectable high-grade osteosarcoma were registered. Eligibility after surgery for good response random assignment included ≥ two cycles of preoperative MAP (methotrexate, doxorubicin, and cisplatin), macroscopically complete surgery of primary tumor, < 10% viable tumor, and no disease progression. These patients were randomly assigned to four additional cycles MAP with or without IFN-α-2b (0.5 to 1.0 μg/kg per week subcutaneously, after chemotherapy until 2 years postregistration). Outcome measures were event-free survival (EFS; primary) and overall survival and toxicity (secondary).Good response was reported in 1,041 of 2,260 registered patients; 716 consented to random assignment (MAP, n = 359; MAP plus IFN-α-2b, n = 357), with baseline characteristics balanced by arm. A total of 271 of 357 started IFN-α-2b; 105 stopped early, and 38 continued to receive treatment at data freeze. Refusal and toxicity were the main reasons for never starting IFN-α-2b and for stopping prematurely, respectively. Median IFN-α-2b duration, if started, was 67 weeks. A total of 133 of 268 patients who started IFN-α-2b and provided toxicity information reported grade ≥ 3 toxicity during IFN-α-2b treatment. With median follow-up of 44 months, 3-year EFS for all 716 randomly assigned patients was 76% (95% CI, 72% to 79%); 174 EFS events were reported (MAP, n = 93; MAP plus IFN-α-2b, n = 81). Hazard ratio was 0.83 (95% CI, 0.61 to 1.12; P = .214) from an adjusted Cox model.At the preplanned analysis time, MAP plus IFN-α-2b was not statistically different from MAP alone. A considerable proportion of patients never started IFN-α-2b or stopped prematurely. Long-term follow-up for events and survival continues.
View details for DOI 10.1200/JCO.2014.60.0734
View details for PubMedID 26033801
Imaging guidelines for children with Ewing sarcoma and osteosarcoma: A report from the Children's Oncology Group Bone Tumor Committee
PEDIATRIC BLOOD & CANCER
2008; 51 (2): 163-170
The Children's Oncology Group (COG) is a multi-institutional cooperative group dedicated to childhood cancer research that has helped to increase the survival of children with cancer through clinical trials. These clinical trials include a standardized regimen of imaging examinations performed prior to, during, and following therapy. This article presents imaging guidelines developed by a multidisciplinary group from the COG Bone Tumor Committee. These guidelines provide both required and recommended studies. Recommended examinations may become required in the future. These guidelines should be considered a work in progress that will evolve with advances in imaging and childhood cancer research.
View details for DOI 10.1002/pbc.21596
View details for Web of Science ID 000256871800004
View details for PubMedID 18454470