Up and Running

Mo-99 production resumes, but long-term questions remain

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Scott Huelskamp is managing editor of rt image.

The good news is that molybdenum-99 (Mo-99) is back in the news again, and for all the right reasons. The bad news is that the fix may not address the long-term supply status of this crucial medical isotope.

But for now, let’s enjoy the small victory. In early July, the Canadian Nuclear Safety Commission (CNSC) approved Atomic Energy of Canada’s (AECL) request to restart its National Research Universal (NRU) reactor in Chalk River, Ontario. Once system tests are completed, the NRU reactor is expected to restart and resume production of Mo-99 by the end of July. Repairs to a major water leak, which shut down the reactor in May 2009, have recently been completed.

The High Flux Reactor in the Netherlands is also expected to restart during the summer. That reactor had been undergoing routine maintenance.

But the NRU reactor is the Big Kahuna of production and supplies approximately 35 percent to 50 percent of Mo-99 to North America; the Mo-99 decay product technetium-99m is used in common imaging procedures. As a result, the year-long shortage has forced imaging facilities to postpone or reschedule exams.

However, the Society of Nuclear Medicine (SNM) feels a long-term solution needs to be created to remedy the isotope shortage. In a news release, SNM is optimistic that the NRU restart will provide short-term relief to the isotope shortage. But SNM cautions that the reactor cannot solve ongoing production and supply issues.

“We are cautiously optimistic that NRU going back online will alleviate some of the most pressing concerns facing the nuclear medicine community,” says rt image editorial advisory board member Robert W. Atcher, PhD, MBA, chair of SNM’s domestic isotope availability work group and former president of the society. “However, this is not a magic bullet, and NRU coming back online will not solve this crisis. As CNSC staff are reported to have observed, gaps in the assessment of the reactor could have a serious impact on the reliability of the reactor’s operation in the future.”

The CNSC ruling also stipulates AECL must provide regular performance updates of the reactor every 6 months and undergo annual inspections. These levels of accountability would hopefully identify minor or major issues that could be rectified quickly, thus avoiding another high-and-dry period that left many imaging facilities with partially empty appointment books. More than 16 million procedures are conducted annually in the United States using Mo-99, according to SNM figures.

"We continue to work to advocate for a domestic supply of Mo-99 in the United States so that nuclear medicine physicians and technologists have a reliable supply of radioisotopes to perform critical imaging tests that patients need for high-quality care," says Dominique Delbeke, MD, PhD, president of SNM, in a news release.

In addition to the impact that the shortage has had on the job market for nuclear medicine technologists and the impact on patients, the latest series of setbacks shows that the United States needs a reliable domestic isotope supply now more than ever before,” says Atcher.