Medical Isotope Crisis

TO THE EDITOR: I was interested to read the article on the medical isotope crisis published in the December 2014 edition of JNMT (1). The subtitle “How We Got Here and Where We Are Going” was somewhat misleading. Some of the detail fell short of outlining on a global perspective (as opposed to a northern hemisphere perspective) where we came from, where we currently are, and where we are headed.

Although I agree that, until recently, global ⁹⁹Mo production was primarily supplied from 5 sites in Canada, Belgium, South Africa, France, and The Netherlands, the article implied that 100% of ⁹⁹Mo production came from these 5 facilities. This is not the case either now or in the past. Indeed, Australia has produced ⁹⁹Mo for many decades through the old HIFAR (High Flux Australian Reactor) and more recently the OPAL (Open Pool Australian Lightwater) reactor mentioned in the article (1). Historically Australia has produced 8% of global ⁹⁹Mo production, and this proportion is increasing with growing demand, particularly in the United States. OPAL-produced ⁹⁹Mo is attractive because it uses not just low-enriched uranium (LEU) targets as mentioned in the article (1) but also LEU fuel—the only ⁹⁹Mo globally that is classified LEU/LEU. Argentina also uses LEU targets to contribute 1.5% of global demand for ⁹⁹Mo. Moreover, there is ⁹⁹Mo production for local and regional use (and hence the data are not as readily available) in Poland, Indonesia, and Russia.

This information is important to discuss because it not only provides a more representative insight into where we have been but also better informs on where we are going. As previously published in JNMT, the ⁹⁹Mo crisis is less a global concern than a northern hemisphere concern (2). There has been recent momentum toward cyclotron-produced ^99mTc and ⁹⁹Mo, and this represents but one solution for those countries where there are chronic supply disruptions. Nonetheless, there is significant ⁹⁹Mo production capacity, and commissioning of ⁹⁹Mo extraction and generator production facilities using imported ⁹⁹Mo target plates is an important strategy for ongoing sustainability.

Although I do not disagree with the perspective of the author, I do believe the above points provide important perspective on this important debate.