by Dr. Robert Atcher

This report originally appeared in the November 2009 issue of DOTmed Business News

A number of issues are currently bedeviling the field of nuclear medicine. We are still struggling to figure out a way to address the issue of medical isotope availability, and apart from that acute problem of the molybdenom 99 and thus, technetium 99m shortage, there is also the health care reform initiative and its impact on advanced imaging. We have to do a better job of proving that imaging has incredible value for the patient and we need to be able to adequately inform everybody concerned - patients, other medical specialists and the people doing the decision making - so that our services are not put in jeopardy.

As far as the molybdenum issue goes, it's like that old song: 'You don't miss your water, 'til the well runs dry.' We were very lucky the Belgian reactor was able to pick up the slack when the reactor in the Netherlands went offline a month ago. That said, we're really going to be in a tight situation in terms of technetium 99m-based agents required for single photon emission tomography (SPECT) imaging next year when the Petten reactor is scheduled to be offline for four to six months. The Belgian facility is not a single-purpose reactor and it runs on a limited operating schedule. It's not equipped to run when Petten is offline. We are continuing to work through options of using US reactors to produce material that will be shipped to Canada to be processed, but people throughout the supply chain have really been complacent and the general attitude has been that, if we're still getting it, we don't have to worry. We should have been on top of this issue 10 years ago and shame on us for not having enough insight to spend the money on new sources before the shortage approached crisis proportions. Of course, the Canadians canceling the MAPLE reactors project has been a real blow to supply, which only complicates matters.

We're also waiting for Medicare to establish whether they're going to reimburse for sodium fluoride-based PET imaging as an alternative to SPECT bone scans. Next spring, when the supply of technetium is really beginning to look grim, we won't have an alternative for the people who really need bone scans for their diagnosis and disease staging and for directing the palliative radiation treatments that can help patients maintain quality of life.

The nuclear medicine community is also concerned about the issue of health care reform. Certain parties have fairly effectively demonized imaging. They consider it to be something that people do in defensive practice of medicine and they've seen it as a too-rapidly growing segment of medical practice in terms of reimbursement.

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