Not a glow­ing out­look

While vi­tal iso­topes needed for med­i­cal imag­ing are back in sup­ply, an­other short­age could loom as the U.S. con­tin­ues to lack ad­e­quate do­mes­tic sources

Modern Healthcare - - Special Report -

When the med­i­cal iso­tope short­age hit its peak ear­lier this year, Manuel Brown, chair­man of the ra­di­ol­ogy depart­ment at Henry Ford Hos­pi­tal and Health Net­work in Detroit, re­mem­bers months when his staff didn’t know from one day to the next whether they would be able to per­form nu­clear imag­ing stud­ies.

“There were nights when we couldn’t re­spond to de­mands from the emer­gency rooms for things like lung scans, which are used to di­ag­nose pul­monary em­bolisms,” says Brown, who also chairs the Amer­i­can Col­lege of Ra­di­ol­ogy’s Com­mis­sion on Nu­clear Medicine. “There were some nights when we only had enough iso­topes for one study, or week- ends when we couldn’t do any. It was very dif­fi­cult, and it be­came a real prob­lem in terms of pro­vid­ing good care to pa­tients.”

The world­wide iso­tope short­age—well doc­u­mented by now—was caused by an un­ex­pected shut­down of Canada’s Chalk River (On­tario) nu­clear re­ac­tor in May 2009 due to leak­age of ra­dioac­tive wa­ter. The fa­cil­ity, which re­mained closed for re­pairs un­til this past Au­gust, pro­duces roughly half of the U.S.’ sup­ply of molyb­de­num-99, a ura­nium-pro­cess­ing byprod­uct used to pro­duce the med­i­cal iso­tope tech­netium-99.

More than 80% of the 18 mil­lion nu­clear imag­ing stud­ies per­formed an­nu­ally in the U.S. use tech­netium-99 as a con­trast agent.

The short­age be­came even more ur­gent when a nu­clear re­ac­tor in Pet­ten, the Nether- lands, shut down for months of main­te­nance work be­tween Fe­bru­ary and Septem­ber 2010. With two of the five med­i­cal-iso­tope-pro­duc­ing re­ac­tors in the world si­mul­ta­ne­ously off­line, ra­di­ol­ogy providers were un­able to ac­cess a suf­fi­cient sup­ply of tech­netium.

As a re­sult, hos­pi­tals and imag­ing cen­ters had to post­pone PET and other types of nu­clear scans used to di­ag­nose cer­tain can­cers and heart and brain con­di­tions. In some cases, doc­tors and their pa­tients had to opt for less ef­fec­tive imag­ing tech­niques, says Steven Lar­son, chief of nu­clear medicine at New York’s Me­mo­rial Sloan-Ket­ter­ing Can­cer Cen­ter.

“We re­duced by 15% to 20% the amount of tech­netium we used in cer­tain pro­ce­dures, but that re­duces op­ti­mal imag­ing,” he ex­plains. “We also used some al­ter­na­tive iso­topes, which had been re­placed by tech­netium be­cause it has ad­van­tages.”

The iso­tope short­age has eased in re­cent months with the re­ac­ti­va­tion of the Chalk River and Pet­ten fa­cil­i­ties, but nu­clear-medicine ex­perts say un­less the U.S. pushes for­ward with de­vel­op­ing a do­mes­tic sup­ply of med­i­cal iso­topes, the sort of prob­lems ex­pe­ri­enced over the past cou­ple of years are likely to re­visit in a much more press­ing fashion. They note that four of the re­ac­tors pro­duc­ing molyb­de­num-99 are ag­ing and ex­pected to be in op­er­a­tion for only a few more years. The Chalk River re­ac­tor, for ex­am­ple, is sched­uled for per­ma­nent clo­sure by 2016.

“I think the events of the past two years have re­ally wo­ken us up to what the fu­ture will be if we don’t make a con­certed ef­fort to solve the prob­lem,” says An­drew Ein­stein, as­sis­tant pro­fes­sor of clin­i­cal medicine at Columbia Uni­ver­sity Med­i­cal Cen­ter’s car­di­ol­ogy di­vi­sion.

A tech­ni­cian mon­i­tors pro­duc­tion of molyb­de­num-99 at GE Hi­tachi’s Val­lecitos Nu­clear Cen­ter, about 30 miles east of San Fran­cisco. The site in­cludes a small re­search re­ac­tor.

Co­vi­dien Health­care op­er­ates this iso­tope pro­cess­ing plant in Pet­ten, the Nether­lands. The tem­po­rary shut­down of a gov­ern­men­towned nu­clear re­ac­tor in the city con­trib­uted to the world­wide short­age of med­i­cal iso­topes ear­lier this year.

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