Atomic Energy of Canada (AECL) continues to repair its National Research Universal (NRU) nuclear reactor in Chalk River, Ontario, while Dutch radiopharmaceutical producer Nuclear Research and Consultancy Group (NRG) took its High Flux Reactor in Petten, Netherlands, offline for planned maintenance in February.
The three remaining Mo-99-producing nuclear reactors in Belgium, France, and South Africa also will be offline temporarily this week for maintenance and refueling.
"It is a perfect storm of predicted and unexpected problems," said Jeffrey Norenberg, Pharm.D., chair of the SNM Commission on Radiopharmaceuticals and member of the SNM Medical Isotope Task Force. "The combination of these reactors having some timely and untimely maintenance issues has led to a circumstance where we have exhausted all our backup capacity."
The situation is disturbing news for as many as 30,000 patients in the U.S. who require nuclear medicine or molecular imaging tests on a daily basis to diagnose, stage, monitor, or treat cancer, heart, or brain disease, according to Norenberg and the SNM. Approximately 80% of these tests use technetium-99m (Tc-99m), the medical isotope derived from Mo-99.
For myocardial perfusion exams, Norenberg, who also serves as the executive director of the National Association of Nuclear Pharmacies and the associate director of the New Mexico Center for Isotopes in Medicine in Albuquerque, NM, said there is no good alternate method of imaging to technetium.
"There is some capability to go back to thallium imaging, but it is an older technology with increased radiation dose, decreased accuracy, and it's a suboptimal study," he added. "I don't want to be Chicken Little here, but whatever modality has taken up the capacity that is not addressed [by technetium] is not the standard of care. That is deeply concerning."
SNM has offered its list of recommendations on how to best cope with the medical isotope shortage this week and in the foreseeable future. The list includes the following advice to providers:
- Coordinate with generator providers or radiopharmacies on technetium availability.
- Perform imaging studies throughout the week, including weekends.
- Adjust administered doses to coincide with an extended imaging time to ensure image quality.
"There are some good coping strategies, but, honestly, I think we have done everything we can in terms of increasing efficiencies," Norenberg said. "If you don't have any technetium, there isn't a lot to talk about."
In its March 17 update, AECL reported that 51% of the repairs to its reactor at Chalk River have been completed. The latest weld repair was "the most complicated and difficult repair undertaken to date," AECL noted in a prepared statement.
"The remaining two repair sites present unique challenges that require first-of-a-kind technical solutions," AECL added. "To ensure that the repair process itself does not cause damage to the vessel, an additional level of preparation is necessary to program the welding sequences and to qualify the welders."
AECL still anticipates NRU's restart for the second half of May. The first medical isotopes will be removed from the reactor for processing and distribution within 10 days of the restart.
The NRG began its planned maintenance and repairs last month, with expectations to return to service in late August.
By Wayne Forrest
AuntMinnie.com staff writer
March 22, 2010
Reason for optimism even in latest Mo-99 supply challenge, March 12, 2010
AECL delays NRU restart to May, March 12, 2010
Canada to invest again in AECL, March 5, 2010
NRG powers down Petten reactor, February 19, 2010
Covidien signs deal to produce Mo-99 at Polish reactor, February 17, 2010
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