Nov. 4, 2024
Contact: Uriah Orland, 573-884-5139, uriah.orland@missouri.edu
The nuclear medicine community is facing a potential 50% reduction over the next three weeks in technetium-99m (Tc-99m), a medical isotope used in over 80% of nuclear medicine procedures worldwide, due to an unplanned shutdown of the high-flux reactor (HFR) in Petten, Netherlands. The shutdown and shortage in Tc-99m, as well as other medical isotopes not being produced during the outage, highlights the challenges of the global supply chain for all short-lived medical radioisotopes.
Medical radioisotope production is centered in a handful of reactors around the world and an unplanned outage at one has far reaching ramifications when it coincides with scheduled maintenance outages at others.
“MURR is an important part of the global supply chain, and we work hard to ensure the reliability of the supply,” said Matt Sanford, executive director of the University of Missouri Research Reactor (MURR). “The isotopes produced in reactors like MURR and HFR are critical to patients and any time we are not operating there is a direct impact on what doctors can do to diagnose and treat cancers and other health issues.”
As the only producer in the United States of four medical isotopes, MURR is acutely aware of supply chain challenges and is witnessing a surge in demand for these isotopes from radiopharmaceutical producers.
MURR is creating new production suites to increase no-carrier-added lutetium-177 (Lu-177) production in 2025. The reactor is also increasing production by 67% of a liver cancer treatment containing yttrium-90 (Y-90). Similar increases are happening for the irradiation of brachytherapy seeds that use iridium-192 (Ir-192) to fight more than a dozen forms of cancer.
While MURR currently does not produce molybdenum-99 (Mo-99), the precursor of Tc-99m, it was the only U.S. source until October 2023 when NorthStar Medical Radioisotopes stopped production. This made the United States solely dependent on foreign producers for the isotope used in over 40,000 medical procedures each day to diagnose heart disease and cancer and to study organ structure and function.
“Challenges like the current outage and production capacities are a constant concern for medical providers, radiopharmaceutical companies and reactor operators alike,” Sanford said. “In fact, last week, leaders from these sectors gathered in Hamburg, Germany, for the 37th Annual Congress of the European Association of Nuclear Medicine (EANM) and the reliability of the global supply chain was a major topic of discussion.”
The demand for medical radioisotopes continues to grow and there are worldwide efforts to strengthen the supply chain and increase irradiation opportunities. Currently, NRG PALLAS is constructing the PALLAS-reactor in Petten, Netherlands, that will increase production and treatment opportunities for 30,000 patients a day.
Domestically, the University of Missouri announced the transformational initiative to build a new, state-of-the art reactor — NextGen MURR — that will expand the university’s critical cancer-fighting research and medical isotope production, creating an innovation hub for nuclear medicine and research. This new reactor will have more than double the irradiation opportunities as MURR and when run concurrently with MURR, Mizzou will more than triple the production of medical radioisotopes. The new design will also open the possibility of producing radioisotopes not currently produced in the U.S., like Mo-99.
The strength and reliability of the global supply chain is an international challenge, and MURR, with its operating schedule of six and half days a week, every week of the year, is a critical producer and partner for medical providers and radiopharmaceutical companies around the world.