• Associate Professor in Nuclear Medicine says Australia is facing its worst radionuclide shortage, which is a medicine vital for cancer diagnoses  
• Australia’s only nuclear reactor has stopped production of generators for 99mTc due to a mechanical fault at the facility that extracts the medical isotope
• Dr Geoff Currie says supplying large population areas and critical care patients facing life-threatening conditions is key to managing the situation

Australia is currently in the midst of what could potentially be the worst shortage of the radionuclide molybdenum-99/technetium-99m the country has ever seen.

The Australian Nuclear Science and Technology Organisation (ANSTO) has been forced to stop extraction of the radioisotope ‘molybdenum-99’. This is the parent product of technetium-99m which is essential for diagnosis in health conditions such as cancer, heart disease, neurological disease, and skeletal, renal and digestive disorders.

The fault is in the facility that extracts the medical isotope from what is produced in the reactor - there are no issues with the reactor itself – and because of where the fault is located, ongoing production in the reactor cannot be extracted and distributed for use.

Over the past two years, ANSTO has sought my advice during a number of mechanical failures on how to manage the equitable distribution of potentially life-saving nuclear medicine doses to those most in need. Balancing Australia’s population size with acute care and urgent services during periods of scarcity is one of ANSTO’s main concerns and a key challenge I am advising them on.

This week the nuclear medical community is operating on about 31 per cent of our normal supply of 99mTc, so as little as 31 per cent of the normal patient load in Australia will be completed this week.

The medical community needs to consider how to equitably distribute the radionuclide, given the circumstances. There are 250 nuclear medicine sites across the country that are currently negotiating with ANSTO to have priority service.

What we need to do is be servicing as many Australians possible, and to do this, the main hospitals and critical care services and patients with life-threatening conditions in areas with the largest populations will need to be prioritised. This is how hospitals will need to determine which patients they will use the medicine on.

Private clinics outside hospitals across the country may not be supplied with the radionuclide and larger clinics and main hospitals will be on limited supplies.

Last week, I lobbied the federal government and worked with the Therapeutic Goods Administration (TGA) and Chief Medical Officers to craft a substitution plan, allowing like-for-like substitution on the Medicare Benefits Schedule rebate for positron emission tomography (PET) alternatives to try to address some urgent studies and relieve some demand for 99mTc. This has been achieved with the valuable support of industry colleagues and commercial entities pulling together.

To help limit the shortages, ANSTO is currently looking into the possibilities of importing the medicine, but this is not a quick-fix solution.

Realistically, the country is looking at a minimum of a two-to-three week delay in getting back to our normal supply levels. It could be longer though, as we currently have no timeline for when the fault will be fixed.

In the past when there has been shortages, additional supplies of the radionuclide have usually been sourced from a supplier in South Africa. However, the South African reactor has just re-commenced production after a three-week scheduled shutdown for maintenance. It does take a while for the reactor to be in a position to produce higher yields, so for the next few weeks, the country will have limited support from South Africa.

I predict next week will be the worst week. Last week we were able to extract some activity in the system before the shutdown of the extraction cell occurred. Next week there won’t be access to any production in Australia, we will be completely reliant on what can be delivered from South Africa, Europe or North America. The estimate is that next week we are likely to be operating on about 27 per cent of usual supply, because that is all the excess supply that can be provided by the South African reactor.

One of ANTSO’s main priorities is to get production levels back to normal because the radionuclide is vital.

As co-founder, vice-president and Facebook site administrator for the Rural Alliance in Nuclear Scintigraphy (RAINS), I have played a proactive role in providing nuclear medicine professionals across Australia with information, insight and support. I am privileged to be in this position and I hope the counsel I provide to ANSTO and Australia’s nuclear medical community is of assistance during the tough molybdenum-99 shortage.