Shortage of Medical Isotopes Has US Hospitals Rationing Nuclear Imaging Tests
Last Updated: 2009-06-12 16:08:13 -0400 (Reuters Health)
CHICAGO (Reuters) - A North American shortage of medical isotopes has forced many US hospitals to begin rationing diagnostic tests, and no quick solution is in sight.
Last month, Canadian health officials shut down a nuclear reactor in eastern Ontario that produces a third of the world's supply of medical isotopes. Repairs of a heavy water leak at the Chalk River reactor, first estimated to take a month, may now take three, and Canadian officials say they eventually may leave the isotope business altogether.
The Canadian plant is one of five aging reactors worldwide -- none located in the US -- that produce molybdenum-99, the most commonly used medical isotope. Molybdenum-99 has a shelf life of just 67 hours, making it impossible to stockpile.
"We are seeing a shortage," said Dr. Peter Conti of the University of Southern California in Los Angeles. The university's three hospitals have begun rationing supplies, and they are not alone.
The Society of Nuclear Medicine said 91% of 375 members, including doctors and nuclear medicine technicians, reported in an e-mail survey this week that they had been affected by the shortage, with 60% postponing procedures and 31% canceling some.
At the University of Chicago Medical Center, doctors are recommending alternative tests that do not rely on molybdenum-99 but may not be as accurate and may cost more.
"Pretty much every reasonable-sized medical center is going to have a nuclear medicine department that relies very heavily on this isotope," said Dr. Daniel Appelbaum, who heads the university's nuclear medicine department.
At USC, Dr. Conti said only the most urgent tests are being done, typically in cardiac patients. He said tests to screen for spread of cancers to bones "have gone by the wayside."
He said some cancer patients will be switched to more expensive positron emission tomography (PET) scans, which are approved by the U.S. Food and Drug Administration but are not covered by Medicare.
"For Medicare, we're going to have to eat some of those costs. We'll try to bill on the private side," Dr. Conti said.
He pointed out that a prolonged shortage could threaten clinical trials because patients may not be able to get protocol scans on schedule.
The shortage has taken a toll on Toronto-based MDS Inc, which distributes medical isotopes worldwide from the Canadian reactor. MDS on Thursday said it lost $17 million in the second quarter.
Privately held Lantheus Medical Imaging of Massachusetts, which processes isotopes for medical use, got most of its supply from Chalk River. The company last month cut a deal with other suppliers to cope with the impact of the shutdown.
Covidien, another major U.S. supplier, gets most of its isotopes from a reactor in Petten, the Netherlands, which has shielded its clients somewhat from the Canadian shutdown. But that may change next month when the Dutch reactor goes off line for a four-week maintenance shutdown.
In a May 22 letter on the FDA website, Covidien said, "Even with numerous global efforts and collaborations now underway, there will be challenges meeting full market need."
Dr. Robert Atcher, president of the Society of Nuclear Medicine, said the nearest-term solution would be to accelerate a US Department of Energy plan to convert a research reactor at the University of Missouri to medical isotopes production.
Without added capacity and a stable domestic supply, he said, patients will be at risk.
Copyright © 2009 Reuters Limited. All rights reserved. Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.
