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  • Report Warns of Radioisotope Shortage for Nuclear Imaging Procedures

    A federal report warns of a shortage of the primary radioisotope used in diagnostic imaging scans for cancer and other illnesses. By Mike Bassett

    May 1, 2017

    A new report warns of a worsening shortage of key medical isotopes used in nuclear imaging scans following the shutdown of an aging Canadian nuclear reactor in late 2016. If the shortage is realized, doctors could be forced to delay procedures that rely on these isotopes.

    Issued in January 2017 by the National Academies of Sciences, Engineering, and Medicine, the report warns of a shortage of Molybdenum-99 (Mo-99) and Technetium-99m (Tc-99m) following the October 2016 shutdown of Canada’s National Research Universal reactor in Chalk River, Ontario, which produced a major share of the world’s medical radioisotopes.

    Chalk River stopped producing Mo-99, which is used to create the radioisotope Tc-99m that is commonly used in diagnostic imaging scans for cancer, heart disease and other illnesses. The reactor, built in 1957, was shut down primarily due to serious age-related breakdowns and safety and security concerns.

    The U.S. government-commissioned report concluded that the Chalk River shutdown has created a “substantial likelihood of severe Molybdenum-99 and Technetium-99m shortages,” at least until other global suppliers complete planned expansions later in 2017 and 2018, said committee leader, S. James Adelstein, PhD, Paul C. Cabot Distinguished Professor of Medical Biophysics at Harvard Medical School.

    “Until these other suppliers get these new facilities online, there are enough historical and technical reasons to think it is highly probable something will happen to disrupt the supply,” Dr. Adelstein said.

    The report urges the U.S. government to work with the Canadian government to “ensure that there is an executable and well-communicated plan in place to restart the supply of Molybdenum-99 from Canada.”

    According to the report, the three existing global Mo-99 suppliers, ANSTO in Australia, Mallinckrodt in the Netherlands, and NTP in South Africa, have announced plans to expand their supply capacities. If these plans are realized, by the end of 2017 supply capacities would increase enough to offset the lost supply capacity represented by Chalk River.

    When the Chalk River reactor closed for repairs in 2009, causing a shortage of radioisotopes, the search began across the globe for an alternative. Canada is pursuing the use of cyclotrons to produce Tc-99m, while the U.S. government in 2009 began assisting efforts to develop domestic capabilities to supply Mo-99 without the use of highly enriched uranium targets.

    Supply Likely to Last through 2017

    Nevertheless, Sally Schwarz, MS, RPh, BCNP, president of the Society of Nuclear Medicine and Molecular Imaging, and professor of radiology at the Mallinckrodt Institute of Radiology at Washington University, is confident the specialty of nuclear medicine will be able to handle a disruption in the supply of Mo-99 through 2017.

    She pointed out that an analysis from the Association of Imaging Producers & Equipment Suppliers — which represents many of the major pharmaceutical and imaging equipment companies in nuclear medicine in Europe — shows that there is enough reactor capacity to provide for the reliable international supply of Mo-99 through 2017.

    “I think if there was any major problem there would be very limited reduced availability because of the existing supply,” Schwarz said. “It’s a different situation from 2009. Suppliers are opening new reactors and managing the process on a global level, so I’m very optimistic that it’s under control.”

    However, Kathryn Morton, MD, a professor in the Department of Radiology at the University of Utah, who is board-certified in nuclear medicine and served on the committee that produced the January 2017 report, said that a decline in demand for nuclear medicine studies could complicate the issue.

    On the committee, Dr. Morton studied the Tc-99m demand among Medicare Part B recipients between 2006 and 2014 and found that Tc-99m diagnostic radiopharmaceutical utilization declined by about 49 percent in that population.

    The drop in demand could affect future decisions about expanding production or developing alternative sources of Tc-99m, she said.


    Chalk River
    The recent shutdown of Canada’s National Research Universal reactor in Chalk River, Ontario, above, could create a shortage of medical isotopes used in nuclear imaging scans.