Isotope Update – Shortage Still Taking a Toll With Scans Missed, Rescheduled or Cancelled
Posted Aug 11 2009 9:27am
The City of Hope is reporting that many scans are sometimes delayed for weeks due to the shortage and the closing of the 2 plants. With lack of imaging the doctors state that some individuals are undergoing surgery for cancer that could have been a procedure done with isotopes instead, i.e. seeding. The UCLA Cancer Center is repeatedly rescheduling patients as they never know exactly how much they will have on hand, depending on quantities shipped. In Canada, tests have been delayed for weeks.
Hospitals are also incurring additional costs as tests are scheduled at late or odd hours to use the isotopes before they expire, so some overtime pay is accumulating and due to the shortage, cost has gone up, 20-30% which is being absorbed by the hospitals. Fluorine-18 is being used instead but does not have the accuracy and Medicare and insurance companies do not cover the replacement of technetium-99m. The alternatives may also result in exposing the patient to higher levels of radiation. BD
The abrupt shutdown of two aging nuclear reactors that produce a radioisotope widely used in medical imaging has forced physicians in the U.S. and abroad into a crisis, requiring them to postpone or cancel necessary scans for heart disease and cancer, or turn to alternative tests that are not as accurate, take longer and expose patients to higher doses of radiation. Because of limits on testing produced by the shortage, some patients will undergo heart or cancer surgeries that could have been prevented by imaging, and others will miss needed surgeries because of the lack of testing, said Dr. Michael Graham of the University of Iowa, president of SNM, formerly the Society of Nuclear Medicine. "It's possible that some deaths could occur," he said.
The focus of this shortage is a short-lived radioisotope that most patients have probably never heard of -- technetium-99m, the "m" standing for metastable. With a half-life of only six hours, the isotope allows physicians to examine bones and blood flow, among other things, then quickly disappears from the body, minimizing the dose of radiation received by the patient. Because of its short half-life, the isotope cannot be stockpiled and must be used within a day or two after it is produced.
When the target is removed from the reactor, it is processed by one of the world's three major isotope suppliers: MDS Nordion, Covidien, or Lantheus Medical Imaging. They dissolve the molybdenum in an acid solution, then bind it onto a column inside a trash-can-sized container called a technetium generator, which is delivered to radiopharmacies. The pharmacies run saline through the column to remove technetium-99m and attach it to other drugs for use in imaging.