Local, State, Federal

The Real Shortage Is Long-Term Solutions

The ongoing radioisotope shortage is one of the biggest medical crises facing radiologists worldwide. But radiologists will soon get some relief when Canada’s National Research Universal (NRU) Reactor at Chalk River comes back online. While this is good news, a long-term solution to avoiding future shortages still seems elusive. Axis Imaging News recently spoke with Bill Dawes, vice president manufacturing and supply chain for radioisotope producer Lantheus, and Robert W. Atcher, PhD, MBA, chair of the Society of Nuclear Medicine’s Domestic Isotope Availability Work Group, about what it means to have Chalk River back online, how to avoid future shortages, and what radiologists can do to solve the shortage now.

Robert W. Atcher, PhD, MBA

IE: How important is the reopening of the NRU reactor at Chalk River and will it alleviate the radioisotope shortage?

Bill Dawes: It’s extremely helpful in offsetting the global shortage. The NRU reactor is one of the largest contributors of radioisotopes in the world. Having it back online will really go a long way to alleviate the shortage.

Robert Atcher: Obviously, its production capability will help significantly. The good news is that there’s light at the end of the tunnel, but that light may be an oncoming train. The reality is that the NRU is a 52-year-old reactor. There’s some indication that there wasn’t appropriate maintenance being performed at the site. The fact that it’s online is good news, but we’re pushing it. The Canadian government plans to relicense it in 2011 only to close it in 2016. More importantly, the Canadian government has no interest in supplying the world market. My cautionary statement is that you can’t relax now because the NRU is online. The NRU reactor, when online, supplies about 33% to 35% of the world’s supply, and it can be pushed to excess capacity of another 15%, which exceeds other reactors. It can be bumped up for 4 to 6 weeks, so that’s the advantage of the NRU to other reactors.

IE: What is Lantheus doing to alleviate the shortage?

Dawes: At Lantheus, we think of the shortage in terms of a short-term approach and a long-term approach. We’re working to build a globally diversified and balanced supply chain at both the reactor level and the process level, and we’re not putting our eggs in any one basket or any one supplier or any one reactor location, so we can rely on [supplies]. So, for instance, if there is a volcanic [eruption], we won’t have a disruption. So that’s what we’re doing. Instead of relying on one supplier, we’re working to establish a globally diversified supply chain. Our plan is to diversify all of our resources. We’re really focusing on a long-term approach to solutions, which includes helping to replace aging assets. We’re also seeing the government, led by Congressman Edward Markey (D-Mass), working to solve the problem by providing funding that would allow for the buildup for additional reactors in America. We think that with these global projects and the fact that [we’re] becoming more diversified and building an infrastructure for tomorrow, we’ll have more strength in the supply chain.

Bill Dawes

IE: Congress recently passed legislation aimed at solving the radioisotope shortage. What is the American Medical Isotopes Production Act of 2009 (HR 3276) and what are its prospects for becoming law this year?

Atcher: The law has three important issues. Because we use weapons-grade molybdenum-99, there’s been a big concern about proliferation. Within 12 years we’ll go from using high-enriched to low-enriched molybdenum-99, which can’t be used for weapons. It will direct the Department of Energy (DOE) to establish production in the United States. Finally, what are we going to do with the waste? The DOE will lease the production of material and then take the waste. The problem from the position of Senator Kit Bond (R-Mo) is that the bill is a long-term solution for a short-term problem. There’s no deadline for the DOE to establish US production. There’s a sense that the nonproliferation community won and the medical community lost. Bond holds that the medical isotope issue isn’t addressed in the bill. The status of the bill is in limbo. There might be a floor vote on it in the Senate to test it, and there’s some question about whether Bond and his [allies] will want to draw a line in the sand with this issue.

IE: What can radiologists do to combat the radioisotope shortage on a day-to-day basis?

Dawes: I think that radiologists and cardiologists have done a great job responding to the shortage. They’ve done things like reduce the overall dose, which is something they can continue to do. They’ve done a good job finding alternative isotopes like thallium, and using that where it’s appropriate for the patient.

Atcher: One of the developments in light of the shortage is that radiologists have gotten better about managing radioisotopes, making them as close to the imaging time as possible. They’ve been a lot more careful to match the dosage to the patient; a lighter patient is given less of a dose than a bariatric patient, for instance. However, when you limit the dose, it takes longer to scan. However, the less material you use with a patient, the less radiation dose they’re being exposed to. For cardiac, they’ve found that if you do a stress test first, and the patient has good flow, then there’s no need to do a rest study.

—C.A. Wolski