Times of India
25 August 2010
By Kounteya Sinha
New Delhi, India

Shutdown Of A Nuclear Reactor In Eastern Ontario Triggers Crisis
Medical scans could get costly in India soon, thanks to a severe global shortage of medical isotopes minute amounts of radioactive substances used to diagnose and treat a variety of diseases. Doctors confirmed that they have been facing a prolonged shortage of the most widelyused diagnostic radio–isotope, Technetium–99m, which is largely issued for scans for almost all body parts.

The global shortage has been due to the shutdown of a nuclear reactor in eastern Ontario that produces a third of the world’s medical isotope requirements. The crisis has led to the escalating price of Molybdenum 99 – the raw materiel from which Technetium 99m is made.

Consequently, hospitals in India are being forced to pay atleast three to four times the original price of molybdenum 99 that are being sourced from Holland, France and South Africa.

"Molybdenum 99 now costs three times more than what it was six months ago. We have no choice but to source it at such high prices. However, we haven’t increased our rates for patients. But if this shortage continues, scans and X–rays will definitely become more expensive," said Dr Uma Ravi Shankar, who heads the department of nuclear medicine at Apollo Hospital.

"Molybdenum 99 is loaded on to generators and then shipped to buyers like us. Technetium–99m is then eluded out of it, and mixed with radio pharmacists and inserted into the body for different scans. Prolonged shortage of Molybdenum 99 will automatically lead to a rise of medical scan costs," said Dr Pankaj Dougall, HoD, nuclear medicine at Max Healthcare.

Isotopes injected into the body enable doctors to diagnose several symoptoms like whether heart has adequate blood flow, if cancer has spread to a patient’s bones and also help detect gallbladder, kidney and brain disorders.

"The shortage in India is mainly of diagnostic radioisotope Technetium–99m. Thankfully, isotopes required for PET scans in cancer isn’t that badly hit because they are manufactured locally," Dr Shankar added. Though experts claim the Ontario reactor will soon be back in operation, Dr Dougall say the shortages may continue in the near future.

"The Canadian plant is one of five aging reactors worldwide. Most of the reactors that are making such medical isotopes are over 40 years old. The Ontario reactor is also aging, and is scheduled to go offline for good in 2016. Thereforem, shortages will continue. That is why US and Europe is looking at alternate ways of making diagnostic radioisotopes which at present is very costly," Dr Dougall explained.

Dr Atul Verma, HoD, nucleur medicine at Escorts Heart Institute, said: "We, too, are facing a shortage of medical isotopes. That’s why we are using more of thallium for our heart imaging." Of every 10 procedures, eight require technetium–99m, which has a half–life of only six hours – the time it takes for 50% of a given quantity of a radioactive substance to decay and disappear.

Hence, Technetium–99m cannot be stockpiled, and has to be constantly made fresh and distributed quickly to medical facilities.

Only Cobalt–60 has a half–life of 5.26 years. Molybdenum–99 has a half–life of 66 hours, which means it loses half its radioactivity in just less than three days. Iodine–131 has a halflife of 8.02 days while iodine–125 loses half its radioactivity every 59.4 days.

An expert said the isotopes provide far more information than an ultrasound. For instance, they make bone scans far more effective than X–rays. Experts say almost half the reactors worldwide are between 40 and 49 years old, and only 14% of them are less 20 years old.