Medical radioisotopes

The use of medical radioisotopes is an important part of modern medical practice. Each year, over 40 million people around the world benefit from nuclear medicine imaging. Medical radioisotopes are used in non-invasive diagnostic imaging techniques to help identify and stratify commonly occurring critical conditions such as heart disease and cancer at an early stage. They are then used to track disease progression and provide predictive information about the likely success of different therapy options. This information helps health care professionals to correctly manage disease and to make well-informed important medical decisions, such as therapeutic drug choice or making a surgical intervention.

Supply status

Disruptions in the radioisotope supply chain can disturb the availability of medical testing for millions of patients around the world. During the 2009-2010 period, there were substantial shortages, but in the period since 2011 there have been only a limited number of minor supply shortages of the most widely used medical radioisotope, molybdenum-99 (99Mo), and its decay product, technetium-99m (99mTc). With short half-lives of 66 hours for 99Mo and 6 hours for 99mTc, these isotopes cannot be stored and must be produced daily and used efficiently in order to meet clinical demand. At the end of 2015, the OSIRIS reactor (France) stopped operation and at the end of October 2016, the National Research Universal (NRU) reactor (Canada) and the associated processing facilities stopped routine production of 99Mo. As a result, 6 multipurpose research reactors, 5 of which are over 45 years old, are now producing over 90% of the world’s supply of 99Mo. That material is processed in only four major radiochemistry facilities. These facilities have added substantial additional irradiation and processing capacity in recent years to help mitigate the risk of supply disruption and further increases in capacity are planned to be implemented during 2017. Additionally, the NRU reactor and the associated facilities will remain in a hot standby mode until the end of March 2018 for emergency Mo-99 production in the event of a global shortage that could not otherwise be mitigated.

Securing the supply

At the request of its member countries, the NEA became involved in global efforts to ensure a reliable supply of 99Mo and 99mTc. The NEA established the High-level Group on the Security of Supply of Medical Radioisotopes (HLG-MR) in 2009. The HLG-MR is comprised of approximately 40 experts representing the governments of Argentina, Australia, Belgium, Brazil, Canada, Czech Republic, France, Germany, Japan, Republic of Korea, the Netherlands, Poland, the Russian Federation, South Africa, Spain, the United Kingdom and the United States, as well as from the European Commission (Euratom Supply Agency) and the International Atomic Energy Agency (IAEA). Members of the HLG-MR were nominated by governments and included experts from government agencies responsible for medical or nuclear policy, as well as from research and industrial organisations with interests in medical radioisotopes.

Last reviewed: 9 November 2016