Efforts to Ensure Sustainable Supply of Medical Isotopes: Molybdenum-99

Efforts to Ensure Sustainable Supply of Medical Isotopes: Molybdenum-99 At the IAEA 55th General Conference a special side event on radioisotopes was held to allow conference participants to gather additional information and talk directly to experts from the IAEA working in this field. By bridging the gaps between businesses, science and medical expertise, the IAEA General Conference was a pivotal opportunity for new ideas to be shared and put to use.

When the National Research Universal Reactor in Ontario, Canada and the HFR-Petten reactor in the Netherlands both shut down within the same one year period, it sparked a worldwide crisis in the supply of a very important radioisotope—namely Molybdenum-99 and it’s daughter, Technetium-99m—one that is essential in helping doctors to map the spread of cancer, track blood flow to heart muscles and other potentially life-saving medical procedures. In fact, because of its excellent nuclear characteristics allowing high quality images with low radiation to patients, Technetium-99m is used in over 80% of diagnostic nuclear medical imaging and an estimated 30 Million diagnostic studies are carried out around the world per year. Technetium-99’s parent isotope, Molybdenum-99 (or “Moly 99” for short), must be produced in reactors. Thus, ensuring that patients around the world can receive proper health care requires that the global supply chain of molybdenum-99 be re-examined and safeguarded from collapsing when unforeseen events such as this occur.

For almost fifty years now, the same five reactors have been responsible for providing the world with molybdenum-99 . However, none of the five major reactors that produce molybdenum-99 is entirely dedicated to the production of molybdenum-99. They were financed and built to provide multiple services to multiple users and not according to any business model designed to best serve the molybdenum-99 market. In order for countries to be guaranteed that their health care programmes will have sufficient amounts of molybdenum-99, it is important that they do not all rely on the same fragile supply chain.

Recognizing the need to explore other options, the Nuclear Energy Agency (NEA) and Organization for Economic Cooperation and Development (OECD) constituted a high level expert group (HLG), to which the International Atomic Energy Agency was invited, to examine the future sustainability of supply of medical radioisotopes, in particular molybdenum-99. While the OECD/NEA HLG studies focused on the economic aspects of the supply chain, the IAEA’s efforts were directed towards the technical aspects molybdenum-99, such as exploring diverse production routes where highly enriched Uranium is not used. The OECD/NEA studies cast light on the fragility of the molybdenum-99 supply chain and potential ways to ensure a sustainable supply.

Creating New Options for Member States

Because each country’s health care infrastructure and technological capabilities varies, it is important that they approach the problem of molybdenum-99 supply in a way that is most appropriate for them. For example, in some areas there is the scope for making greater use of existing smaller scale production facilities. For example, the Comision Nacional de Energia Atomica (CNEA) in Argentina has plans to double its current production capacity by promoting the local production of molybdenum-99. Nevertheless, with one single reactor in Canada capable of meeting most, if not all of global molybdenum-99 demand, the challenge is to convince smaller commercial manufactures that creating new facilities will be both profitable and sustainable.

Many countries have also already begun exploring accelerator-based technologies for creating molybdenum-99, which allow them to avoid relying on one multinational supply chain and simply process the radiopharmaceutical in the basement of their nation’s hospitals. This is especially advantageous given that technetium-99m has a half-life of only six hours, and therefore must be produced nearby and shortly before it is to be used. Transferring this process to a closer proximity of the patients can prevent cancellations or delays in important medical testing services.

While it is not always practical or possible for every country to embark on production of molybdenum-99 through fission of Uranium—and hence the reliance on the major producers will continue—alternate production methods using accelerators could serve as stand-by routes to fall back upon when needed. The purpose of the IAEA’s work is to help provide Member States with alternatives for molybdenum-99 production, given their particular capacities and the structure of their economies. In addition, this year the IAEA plans to help organize an interregional project that contributes to the sharing of knowledge and expertise on molybdenum-99 production and will further explore the sustainability of its global supply.