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Q&A with SNMMI incoming president Alan Packard

by Sean Ruck, Contributing Editor | June 16, 2020
Molecular Imaging
From the May 2020 issue of HealthCare Business News magazine

There’s also a long-term problem with the availability of molybdenum-99. We haven’t had a domestic supply since the 1980s, when the last U.S. reactor shutdown. The problem was exacerbated when the Canadian Chalk River reactors shut down a few years ago. The manufacturers have done a great job of assembling a coalition of five or six international reactor operators that produce the molybdenum-99 and the processors that separate the molybdenum from the targets after it comes out of the reactors. This was a greater challenge following 9/11 since a lot of these reactors use highly enriched uranium. There was a mandate from the National Nuclear Security Agency to eliminate the use of highly enriched uranium both as a reactor fuel and as a target material. Also, Congress passed AMIPA (American Medical Isotopes Production Act) a few years ago, which provided funding to create domestic supplies of molybdenum-99. One of these projects, Northstar, is already online. Another, SHINE, should be coming online in the next year or so, and there are three or four other companies a little further down the pipeline.

HCB News: We’ve covered the molybdenum-99 shortages extensively over the years, but it sounds like even in the face of the COVID-19 pandemic, the supply is currently steady?
AP: The supply is steady. The accessibility is the problem. Most of the molybdenum-99 is shipped to the U.S. on commercial airliners and a lot of those flights have been cancelled. The biggest challenge seems to be getting it from South Africa to Europe, because there are very few flights coming out of South Africa at the moment.

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HCB News: How does our nuclear medicine program compare to that of Europe?
AP: The environment is very different. In the U.S. in general, nuclear medicine is now part of the radiology departments, whereas in Europe, it’s a freestanding specialty. That may lead to different perceptions by the referring physicians, in terms of the partnerships that are developed and in terms of how new tracers are developed. There are some differences, but I think overall we’re pretty similar. There’s a greater difference in the regulatory environment, in terms of both approval and reimbursement, which leads to faster adoption of new tracers in Europe than in the U.S.

HCB News: Hospitals have delayed elective procedures in the face of the epidemic, but are you aware if it’s impacted nuclear medicine-based procedures at all?
AP: There has been a significant slowdown because, as with most other medical procedures, the hospitals are restricting access to procedures that aren’t either urgent or emergent. So the volume of procedures is down significantly in nuclear medicine and in radiology more generally.

HCB News: Other than the pandemic hurting everyone, continued shortages of Mo-99 and reimbursement issues, are there any other big challenges facing members today?
AP: I’d call it more an opportunity — the growth of theranostics. Nuclear medicine has done theranostics since the 40s with I-131 for thyroid cancer. But the development of new agents over the past five years or so and the recent approval of several has provided a great opportunity. The challenge is to make sure that these new agents are broadly adopted. They’re very effective, but their visibility is perhaps not as high as it should be. This is one area where the Society can help a great deal, in terms of educating referring physicians and oncologists, but also educating patients about the availability and effectiveness of these new drugs.

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