When the Maria Research Reactor in Poland began to produce medical isotopes in March, U.S. nuclear cardiology practices breathed a sigh of relief. Now, they are just holding their breath, hoping the huge cloud of grit and ash covering much of Northern and Central Europe dissipates, allowing many airports to resume flights of the precious molybdenum-99 (Mo-99), which is the parent isotope of technetium-99m (Tc-99m).

"We have heard from our supplier that the closing of airports in Europe has affected the production of technetium," said Dan Caldwell, executive director of Little Rock Cardiology Clinic in Little Rock, Ark. "We have no other options. That's the crazy thing. Globally, our supply depended on so few suppliers."
 
The airport closures also affected isotopes supplied by the BR2 reactor in Mol, Belgium and the Osiris reactor in Saclay, France.

The High Flux Reactor in Petten, the Netherlands remains down as scheduled through mid-August for repairs, and Canada's National Research Universal (NRU) reactor has been shut down for repairs since May 2009, and is now expected to be out of operation into late July, according to Covidien, a supplier of Tc-99m. Globally, the remaining operating reactors are the Safari reactor in Pelindaba, South Africa and the OPAL reactor in Sydney, Australia.

"When the FDA quickly approved the Polish reactor, it looked like the situation was going to improve," Caldwell said. "It seems that if it's not one thing, it's another."

A letter sent by Covidien to customers on April 19 stated that the company "is exploring all possible transportation options, including ground transport within Europe, rerouting through other airports, arranging special charter flights or utilizing commercial carriers not normally used."

The letter also mentioned that such alternatives often involve "complex regulatory hurdles, both in Europe and the U.S."