Good golly, missing moly

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Milking the moly from a technetium cow, the process of injecting sterile saline into molybdenum-99 (Mo-99) in order to wash out technetium-99m (Tc-99), is showing signs of drying up. At least that’s the concern of a coalition comprised of nine professional societies that employ Tc-99 in their medical practice.

The concern is valid: The creaky Chalk River reactor—the sole supplier of medical Mo-99 in North America—is on its last legs, and European medical isotope reactors are beginning to show their age. South Africa’s Safari-1 reactor at Pelindaba has boosted Mo-99 production, but there’s just so much of the isotope traditional highly-enriched uranium (HEU) facilities can produce.

Bi-partisan legislation was floated in the U.S. House of Representatives this month, the American Medical Isotopes Production Act, which proposes a $163 million shot in the arm to establish domestic production of Mo-99 for medical use. In addition, the bill proposes winding down HEU Mo-99 production in favor of low-enriched uranium (LEU) methods of manufacturing.

On a regulatory note, both the FDA and Health Canada have greenlighted LEU-produced Mo-99. The regulatory bodies have granted it supplemental new drug application (sNDA) and supplemental new drug submission (SNDS) status, respectively, and qualified the Australian Nuclear Science and Technology Organization as its valid supplier.

On the clinical front, there are alternatives to Tc-99m for cardiac stress testing, such as the tracer 82-rubidium (82Rb). A multinational team from Lebanon and the United States has found that the PET tracer can also deliver quantification of myocardial blood flow and coronary flow reserve that is equivalent to using PET and 13N-ammonia and 15O-water flow tracers.

Also on the radioisotope front, a study from the University of Iowa Hospitals and Clinics has determined that the PET tracer 18F-fluorothymidine (18F-FLT) can provide biologic tumor information useful in chemoradiotherapy planning for head and neck cancer.

If you want to find out more about the possibilities for molecular imaging in your practice head over to our Healthcare TechGuide and check out the variety of systems offered there.

Lastly, if you have a comment or report to share about the utilization of molecular imaging and nuclear medicine in your practice, please contact me at the address below. I look forward to hearing from you.

Jonathan Batchelor, Web Editor