Potential Ways to Address Shortage Situations of99Mo/99mTc.
99mTc, the most common radioisotope used in nuclear medicine, is produced in a nuclear reactor from the decay of99Mo. There are only a few aging nuclear reactors around the world that produce99Mo, and one of the major contributors, the National Research Universal (Canada), ceased production on October 31, 2016. The National Research Universal produced approximately 40% of the world's99Mo supply, so with its shut down, shortages of99Mo/99mTc 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 of99Mo/99mTc. Each of these strategies was evaluated on the basis of its effectiveness for conserving99mTc while still meeting the needs of the patients.Results:From the responses, the following 6 categories of strategies, in order of importance, were compiled: contractual agreements with commercial nuclear pharmacies, alternative imaging protocols, changes in imaging schedules, software use, generator management, and reduction of ordered doses or elimination of backup doses.Conclusion:The supply chain of99Mo/99mTc 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 of99mTc available during a shortage situation can be maximized.
Division of Nuclear Medicine, Department of Radiology, Mayo Clinic, Rochester, Minnesota.
Leah M
LM
Filzen
Division of Nuclear Medicine, Department of Radiology, Mayo Clinic, Rochester, Minnesota.
Lacey R
LR
Ellingson
Division of Nuclear Medicine, Department of Radiology, Mayo Clinic, Rochester, Minnesota.
Andrew M
AM
Paulsen
Division of Nuclear Medicine, Department of Radiology, Mayo Clinic, Rochester, Minnesota jhung@mayo.edu.
Joseph C
JC
Hung
D003952:Diagnostic Imaging; D008982:Molybdenum / Q000600:supply & distribution*; D011829:Radiation Dosage; D011854:Radiochemistry; D011868:Radioisotopes / Q000600:supply & distribution*; D013667:Technetium / Q000600:supply & distribution*
D011868:Radioisotopes; D013667:Technetium; D008982:Molybdenum
99Mo; 99mTc; nuclear reactors; radioisotope productions; radioisotope shortage