Dec 7, 2007 5:44 pm US/Central
Shortage Prompts Delay In Medical Tests
NEW YORK (AP) ―
Thousands of patients are facing delays in crucial medical tests
because of a shortage of a radioactive substance used in those
examinations — all because of the shutdown of one nuclear reactor in
Canada.
The substance is used in at least 15 million medical scans a year in
the United States, by one estimate. Those scans are used to diagnose
and assess a wide variety of conditions including cancer, heart disease
and bone or kidney illnesses.
They are often crucial for guiding therapy, telling a doctor whether a woman's breast cancer has invaded her bones, for example.
But over the past few days, many hospitals began facing a shortage
of a radioactive substance called technitium-99 that is injected into
patients to do these body scans. And that has forced them to cut back
on the procedures.
"Many, many hospitals are working at about 20 to 30 percent of
capacity" in doing the scans in the United States and Canada, estimated
Dr. Sandy McEwan, president of the Society of Nuclear Medicine, based
in Reston, Va. He said he didn't know how many scans had been postponed.
The shortage seemed to be hitting parts of Canada hardest. Dr. Chris
O'Brien, president of the Ontario Association of Nuclear Medicine, put
it this way to Canadian Press: "Last week, I guess you could describe
it as struggling. This week it's devastating, and next week potentially
catastrophic."
Ontario, for example, is now down to about half of its normal scan
capacity, meaning about 1,000 patients a day are having their tests put
off, he said.
"We don't know where to put these people," O'Brien said.
The Canadian Society of Nuclear Medicine estimates the shortage will
cause delays in treatment for 50,000 Canadians each month that services
are reduced.
While doctors can often turn to other tests, these can be more complicated and more awkward to interpret, experts said.
What's the cause of all this?
It's the unexpectedly long shutdown of a nuclear reactor in Chalk
River, Ontario. The 50-year-old reactor is North America's biggest
source of the radioactive isotope that makes technitium.
The owner of the reactor, Atomic Energy of Canada Ltd., shut it down
Nov. 18 for what was supposed to be five days of routine maintenance.
However, the company decided to keep it closed to do more work. The
reactor will probably be working again by the end of December and
almost surely by the end of January, the company says.
But in the meantime, the shutdown stopped the reactor's output of a
radioactive substance called molybdenum-99, which is processed and
packaged into canisters that are sold to big hospitals and specialized
pharmacies. These cylinders are "milked" for their technitium-99, which
is then prepared for use in the medical scans.
Since the technitium supply from each cylinder eventually peters
out, the cylinders have to be regularly replaced. That's when the
effect of the Chalk River reactor shutdown shows up.
Companies that make these cylinders say they're working with other
molybdenum suppliers in Europe and South Africa to try to ease the
shortage.
But in the meantime, the shortage has affected places like Caritas
Holy Family Hospital in Methuen, Mass. Spokeswoman Danielle Perry said
the 270-bed hospital has had to delay a few tests because of the
shortage.
"We've already started to preserve our supply. We're giving priority
to those patients with more urgent or critical needs," she said.
Larger hospitals are watching their supplies closely.
"We are going day by day," said Gopal Saha, director of nuclear
chemistry and pharmacy at the Cleveland Clinic, which gets two
canisters a week. No scans have been canceled there yet, he said Friday
morning.
"I can't tell you what's going to happen tomorrow. It's clearly
not a good situation" said Dr. Philip Alderson of New York-Presbyterian
Hospital.
"I'm a little nervous. I'm concerned about where this is headed if this doesn't get resolved relatively quickly."
Alderson said his department learned Thursday that it would no
longer get two molybdenum canisters a week, but instead will have to
buy technitium dose-by-dose. That could pose a logistical problem if a
patient suddenly needs a scan, he said.
"I'm worried about ... the patient who comes to the emergency
room at 3 o'clock this afternoon with chest pain" and needs a lung scan
to look for a clot, he said. "Will we be able to get that dose?"
McEwan said the nuclear medicine society has long pushed for
the United States to build its own reactor to produce medical
materials. That hasn't happened for a variety of reasons, including
cost, he said. He called that "shortsighted."
The society is now working with federal regulators to expand
the possibilities for using alternative tests, he said, and hospitals
are sharing technitium-99 the best they can.
And what should patients think of all this?
"They need to talk to their doctors about the best alternative
tests," McEwan said. And "they need to be assured that the whole
industry is looking at alternative supply so they can resolve the issue
as quickly as possible."
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