Reactor repairs hold up diagnostic test supplies

There are only five nuclear reactors in the world producing molybdenum-99, used for tests such as myocardial perfusion for cardiac disease patients, bone and lung scanning, kidney function imaging and sentinel node detection in breast cancer.

Any ongoing delays in access to the sentinel node biopsy procedure because of these shortages could mean that patients are forced to choose more invasive surgical procedures to diagnose their cancer

At present, at least two of the five reactors are shut for repairs. The Chalk River reactor in Canada produced 40 per cent of the world’s supply of molybdenum-99 until it was shut for repairs in August last year after leakages sparked pollution fears.

Nottingham University professor of medical physics and president elect of the British Nuclear Medicine Society Alan Perkins told HSJ shortages caused by the Canadian shutdown had been exacerbated by the closure of a reactor in the Netherlands this month for maintenance.

He said the shortages were particularly concerning for breast cancer and paediatric kidney function tests.

The Department of Health is aware of the shortage of molybdenum-99 and says it expects it to continue during this year.

A spokeswoman for the charity Breast Cancer Care said there had already been some delays in access to biopsies.

She said: “Any ongoing delays in access to the sentinel node biopsy procedure because of these shortages could mean that patients are forced to choose more invasive surgical procedures to diagnose their cancer, which may increase their risk of developing long term conditions such as lymphoedema.”

Professor Perkins said his own department at Nottingham University Hospitals Trust was getting just 60 per cent of its normal supply, but he knew of other departments getting no supplies. The BNMS has been coordinating nuclear medicine departments on behalf of the DH to ensure supplies are shared and waste is reduced.

He said: “We will do our best to handle what is becoming a scarce resource.”

He said this would mean delaying some tests and using alternative diagnostics where possible. But he said waiting lists in some areas - particularly for myocardial perfusion - were already “huge” due to the shortage and would likely get worse.

Nuclear medicine departments are also facing cost increases. Professor Perkins said suppliers were so far cooperating with attempts to stabilise and monitor the NHS supply.