The Supply Of Medical Isotopes

This report explores the main reasons behind the unreliable supply of Technetium-99m (Tc-99m) in health-care systems and policy options to address the issue. Tc-99m is used in 85% of nuclear medicine diagnostic scans performed worldwide – around 30 million patient examinations every year. These scans allow diagnoses of diseases in many parts of the human body, including the skeleton, heart and circulatory system, and the brain. Medical isotopes are subject to radioactive decay and have to be delivered just-in-time through a complex supply chain. However, ageing production facilities and a lack of investment have made the supply of Tc-99m unreliable. This report analyses the use and substitutability of Tc-99m in health care, health-care provider payment mechanisms for scans, and the structure of the supply chain. It concludes that the main reasons for unreliable supply are that production is not economically viable and that the structure of the supply chain prevents producers from charging prices that reflect the full costs of production and supply.

This book is the product of a congressionally mandated study to examine the feasibility of eliminating the use of highly enriched uranium (HEU2) in reactor fuel, reactor targets, and medical isotope production facilities. The book focuses primarily on the use of HEU for the production of the medical isotope molybdenum-99 (Mo-99), whose decay product, technetium-99m3 (Tc-99m), is used in the majority of medical diagnostic imaging procedures in the United States, and secondarily on the use of HEU for research and test reactor fuel. The supply of Mo-99 in the U.S. is likely to be unreliable until newer production sources come online. The reliability of the current supply system is an important medical isotope concern; this book concludes that achieving a cost difference of less than 10 percent in facilities that will need to convert from HEU- to LEU-based Mo-99 production is much less important than is reliability of supply.

The decay product of the medical isotope molybdenum-99 (Mo-99), technetium-99m (Tc-99m), and associated medical isotopes iodine-131 (I-131) and xenon-133 (Xe-133) are used worldwide for medical diagnostic imaging or therapy. The United States consumes about half of the world's supply of Mo-99, but there has been no domestic (i.e., U.S.-based) production of this isotope since the late 1980s. The United States imports Mo-99 for domestic use from Australia, Canada, Europe, and South Africa. Mo-99 and Tc-99m cannot be stockpiled for use because of their short half-lives. Consequently, they must be routinely produced and delivered to medical imaging centers. Almost all Mo-99 for medical use is produced by irradiating highly enriched uranium (HEU) targets in research reactors, several of which are over 50 years old and are approaching the end of their operating lives. Unanticipated and extended shutdowns of some of these old reactors have resulted in severe Mo-99 supply shortages in the United States and other countries. Some of these shortages have disrupted the delivery of medical care. Molybdenum-99 for Medical Imaging examines the production and utilization of Mo-99 and associated medical isotopes, and provides recommendations for medical use.

Participants of the July 17-18, 2017, symposium titled Opportunities and Approaches for Supplying Molybdenum-99 and Associated Medical Isotopes to Global Markets examined current trends in molybdenum-99 production, prospects for new global supplies, and technical, economic, regulatory, and other considerations for supplying molybdenum-99 to global markets. This publication summarizes the presentations and discussions from the symposium.

Nearly 20 million nuclear medicine procedures are carried out each year in the United States alone to diagnose and treat cancers, cardiovascular disease, and certain neurological disorders. Many of the advancements in nuclear medicine have been the result of research investments made during the past 50 years where these procedures are now a routine part of clinical care. Although nuclear medicine plays an important role in biomedical research and disease management, its promise is only beginning to be realized. Advancing Nuclear Medicine Through Innovation highlights the exciting emerging opportunities in nuclear medicine, which include assessing the efficacy of new drugs in development, individualizing treatment to the patient, and understanding the biology of human diseases. Health care and pharmaceutical professionals will be most interested in this book's examination of the challenges the field faces and its recommendations for ways to reduce these impediments.

Participants of the July 17-18, 2017, symposium titled Opportunities and Approaches for Supplying Molybdenum-99 and Associated Medical Isotopes to Global Markets examined current trends in molybdenum-99 production, prospects for new global supplies, and technical, economic, regulatory, and other considerations for supplying molybdenum-99 to global markets. This publication summarizes the presentations and discussions from the symposium.