Survey: Nuclear exams in Canada decreased significantly in 2009

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The number of nuclear medicine exams on Canadian patients for cardiac, bone and lung diagnostic tests had decreased by 21.8 percent (12,000 fewer exams) in October 2009 compared with October 2008, based on a survey conducted by the Canadian Institute for Health Information in February.

The survey found that most nuclear medicine departments implemented mitigation strategies such as rescheduling patient exams and setting up new ways to prioritize patients. This was in response to a global medical isotope supply disruption caused by the May 2009 Chalk River Reactor shutdown and heightened by the planned temporary shutdown in August of the reactor in the Netherlands.

Two-thirds of nuclear medicine sites participated in the survey, representing 75 percent of all nuclear medicine exams performed in Canada. The disruption also resulted in changes to staff scheduling and decreased staff morale within the participating nuclear medicine sites, according to the survey.

The survey looked at the impact of the supply disruption of the isotope technetium (Tc-99m) on the three types of nuclear medicine exams that account for more than 80 percent of the use of Tc-99m: bone exams, lung perfusion exams and cardiac perfusion/function and MUGA (MUltiple Gated Acquisition) cardiac scans.

The survey assessed exam volume during three distinct periods in 2009: February, August and October.

  • February 2009: Even before the shutdown in May 2009, there was a slight decrease in the number of selected nuclear medicine exams performed when compared with February 2008--from 3 percent for lung perfusion exams to 5 percent for bone and cardiac tests.
  • August 2009: In addition to Chalk River, the Dutch reactor in Petten was also temporarily out of service which contributed to a significant decline in the number of selected exams. The comparison between August 2008 and August 2009 showed decreases ranging from 18 percent for lung perfusion and bone exams to 25 percent for cardiac tests.
  • October 2009: The Petten reactor had re-opened, but Chalk River remained closed. During this month, the number of selected nuclear medicine exams across Canada increased from August 2009 levels but decreased significantly ranging from 16 percent for lung perfusion exams to 22 percent for bone and cardiac tests when compared to October 2008.

About two-thirds of respondents also reported that they experienced an increase in isotope costs and that they were managing but exceeding their budget due to vendor surcharges.