Along with the large demand for Tc-99m, there are significant supply side issues that jeopardize the reliable supply of Tc-99m. Supply disruptions and constraints are the key concern of radioisotope buyers and over 90% of professionals said they have suffered from recent Tc-99m shortages. Current supply constraints and disruptions are caused by the unreliability of the aging nuclear reactors that currently produce the source material of Tc-99m.
Mo-99 made in nuclear reactors is sourced from relatively few research reactors. Over 90% of Mo-99 is made in five reactors. These facilities have experienced several shutdowns over the past decade. In fact, all of the facilities are around 50 to 60 years old and experience continual unanticipated shut downs. Even worse, several of these reactors are set to be retired in the near future.
Medical isotopes come with the unique challenge of decay – the Mo-99 isotope takes 66 hours to decay into the medical isotope Tc-99m. The new isotope has a half-life of only six hours, which means much of the Tc-99m is wasted in shipment from the nuclear reactors where they are produced.
Given the short half-lives of the isotopes and resulting decay of the key ingredient, the supply chain is incredibly time critical. It is not possible to stock-pile inventory of the isotope in the event of shortages. When the National Research Universal Reactor shut down in 2009, it removed 40% of the world supply of Tc-99m. Health officials in Canada and the United States scrambled to find alternative sources, and thousands of tests and treatments were rescheduled. Given the lack of diversity in supply sources and the linear nature of the supply chain, an issue with one source or at one link in the supply chain can immediately affect medical facilities’ ability to adequately care for patients.
At CII, we use linear accelerators to produce pure Mo-99, process it and then ship it directly to radio-pharmacies and hospitals, which halves the conventional reactor supply chain distribution time and greatly reduces the distribution costs.