The Medical Isotope Shortage

The Medical Isotope Shortage

Most people are not aware just how important a role nuclear medicine imaging procedures play in the diagnosis and treatment of disease.  It is estimated that approximately one third of all hospital inpatients receive some kind of nuclear medicine scan during their stay in the hospital. Nuclear medicine imaging is critical in the diagnosis of many types of cancer, in assessing cardiac function and increasingly in evaluating neurological conditions such as Alzheimer's disease or other dementias.

It is surprising then that the medical isotopes which are needed for performing these procedures are provided by only a very few sources. The large majority of nuclear medicine procedures, nearly 80%, are performed using Tc-99m. The primary supplier for the U.S. for the parent isotope for TC-99m, Molybdenum – 99, is the Nordion National Research Universal reactor at Chalk River, Ontario.  This reactor, which is operated by Atomic Energy of Canada Ltd., has undergone a number of shutdowns in the last few years due to routine maintenance, regulatory issues or problems requiring repair.  When this reactor is shut down it has a direct impact on the number of nuclear imaging examinations which can be performed, and can affect the scheduling of these procedures, often causing performance of these procedures to be deferred or cancelled due to shortages in supply. 

There are only a few other reactors which exist worldwide which produce this medical isotope, most of which are located in Europe. The reactor in Petten, Netherlands has recently been shut down and start-up is not anticipated until November 2008. This has already resulted in delays in scheduling of nuclear medicine imaging procedures in Europe. Since early diagnosis is critical to beginning lifesaving treatment for patients, the shutdown of this reactor has raised the level of concern among nuclear medicine physicians.

For a number of years, the U.S. Department of Energy and the Society of Nuclear Medicine have sought government appropriations for establishing a reliable U.S. supply of nuclear medicine imaging isotopes. Given that nearly all isotopes come from non-U.S. sources, many have believed this to be not only a medical issue but a national security issue as well. Unfortunately, despite repeated efforts over the years, funds have never been appropriated by Congress to create a U.S. source of supply. There have been recent discussions with regard to utilizing several existing reactors in the U.S., such as the reactor at the University of Missouri, to manufacture Molybdenum – 99. With most of the U.S. government's attention now preoccupied with bailing out the ailing U.S. financial system, as well as the wars in Afghanistan and Iraq, there is considerable concern whether this issue will receive the attention it deserves in the near future. The MITA Nuclear Section members and Society of Nuclear Medicine will be monitoring the situation and will be exploring strategies to address this important issue in 2009. 

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