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Medical Isotope Shortage Delays Procedures for Patients Across Canada

Posted on: Wednesday, 5 December 2007, 18:00 CST

By Colin Perkel, THE CANADIAN PRESS

TORONTO - Hundreds of cancer patients and others awaiting treatment across Canada had their procedures delayed while hospitals scrambled Wednesday to deal with a growing shortage of medical isotopes caused by a nuclear reactor shutdown in Chalk River, Ont.

The unprecedented disruption, which is affecting health-care facilities across North America, has drawn attention to the vulnerability of the country's supply of a key ingredient used in diagnosing complex diseases.

"It's a dire situation - it's been a huge scramble," said Dr. Andrew Ross, a nuclear medicine physician at the QE2 Health Sciences Centre in Halifax.

"As of Friday, our source of what we use for our scans will be non-existent."

Already more than 100 patients in Halifax alone have had appointments put off indefinitely and the number will grow by about 30 a day starting next week, a frustrated Ross said.

Radioactive isotopes, which are normally injected into patients to allow imaging equipment to produce detailed scans, have become a critical part of decision-making in modern medicine, especially when it comes to cancer, with doctors relying heavily on the scans to formulate treatment plans.

In Toronto, the three hospitals that make up the University Health Network have had to put most of the scores of scans they do daily on hold.

"There's no question it does cause anxiety," said Dr. Bob Bell, CEO of the health network.

The Chalk River reactor, operated by Atomic Energy of Canada Limited, produces molybdenum ore, a low-energy radioactive material, which is purified by MDS Nordion, which accounts for between 35 and 45 per cent of the world's medical supply.

MDS sends the refined product to suppliers, who put it into a "generator" in which the material breaks down into technecium, which is used for the scans.

The planned maintenance shutdown of the 50-year-old NRU reactor was supposed to last from Nov. 18 to Nov. 23, but safety problems persist.

"We hope to reactor back into service as soon as possible," said AECL spokesman Dale Coffin. "We're not going to speculate on the timing."

Technecium is much like electricity in that it can't be stored for more than a couple of days, so hospitals have to be able to count on a steady reliable supply stream.

Ross said he was particularly upset about the poor flow of information about the shutdown.

In the House of Commons, Federal Health Minister Tony Clement found himself on the defensive.

"There were contingency plans in place, of course, (but) you can't have too much of a contingency plan because the half-life of these isotopes is just three days," Clement said.

"We are working with industry right now and we are getting emergency supplies for emergency procedures and that will continue."

MDS Nordion did not return calls Wednesday, but said in a statement it was concerned about the impact of the AECL supply disruption on customers and patients and was working to "mitigate the impact."

In some cases, diagnostic procedures that do not rely on isotopes, such as angiograms and MRIs, can be used instead of nuclear scans. Experts, however, warned that a prolonged drought could compromise urgent cases and create undue stress on non-nuclear diagnostics.

"This disruption goes across North America; it's not just Canada," said Dr. Karen Gulenchyn, who manages nuclear medicine for four Hamilton hospitals, where scans have fallen from 60 a day to just 12.

"As this goes on longer and waiting lists get longer, it gets more difficult to manage the situation."

Toronto's University Health Network said it had managed to secure a technecium generator in Europe that it hopes will be flown in on the weekend, when staff will work overtime to make the most of its limited availability.

"Although we clearly have a disruption of supply, we are able to provide urgent care for patients who really need to be looked after in time-limited fashion in the next week," Bell said.

The Winnipeg Regional Health Authority, where several dozen patients had their scans rescheduled, was sourcing its isotopes from a backup supplier in Europe for urgent cases, a spokeswoman said.

The Chalk River reactor was supposed to be shut down in 2005 but has been kept going because two replacements are a decade behind schedule.

Source: Canadian Press

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