[ RadSafe ] shortage of tech 99

[conrad gmail]

  from NY times just now



  Radioactive Drug for Tests Is in Short Supply

By MATTHEW L. WALD 
<http://topics.nytimes.com/top/reference/timestopics/people/w/matthew_l_wald/index.html?inline=nyt-per>

WASHINGTON — A global shortage of a radioactive drug crucial to tests 
for cardiac disease, cancer 
<http://health.nytimes.com/health/guides/disease/cancer/overview.html?inline=nyt-classifier> 
and kidney function in children is emerging because two aging nuclear 
reactors that provide most of the world’s supply are shut for repairs.

The 51-year-old reactor in Ontario, Canada 
<http://topics.nytimes.com/top/news/international/countriesandterritories/canada/index.html?inline=nyt-geo>, 
that produces most of this drug, a radioisotope, has been shut since May 
14 because of safety problems, and it will stay shut through the end of 
the year, at least.

Some experts fear it will never reopen. The isotope, technetium-99m, is 
used in more than 40,000 medical procedures a day in the United States.

Loss of the Ontario reactor created a shortage over the last few weeks. 
But last Saturday a Dutch reactor that is the other major supplier also 
closed for a month.

The last of the material it produced is now reaching hospitals 
<http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/hospitals/index.html?inline=nyt-classifier> 
and doctors’ offices. The Dutch reactor, at Petten 
<http://www.nrg-nl.com/public/medical/valley/node2.html>, is 47 years 
old, and even if it reopens on schedule, it will have to be shut for 
several months in 2010 for repairs, its operators say.

“This is a huge hit,” said Dr. Michael M. Graham, president of the 
Society of Nuclear Medicine <http://www.snm.org/> and a professor of 
radiology at the University of Iowa 
<http://topics.nytimes.com/top/reference/timestopics/organizations/u/university_of_iowa/index.html?inline=nyt-org>.

There are substitute techniques and materials for some procedures that 
use the isotope, Dr. Graham and others said, but they are generally less 
effective, more dangerous or more expensive. With the loss of diagnostic 
capability, “some people will be operated on that don’t need to be, and 
vice versa,” he said.

Dr. Andrew J. Einstein, an assistant professor of clinical medicine at 
the Columbia University 
<http://topics.nytimes.com/top/reference/timestopics/organizations/c/columbia_university/index.html?inline=nyt-org> 
College of Physicians and Surgeons, said the isotope was used to 
determine if a patient had a coronary blockage that required an 
angioplasty 
<http://health.nytimes.com/health/guides/surgery/angioplasty/overview.html?inline=nyt-classifier> 
or stent 
<http://health.nytimes.com/health/guides/surgery/stent/overview.html?inline=nyt-classifier>. 
Without the test, Dr. Einstein said, those invasive procedures would be 
performed on some who did not need them. His hospital is already 
sometimes using smaller doses of the radioactive drug than guidelines 
specify, he said.

In patients with a known cancer, the drug pinpoints additional tumors 
<http://health.nytimes.com/health/guides/disease/tumor/overview.html?inline=nyt-classifier> 
in bone. At a tumor 
<http://health.nytimes.com/health/guides/disease/tumor/overview.html?inline=nyt-classifier> 
site, new bone will develop, and new bone growth absorbs the radioactive 
material.

In breast cancer 
<http://health.nytimes.com/health/guides/disease/breast-cancer/overview.html?inline=nyt-classifier> 
surgery, the radioisotope is injected to find the lymph node 
<http://health.nytimes.com/health/guides/test/lymph-node-culture/overview.html?inline=nyt-classifier> 
nearest the tumor, so it can be biopsied for signs of cancer, to 
determine whether more extensive surgery is needed.

The alternative is to inject a dye, which sometimes does not let the 
surgeon find the node.

Without the tool, Dr. Graham said, the quality of medical care is 
“dropping back into the 1960s.”

On Tuesday, Representative Edward J. Markey 
<http://topics.nytimes.com/top/reference/timestopics/people/m/edward_j_markey/index.html?inline=nyt-per>, 
a Massachusetts Democrat who is one of the House’s fiercest critics of 
the nuclear industry, declared that the United States was facing “a 
crisis in nuclear medicine.”

Mr. Markey, chairman of the House Energy and Commerce subcommittee on 
energy, called for establishing new production facilities in the United 
States. He joined the ranking Republican on the subcommittee, 
Representative Fred Upton of Michigan, to introduce a bill to authorize 
$163 million over five years to assure new production.

The White House is coordinating an interagency effort to find new 
sources of supply, involving the Nuclear Regulatory Commission 
<http://topics.nytimes.com/top/reference/timestopics/organizations/n/nuclear_regulatory_commission/index.html?inline=nyt-org>, 
the Food and Drug Administration 
<http://topics.nytimes.com/top/reference/timestopics/organizations/f/food_and_drug_administration/index.html?inline=nyt-org> 
and the Energy Department, but officials said the process would take months.

The reactors are typically small — sometimes no larger than a 
homeowner’s trash barrel — but a complete setup costs tens of millions 
of dollars.

Tech-99m, as it is abbreviated, emits a gamma ray that makes its 
presence obvious. It has a half-life of six hours, meaning that it loses 
half its strength in that period. Thus it does its job quickly, without 
lingering to give the patient a big dose. But it also means the isotope 
must be produced and used faster than most other drugs.

Tech-99m is the product of another isotope, molybdenum-99, which also 
has a short half-life, 66 hours. Thus a week after it is made, less than 
a quarter of the molybdenum-99 remains. Stockpiling is not practical.

“You lose about 1 percent an hour,” said another expert, Kevin D. 
Crowley, director of the Nuclear and Radiation Studies Board at the 
National Research Council 
<http://topics.nytimes.com/top/reference/timestopics/organizations/n/national_research_council/index.html?inline=nyt-org>. 
“So time is of the essence.”

Molybdenum-99 is made when uranium-235 is split, but only about 6 
percent of the fission fragments are molybdenum. Purification has to be 
done in a heavily shielded “hot cell.”

The common method is to put a uranium target into the stream of neutrons 
produced in the reactor as uranium is split. But the preferred material 
is a high-purity uranium-235, which is also bomb fuel.

Mr. Markey and others are trying to have the industry switch to 
low-enriched — nonweapons-grade — uranium.

Dr. Crowley said that could be done, although the industry has resisted.

The reactors’ poor condition has been obvious for a while. In 2007, 
Canadian safety regulators said the Ontario reactor should not restart, 
but the Canadian Parliament overruled them.

In 1996, the company that purifies the molybdenum from the Ontario 
reactor, MDS Nordion, contracted with Atomic Energy of Canada Ltd. 
<http://www.aecl.ca/site3.aspx>, which owns the reactor, to build two 
new ones. MDS Nordion paid more than $350 million for them.

But when the new reactors were started up, both showed a problem: as the 
power level increased, the reactors had a tendency to run faster and 
faster, a condition called positive coefficient of reactivity. That is a 
highly undesirable characteristic in a reactor, one that contributed 
heavily to the Chernobyl disaster in 1986. So Atomic Energy of Canada 
Ltd., which is owned by the Canadian government, said it would not open 
them.

For all the years that the Ontario plant was running or the replacements 
were under construction, other potential manufacturers believed they 
could not compete, Dr. Klein said. And the business has always been 
small, he said, adding that a big pharmaceutical company “can make more 
on Viagra 
<http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/viagra_drug/index.html?inline=nyt-classifier> 
in two days than on tech-99m in a year.”

Several long-term alternatives are available. Babcock & Wilcox, a 
reactor manufacturer, has proposed a new kind of reactor that would 
manufacture molybdenum that could be siphoned off continuously.

In a few weeks, a company in Kennewick, Wash., Advanced Medical 
Isotopes, plans to test a new system, using a linear accelerator, a 
machine that shoots subatomic particles at high speeds.

Reactors in Belgium, France, South Africa and Argentina could also be 
used to make small amounts.

The High Flux Reactor at the Oak Ridge National Laboratory in Tennessee, 
owned by the federal government, and a research reactor at the 
University of Missouri 
<http://topics.nytimes.com/top/reference/timestopics/organizations/u/university_of_missouri/index.html?inline=nyt-org>, 
could do the work, but neither has the equipment in place to extract the 
molybdenum from the targets.