Tc-99m Production: Losing the Reactor

Periodically in this blog I have discussed the growing technetium-99m shortage that faces medical physics (see, for instance, here, here, here, and here). Russ Hobbie and I discuss technetium in the 4th edition of Intermediate Physics for Medicine and Biology.

The most widely used isotope is ^99mTc. As its name suggests, it does not occur naturally on earth, since it has no stable isotopes … The isotope is produced in the hospital from the decay of its parent, ⁹⁹Mo, which is a fission product of ²³⁵U and can be separated from about 75 other fission products. The ⁹⁹Mo decays to ^99mTc.

Interestingly, the ^99mTc shortage here in the United States may be solved in part by our friends up north (or, for those of us living in the Detroit area, our friends down south; look at a map), the Canadians. You can learn more in an article on medicalphysicsweb.org (and I hope you are a regular reader of that very useful website).

Technetium-99m (Tc-99m) is the most widely used medical imaging isotope, employed in more than 30 million procedures worldwide each year. The isotope is created via decay of molybdenum-99 (Mo-99), which itself is produced in nuclear reactors. And herein lies the problem.

The nuclear reactor is needed to generate neutrons that bombard uranium-235 targets, with the resulting fission reaction producing Mo-99 around 6% of the time. This Mo-99 then decays into Tc-99m. Unfortunately, over 90% of the world’s Mo-99 is produced by just five ageing reactors, resulting in an extremely fragile supply chain - the vulnerability of which was highlighted recently when unexpected shutdowns and routine maintenance closures combined to create serious shortages.

But there are other ways to create Tc-99m, and ways that don’t require nuclear reactors or a uranium target—itself a cause for concern as most facilities currently process highly-enriched (weapons-grade) uranium. Instead, researchers are investigating production methods based on cyclotrons and linear accelerators. Such processes exploit nuclear reactions within targets of Mo-100, bypassing the need for uranium completely.

In a bid to advance such technologies, the government of Canada has invested $35 million in four development programmes. The projects are headed up by: TRIUMF (Vancouver, BC); Canadian Light Source (Saskatoon, SK); Advanced Cyclotron Systems (Richmond, BC); and Prairie Isotope Production Enterprise (Winnipeg, MB) ….

In terms of practical implementation, the cyclotron-based method produces Tc-99m, which has a half-life of just six hours and must therefore be manufactured at or very near to clinical sites. This approach can, however, take advantage of a wide network of existing medical cyclotrons.

The electron accelerator approach creates Mo-99, which has a half-life of 66 hours and, as such, can be shipped. “One or two linacs could probably supply most of Canada,” Barnard said. This method also benefits from being more similar to, and thus able to exploit, the existing Tc-99m supply chain based on shipping of Mo-99.

The article was written by medicalphysicsweb’s editor, Tami Freeman, who has worked as a journalist for the Institute of Physics for the last dozen years, and who has a PhD in physics.

P.S. There is a nice article in the February issue of Physics Today about U.S. attempts to address the Tc-99m shortage (see the comments to this blog entry).