Three years ago, Sandy Patenaude was given the devastating news that she had stage 4 colorectal cancer. It had spread to her liver and lungs, and was inoperable. Sandy’s oncologist asked if she would like to go on a clinical trial, testing a new cancer stem cell inhibitor drug along with her chemotherapy.

“Cancer stem cell inhibitors, why not?” said Sandy who agreed to be part of the trial.

Dr. Derek Jonker, Medical Oncologist at The Ottawa Hospital, is leading the international trial for people with colorectal cancer, with the experimental drug napabucasin. He explained that cancer stem cells are the rare, immature cells in a tumour, which are often resistant to chemotherapy. They can give rise to the more mature cancer cells that make up the bulk of a tumour. Cancer stem cells are not the same as the normal stem cells that live in many healthy adult tissues and help with healing and repair.

“With chemotherapy, we can deliver treatment that can shrink the vast part of the cancer,” said Dr. Jonker, who is also an associate professor at the University of Ottawa. “Often the bulk of the tumour disappears, but what’s left is a small tumour with lots of these chemo-resistant cancer stem cells, which are able to spread and seed other places in the body. Often, we keep giving the same chemotherapy and find the tumour has regrown, but it’s not the same tumour it was when we started.”

Dr. Derek Jonker
Dr. Derek Jonker led a clinical trial for colorectal cancer with a cancer stem cell inhibiting drug that has helped Sandy Patenaude.

Dr. Jonker is switching up the treatment to target the  cancer stem  cells that aren’t affected by standard chemo. In a previous randomized  clinical  trial he led , patients either  received a placebo or  napabucasin  to test its effectiveness at  inhibiting, or preventing,  the growth of the  cancer stem cells. The trial was carried out at  40  sites in Canada, Australia, New Zealand, and Japan. The  562  patients enrolled had advanced colorectal cancer  and chemotherapy no longer worked for them.

Looking at the results of the trial, Dr. Jonker said  they didn’t see much benefit in the group overall. “But when we looked at patients who had a  tumour  that  had characteristics of a high cancer stem cell (phospho-STAT3) over expression there was very significant improvement in their survival.”

Dr. Jonker presented his findings in October 2016 at the European Society for Medical Oncology, showing that where the cancer stem cell inhibitor didn’t work in all patients, there was an improvement in the survival of the 22 percent of patients who had  tumours  with high phospho-STAT3.  He said it’s “proof of principle that stem cells are an important target for cancer patients.” Napabucasin is now being combined in the  current trial  with chemotherapy to attack the cancer on two fronts  at the same time.

“We know  with results of the clinical trial that  the majority of  patients did not respond to it, but we have two patients here in Ottawa who  have responded and definitely developed benefit from the clinical agent,” said  medical oncologist Dr. Christine Cripps.

I thought I’d be part of the trial, because I thought well, it’s new.”

Sandy is one of those patients who benefited.  Her tumours shrank,  and the surgeons were able to remove spots in her liver and the primary  tumour in her rectum.  Dr. Cripps said she believes that part of the success in keeping Sandy’s cancer at bay is the napabucasin she is taking as part of  the  clinical trial.

“A stem cell inhibitor works differently than traditional chemotherapy, in that it prevents new disease from  appearing,” said  Saara  Ali, research coordinator for clinical trials in gastrointestinal cancers. “The hope is that the pill [napabucasin] will prevent new disease from showing. And in Sandy’s case there hasn’t been new disease  since her treatment. Everything was there before, so it may be doing its job.”

Next steps: Dr. Jonker hopes to start  another clinical trial with the cancer stem cell inhibitor that will be used specifically for patients who have lots of phospho-STAT3 in their  tumour. These patients could be identified for the clinical trial with molecular testing, using The Ottawa Hospital’s Molecular Oncology Diagnostics lab.  This would target the patients presumed to be the most likely to benefit most from the drug.

“We would repeat our study, randomize those patients with  napabucasin  and a placebo, and if we can prove that  napabucasin is effective for them, then it would be an option for patients who have run out of all other treatment options,” said Dr. Jonker.

Dr. Cripps said that Sandy is a candidate for this next trial,  and her tumours  will be analyzed by the molecular lab to see  whether she has high phospho-STAT3 cancer stem cell expression. Regardless, Sandy will continue using the trial drug as long as it is working for her. And it is working. The mother of three adult children said  she’s busy doing a million things, playing euchre, the ukulele, skiing, hiking, biking, and enjoying life.


The Ottawa Hospital is a leading academic health, research, and learning hospital proudly affiliated with the University of Ottawa.

Although the connection between the immune system and cancer has been recognized for over a century, understanding how the immune system works against cancer has been the biggest challenge for scientists like Dr. Michele Ardolino.

Initially, efforts were made to stimulate the immune system to make it attack the cancer. But the game changer was the discovery that there are key molecules, called immune checkpoints, on cancer cells that suppress the immune cells and prevent them from attacking the cancer. There are many types of immune cells. T-cells have been recognized as key immune cells and the ones that immunotherapy drugs have been designed to target.

Dr. Michele Ardolino in his lab
Dr. Michele Ardolino’s discovery focused on ‘natural killer’ immune cells.

“What we didn’t know before is that some of these receptors are present in other immune cells,” said Dr. Michele Ardolino, scientist at The Ottawa Hospital and assistant professor at the University of Ottawa. “What we discovered is that these receptors are present on another type of immune cell called natural killer cells.”

He said that even though most of the immunotherapy drugs target the T-cells to make them work better, not all cancer tumours are responsive to T-cells.

“But,” said Dr. Ardolino, “These tumours might be very effectively killed by natural killer cells. So, if we know what kind of tumour the patient has, we can design therapies to elicit the most effective immune response. Which in some cases could be a T-cell response and in other cases could be a natural killer response.”

“We now have a better idea of how the immune system suppresses cancer. This means that we can now target the mechanism that suppresses the immune system in a more specific way.”

“This is cool for a number of reasons,” said Dr. Ardolino. “We now have a better idea of how the immune system suppresses cancer. This means that we can now target the mechanism that suppresses the immune system in a more specific way. And we can elicit a stronger natural killer cell response against cancer.”

It is becoming widely recognized that not only is cancer unique to each patient, but the immune system is also unique to each person. Researchers and clinicians are realizing the importance of tailoring the immunotherapy not only to each person’s cancer but to their own unique immune system. It is a complex problem to give a drug that would have maximum therapeutic effect with the least side effects, to be as targeted as possible.

Dr. Ardolino recently published a breakthrough discovery that has potential to make immunotherapy treatments to work for more people, and more types of cancers.

In October 2018, immunologists James Allison and Tasuku Honjo were awarded the Nobel Prize in Medicine for their discoveries of immune checkpoint inhibitors, considered a landmark in the fight against cancer.


The Ottawa Hospital is a leading academic health, research, and learning hospital proudly affiliated with the University of Ottawa.

A strange thing happened before John Chafe started working in Kenora in 1993. His eyes crossed. He didn’t know it at the time, but it was the first sign of a debilitating disease that would change the course of his life forever.

His family doctor told him he had the flu and prescribed antibiotics. But after a week, when his eyes remained crossed, he bought an eye patch and drove five hours from Thunder Bay to fill the temporary posting at a bank in Kenora. A week later, his eyes straightened and returned to normal. But then other symptoms started appearing, he was losing his balance and couldn’t walk in a straight line.

“I then started have difficulties walking straight. I completely failed a simple balance beam experiment at the Ontario Science Centre,” said John. “I mentioned these symptoms to a friend, who mentioned them to a friend, who fortunately happened to be Dr. Heather MacLean, a neurologist at The Ottawa Hospital.”

To Dr. MacLean, John’s symptoms sounded like multiple sclerosis (MS), an autoimmune disease where the body’s immune system attacks its own central nervous system, brain, and spinal cord. John needed an MRI and spinal tap to properly diagnose his symptoms. The results were analyzed by Dr. Mark Freedman, Director, Multiple Sclerosis Research Unit, Neurology, who confirmed his diagnosis. John had an aggressive form of multiple sclerosis.

John Chafe skiing
John Chafe skiing at Blackcomb just after diagnosis in 1994.

A different life after MS diagnosis

Incredibly interested in rock climbing and skiing, John didn’t give up his active lifestyle after his diagnosis, despite the fact that he was experiencing MS exacerbations – an attack that causes new MS symptoms, or worsens old symptoms – every eight months. He returned to Thunder Bay and opened a rock-climbing gym, thinking, “MS is not going to affect me.”

But it did. It completely sidetracked his life.

After suffering another MS exacerbation, John realized it was becoming more difficult for him to get out to see clients for financial planning sessions.

“I was stumbling along and thought, ‘How can I ask them to trust me with their money?’ My MS was getting worse and worse,” said John. “I needed a desk job, so I went into computer programming.”

His treatments weren’t helping. He needed a miracle. So he moved to Ottawa to be close to The Ottawa Hospital where we could receive the very best treatment.

Leading-edge clinical trial in Ottawa

Dr. Harold Atkins and Dr. Mark Freedman
Dr. Harold Atkins and Dr. Mark Freedman conducted an innovative stem cell treatment for MS that has halted the disease in over 50 patients

One day, John heard Dr. Freedman on the radio talking about an innovative stem cell transplant study that he described as akin to pressing reboot on the immune system. Dr. Freedman was working with hematologist and scientist Dr. Harold Atkins, a professor of medicine at University of Ottawa, to see if a groundbreaking treatment would halt an aggressive form of MS.

When John met with Dr. Freedman, he told him he was interested in participating in this new study. Dr. Freedman agreed he might be a good candidate because he was young, generally healthy, and his symptoms were quickly getting worse.

“If you saw his trajectory, how fast he was becoming disabled going into the transplant.  He should’ve been completely wheelchair bound, or worse, within two to three years,” said Dr Freedman.

John was willing to try an experimental treatment that had the potential to change that trajectory. “MS robbed me of my ability to climb, ski, and walk. I said, ‘I’m going to take a chance.’”

“John was very enthusiastic. That was a very important facet of his recovery,” said Dr. Freedman. “John has never been a quitter. He’s a stubborn guy. His goal was someday to end up on the ski hill again.”

Preparing for treatment

For almost a year, John underwent the exhaustive testing by Dr. Atkins and Marjorie Bowman, the bone marrow transplant nurse, to see if he was physically and mentally suitable for the clinical trial. They wanted to ensure he was prepared to go through the intensive trial treatment and accept the risks, which included death.

“This is fundamentally different than every other treatment,” said Dr. Atkins. “What we’re doing is getting rid of the old immune system and creating a new one that behaves more appropriately.”

“MS robbed me of my ability to climb, ski, and walk. I said ‘I’m going to take a chance.’”

— John Chafe

Replacing his immune system was a rigorous procedure.  John would undergo intensive chemotherapy to help eliminate his immune system.  In November 2001, he was given a dose of chemotherapy to stimulate and move his stem cells into his blood stream.  These stem cells were then collected and cleansed of any traces of MS.

A month later, John was given huge doses of chemo in an attempt to destroy his immune system and started getting weaker and weaker.  On December 13, 2001, after the chemo had wiped out his immune system, John had the cleansed stem cells re-infused by an intravenous  drip.

“I didn’t feel better immediately,” said John, who was only the second patient in the world to undergo a stem-cell transplant of this kind for multiple sclerosis.  “But I started getting stronger in the days following, so much so that Dr.  Atkins released me on Christmas Eve.” He spent three months living with his parents while he recuperated. By spring, he was ready to move back into his own home again.

John Chafe rock climbing
John Chafe rock climbing outside Thunder Bay in 1994 after his MS diagnosis.

Groundbreaking research in Ottawa

Dr. Freedman said that he and Dr. Atkins had anticipated that by rebooting MS patients’ immune systems, they fully expected the disease was going to restart.

“At that time, genetic researchers said, ‘If people are genetically prone to develop MS, there’s nothing you can do to stop it. They’re going to keep redeveloping MS,’” said Dr. Freedman. “If that was true, it would be a matter of time before people started having active disease again.”

Dr. Freedman explained that nobody knows what causes MS. He and Dr. Harold Atkins hoped that through the trial they could reboot a patient’s immune system and monitor it with all the latest immune system  monitoring  and imaging technology, and then watch as the disease restarted and discover the  secret of what triggers MS. However, none of the 24 patients in the trial developed new symptoms of MS again.

“In that respect, the trial was a failure. It halted their disease and in some cases their disabilities went away too,” said Dr. Freedman. “We’ve followed these patients for 18 years, and nobody’s developed anything.”

“Those patients at the beginning, like John, are probably the bravest because there were more unknowns about the treatment,” said Dr. Atkins. “Each patient we’ve treated over the years has taught us something, but we learned more from the early patients at that time.”

A second chance at life

Prior to his stem cell transplant, John had a final exacerbation, which crippled him. After the transplant, his MS did not return. John remained healthy, but the damage caused by the disease wasn’t reversed and he still walks using a cane and walker.

“You almost wonder what would’ve happened to John if he’d had the transplant five years earlier,” said Dr. Freedman. “Today, when we see a patient that has the same profile as John’s, we offer them the stem cell treatment. We’re not waiting years. We’ve become more savvy, able to pick out individuals who warrant this aggressive approach.”

About 77,000 Canadians live with MS. However, only five percent of patients with MS warrant a stem cell transplant. They are generally young and have the most aggressive and debilitating forms of the disease.

After his transplant, nothing was going to hold John back. Three years later, he met Patricia, and they married in 2005. Five years later, his beautiful daughter Mary was born.

John Chafe with his daughter Mary and wife Patricia
John Chafe with his daughter Mary and wife Patricia in 2013.

“I recall that as Mary started moving more, she motivated me to get more active again. She became my personal trainer,” said John. “I joined the Canadian Association of Disabled Skiing. I was terrible at first because I didn’t have the strength. But I’m stubborn and refused to give up, and today I can ski independently for hours – albeit with outriggers for balance.”

“I saw John a few years ago. The problem with this business is patients get better and so I don’t see them much afterwards,” said Dr. Atkins. “I do remember him showing me pictures of his young baby, and pictures of him on the ski slope. It is exciting to hear that people can have these treatments and go skiing again.”

John Chafe skiing with his family
John Chafe, Mary and Patricia skiing at Edelweiss in 2016.

“I’m not a bank president, but my life is better than incredible. I ski, I dance with my wife, and have an nine-year-old daughter. Because Dr. Freedman and Dr. Atkins were persistent about finding the answers to stop a disease like MS, they saved my life.”

— John Chafe

The following video focuses on Jennifer Molson who was also one of the early patients on the MS clinical trial, and includes interviews with Drs. Atkins and Freedman.


The Ottawa Hospital is a leading academic health, research, and learning hospital proudly affiliated with the University of Ottawa.

June 20, 2017, was a day like any other on the construction site, until the 14-inch diamond blade on Adrian Molloy’s power saw jammed in the concrete he was cutting and kicked back into his arm, slicing through to the bone. Though he was not particularly close The Ottawa Hospital’s Trauma Centre at the time, a new 60-minute bypass initiative brought him straight there to an assembled team of trauma experts who were ready for him.

The 40-year-old contractor had been using power saws on the job for 20 years. He was down in a hole cutting concrete when the saw kicked back. He was covered in dust so couldn’t see his arm, but knew he’d hit himself. He grabbed his right arm above the elbow, and his fingers landed on bone. Adrian knew it was a serious injury, and managed to get out of the hole and head to the road for help. His arm was bleeding badly.

“It happened so quickly, I didn’t even know I was injured,” Adrian said.

Adrian Molloy
Contractor Adrian Molloy underwent two four-and-a-half-hour surgeries to repair his partially severed arm.

Quick thinking

At the road, two Hydro One workers were sitting in their truck getting ready to leave. When they saw Adrian, the passenger called 911. The driver jumped out, and quickly took off his belt and tightened it around Adrian’s arm in a tourniquet. He was calm, and kept Adrian talking until the ambulance arrived.

In the ambulance, Adrian heard the paramedics talking with the dispatch.

“I knew they were looking to bypass Kemptville, but didn’t know what was going on,” said Adrian. “I knew my best hope was The Ottawa Hospital, so was happy they said we were heading to the Trauma Centre at the Civic. I was going somewhere where they could handle my injury.”

60-minute bypass initiative

What Adrian didn’t realize was that he was one of the first patients to be part of a quality improvement initiative that the Ottawa Regional Trauma Program was testing in an effort to get patients to trauma care and provide more successful outcomes.

“Adrian was a direct recipient of our 60-minute bypass initiative,” said Mathieu LeBreton, Trauma Coordinator of the Ottawa Regional Trauma Program at The Ottawa Hospital. “Provincially, paramedics have rules that can permit them to bypass local hospitals to get to a lead trauma hospital if they are within 30 minutes of getting to a trauma centre. With the approval of all regional community hospitals, we expanded it to 60 minutes. Much of the literature suggests the sooner a patient receives definitive trauma care, the better.”

Where Adrian was injured was about a 45-minute ambulance drive to the Trauma Centre. Previously, he would’ve had to go to the nearest community hospital. LeBreton said trauma patients who need resuscitation from life-threatening injury need very resource-intensive care. They require more medical staff, access to operating rooms, imaging capabilities, more blood, and other resources that community hospitals do not have in their emergency departments. There is a team of health-care professionals at the Civic Campus specifically trained to deal with trauma situations.

Trauma team assembles

When paramedics notify the Civic Campus Emergency Department that they are bringing in a patient with multiple or life-threatening injuries, a Code 1 Trauma is called over the hospital’s intercom. This alerts the trauma team, which includes trauma surgeons, emergency physicians, nurses, anaesthesiologists, respiratory therapists, and trauma coordinator Mathieu LeBreton, to prepare for the patient’s arrival. A Code 1 Trauma also notifies the blood lab, radiology department, and operating room staff that blood-work, X-Rays, CT scans, and surgery may be needed.

“Sometimes a trauma code comes in without advance notice, and then we’re reacting to it in the moment,” said Kelly Barnett, Clinical Manager of the Trauma Unit. “Everyone has a job, and it’s a code that runs smoothly to diagnose, triage, and save the patient.”

“I’d never been to a hospital injured like this before,” said Adrian. As he lay in the ambulance, his mind raced with concerns. “I asked, ‘Do they know I’m coming? Are they ready for me?’”

Rushed to surgery

The answer was yes. The trauma team was ready and waiting for him when the ambulance arrived. When he was rushed through the emergency room doors, Adrian said he couldn’t believe, “You can get so many people in one room for one patient.” He was in the operating room within 47 minutes from the time he entered the emergency department.

“I knew my best hope was The Ottawa Hospital, so was happy they said we were heading to the Trauma Centre at the Civic. I was going somewhere where they could handle my injury.”

The power saw had cut 75 percent of his right bicep, two arteries and a nerve. In the operating room, surgeons reattached his arm. The four-and-a-half-hour surgery repaired arteries and his severed nerve. He underwent a second four-hour surgery to repair the damaged bicep with a donor muscle in November 2017.

The Ottawa Hospital’s Civic Campus is the adult lead trauma hospital for eastern Ontario. This takes in an area of 1.3 million people that includes Ottawa, stretches west to Pembroke and east to Hawkesbury. People with life-threatening injuries from Gatineau and western Quebec, as well as patients from Baffin Island and eastern Nunavut are brought to the Trauma Centre. Twenty percent of the population it serves lives in a rural area.

The Centre treated 856 trauma cases last year. One hundred and ninety-two of those patients benefited from the extended time guidelines from accident scene to trauma centre, with the average transfer time being 42 minutes.

Trauma care for 1.3 million people

The power saw had cut 75 percent of his right bicep, two arteries and a nerve. In the operating room, surgeons reattached his arm. The four-and-a-half-hour surgery repaired arteries and his severed nerve. He underwent a second four-hour surgery to repair the damaged bicep with a donor muscle in November 2017.

The Ottawa Hospital’s Civic Campus is the adult lead trauma hospital for eastern Ontario. This takes in an area of 1.3 million people that includes Ottawa, stretches west to Pembroke and east to Hawkesbury. People with life-threatening injuries from Gatineau and western Quebec, as well as patients from Baffin Island and eastern Nunavut are brought to the Trauma Centre. Twenty percent of the population it serves lives in a rural area.

The Centre treated 856 trauma cases last year. One hundred and ninety-two of those patients benefited from the extended time guidelines from accident scene to trauma centre, with the average transfer time being 42 minutes.

The eight-bed trauma unit is dedicated to patients who have multiple injuries. This could include head or brain trauma, limb loss, vascular, spinal cord, internal organs, multiple broken bones, broken spine, or neck injuries.

“Patients come into trauma from emerge [emergency department], and once they are stabilized, they then move through the hospital, as soon as possible, in order to get them back home, into rehab, or somewhere they can convalesce,” said Kelly.

Kelly said a patient’s length of stay in the trauma unit can be as short as 24 hours or as long as several months, depending on the severity of the injury and the ability to recover and heal. The health professionals in the Centre plan the patient’s follow up care or work closely with physiotherapy, and rehabilitation services to assess their need for rehabilitation.

“I know we often compare ourselves to similar standards from regional trauma perspectives: other hospitals we benchmark against in standardizing trauma care. We look to hospitals like St. Mikes [St. Michael’s Hospital] in Toronto to see their practices, and share ideas and common goals that we are trying to achieve,” said Kelly.

The Ottawa Hospital is part of the Trauma Association of Canada where members from across the country share vibrant practices about ways to improve patient care.

Hamilton and Kingston also have trauma centres, though The Ottawa Hospital is bigger because of the larger area patients come from.

The Ottawa Hospital has one of the largest trauma centres in the province, with Sunnybrook and St. Michael’s as the two largest. However, both Toronto hospitals cater to a dense urban population. The Ottawa Hospital covers a larger geographical area, so the timing to get patients to the trauma centre from a distance and the reason why the 60-minute bypass initiative is critical.

“What we found is there have been no negative outcomes yet. People like Adrian have benefitted directly from this,” Mathieu said.

Back to work

A year later, Adrian is back on the construction site with full use of his right arm and hand.

“I lost the motion for using a screwdriver. I use it as an excuse to get out of work I don’t like. I use it to my advantage now,” laughed Adrian. “I’m doing everything I was doing before.”

Adrian Molloy with his wife Shelly
Adrian Molloy stands with his wife Shelly outside their home.

The Ottawa Hospital is a leading academic health, research, and learning hospital proudly affiliated with the University of Ottawa.

Picture a life where every movement is a battle — your hands and limbs tremble against your will, your find yourself off balance and uncoordinated, your sense of smell disappears, and muscle pain and stiffness strikes without warning. This is the harsh reality faced by those living with Parkinson’s disease every single day.

More than 110,000 Canadians live with Parkinson’s, including 8,000 here in Ottawa. Parkinson’s is a progressive neurodegenerative disease that primarily affects voluntary, controlled movement. Despite being discovered almost 200 years ago, the exact cause of the disease is unknown, and there is still no cure or proven treatment available to eliminate symptoms. A person can develop Parkinson’s disease at any time in their life and it can progress at a different rate for everyone.

While medication can help manage symptoms, the following therapies can play a vital role in symptom management:

Physical therapy improves mobility, flexibility, and balance.
Occupational therapy assists with daily activities and independence.
Speech therapy helps with voice control and communication.
Exercise strengthens muscles and joints, while boosting overall health and well-being.

Living with Parkinson’s disease requires a personalized approach that covers every aspect of a patient’s life. This includes managing physical, emotional, and cognitive challenges, as well as adjusting to changes in daily routines and activities.

Parkinson’s research at our new hospital

Neuroscience research at new hospital campus will have the potential to be among the best in the world.

It will bring basic neuroscientists, neurologists, neurosurgeons, and other experts together to accelerate how quickly research gets from the lab to the bedside of patients.

There will be state-of-the-art laboratory facilities and a hub for more than 400 researchers, clinicians, trainees, and staff working on brain-related conditions including Parkinson’s disease.

“Our ageing western societies will be faced with many more patients with Parkinson’s over the coming decades. In many ways, Parkinson’s is both complicated and complex. I strongly believe that together we can solve the riddle. We have a once-in-a-generation opportunity to transform neurological care by taking research to new heights in Ottawa and by building the technologically most advanced hospital for the citizens of Ottawa, for Ontarians and for the country.”

– Dr. Schlossmacher, Director of Neuroscience at Ottawa Hospital

Recent Milestones in Parkinson’s Disease Research

• Publication of Canada’s first Parkinson’s care guideline and its revision in 2019.
• Development of an Intergrated Parkinson’s Care Network driven by patients.
• Development of a prediction tool model for Parkinson’s disease.
• Development of a simplified smell test.
• Development of mouse models that mimic different forms of Parkinson’s.
• Participation and leadership in new drug treatment trials for Parkinson’s.

PIPR logo in red on white background

Partners Investing in Parkinson Research (PIPR)

In 2009, a group of investment advisors from Ottawa’s financial community came together to create Partners Investing in Parkinson Research (PIPR). Their initial goal was to raise $500,000 to fund research aimed at better understanding and diagnosing Parkinson’s disease. Since then, PIPR has grown to include countless individuals and families impacted by Parkinson’s, all united in their commitment to advancing research. To date, PIPR has successfully raised 1.8 million dollars.

Chaired by Andrew Frank of RBC Dominion Securities, PIPR members reach out to the community at large to raise vital funds to support leading edge Parkinson Research at The Ottawa Hospital.

PIPR has provided important funding to researchers, allowing them to leverage further grants and make incredible medical advancements. PIPR has not only helped to fund research for the treatment and cure of Parkinson’s disease, but it has also encouraged the community to support the cause that previously received little attention. Above all, the PIPR team has given hope to those who live with this persistent disease.

PIPR is always open to new members and encourages anyone interested to join!

Support Parkinson’s Research

Support ongoing research efforts by donating, or by calling 613-761-4295. For more information about the research or how to join the team, contact Karen Lawrence, Development Officer, Philanthropy, at 613-737-8899, ext: 72941, or klawrence@toh.ca.

Learn more about PIPR and hear about some of the exciting research advancements on Episode 34 of Pulse, featuring Dr. Julianna Tomlinson and Kim Teron.

Patients don’t need to have a metal halo screwed into their skull when they receive radiation treatment with the CyberKnife. That was one of the appealing factors for neurosurgeon Dr. John Sinclair to bring the radiosurgery robot to The Ottawa Hospital.

With other radiosurgery, patients with brain tumours had to have their head held perfectly still during treatment. A metal frame or “halo” was screwed into their skull and then fastened to the table they’d lie on for treatment.

However, patients do not need to be held still when receiving CyberKnife radiosurgery. The robot uses x-rays and complex precision software to accurately track the tumour. It gives a high dose of radiation to the precise location of the brain tumour while the patient, who is fitted with a custom-made plastic mask, lies on the table.

“CyberKnife has an advantage over regular radiation because it is so much more accurate; its precision is less than a millimetre,” said Dr. Sinclair, Director of Cerebrovascular Surgery at The Ottawa Hospital. “You can give very high doses of radiation right to the lesion [tumour] and get almost no spill over to normal tissue. And as a result, we see greatly improved responses to this type of treatment compared to regular radiation.”

Dr. John Sinclair leaning against bed in the operating room
Dr. John Sinclair was instrumental in bringing the CyberKnife to The Ottawa Hospital.


Dr. Sinclair was first introduced to the CyberKnife when he did a fellowship at Stanford Medical Center in California. CyberKnife was invented at Stanford, so the neurosurgeon was one of the first to see the benefits of this frameless radiosurgery treatment.

When Dr. Sinclair was recruited to The Ottawa Hospital in 2005, he had hoped to bring this novel technology to patients here. At the time, it was a technology that wasn’t approved by Health Canada. So, Dr. Sinclair and his team made a case for robotic radiosurgery, presenting scientific data that validated its success.

The Ottawa Hospital was eventually one of two health research centres in Ontario allowed to test the CyberKnife. However, there was no government funding available to purchase the machine. The hospital appealed to the community, which pulled together and generously donated the entire $4 million to purchase it. CyberKnife began treating patients at The Ottawa Hospital in September 2010.

“Because it’s delivering a high dose, it’s considered similar to surgery without using a scalpel, so patients experience no blood loss, no pain, no ICU stay, or recovery time,” said Dr. Vimoj Nair, one of the radiation oncologists trained to prescribe CyberKnife treatment. “So CyberKnife radiosurgery does provide an option where people can be treated with outpatient techniques.”

With regular radiation, the daily doses were lower and patients had to come to the clinic for more radiation treatments overall. Regular radiation treatment could range from five to six weeks. With CyberKnife, radiation is focused precisely on the tumour, allowing larger doses to be given daily, therefore giving the total treatment in one to six days. The hospital’s CyberKnife has gained a reputation for improving treatment of various tumours. Dr. Nair said that because it is one of only three in Canada, patients from British Columbia to the Maritimes are occasionally referred to The Ottawa Hospital for treatment.

“At first, we would treat one tumour,” said Dr. Sinclair. “Now, we treat five or six individual tumours at a time and spare the rest of the brain. We’re sending radiation only to those metastatic tumours. There is a proportion of patients who develop cognitive problems a few months after whole-brain radiation. But with radiosurgery, because we give a higher dose of radiation only to the actual tumours, patients have improved outcomes, and so their quality of life is better.”

This has meant an increase in the number of patients having multiple tumours treated in the same session.

“Treating several tumours at once helps keep the patient’s clinic visits to a minimum,” said Radiation Therapist Julie Gratton, who has worked with CyberKnife since it was installed at The Ottawa Hospital. “Targeting individual tumours rather than treating the whole organ helps spare healthy tissues and reduce side effects.”

The CyberKnife robot
The CyberKnife at The Ottawa Hospital is one of only three in Canada.
Julie Gratton stands in front of the CyberKnife.
Radiation Therapist Julie Gratton has given CyberKnife treatments to patients since 2010.

Until 2017, 1,825 patients had been  treated with the CyberKnife. In 2018, 359 patients received 1,824 CyberKnife treatments. Gratton said that because more tumours are being treated at once in each patient, the number of treatments given per year has increased as expected.

Although 90 percent of CyberKnife treatments are for malignant or benign brain tumours, CyberKnife is also being used to treat tumours in other parts of the body. Because it doesn’t require a frame to keep the area receiving radiation still, CyberKnife’s image guidance system is used to treat tumours in organs that move constantly, such as the lungs, kidneys, liver, prostate gland, and lymph nodes. CyberKnife can precisely align the radiation beam to the tumour even when it moves. The method of tracking tumours in organs and soft tissue has been improved by research at The Ottawa Hospital.

Read more about how our team is increasing the success rate of this already powerful and precise treatment.


The Ottawa Hospital is a leading academic health, research, and learning hospital proudly affiliated with the University of Ottawa.

Published: February 2019
For an update on Stefany’s story, click here to see what Stefany is doing now.

A game-changing cancer treatment

Stefany Dupont’s leukemia symptoms have disappeared. Her cancer was put into complete remission by a revolutionary new treatment called CAR T-cell therapy. This emerging form of immunotherapy has the potential to transform how cancer patients are treated in Canada and around the world.

Daunting odds

Stefany was first diagnosed with acute lymphoblastic leukemia (ALL) when she was just 13 years old. Children with leukemia are given a strict chemotherapy protocol that effectively cures more than 90 percent of patients. Unfortunately, this was not the case with Stefany.

She was in remission for five years but, in 2010, her leukemia came back. By then she was 18, an adult, and began receiving treatment at The Ottawa Hospital. In 2015, she received chemotherapy followed by a hematopoietic bone marrow stem cell transplant. She was on the mend until a year and a half later when she had another relapse. Adults with leukemia who relapse after a transplant have less than a 10 percent chance of survival.

“Stefany was unlucky enough to relapse within two years of her transplant,” said Dr. Jill Fulcher, Stefany’s doctor, who specializes in malignant hematology and is a clinician-investigator at The Ottawa Hospital. “But her leukemia came back with a blast and she was very sick. Palliative management was all we had to offer patients with ALL who relapsed so soon post-transplant.”

Dr. Jill Fulcher stands behind Stefany listening with stethoscope
Hematologist Dr. Jill Fulcher confirms that Stefany Dupont is in remission over one year after her CAR T-cell therapy. Previously, Stefany was given a 10 to 20 percent chance of survival, pre-CAR T-cell treatment.

New hope

Dr. Fulcher and her colleague Dr. Natasha Kekre, a hematologist and associate scientist at The Ottawa Hospital, knew that clinical trials in the United States, using CAR T-cell immunotherapy, showed promising results in children and adolescents with leukemia and blood cancers, putting many into long-lasting remission.

For patients like Stefany who are extremely sick and out of options, CAR T-cell therapy offers new hope. That’s why Dr. Kekre is leading the charge to bring CAR T-cell immunotherapy to The Ottawa Hospital.

Giving Canadians access to leading-edge treatments

As one of Canada’s leading research and treatment centres, equipped with world-leading expertise, The Ottawa Hospital is ideally positioned to help bring this innovative treatment to Canada, and to Canadian patients. The Ottawa Hospital is one of the first hospitals in Canada to participate in internationally-led CAR-T trials, and the Hospital is now playing a lead role in a made-in-Canada CAR-T research program.

“Our goal is to build Canadian expertise and capacity for innovation in the promising CAR-T field through both laboratory research and clinical trials,” said Dr. Kekre, who is working with a team across the country. “This could lead to better CAR-T therapies that work for more kinds of cancer, as well as innovative approaches for providing CAR-T therapy in the Canadian system.”

A key component of the program is a clinical trial using the first made-in-Canada CAR T-cell therapy. This trial is expected to open at The Ottawa Hospital and BC Cancer in 2019.

From translational research to trial design to manufacturing, The Ottawa Hospital, alongside BC Cancer, is ideally positioned to shepherd this complex trial of an experimental therapy to our patients.

“It’s well recognized that Ottawa is a world leader in clinical trials and innovative trial designs,” said Dr. Manoj Lalu, associate scientist and anesthesiologist at The Ottawa Hospital who is part of the CAR-T team. “Many of the guidelines produced internationally around trial design and reporting originate from The Ottawa Hospital.”

Hematologist Natasha Kekre
Dr. Natasha Kekre is working with other hospitals across Canada to develop a “made-in-Canada” approach for CAR-T cancer therapy.

About CAR-T Therapy

CAR T-cell therapy harnesses the power of a patient’s own immune cells, known as T-cells, to treat their cancer. T-cells play a critical role in the immune system by killing abnormal cells, such as cells infected by germs or cancer cells. In some cancers, like acute lymphoblastic leukemia (ALL), cancerous cells become invisible to the T-cells that are meant to kill them. In CAR-T therapy the T-cells are collected and reprogrammed in the lab to recognize and destroy the cancerous cells.

“This type of immunotherapy research is groundbreaking,” said Dr. Kekre, “but it is important to remember that CAR-T therapy is still very new and there can be serious side effects. We need more research to learn about this therapy and make it work for even more people.”

A well-deserved reprieve

CAR-T treatment was not yet available in Canada when Stefany needed it. So, her only option at the time was to try to join a CAR-T clinical trial at the Children’s Hospital of Philadelphia. Since the hospital’s clinical trial was still accepting patients with ALL up to 25 years of age, Stefany was eligible to participate.

Three months following Stefany’s CAR T-cell infusion in Philadelphia, she had a bone marrow biopsy that showed she was in remission — her treatment was working.

Three months after that, Stefany went on a well-deserved trip.

“After the sixth month waiting time, I went to Australia,” said Stefany. She visited Sydney, Brisbane, Melbourne, went scuba diving at the Great Barrier Reef, and hang-gliding over the shores of Byron Bay. It was a wonderful break after the intensive treatment.

“It is a really good sign that Stefany has remained in remission for over 2 years after having CAR T-cell therapy,” said Dr. Fulcher. “Without this therapy, she definitely would not be with us today.”

A graphic explaining how CAR-T works

Unique biotherapeutics facility

CAR-T therapy needs to be individually manufactured for each patient, using a patient’s own cells combined with large amounts of highly pure virus to deliver the CAR gene. The Ottawa Hospital’s Biotherapeutics Manufacturing Centre is ideally positioned to manufacture this kind of therapy because it has the most advanced system to make the clinical grade virus needed to create CAR T-cells for clinical trials. This is the only facility in Canada that has produced this kind of virus for clinical trials.

“With our unique manufacturing facility, our expertise in clinical trials and our world-class cancer and hematology programs, The Ottawa Hospital is ideally positioned to lead the way in developing the next generation of CAR-T therapy,” said Dr. Rebecca Auer, Director of Cancer Research at The Ottawa Hospital.

“The Ottawa Hospital is ideally positioned to lead the way in developing the next generation of CAR-T therapy.” – Dr. Rebecca Auer

“Patients with ALL, lymphoma, and other blood cancers could benefit from this experimental treatment,” said Dr. Kekre. The hope is that one day CAR T-cell therapy may also be a treatment for a variety of cancers, such as breast and colorectal cancer. It is through clinical trials conducted at The Ottawa Hospital that innovative cancer treatments will be discovered and will continue to offer hope to patients like Stephany.

Organizations such as BioCanRx, the Canada Foundation for Innovation, and the Government of Ontario have supported The Ottawa Hospital’s CAR-T research and the Biotherapeutics Manufacturing Centre, but additional funding is essential to make this program a reality.

January 2023 update:

It’s been a rollercoaster of a ride for Stefany in the last year. Since December 2021, she’s struggled with lung infections, which she developed as a result of being immunocompromised and because, since 2017, she has important scarring on her lung. Such scars are the result of what happened to her while she was on a months-long waiting list to get to the CAR-T program in Philadelphia. “My [leukemic] condition got worse, I contracted pneumonia with no functional immune system, and despite overcoming it, I was left with considerable scarring on my lung, putting it at risk for various infections.”

It’s for this reason, Stefany is grateful to hear patients in a Canadian-first clinical trial at our hospital are getting access to CAR T-cell therapy right here in Ottawa. “Thankfully, the participants don’t have to go through what I’ve gone through with pneumonia and the waiting,” says Stefany.

She is slowly improving and is hoping to become a schoolteacher in the future. Stefany’s currently tutoring students and has given presentations on social justice topics to secondary school students. She’s also been enjoying some travel recently, including a nature expedition that supports youth affected by cancer and is looking forward to trips to Mexico and Costa Rica in 2023.

Learn more about the Canadian-Led Immunotherapies in Cancer (CLIC) research program, funded by BioCanRx, the Canadian Institutes of Health Research, The Ottawa Hospital Foundation, BC Cancer, BC Cancer Foundation, the Ontario Institute for Cancer Research, the Ottawa Regional Cancer Foundation and the Leukemia and Lymphoma Society of Canada.


The Ottawa Hospital is a leading academic health, research, and learning hospital proudly affiliated with the University of Ottawa.

The “seeds” are one millimetre by three millimetres, a third the size of a grain of rice, and made of platinum. These tiny seeds, created by researchers at The Ottawa Hospital, improve the CyberKnife robot’s accuracy in detecting and delivering precise doses of radiation to tumours in the brain and body.

Hand holding a grain of rice and platinum seed
Platinum seeds, a third the size of a grain of rice, are improving the accuracy of CyberKnife treatments.

CyberKnife uses X-rays and complex precision software to track and focus radiation directly to the tumour. With accuracy of less than a millimetre, there is virtually no radiation spill over to normal tissue. As a result, patients have much better responses to this type of treatment compared with traditional radiation where a larger area is targeted.

“Because CyberKnife delivers a high dose, it’s considered similar to surgery without using a scalpel, so no blood loss, no pain, no ICU stay, or recovery time,” said Dr. Vimoj Nair, one of the radiation oncologists trained to prescribe CyberKnife treatment.

Ninety percent of CyberKnife treatments are for malignant or benign brain tumours, but CyberKnife’s image guidance system can also treat tumours in organs that move constantly, such as the lungs, kidneys, liver, prostate gland, and lymph nodes. It can precisely align the radiation beam to the tumour even when it moves. But radiation oncologists and researchers at The Ottawa Hospital are refining techniques to further enhance the performance of this state-of-the-art technology to improve patients’ outcomes. These techniques are ultimately changing radiosurgery practice.

Dr. Vimoj Nair
Radiation oncologist Dr. Vimoj Nair said platinum seeds improve the accuracy of CyberKnife radiosurgery.

“One unique thing that the CyberKnife research team at The Ottawa Hospital has come up with are in-house designed platinum MRI-compatible seeds that can be implanted around the moving tumour,” said Dr. Nair, who is also a clinician investigator at The Ottawa Hospital and an assistant professor at University of Ottawa. “We can see the tumour and the seeds better on the MRI, and the CyberKnife software can detect and track the motion of the tumour with the help of these seeds. The robotic arm of the CyberKnife matches the target motion to treat the tumour more accurately while the patient breaths normally.”

The Ottawa Hospital is one of the first centres in North America to use these platinum seeds. In the past, oncologists used tiny gold seeds, but they were difficult to see in the MRI sequences used to view the tumour. This made the treatment planning less accurate. Dr. Janos Szanto, medical physicist, and Dr. Len Avruch, radiologist (now retired), were the initial brains who took platinum wire (otherwise destined to be jewelry), cut it into minute pieces, and then put through a sterilization process to ensure the seeds were appropriate for insertion into the human body. It worked. They were visible to the naked eye, more visible in an MRI than the gold seeds, and could be detected by CyberKnife.

Julie Gratton with patient beside CyberKnife robot
Radiation therapist Julie has delivered CyberKnife treatments since 2010.

“The benefit of this technique is we see both our target and seeds more clearly together, which provides the best use of advanced imaging and improves the accuracy,” said Dr. Nair, who called the discovery novel research and application that positions The Ottawa Hospital very favourably on the world stage.

Dr. Nair was the first author on the research paper published about the platinum seeds. He said that researchers and clinicians are continually sharing innovative CyberKnife techniques they’ve developed, like this one, at conferences and with other health centres across Canada and globally. In September 2018, he gave presentations on The Ottawa Hospital practices on clinical uses of CyberKnife at a conference in India.

“We can see the tumour and the seeds better on the MRI, and the CyberKnife software can detect and track the motion of the tumour with the help of these seeds.”

Read more about the history of the community-funded CyberKnife at The Ottawa Hospital.


The Ottawa Hospital is a leading academic health, research, and learning hospital proudly affiliated with the University of Ottawa.

The uterus fits in the palm of Dr. Sony Singh’s hand. The large pink lumps inside the clear, plastic 3D-printed model are fibroids, or tumours, and there are more than 50 of them. To ensure his patient could carry a child in the future, Dr. Singh had to do something that had never been done before.

Maureen had suffered for years with abdominal pain. Over the past six years, she was told by five doctors that she had so many fibroids in her uterus, her only option was to have a hysterectomy – complete removal of her womb. She refused this option.

“I will die with my womb. Nobody will touch it,” said Maureen (who did not want her last name used).

She was referred to the Shirley E. Greenberg Women’s Health Centre at The Ottawa Hospital, where she saw the Minimally Invasive Gynecology team of doctors and nurses. Dr. Singh, a surgeon and the Elaine Jolly Research Chair in Surgical Gynecology, told Maureen he could remove all the fibroids, and she would not need a hysterectomy.

Dr. Sony Singh uses 3D printed model for complex surgery.
Holding the 3D printed model of Maureen’s uterus, Dr. Sony Singh examined the MRIs and 3D renderings – the images that appear on the operating room screens that doctors can move to get a 3D view of the surgical area.

“Maureen had close to 50 fibroids and we wanted to make sure her uterus was able to carry a baby in the future and function normally,” said Dr. Singh. “But we needed help to plan the complicated surgery to remove them.”

Dr. Teresa Flaxman, Research Associate at The Ottawa Hospital, said it was difficult to see tumours in the patient’s uterus on an MRI. So, she contacted the hospital’s 3D Printing Lab. She had heard how 3D-printed models were helping orthopaedic surgeons see exactly what they were operating on, so they could better plan the surgery.

In 2016, thanks to a donor’s generosity, The Ottawa Hospital acquired a medical 3D printer that uses acrylics and plastics to create exact replicas of patients’ bones and organs from a CT scan or MRI. With the opening of the 3D Printing Lab in February 2017, the hospital became the first in Canada to have an integrated medical 3D-printing program for pre-surgical planning and education.

Dr. Adnan Sheikh, Director of The Ottawa Hospital’s 3D Printing Program, said the Department of Orthopaedics is one of the main users of the lab, which prints models for orthopaedic oncology surgeons to plan operations in advance, reducing surgery times and costs.

“3D printing is revolutionizing the way we look at anatomy,” said Orthopaedic Surgeon and Oncologist Dr. Joel Werier, who has used 3D-printed models of his patients’ hips and bones since the lab opened. “It adds another perspective to how we view tumours, how we plan our surgery techniques, and our ability to offer precision surgery.”

Bones are relatively easy to create from CT scans and MRIs, said Dr. Flaxman. However, soft tissues, such as uterine tissue, is harder to identify, and a model hadn’t been made of one before.

“We’re going to be one of the first hospitals internationally to study how we can provide this improved care by using 3D-printed models in planning surgery for women’s health.”

Dr. Flaxman and other researchers from the Women’s Health Centre worked with Waleed Althobaity and Olivier Miguel at the 3D Printing Lab to create 3D images from an MRI of Maureen’s uterus. Then the lab printed a model that allowed them to see exactly where the fibroids and the lining of the uterus were located.

“This was a very challenging case,” said Dr. Sheikh. “The multiple fibroids within the uterine cavity made it very difficult to print, and we had to identify each one of them, in order to replicate the exact anatomy on a 3D-printed model. We used a softer, flexible material to create the model that was more consistent with uterine tissue.”

The model took 14 hours to print. Although the model was scaled to eight times smaller than her actual uterus, her fibroid-filled uterus was 20 times bigger than normal. Having a 3D-printed model was a huge asset to the gynecological surgery team, which included surgeons Drs. Singh and Innie Chen.

“This model helped to provide a good visual aspect. To have a model in my hands during surgery was incredible,” said Dr. Singh. “At the same time, we also had 3D images that I could look at on a TV screen in the operating room. It seems very futuristic, but in the operating room I was able to turn the image of the uterus at any angle or degree that I wanted, so I could see it from different perspectives, which helped during surgery.”

A picture might be worth a thousand words, but a 3D version is worth a million words. The 3D-printed models are not only helping surgeons, but also helping patients like Maureen understand their illness and prepare for their surgery. For patients, seeing a 3D model of the problem inside their bodies makes it tangible and real.

“Just before my surgery, Dr. Singh brought the model to me,” said Maureen. “He explained how he could use it in the surgery to see where the fibroids are, and he asked my permission to use it during the operation.”

She agreed, knowing that it would help other women suffering similar experiences. Dr. Singh successfully removed the fibroids, sparing Maureen from having a hysterectomy.

“We wanted to save her uterus in hopes that she can carry a pregnancy in the future, which wasn’t a hope for her up until this point,” said Dr. Singh.

“By working together with the 3D Printing Lab at The Ottawa Hospital, we’re going to be one of the first hospitals internationally to study how we can provide this improved care by using 3D-printed models in planning surgery for women’s health,” said Dr. Flaxman.

Dr. Sheikh said that, since the success of this first use of a 3D-printed model for gynecological surgery, the 3D Printing Lab is already working on a couple of other similar projects with the Minimally Invasive Gynecology team to offer other women alternatives to major surgery in the future.

Maureen was so grateful the gynecology team was able to spare her uterus, that she donated to the Gratitude Award Program to thank them.


The Ottawa Hospital is a leading academic health, research, and learning hospital proudly affiliated with the University of Ottawa.

When a routine mammogram identified a small tumour, Rita Nattkemper was given an innovative option to mark its location for the surgery. A radioactive seed, the size of a pinhead, was injected directly into the tumour in her breast.

“All I have to say is it’s a painless procedure to get this radioactive seed in and it helps the doctor with accuracy,” said Rita. “And as he removes the mass, he’ll be removing the seed at the same time.”

For the last 20 years, when a woman had a breast cancer tumour that was too small to feel or be seen in surgery (called a non-palpable tumour), she had to have a wire (known as a harpoon) implanted at the tumour site to locate it for the surgeon. The wire, which stuck out of the woman’s breast, had to be inserted the morning of her surgery. Then, women had to wait uncomfortably for surgery with the wire sticking out of their breast. To add to the discomfort, many women had to fast overnight to prepare for surgery, causing many to faint in the radiology suite at the sight of the wire protruding from their breast.

The procedure also posed other problems.

“Sometimes the wire moved. And sometimes, because of the location of the tumour, the wire might overshoot or undershoot the tumour, so ultimately there was an enormous amount of guess work involved in taking out a breast cancer tumour properly,” said Dr. Carolyn Nessim, surgical oncologist, and clinician-investigator in the Cancer Therapeutics Program at The Ottawa Hospital.

Dr. Nessim, and other breast oncology surgeons, wanted to find a better option.

That was where radioactive seeds came in. Radioactive seeds have been used for many years to treat prostate cancer. Multiple seeds are implanted in the prostate, where they emit radiation and kill the cancer. Then a procedure was developed for breast cancer patients using a radioactive seed to mark the exact location of small breast-cancer tumours. Using a mammogram for guidance, a radiologist places one seed, so tiny it can be safely injected with a needle, inside the tumour. It emits a very small amount of radiation that is picked up in the operating room with a small, handheld Geiger counter. After the piece of breast tissue with the radioactive seed is removed, the seed is separated from the tissue and appropriately disposed of, with every seed being accounted for.

Realizing the benefits of this procedure, The Ottawa Hospital began a radioactive seed program in 2015. One of the main benefits is that the seed can be placed up to a week before surgery, which makes the day of the operation easier for patients. A woman doesn’t have to wait for surgery with a wire sticking out her breast. From a logistical point of view, it’s easier to organize the procedure days in advance, and means more efficiency in the operating room. Dr. Nessim led a research study comparing seeds to wires, which showed the benefit of seeds.

“The results of the radioactive seed program have been uniformly excellent,” said Dr. Erin Cordeiro, breast surgical oncologist and senior clinician-investigator at The Ottawa Hospital. “We did a study that found that radioactive seeds were more cost effective and decreased wait times for patients on the day of surgery when compared to wires. And the patient experience has also been wonderful. Patients are very supportive of this.”

Rita agrees. She said the surgeon and radiologist both explained the procedure and put her at ease about it.

“I felt a minor pinch, and that was all I felt,” Rita said immediately after the procedure. “And the radiologist had the screen turned, so I could see where she put in the needle and left the seed. It was very easy, very quick, and very painless.”

Dr. Cordeiro said women are often concerned about the seed’s radioactivity, but the staff reassures patients the procedure is completely safe. The amount of radiation that is emitted in the week the patient has the implanted seed is less than having two mammograms.

“A woman can continue to hug her children and do everything in life she would normally do,” said Dr. Cordeiro. “No concerns from that point of view. It’s an extremely safe procedure. The vast majority of women have no concerns.”

Over the past year, 355 radioactive seed procedures have been performed at The Ottawa Hospital. Only two patients have refused the seeds and opted for the traditional wire instead.

Because of the program’s radioactive element, there were stringent guidelines around starting the program.

A multidisciplinary team of nuclear medicine, radiation safety experts, radiologists, pathologists, surgeons, technicians, and nurses were involved.

Key members of the team, led by Dr. Nessim, went to the Mayo Clinic in Rochester, N.Y., to learn how to implement the program. They then ran 15 training sessions for staff at The Ottawa Hospital. The radioactive seed program now “runs like a well-oiled machine,” said Dr. Nessim.

The Ottawa Hospital was the third centre in Canada to have a radioactive seed program, and is a leader in the procedure. Other health centres across the country are now adopting it and looking to The Ottawa Hospital for guidance in successfully implementing their program.


The Ottawa Hospital is a leading academic health, research, and learning hospital proudly affiliated with the University of Ottawa.