The U.S. Department of Energy wants to create a domestic sourcefor isotopes, both stable and radioactive. Witnesses at a Congressionalhearing on Aug. 12, however, criticized the DOE's efforts as inadequate. Nuclear medicine's dependence on a single
The U.S. Department of Energy wants to create a domestic sourcefor isotopes, both stable and radioactive. Witnesses at a Congressionalhearing on Aug. 12, however, criticized the DOE's efforts as inadequate.
Nuclear medicine's dependence on a single source for many commonlyused radioisotopes was made frighteningly clear last month whena labor dispute at a nuclear reactor site in Canada almost ledto a worldwide cutoff of the raw material for technetium-99m (SCAN8/12/92).
In sometimes stormy proceedings before a House of Representativesoversight subcommittee, the DOE was chastised for ignoring therisks of U.S. dependence on foreign isotopes. The DOE's ongoingisotope production program is struggling. The department has failedto support a proposal by nuclear medicine specialists to createa National Biomedical Tracer Facility (NBTF) dedicated to isotopeproduction.
The DOE's current isotope effort, the Isotope Production andDistribution program (IP&D), was set up with the intentionof avoiding incidents like last month's technetium scare. Theprogram has been unable to create a reliable isotope supply, however.A recent General Accounting Office report characterized the programas nearly bankrupt.
"The supply is very precarious," said David Berick,a staffer on the House subcommittee. "The shortage we havenow is just as serious as an overnight cutoff."
The isotope shortage is affecting both research and healthcare in the U.S. Research in other countries is outpacing thatbeing done in the U.S. because those countries have created reliablesupplies of isotopes, testified Dr. Richard C. Reba, a nuclearmedicine specialist at the University of Chicago. Reba representedthe Society of Nuclear Medicine and the American College of NuclearPhysicians.
"The unavailability of isotopes stifles product research,development and marketing, resulting in yet another hurdle thatAmerican business must overcome," Reba said.
Reba cited several cases in which research studies had to becanceled and nuclear medicine procedures postponed because isotopescould not be obtained.
A fundamental problem with the DOE's IP&D program is arequirement in its mandate that it be self-funding, with proceedsfrom isotope sales covering costs. The program has been unableto compete with foreign isotope manufacturers, however, and hasbeen forced to borrow money to continue operations.
While the IP&D program struggles at the DOE, nuclear medicine'sNBTF proposal languishes. The facility is needed because the DOEis planning to shut down several sites that are producing researchisotopes. Despite several years of lobbying by the SNM and theACNP, however, the DOE has failed to budget funds to get the facilitystarted.
"(The DOE) can't find a couple of million to do a feasibilitystudy for NBTF," Berick said. "The proposal has beensitting over there for two years. The program hasn't receivedmanagement nor budget attention. It's out of sight, out of mindover there."
THE DOE's EFFORT TO CREATE a domestic source for molybdenum-99,the raw material for technetium-99m, has progressed somewhat better,with production scheduled to begin sometime in 1993 at Los AlamosNational Laboratory. But that program is also required to be self-funding,a mandate that could cause a repeat of problems already experiencedin the IP&D program.
The DOE must fundamentally reorder its priorities toward domesticisotope production if the U.S. is to avoid future crises likethe Canadian scare, according to Kristen Morris, director of governmentrelations for the SNM and ACNP.
"Their priorities are focused on physics research, defenseresearch, things of that nature," Morris said. "(TheNBTF) doesn't even show up on the radar screen."
Nuclear medicine specialists hope that the hearing will prodthe DOE into taking a more aggressive role in isotope production.Subcommittee chair Rep. Michael Synar (D-OK) promised anotherhearing next year to monitor the DOE's progress.
"We were trying to get the DOE to admit there was a seriousproblem," Berick said. "They wouldn't admit it. Thisis a very low administrative and budget priority with the department."
Anthony DiGiacomo is the latest defendant to be sentenced inthe case, dubbed "Operation Catscam." FBI investigatorsuncovered several rings that defrauded hospitals in New Jerseyand New York of millions of dollars by stealing film, forginginvoices and arranging kickbacks and bribes (SCAN 7/15/92).
DiGiacomo was radiology manager of St. Barnabas Hospital inLivingston, NJ, until 1985. He pleaded guilty to conspiracy andmail fraud charges in connection with a scheme to steal x-rayfilm from St. Barnabas. Court records indicate that DiGiacomonetted $1.5 million in the scam.
U.S. District Judge Maryanne Trump Barry declined to orderDiGiacomo to make restitution to St. Barnabas, noting that thehospital had discovered the thefts in 1985 but failed to reportthem to the authorities.
TMG interviews 250 radiologists, 100 administrators and 100management information systems directors at U.S. public and privatehospitals with over 200 beds. The survey projections do not includemilitary and VA acquisitions.
The TMG Tracking Study reported that U.S. PAC system and componentpurchases equaled $314 million last year. PACS sales are expectedto rise only about 2% to reach $321 million this year. TMG projectsan upturn in the market in 1993, however, with annual sales reaching$489 million by 1994, or a growth of 21% over the two-year period.
The study indicates varying hospital demand according to thetype of PACS equipment. Sales of multimodality workstations, viewingconsoles, single-drive optical disk archives, laser scanners,computed radiography systems and laser printers are increasing.
Demand for teleradiology systems, three-dimensional workstations,jukebox-style optical disk archives and radiology informationsystems are relatively flat, while there is a decline in actualand projected purchases of independent physician consoles andmulti-image formatters, TMG said.