Transporters are beginning to overcome challenges created by the COVID-19 pandemic that have affected delivery of radiopharmaceuticals for necessary nuclear imaging exams.

Nuclear medical exams expected to increase with improvements to radioisotope transport

May 01, 2020
by John R. Fischer, Senior Reporter
PET, SPECT and other nuclear imaging procedures are expected to pick up over the coming weeks across the U.S. and Europe against the backdrop of the ongoing COVID-19 pandemic, according to Nuclear Medicine Europe.

The news comes as international transporters begin to overcome challenges in the shipment of radiopharmaceuticals created by the crisis, reports World Nuclear News.

"Air transportation options, including via scheduled commercial flights, have been increasing, although there are still many last-minute changes and difficulties in transporting radioisotopes to some regions," said NMEu’s Security of Supply Working Group Emergency Response Team (ERT) in a statement, adding that it had been “advised that nuclear medicine procedures are expected to increase in the coming weeks in both Europe and the U.S., and it is anticipated that there will not be a problem in meeting an increase in demand.”

Scheduled commercial flights typically transport radioisotopes and radiopharmaceuticals internationally for use in nuclear medicine exams, but have been curtailed due to the pandemic. While no specific shortages in general are expected, these logistical changes have created short-term difficulties in availability of medical radioisotopes and have raised concerns around short-lived radioisotopes.

An example of how transport of these materials is improving came last month when Dutch national carrier KLM, which has previously refused to carry Class 7 radioactive materials, agreed to resume transport of medical isotopes from Europe to the U.S. The decision was made “based on humanitarian needs and medical urgency” and a safety audit was conducted by KLM to ensure passage of such items on its aircraft was safe. Transport began on April 27.

“The transport of radioisotopes will be for a limited period of time (initially five weeks), until United Airlines or a stable alternative is up to speed,” said the Society of Nuclear Medicine and Molecular Imaging in a statement. “After five weeks, KLM will review the situation and can look at an extension if necessary.”

South African radioisotope producer NTP Radioisotopes also made headway with South African Airways, which is orchestrating a number of repatriation flights that have so far transported 14 emergency shipments of radioisotopes from South Africa to Europe, North America and South America via SAA flights.

A survey of radioisotope producers by the International Atomic Energy Agency found that bottlenecks in transport and distribution could cause shortages at hospitals. While many airlines are starting to use passenger aircraft for cargo-only flights, they require permission from air regulators to make such changes.

In addition, panelists from 18 countries confirmed in an IAEA webinar last month that fewer radiological procedures are being carried out worldwide due to the focus on the pandemic by healthcare professionals. Shipments of Mo-99/Tc-99m generators from Germany and the Netherlands to Tunisia, for instance, are now more costly to transport due to shifts in how they are transferred to Istanbul, with the devices arriving with an activity of around 500 mCi instead of the usual 840 mCi prior to the pandemic.

To help providers modify procedures to offset potential shortages due to air traffic restrictions — as well as keep patients safe — IAEA recently issued a number of guidelines that advise managers to maintain detailed inventories as well as lists of all possible suppliers and distribution channels, among other recommendations. The guidelines were published in the European Journal of Nuclear Medicine and Molecular Imaging.

“Nuclear medicine physicians and staff need guidance to carry out imaging studies while preventing the further spread of COVID-19 during procedures,” said the director of the IAEA’s human health division May Abdel-Wahab in a statement. “They also need to be prepared for potential disruptions in the supply chain of essential radioactive tracers.”