U.S. hospitals, clinics and imaging centers face an ongoing shortage of an essential ingredient in most nuclear medicine imaging.
Isotope shortage could affect medical imaging
Repairs to a Canadian nuclear reactor that produces one-third of the worlds supply of the isotope molybdenum-99 will take at least three months, the operator of the Chalk River, Ontario, reactor said last week. Atomic Energy of Canada first closed the reactor in mid-May after discovering a heavy water leak.
News of the reactors extended shutdown left drugmakers and healthcare providers bracing for a medical isotope shortage that could delay some procedures and push doctors to use alternative diagnostic tests.
Milton Guiberteau, chief of nuclear medicine at 344-bed St. Joseph Medical Center, Houston, said that the hospital immediately scaled back nuclear medicine imaging by at least 15% after St. Josephs medical isotope supplier alerted customers that supply would be curtailed.
He called the Ontario reactors unexpected closure and news that maintenance will temporarily shutter a second reactor in the Netherlands very significant.
Guiberteau, also a professor of clinical radiology and nuclear medicine at the University of Texas Medical School, said that certain procedures may be delayed or doctors can use alternatives like CT scans, MRIs or an alternative radiological isotope, he said. But in some cases, such as bone scans for cancer patients, alternatives will be significantly more expensive and less effective.
Molybdenum-99 rapidly decays to form technetium-99m, another short-lived isotope that is combined with drugs to target tissue or disease. Cameras that detect technetium-99m capture an image of the area infused by the isotope-laced drugs, a widely used procedure in cardiology, oncology, orthopedics and other specialties.
Robert Atcher, president of the Society of Nuclear Medicine, said that the four remaining reactors in Belgium, France, the Netherlands and South Africa lack capacity to offset Canadas lost supply for a prolonged period because of licensing, maintenance or resource constraints. Atcher said that the scheduled maintenance in July of the reactor in the Netherlands could further strain supply.
The isotopes rapid decay prevents manufacturers from building a stockpile for emergency use, Atcher said. Because its radioactive material and it does decay away, theres no shelf life. We have to replenish each week.
Michael Graham, director of nuclear medicine at the University of Iowa Carver College of Medicine in Iowa City, said that the University of Iowa Hospitals & Clinics exhausted its supply of molybdenum-99 last week after its final so-called generatorthe 400-pound delivery device for molybdenum-99reached its expiration date.
Graham, who is also a professor of radiology and radiation oncology, said that the school negotiated a deal with a Davenport, Iowa, pharmacy for a smaller supply of medical isotopes, but its uncertain how long the supply will last. Its not clear whats going to happen then, he said.
Drug manufacturer Covidien in a May 22 letter to customers said it anticipated an increase in supply from the Netherlands reactor and placed additional orders with the remaining reactors but also stressed providers should be ready for limited supply and consider using alternatives.
Troy Kirkpatrick, a spokesman for Cardinal Health, said that the distributor has also worked with its supplier base to boost supplies of molybdenum-99 and stressed customers conserve isotopes for the most critical uses.
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