Isotope Shortage Less Severe

The two-year medical isotope shortage plaguing nuclear medicine is over. The five reactors providing two essential isotopes are fully functional, but industry leaders hope the flush supply won’t tempt you to abandon conservation efforts to return to business as usual.

Technetium-99m and molybdenum-99 are readily available after a spate of scheduled reactor maintenance and forced shutdowns. The specter of future shortages hangs in the air, however, because the United States has no domestic isotope supplier, current reactors are old, and new ones aren’t expected until 2015.

“No one is complaining because supply is back to normal,” said Robert Atcher, M.D., immediate past president of the Society of Nuclear Medicine (SNM). “Things have returned to where they were, but that can be both good and bad news if we don’t maintain the savings measures from the last few years.”

According to SNM, the recent shortage affected roughly 84 percent of radiologists. You took steps to ensure you met patient needs within an acceptable time frame – at most, Atcher said, delaying tests by 24-to-48 hours.

Conservation tactics

Juggling patient schedules to run more scans at the beginning of the week is an easy fix, said Michael Graham, M.D., University of Iowa Health Care nuclear medicine director. Your generators are at peak performance, producing the best quality images. You should conduct scans requiring more time, such as bone scans, on the weekends, he said.  

The shortage significantly impacted cardiac imaging – studies comprising 60 percent of nuclear medicine tests. You can rack up isotope savings with nearly half of cardiac stress tests that read normal, Atcher said. In those cases, skip the rest test.

The technetium-99m dip also pushed the industry to revert to a myocardial perfusion method unused widely for nearly two decades, Graham said. While some practices had to learn an unfamiliar technique, thallium-201 is again being used for 60 percent of myocardial perfusions – a scan that uses 50 percent of the technetium-99m supply. 

Many practices have taken smaller, but effective, steps to manage the shortage, said Chaitanya Divgi, M.D., director of the Kreitchman PET Center at Columbia University Medical Center.

“Most commonly, we’ve reduced the radiation given and increased the time it takes for quality scans,” Divgi said. “We’ve looked closely to see if we can substitute PET scans for other tests, and in some cases, we’ve determined the patient might not actually need some tests.”

The effect on radiopharmaceutical therapies has been smaller. Idione-131, a byproduct of technetium-99m’s decay, is used for thyroid cancer treatment. Although some practices reported an Iodine-131 shortage, the isotopes 8-day half-life prevented an excessive shortfall.

As isotope supply vacillates, Perry Polsinelli, president of United Pharmacy Partners (UPPI), recommends, above all else, you maintain frequent communication with the radiopharmacies that supply your isotopes.

“Day in and day out, network with your pharmacies – or at least do it once a week. That way, you’ll know if there’s a scheduled reactor downtime or if there’s a glitch,” Polsinelli said. “As the end user, talk with your supplier so they know when you have heavier patient loads and will need more product.”