Radioisotope shortage may impact availability of bone scans


For some time we have been monitoring a problem with the supply of the radioisotopes used in bone scans for patients suspected to have metastatic prostate cancer to their bones.

Ther basic problem is that an old nuclear reactor in Ontario, Canada, which has long been the main source of an isotope called molybdenum-99 for North America, had to be shut down in May 2009 for a major overhaul and “refit.” Molybdenum-99 gets converted to technectium-99m, which is the isotope normally used to do bone scans.

For most of the past 10 months, the North American nuclear medicine industry has been able to “fill the gap” with molybdenum-99 from a reactor in the Netherlands, but, as of this week, that reactor will also be shutting down for a scheduled 6-month maintenance program. Many of the nuclear reactors we have come to rely on for certain specialized types of isotopes are getting older, and now need such regular “care and attention” in order to be able to perform. Like the problem with deterioration of bridges in the U.S., this should come as a strong signal to everyone of the importance of maintaining infrastructure over time. However, whether the politicians can really grasp the importance of such relatively unexciting issues is a more difficult question to answer!

The nuclear medicine community is sending out signals that “everyone will be able to get by” until either these older reactors are back on line or newer reactors can be brought in to “fill the gap.” However, The “New” Prostate Cancer InfoLink suspects that, over the next 12 months or so, some patients who ask about bone scans will be told that they “don’t really need one” or that they are going to get a CT scan or an MRI or even a PET scan instead. The problem is that bone scans are, in fact, still the most accurate way to assess whether prostate cancer has metastasized to bone.

In some cities the various hospitals are working carefully together to make sure that they source enough radioisotope materials to be able to work cooperatively in ways that will ensure that every patient who really needs the relevant radioisotopes for diagnosis or for treatment can be appropriately cared for. However, don’t be at all surprised if you find a bone scan being rescheduled or canceled at short notice over the next few months. All we can do is hope that appropriate reactors are back on line as soon as possible so that patient care is minimally affected by this problem.

For greater detail about this issue, see the article “Looming isotope shortage has clinicians worried” on the MedPage Today web site.

3 Responses

  1. “… some patients who ask about bone scans will be told that they ‘don’t really need one’ or that they are going to get a CT scan or an MRI or even a PET scan instead. The problem is that bone scans are, in fact, still the most accurate way to assess whether prostate cancer has metastasized to bone.”

    Is it not a fact that many commentators have been saying for years that most of the PCa-related bone scans are unneccessary because they are ordered automatically despite the probability of metastasis having occurred being as close to zero as you can get, statistically, in the majority of cases diagnosed today?

    Perhaps this shortage will dramatically reduce the cost of diagnosis, given the exhorbitant price attached to these scans.

  2. Has there been overuse of bone scans? Sure there has. Arguably there has been overuse of nearly every form of prostate cancer test. However, that isn’t going to be relevant to the guy who does need to get a bone scan but can’t if the place he needs to go to to get a scan hasn’t been able to arrange sufficient isotope supplies during the current shortage.

  3. I suppose I was (foolishly) imagining that the unneccesary scans might be stopped to limit use of short supplies.

    But then, that would cut into income wouldn’t it? Hmmmm … a greater focus on medical income than patient outcome?

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