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Originally published Saturday, December 8, 2007 at 12:00 AM

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Shortage delays some medical tests

Thousands of patients are facing delays in crucial medical tests because of a shortage of a radioactive substance stemming from the shutdown...

The Associated Press

NEW YORK -- Thousands of patients are facing delays in crucial medical tests because of a shortage of a radioactive substance stemming from the shutdown of one nuclear reactor in Canada.

By one estimate, the substance, technetium-99m, is used in at least 15 million medical scans a year in the United States. Those scans are used to diagnose and assess a variety of conditions, including cancer, heart disease and bone or kidney illnesses.

They are often crucial for guiding therapy, telling a doctor whether a woman's breast cancer has invaded her bones, for example.

But in the past few days, many hospitals -- including some in Seattle -- began facing a shortage of technetium-99m that is injected into patients to do these body scans. And that has forced them to cut back on the procedures.

"Many, many hospitals are working at about 20 to 30 percent of capacity" in doing the scans in the United States and Canada, estimated Dr. Sandy McEwan, president of the Society of Nuclear Medicine, in Reston, Va. He said he didn't know how many scans had been postponed.

The shortage hit the University of Washington Medical Center about a week ago, said Dr. Joseph Rajendran, a nuclear-medicine physician. Typically, UW's Nuclear Medicine Clinic handles 40 patients a day. But the daily delivery of technetium-99m has fallen so that there is only enough to treat half that number, Rajendran said.

UW uses technetium-99m for a variety of tests, including brain imaging and cardiac and cancer scans. Rajendran said the clinic is scrambling to secure substitute scans for affected patients. For instance, a CT scan is effective in locating a blood clot in the lungs, Rajendran said. A PET scan can assess how well a cancer patient is responding to treatment.

Still, "this is an unfortunate situation," Rajendran said. The clinic's supplier said the shortage ought to ease in two or three weeks. "But nobody knows" for sure, he added.

At Swedish Medical Center, the impact has been minimal, said Tony Smith, supervisor of nuclear medicine at the First Hill campus. The hospital's supplier, Cardinal Health, is receiving 60 percent to 70 percent of its normal supply. Patient appointments have not been affected, although same-day studies sometimes are delayed by an hour or more while a dose is prepared and delivered to Swedish.

The shortage seemed to be hitting parts of Canada hardest. Dr. Chris O'Brien, president of the Ontario Association of Nuclear Medicine, put it this way to Canadian Press: "Last week, I guess you could describe it as struggling. This week it's devastating and next week potentially catastrophic."

Ontario, for example, is down to about half of its normal scan capacity, meaning about 1,000 patients a day are having their tests put off, he said.

The Canadian Society of Nuclear Medicine estimates the shortage will cause delays in treatment for 50,000 Canadians each month services are reduced.

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While doctors can often turn to other tests, these can be more complicated and more awkward to interpret, experts said.

What's the cause?

It's the unexpectedly long shutdown of a nuclear reactor in Chalk River, Ontario. The 50-year-old reactor is North America's biggest source of the radioactive isotope that makes technetium-99m.

The owner of the reactor, Atomic Energy of Canada, closed Nov. 18 for what were supposed to be five days of routine maintenance. However, the company kept it closed to do more work. The reactor probably will be working again by the end of December and almost surely by the end of January, company officials said.

While the shortage continues, U.S. hospitals are watching their supplies closely.

"I can't tell you what's going to happen tomorrow. It's clearly not a good situation" said Dr. Philip Alderson of New York-Presbyterian Hospital.

"I'm a little nervous. I'm concerned about where this is headed if this doesn't get resolved relatively quickly."

McEwan said the nuclear-medicine society has long pushed for the United States to build its own reactor to produce medical materials.

Seattle Times reporter Kyung M. Song contributed to this report.

Copyright © 2007 The Seattle Times Company

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