Nuclear medicine averted a crisis last month when workers at theworld's main source of the raw material for technetium-99m settledcontract negotiations hours before a strike deadline. A laborwalkout would have caused a major shortage of the most
Nuclear medicine averted a crisis last month when workers at theworld's main source of the raw material for technetium-99m settledcontract negotiations hours before a strike deadline. A laborwalkout would have caused a major shortage of the most commonlyused radiopharmaceutical in nuclear medicine.
The incident highlighted nuclear medicine's dependence on aCanadian nuclear reactor that produces over 80% of the world'ssupply of molybdenum-99, the raw material for technetium-99m.The close call adds impetus to an effort sponsored by the U.S.government to develop a domestic source for molybdenum-99. Thefederal program has been hampered by foreign competition and requirementsthat it be self-sustaining, however.
"We are totally at the mercy of Canada and one facilityfor all the nuclear medicine in this country," said Dr. RobertJ. Lull, president of the American College of Nuclear Physiciansand head of nuclear medicine at San Francisco General Hospital."They were within a day of striking. It would have essentiallywiped us out within a week."
The Canadian facility is a research reactor at Chalk RiverLaboratories in Ontario. Run by a Canadian government agency,Atomic Energy of Canada, Ltd. (AECL), the reactor is one of thelast remaining facilities in the world that produces molybdenum.As a result, Chalk River Laboratories and Nordion International,the Canadian company that refines and distributes Chalk River'smolybdenum, have a virtual lock on the supply of the radioisotope.
That supply was in danger of being disrupted in late July asa strike deadline loomed during negotiations between AECL anda union representing about 150 reactor operators. The operatorswere asking for a wage increase that would have put them at asalary level close to that of better paid operators at an Ontariohydroelectric power plant, according to John A. Macpherson, directorof public affairs for Chalk River Laboratories.
The union had filed for and received government approval togo on strike as of midnight, July 20. Negotiations continued asthe deadline approached and the two sides reached an agreementtwo hours before midnight, Macpherson said. The union settledfor a modest wage hike and increased training. The contract wasratified by the operators a week later.
THE CLOSE CALL REINFORCED FEARS of many nuclear medicine physicianswho were already concerned about the field's reliance on a singlesource for molybdenum-99.
"The lack of molybdenum from that facility would havecaused significant disruptions of what we could provide for nuclearmedicine services," said Dr. Paul H. Murphy, president ofthe Society of Nuclear Medicine and a medical physicist at BaylorCollege of Medicine in Houston.
Technetium-99m is the workhorse of nuclear medicine, used inover 30,000 procedures a day. Physicians at Baylor could haveswitched from technetium-99m to thallium for some studies, suchas myocardial perfusion imaging, Murphy said. But many other imagingstudies would have been canceled.
"We would have been in real trouble with some of our otherhigh-volume procedures that rely exclusively on technetium,"Murphy said. "We would have had to postpone them until wecould get the supply."
It is impossible to build a long-term stockpile of molybdenumbecause of the element's 66-hour half-life, according to Murphy.In the event of a cutoff, hospitals would have had at most a one-weeksupply of technetium.
Officials at AECL and Nordion International said they've takensteps to mitigate the possible impact of a molybdenum shortage.Nordion informed its customers of the situation as soon as itknew that a strike could occur, said William MacCallum, salesdirector of the isotope division. This was proof that the companytakes its responsibility as the world's major molybdenum supplierseriously, he said.
"We understand our role in all of this," MacCallumsaid. "We're not cavalier about it. In fact, notifying customersmay or may not have been a mistake, because there wasn't a strike,there was just a chance of one. We wanted them to know if therewas anything coming down that might have been a problem."
Another Nordion reactor in Belgium would have been used toproduce molybdenum if a strike had occurred, MacCallum said. Butthe Belgian reactor alone would not have been able to meet allof the world's demand for molybdenum, he acknowledged.
In the event of technical problems at Chalk River's main reactor,the facility has a backup reactor that could be fired up to producemolybdenum, MacCallum said. The backup was used a year ago toproduce molybdenum after the main reactor was closed for 11 monthsfollowing a breakdown. A new reactor is also being built to replacethe one currently in use, he said.
But nuclear medicine practitioners remain edgy about the situation,with some U.S. physicians suggesting that the Canadian monopolyon molybdenum could represent a national security risk. When PresidentGeorge Bush and first lady Barbara Bush were diagnosed as havingGraves' disease, they were treated with Canadian radioisotopes.
U.S. Department of Energy officials have been moving to developa program to create a domestic source for molybdenum. It will,however, be part of an existing DOE program that produces stableand radioactive isotopes. That program has been criticized byCongress as woefully underfunded.
The molybdenum effort of the DOE will use a research reactorat Los Alamos National Laboratory in New Mexico to produce molybdenum.DOE officials expect to have radioisotopes from the facility availableon a regular basis by April 1993.
The DOE's existing isotope program has been hamstrung by arequirement in its mandate that it be self-supporting, with coststo be covered by sales of isotopes to radiopharmaceutical manufacturers.A General Accounting Office report described the DOE program ascritically short of money and unable to compete with foreign suppliers,which often undercut prices of isotopes produced in the U.S.
Radioisotope production in other countries usually receivesgovernment subsidies, according to Kristen Morris, director ofgovernment relations for the SNM and ACNP. U.S. radioisotope productionthus operates at a competitive disadvantage because it must recoverits costs.
"A federal agency should not be required to operate likea business," she said.
A hearing in the U.S. House of Representatives is scheduledfor August 12 to review the GAO report and discuss ways to revivethe isotope program.
Ironically, some industry observers see the timing of the Canadiancrisis as fortuitous in spurring the resurrection of domesticmolybdenum production.
"I think the GAO report, if it had come in a sterile environment,without the strike looming, probably would not have received muchattention," a DOE official told SCAN. "As it is now,the threat of a strike by the AECL operators at Chalk River haseffectively assured that the GAO report is going to receive alot of attention."