Potential ways to address shortage situations of Mo-99/Tc-99m

Abstract

Technetium 99m (Tc-99m) is the most common radioisotope used in nuclear medicine, which is produced in a nuclear reactor from the decay of molybdenum-99 (Mo-99). There are only a few aging nuclear reactors around the world that produce Mo-99 and one of the major contributors, the NRU (National Research Universal, Canada), will cease production on October 31, 2016. The NRU produces approximately 40% of the world’s Mo-99 supply, so with its impending shut down, shortages of Mo-99/Tc-99m are expected. Methods: Nuclear pharmacies and nuclear medicine departments throughout the United States were contacted and asked to provide their strategies for coping with a shortage of Mo-99/Tc-99m. Each of these strategies was evaluated based on its effectiveness for conserving Tc-99m while still meeting the needs of the patients. Results: From the responses, six categories of strategies, in order of importance, were compiled: (1) contractual agreements with commercial nuclear pharmacies, (2) alternative imaging protocols, (3) changes in imaging schedules, (4) software utilization, (5) generator management, and (6) reducing ordered doses or eliminating “backup” doses. Conclusion: The supply chain of Mo-99/Tc99m is quite fragile; therefore, being aware of the most appropriate coping strategies is crucial. It is essential to build a strong collaboration between the nuclear pharmacy and nuclear medicine department during a shortage situation. With both nuclear medicine departments and nuclear pharmacies implementing viable strategies, such as the ones proposed, the amount of Tc-99m available during a shortage situation can be maximized.