SNM (formerly the Society of Nuclear Medicine) conducted a survey of nuclear pharmacies and discovered that 60 percent of the facilities were impacted by a shortage of molybdenum-99 (Mo-99).
Technetium-99m (Tc-99m), used in more than 16 million U.S. nuclear medicine procedures annually, is derived from molybdenum-99, which is in short supply due to the closure of the High Flux Reactor in Petten, the Netherlands for a month-long scheduled maintenance, along with the long-standing closure of the National Research Universal (NRU) reactor in Chalk River, Ontario.
The situation has been exacerbated by the recent announcement that the NRU reactor will remain off-line until 2010.
Nuclear physicians and pharmacists are making changes to cope with the shortage.
For example, 75 percent of physicians surveyed rescheduled patient tests by at least one day. In more than one out of three of these cases, tests have been delayed for longer than one month.
"In some cases, waiting even a day can severely impact care, especially if the condition is progressing rapidly," said Michael M. Graham, MD, PhD, president of SNM. "Getting information early on in the disease progression is critical, and is one of the real benefits of molecular imaging."
In addition to delays, more than 80 percent of nuclear physicians and specialists are decreasing the dosage, which can lead to "longer exposure and less effective imaging scans,” said Robert W. Atcher, PhD, chair of SNM's Domestic Isotope Availability Task Force. "This situation is untenable."
"Radiopharmacists are doing the best they can with the limited resources at their disposal," said Jeffrey P. Norenberg, PharmD, executive director of the National Association of Nuclear Pharmacies and a member of SNM's Domestic Isotope Availability Task Force. "But clearly, patients deserve better because better agents like Tc-99m exist. Governments should work together to prevent such shortages from ever happening again."
There are no reactors in the United States that produce Mo-99, making the isotope shortage especially acute. Nuclear medicine experts are trying to keep up with demand, while using less effective products.
"It's a juggling act," Atcher said.