World shortage of molybdenum may hinder nuclear medicine services

Problems with the world production and supply of molybdenum are leading to shortages of radioisotopes for nuclear medicine imaging tests, according to an editorial in the journal Nuclear Medicine Communications, official journal of the British Nuclear Medicine Society (BNMS).

The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health, a leading provider of information and business intelligence for students, professionals, and institutions in medicine, nursing, allied health, pharmacy and the pharmaceutical industry.

International co-operation is needed to meet the challenges of maintaining a stable, reliable supply of radioactive tracers for essential bone, heart, and other imaging studies, according to the article by Alan C. Perkins of University of Nottingham and Gill Vivian of Plymouth Hospitals NHS Trust.

Supply Problems Disrupt Nuclear Medicine Services
Over the years, production and distribution of molybdenum—used to produce radiopharmaceuticals containing technetium-99m, widely used in nuclear medicine—has been highly reliable. However, problems have arisen due to the age of the commercial reactors that make molybdenum. All but one of the six reactors worldwide are more than 40 years old.

In the last two years, shutdowns of reactors in Canada and the Netherlands have led to disruptions in the supply of molybdenum to hospital nuclear medicine departments in the United Kingdom, Europe, and North America. With supplies reduced to 30 percent of normal, departments have had to adapt to make the most effective and efficient use of their supplies.

Earlier this year, the Nuclear Energy Agency convened an international workshop of molybdenum producers and distributors, nuclear medicine societies (including the BNMS), and clinicians to discuss the problem. "In the foreseeable future there will be further disruptions in molybdenum supplies and the cost will increase significantly," workshop attendees agreed. At the same time, they pledged to address the problems through exchange of materials, information, and strategic support.

Call for International Co-operation to Address Shortage
However, many challenges will have to be met to ensure and maintain an adequate world supply of medical molybdenum. The small number of ageing reactors poses problems—new reactors require significant time and investment, and new technologies for molybdenum supply are limited. Attention is needed to the complex supply chain involved in producing and distributing a decaying radioactive product.

Co-operative efforts will also be needed to address security issues related to the proliferation of nuclear material. Meanwhile, nuclear medicine departments will have to devise ways of making the best use of limited supplies, including efficiencies in patient scheduling and radiopharmaceutical use and new means of achieving results while using lower doses of radioactivity.

Currently, neither the United Kingdom nor the United States has a facility for producing medical molybdenum. The current interest in sustainable "green" energy may drive a "nuclear renaissance," which the authors hope will include provisions for the manufacture of radiopharmaceuticals.

"The medical use of radionuclides is probably the single most beneficial application of atomic and nuclear sciences to mankind," Drs. Perkins and Vivian conclude. The BNMS will play a central role in minimizing the impact of the molybdenum shortage on patient services while advocating investment in alternative means of meeting the critical demand for medical radioisotopes.

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