Global shortages of Tc-99m have had an impact on the nuclear medicine industry for the past few years. This is a result of the shutdown of at least 2 nuclear reactors, located in Ontario, Canada and Petten, Netherlands, due to safety issues. The Ontario reactor (Chalk River Labs) is where North America gets most of its technetium. Although the Chalk River reactor started producing isotopes once again at the end of 2010, it is scheduled to close permanently in 2015.
With about 90% of all nuclear medicine studies using technetium, our clients, and subsequently, their patients, continue to be affected. The largest impact we see with our client base is cardiac imaging used for the detection of heart disease and cardiovascular health assessment. Other procedures being affected are pre-surgery sentinel node imaging, metastatic bone disease detection and thyroid cancer detection.
Hospitals and imaging centers are limited in how they can mitigate the effects of the shortage for both their patients’ health, as well as their own financial health. The obvious outcome would be doctors scheduling testing more discriminately and the inability to schedule the same patient loads as departments and imaging centers were once used to. This increases patient waiting times for scheduling a test, as well decreases the revenues of imaging departments.
Another option that is now available for departments to lessen effects brought on by the shortage is to use smaller doses in combination with imaging software that allows for diagnostic-quality images with half the normal dose. Much of the community is already familiar with programs such as GVI’s Resolve and Segami’s Shine, originally marketed to decrease imaging time by up to 50% (using a normal cardiac dose). These same programs can be used, decreasing dose by up to 50%, while keeping imaging time within the same limits as normal. Programs such as this can keep resting doses between 4-6 mCi and stress doses between 12-18 mCi, allowing up to a 50% reduction in the total Tc99m demand of the department.
The White House is currently working with the NRC, FDA and the Energy Department to ensure that new production of Tc99m will be developed. The process of establishing new reactors in the United States will be an expensive and lengthy one. This means that measures the community is taking now to maintain diagnostics and business may become more standard practice in the months to come. The SNM has suggested: imaging throughout the entire week (including Saturdays and Sundays: isotopes are produced on a daily basis), lowering doses and increasing scan time, using Thallium 201 for resting (or rest and stress) procedures and using alternative isotopes and/or imaging procedures (echo, CTA, PET) when applicable. The SNM is also working with government to attempt to allow other positron emission isotopes to be used for procedures such as bone scintigraphy.
For a detailed assessment of the current state of the shortage and its impact on the industry, visit the article Producing Medical Isotopes in the U.S.: A Worthy Goal for the Biotech Industry, written by Jim Katzaroff, CEO and chairman of medical isotope company Kennewick.
For more information on GVI’s Resolve software, visit www.gvimd.com