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Q&A with Tiffany Olson President, Nuclear Pharmacy Services, Cardinal Health

June 16, 2017
Molecular Imaging SPECT
Tiffany Olson
From the June 2017 issue of HealthCare Business News magazine
HealthCare Business News recently caught up with Tiffany Olson to discuss supply chain issues in the radiopharmaceutical industry.

HCB News: There have been molybdenum-99 (Mo-99) supply interruptions in the past. Does the supply chain in the U.S. look stable now, or are there weaknesses to keep an eye on?
Tiffany Olson: When I started in the radiopharmaceutical industry in 2013, I was astonished at the complexity of the supply chain. It truly impacts the business, and industry as a whole, more than I’ve seen in other industries in which I’ve worked. Technetium-99m (Tc-99m) is the daughter of molybdenum-99 (Mo-99) and is used in approximately 80 percent of the nuclear medicine procedures worldwide. Tc-99m has become the principal radioisotope used for medical diagnostic imaging because of the manageable half-life, low radiation exposure to patients and health care providers and clarity of images provided. Tc-99m is critical to how physicians make diagnoses and direct patient care, and we are therefore dedicated to managing the complicated dynamics in the Mo-99 supply chain.

Many factors combine to make the current supply chain for Mo-99 complex, including:
• The short half-life of Mo-99 at 66 hours, and Tc-99m at six hours.
• The U.S. does not have a domestic source of Mo-99, which can create difficult transportation and customs issues.
• The advanced age of most of the international reactors creates concern.

The Mo-99 supply shortage in 2009 created an impetus for the industry to focus on enhancing the reliability of supply. Over the last several years, the industry has increased outage reserve capacity and added extra targets at current reactors. Generator manufacturers, downstream to reactors, have diversified their supply chains and incorporated multi-source agreements for Mo-99. Industry groups such as the Organisation for Economic Co-operation and Development (OECD) are meeting with groups to ensure reactor maintenance schedules are coordinated. Mo-99 production has become more reliable with these additional reactors and processing capacity. We continue to monitor these conditions closely, and feel confident in the plans the industry has in place to minimize interruptions and ensure continuous supply for patients.

HCB News: How can nuclear pharmacies and nuclear medicine departments help optimize the use of Tc-99m and ensure patients continue to have access to important radiopharmaceuticals in case of a shortage?
TO: Improving the reliability of the Mo-99 supply chain doesn’t end with the reactors and generator manufacturers. Recall that necessity is the mother of invention, and nuclear pharmacies and nuclear medicine departments learned from prior Mo-99 shortages. Nuclear pharmacists are passionate about providing patients access to these critical diagnostic tools, and have adapted from the challenges of prior shortages. To optimize Tc-99m in the event of a shortage, nuclear pharmacies manage discretional orders of Tc-99m and, if necessary, engage in a triage process. Nuclear pharmacies have also become more efficient with their use of Mo-99/Tc-99m generators. Software applications have helped nuclear medicine departments simplify ordering and optimize deliveries. Nuclear medicine departments also use software and analytics to optimize patient scheduling.

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