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Technetium-99m: Necessity is the mother of invention

by Gus Iversen , Editor in Chief
From the June 2015 issue of DOTmed HealthCare Business News magazine

New signs of life as an era of private production dawns for SPECT’s workhorse isotope

An estimated 80 percent of the world’s nuclear medicine – or approximately 70,000 SPECT scans per day – are contingent upon access to an isotope traditionally generated in nuclear reactors.
For the Western Hemisphere, the National Research Universal (NRU) reactor at Chalk River in Ontario, Canada, has been the primary supplier of molybdenum-99 (Mo-99), the parent isotope of technetium (Tc-99m), since 1957.

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In a couple of years, all that will change.

Six years ago, when the NRU reactor went out of operation at the same time as another major reactor – the High Flux Reactor (HFR) in Petten, Netherlands, the potential for supply disruptions of Tc-99m became frighteningly clear. The NRU reactor is retiring in 2018, meanwhile the HFR, and another reactor in France called Osiris, are timelined to go permanently offline as well, with replacement nuclear reactors in various stages of development.

From the time of those shutdowns, Rob Atcher, chair of the Medical Isotope Taskforce for the SNMMI, says the price of Tc-99m has gone up 200 to 300 percent. In North America government funded initiatives were put in motion to find alternative methods of generating those isotopes. Different approaches to producing the isotopes are attractive in part because reactor-generated Mo-99 requires highly-enriched uranium, which is a weapons-grade substance.

Approximately half of the Tc-99m used for SPECT imaging measures blood flow to the heart on patients with chest pain or other symptoms indicating a block in the cardiac arteries. The remaining procedures use Tc-99m to detect bone metastases from the spread of breast, prostate, and lung cancer.

As access to Tc-99m remains uncertain, some experts are turning to innovations with PET imaging to absorb some of the diagnostic burden. Sodium fluoride has been shown effective for detecting bone metastases, but is it still too soon to realistically imagine a future where molecular imaging doesn’t depend on Tc-99m at all?

Linac vs. cyclotron
Australia recently poured $157 million into the processing facility of its Open Pool Australian Lightwater (OPAL) reactor, which already produced 550,000 doses of Mo-99 per year going into the upgrade; enough to meet the country’s own needs. Slated to open in 2016, the improved facility is anticipated to triple that output and establish Australia as a major international supplier of the isotope with an output comparable to Canada’s NRU.
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