Isotope shortage leaves Dutch bracing for the worst

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Chalk River and Petten Isotope Shortage threatens nuclear medicine diagnostics as aging reactors face outages and repairs, tightening molybdenum-99 and technetium-99m supplies, raising costs, and forcing contingency planning across radiopharmaceutical supply chains and hospitals.

The Situation Explained

A dual outage at key reactors cuts Mo-99/Tc-99m output, straining nuclear medicine diagnostics and driving higher costs.

Chalk River leaks force extended shutdown and uncertainty
Petten reactor faces six-month repair for cooling system leak
Belgian reactor backfills, but capacity and duration are limited

The Netherlands is bracing for the worst if the world is without its two top sources of medical isotopes next year, a scenario that became more likely after Canada's nuclear agency said it will take longer than planned to repair a leaky reactor at Chalk River, Ont.

An aging Dutch nuclear reactor in the community of Petten is scheduled for lengthy maintenance work next spring, which is the earliest its downed Canadian counterpart is expected back up and running.

The two reactors built a half-century ago supply the bulk of the isotopes used to diagnose cancer and heart ailments.

But Atomic Energy of Canada Ltd.'s repeated delays in returning Chalk River to service have cast doubts about whether the 52-year-old reactor will ever work again, even as AECL says Chalk River could meet shortfalls if restarted soon.

That has the Dutch worried that an already shaky isotope supply is about to get a whole lot shakier, as the medical community braces for isotope shortages across multiple countries.

"We here in the Netherlands are forming a task force this month to prepare for the worst scenario in 2010," Dr. J. Fred Verzijlbergen, the head of the Dutch Society of Nuclear Medicine, said in an email.

"People from the industry... government, nuclear medicine and radiotherapy have to co-operate and study every possibility to keep the medical radioisotope production intact."

"Shutdown of Chalk River and Petten for a long period will have huge consequences, this time also for patients with cancer diagnostics and treatments, including testing delays for thousands worldwide."

The Dutch reactor's operator, NRG, has a licence to run the reactor until March 2010, at which point it must be shut down for major repairs.

The reactor is leaking tiny bubbles of gas into the primary cooling system – a tricky fix because the cracked pipe is hard to reach and encased in concrete.

It's expected to take six months to repair the Dutch reactor, leaving it out for months before operations resume.

The past month – during which the Dutch and Chalk River reactors have been off-line – has been a preview of what may be in store next spring.

Last month, Health Minister Leona Aglukkaq and Natural Resources Minister Lisa Raitt warned of "a period of more critical shortage during the month of August."

And medical products maker Covidien Ltd. – which refines and sells raw isotopes to pharmaceutical companies and clinics – told its customers to expect shortages in July and August.

"Chalk River and Petten are closed at the same time presently and we've been able to muddle through," said Dr. Christopher O'Brien, head of the Ontario Association of Nuclear Medicine.

He added that's only because a smaller Belgian reactor that normally produces isotopes for only a third of the year has dutifully been filling in for its larger counterparts.

But the Belgian reactor is primarily a research reactor and isn't usually used to make isotopes for months on end. It produces 10 per cent of global supply.

So it's uncertain if the Belgian reactor can stand in for any length of time.

There won't be many backups if it can't. France's small OSIRIS reactor is also scheduled for repair work next year.

The only other reactor up and running besides the one in Belgium is in South Africa.

It was hoped that brand new reactor in Australia would help stem the isotope shortage, but the Australian Nuclear Science and Technology Organization says it's still months from supplying other countries.

Isotopes have been in short supply since May when AECL shut down the Chalk River reactor after finding a pinprick-sized radioactive water leak, which, when running, has previously stepped up production to stabilize supply.

That's left doctors scrambling to make do with an erratic supply of medical isotopes, which have a short shelf life and can't be stockpiled.

Hospitals and clinics have also been hit with massive bills, which are up to $30,000 higher than normal from isotope suppliers who hiked their prices this spring, as hospitals seek isotopes amid the prolonged outage.

Quebec has said it will ask for help from the federal government as the province estimates the cost overrun could be in the neighbourhood of $10 million.

Ontario and Nova Scotia haven't made any decisions on whether to increase funding to cover isotope costs.

But Ottawa says it doesn't plan to cover the extra costs, even as it has earmarked $6 million for medical isotopes to support supply efforts. Instead, the federal government is exploring alternatives to radioactive isotopes.