Diagnostic imaging tests across Europe disrupted by isotope shortage

8 September 2008

The closure of three European nuclear reactors producing medical isotopes is causing a worldwide shortage of the isotopes and limiting European hospitals to between 20% and 40% of their usual nuclear medicine activities, the European Association of Nuclear Medicine has warned in a letter in the British Medical Journal [1].

The isotopes are used in over 80% of routine diagnostic nuclear imaging procedures such as heart imaging, bone scans and some cancer detection procedures.

The reactors supply Molybdenum 99, which is used in hospitals to produce Technetium-99m, the main radionuclide used for over 80% of routine diagnostic nuclear medicine investigations. The isotopes cannot be stockpiled as they decay in a few days (Molybdenum 99 has a half-life of 2.7 days, decaying into Technetium-99m).

Two reactors, one in France and one in Belgium, are closed down for regular maintenance, but the third reactor in Petten in the Netherlands was unexpectedly closed down after gas bubbles were discovered escaping from a pipe into the primary cooling system in late August. The Petten reactor is the second largest global producer, normally providing more than 25% of global demand and more than half of Europe’s demand.

In addition, another producer in South Africa is getting back online after closure for maintenance, the letter says. The world's main producer at Chalk River in Canada was shut down in August for routine maintenance, and resumed production on 31 August (correction: it was reported that it had been shut due to an electrical storm, but this was erroneous, according to Atomic Energy of Canada Ltd).

There is just one other reactor in Australia, which, according to the authors, does not have enough potential to significantly increase supply to the world market.

Wolfram Knapp, the president elect of the European Association of Nuclear Medicine, said that “the end of September is a best case scenario” for the return to sufficient supplies.

Although 80% of molecular imaging investigations are not urgent and can be postponed by one to three weeks, others must be done within days, and these cases will be at the top of the priority list, said Dr Knapp, who is director of nuclear medicine at the University of Hanover Medical School in Germany.

Alan Perkins, honorary secretary of the British Nuclear Medicine Society and professor of medical physics at University Hospital Nottingham, said that in some non-urgent cases doctors will have the option to use alternative tracers or alternative imaging methods, such as magnetic resonance tomography. “But some patients will receive suboptimal diagnostic observation,” he said. “It will slow up the system.”

Liselotte Højgaard, director of clinical physiology, nuclear medicine, and positron emission tomography at University Hospital, Copenhagen, said that supplies of medical isotopes at her hospital last week were 50% of normal but will drop to 16% of normal this week.

Dr Knapp said that new production capacity for medical isotopes is needed to avoid future shortages, with the best solution being a new reactor dedicated to production of isotopes for medical uses. The current large reactors that produce isotopes are over 40 years old and do not focus on producing medical isotopes.


1. Stafford N. Isotope shortage is limiting nuclear medicine across Europe. BMJ 2008;337:a1575. (6 September.)

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