Nuclear Medicine Meltdown Threatens Heart and Cancer Patients

It is time to add a new phrase to the dictionary of disasters: Technetium-99 -- also known as Tech-99 or Tc99m. If you, or someone you know, suffers from heart disease, cancer or a score of other medical conditions, a shortage of Tc99m could be life-threatening.

Tc99m is the radioactive material used in four out of five of the 20 million nuclear medicine procedures performed in the United States every year, and it is now in critically short supply.

The 52-year-old nuclear reactor that produces close to half the world's supply of Tc99m has been shut down and may never reopen. Compounding the problem, Tc99m cannot be stockpiled because it has a short half-life. Doctors and hospitals that use this material must be re-supplied every 67 hours to have a continuous supply.

If Tim Russert, the late host of Meet the Press, had received a nuclear stress test instead of a less accurate echo stress test he might be alive today. If the 41st president, George H.W. Bush, had not been tested using Tc99m, his diagnosis of Graves Disease might have come later, after significant medical problems had progressed.

The Society of Nuclear Medicine will hold a press conference Monday at its annual meeting to discuss "the latest developments surrounding the international medical isotope crisis." Ironically, the Society announced yesterday that it would bestow its Nuclear Pioneering Award on the three men who innovated the heart test that uses Tc99m.

The award announcement read, "Millions of heart attack patients and other potential sufferers who have undergone a noninvasive nuclear imaging test with the isotope technetium-99 can thank [these] three innovators."

Worldwide, there are five old, high-energy Uranium 235 reactors that produce virtually all of the raw material from which Tc99m is made. They are in Canada, Belgium, South Africa, the Netherlands and France. These high-energy nuclear reactors run on Uranium 235, are 40 to 50 years old and have been closed down several times over the last few years.

Chalk River Problems Deal Huge Blow to Isotope Supply

The only reactor in North America that makes the raw material for Tc99m was closed in mid-May. It is located on the Chalk River, 115 miles northwest of Ottawa, Canada. There is no hard information about when or whether the Chalk River reactor will ever reopen. When it was closed, it was expected to be reopened in three months, then eight months -- and now some people -- including Jean-Luc Urbain, president of the Canadian Association of Nuclear Medicine -- question whether it will ever reopen.

The remaining reactors cannot make up for the shortage caused by the Chalk River shutdown, even while running at full capacity. To make matters worse, the South Africa reactor is now closed for scheduled maintenance, adding to the short supply of the isotope. And in July, when the South Africa reactor is scheduled to reopen, the Dutch reactor is scheduled to close for a few months.

The price of Tc99m has already increased significantly and it is sure to rise further in the coming months. Some Canadian news reports have claimed that hospitals could expect to pay $80,000 to $200,000 more per year for isotopes. More importantly, it may not be available when and where patients need it.

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