Every day in America, nearly 55,000 patients undergo nuclear medicine tests, such as scans for heart disease or cancer, but those diagnostic tests are now in jeopardy.

Most nuclear medicine tests require the use of technetium-99m, a radioisotope that — until recently — was produced in only five nuclear facilities worldwide. Of those, all are at least 45 years old, and none are in the United States.

The abrupt closures of two of those facilities has left physicians scrambling to find access to the radioisotope and requiring them to postpone or cancel necessary scans for heart disease and cancer, or to turn to alternative tests that are not as accurate, take longer and expose patients to higher doses of radiation.

The National Research Universal reactor in Chalk River, Canada — which supplies about a third of U.S. technetium-99m — has been shut down no less than three times in the last 18 months on account of leaks of radioactive tritium-contaminated water. The most recent closure on May 14 brought an announcement that the facility would not reopen until the end of the year, though some experts suspect that it will never reopen if a containment vessel is badly corroded.

But even if it reopens as planned, it would be a short-term venture. Canadian Prime Minister Stephen Harper said that the facility would not continue to produce the radioisotope past 2016, due to the inability to bring a new reactor online.
Compounding the shortage caused by the closure of the Chalk River facility, the Petten nuclear reactor in the Netherlands — which provides half of the U.S. supply — shut down for one month for scheduled maintenance. The plant anticipates closing for at least three months next year for repairs.

The loss of America’s two major sources of technetium-99m — m for “metastable” — has caused no less than a crisis. And intuitive practices like saving and storing the isotope are not options — the radioisotope is short-lived, with a half-life of only six hours that requires it be used within a day or two after production. The radioisotope allows physicians to examine bones and blood flow, among other things, and its short shelf life means it quickly disappears from the body, minimizing the dose of radiation a patient receives, but it also renders the isotope unable to be stockpiled.

About 91 percent of radiologists have reported suffering shortages, some that resulted in delays of several weeks due to the limited, sporadic supply, according to Michael Graham, M.D., president of SNM (which was formerly known as the Society of Nuclear Medicine). “It’s possible that some deaths could occur (as a result of the shortage),” he told the L.A. Times.

And based on the simple economic principle of supply and demand, the cost of technetium-99m has climbed by 20 to 30 percent, while reimbursement for the procedures has remained fixed.

Both private companies and government agencies in the United States and Canada are actively searching for new sources of the isotope, including researching the feasibility of building new reactors or modifying existing research reactors, but any long-term solution is at least two to three years away.

The best hope seems to lie in the University of Missouri Research Reactor in Columbia, which could be modified to produce molybdenum-99 — the base from which the isotope is derived — at a cost of $50 million. The American Medical Isotopes Production Act, introduced by Reps. Edward Markey (D-Mass) and Fred Upton (R-Mich), would provide $163 million over five years for projects including the University of Missouri reactor upgrades. But even with funding, the reactor couldn’t be viable until at least 2012.

In the meantime, some radiologists are using alternatives like fluorine-18, but Medicare and insurance companies typically do not cover these tests. Thallium-201 can be used in a pinch for heart perfusion scans, but both options are more invasive, less accurate and often result in large radiation doses to patients.

Rebekah Stone is the editor of the Healthcare Journal. You can reach her at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .