The made-in-Canada isotope shortage facing medical scans
Where have all the medical isotopes gone?
Albert Mann winced as he sat upright on the scanner bed to talk to me. A large camera had just processed an image of his body, reading the gamma rays radiating from his bones.
I asked him what he had to do to prepare for this test. "What did I have to do? Get cancer," he said.
Down the hall, seven other camera rooms were buzzing with patients having similar scans. At this hospital in Brampton, Ont., the machines run six days a week.
Across Canada, about 20,000 patients undergo nuclear imaging procedures every week and the field of nuclear medicine is growing around the world.
But almost all of it rests on an increasingly fragile supply of radioactive isotopes, a short-lived medical product made mostly by small research reactors, and a looming shortage has specialists worried.
"I don't want to sound alarmist," said Dr. Norman Laurin, president of the Canadian Association of Nuclear Medicine. "But it's going to have medical consequences. There are people who are going to be denied care, or have a different kind of care that might not be the best for them."
These patients probably won't know there's a problem until their test is cancelled, or they have to wait months for a diagnosis. But if they ask enough questions they'll find out the shortage of medical isotopes is largely a made-in-Canada problem.
Going out of business
Most Canadians don't realize it, but this country has been an international leader, the world's largest single supplier of medical isotopes used in nuclear imaging, for more than 50 years.
What's an isotope
A medical isotope is radioactive material that is injected into the body, binding to specific tissue, and emitting gamma rays that are detected by special cameras.
These diagnostic tests have become an essential tool for helping diagnose cancer and heart disease, among other ailments, but the system will collapse without a reliable supply of the delicate isotopes, which decay quickly, losing radioactivity in six hours.
That means they cannot be stockpiled. So every day fresh isotopes are produced in nuclear reactors and quickly shipped around the world before they expire.
But all of that is about to end. Buried deep in the federal budget bill, now winding its way toward approval, is something called the Nordion and Theratronics Divestiture Authorization Act.
In a few short sentences that amendment removes all foreign ownership restrictions on Canada's medical isotope processor, Nordion, paving the way for the former Crown corporation to be sold to a U.S. firm.
The buyer, Sterigenics, is ready and waiting with an offer on the table. Shareholders will vote on May 27.
"The sale of Nordion represents the end of the road for the Canadian nuclear medicine file," says Dr. Norman Laurin said. But it is not so much the sale itself as the pending shutdown of the medical isotope production at the aging Chalk River research reactor in 2016 that will affect the diagnostic imaging business across this country.
The federal government is determined to close Chalk River's isotope production as planned in less than two years, and when it does up to 40 per cent of the world's isotope supply will vanish, with no new supplier ready and waiting to fill the void.
Exit the business
Last week, Nordion reminded its investors about that problem. "Currently, the company does not have an alternative supply of reactor-based medical isotopes," it said in a news release. "It cannot be certain that it will be able to secure an alternate source of commercial supply that is viable."
Nordion says it is looking for a new source, but where? There are only a handful of other research reactors in the world producing isotopes, and most are also at the end of their life, and prone to the same repeated and unexpected shutdowns that have plagued Chalk River.
The new technologies for making the key isotope ingredient — technetium-99 — without a nuclear reactor are still in the research stage, with too many infrastructure and regulatory hurdles to be ready when Chalk River stops production.
Nordion bluntly warns that "if the company is unable to secure a long-term supply of medical isotopes it may exit the reactor-based medical isotope segment of its business." And that's exactly what some analysts expect will happen.
A recent report by the Nuclear Energy Agency of the Paris-based Organization for Economic Co-operation and Development is assuming Nordion's isotope processing capacity will disappear.
"The loss of Canada's processing capacity in the second half of 2016 reduces current global processing capacity by approximately 25 per cent in that period." the report says.
It also says there is "an increased risk" of supply shortages beginning as soon as next year.
Been down this road
That OECD warning triggered flashbacks for those Canadian nuclear medicine specialists who lived through the white knuckle crisis in 2009 when a leak shut down Chalk River for 15 months at the same time as an isotope-supplying Dutch reactor went down for repair.
In the political chaos that followed, Prime Minister Stephen Harper announced Canada would be getting out of the isotope business by 2016.
Ottawa would not follow the advice of its expert panel and build a new research reactor. Instead it offered $25 million in research money to encourage an alternative supply chain.
It would be up to the market to solve the problem of long-term isotope supply. And that likely means higher prices, because alternative processes like PET scans (positron emission tomagraphy) are more expensive, and because private isotope suppliers will have to charge more to recover costs and make a profit.
"These isotopes are going to become more expensive, and I think it's right they should become more expensive," says OECD economist Ron Cameron. "In some cases they were sold at below the cost of producing them, that is economically unsustainable."
In other words, Canada helped create the world of nuclear medicine by making the supply of isotopes affordable, but without that low-cost option the situation changes.
It's the latest chapter in Canada's storied history of nuclear medicine, from the pioneering days in the 1950s, as this country moved from innovator and international leader to faltering player.
There is a sadness among scientists and doctors as they watch this era of once ground-breaking science quietly come to an end.
"Getting out of it I think is a mistake," says Dr. Laurin. "It will mean a loss of Canadian know-how and expertise. Very good science will be lost, business and jobs are going to go elsewhere or be lost altogether, so I personally think it's a mistake.
"I may be biased because I'm a physician and I need what's being made at Chalk River for patient care. But if you look at it from a Canadian point of view, I think it's a loss for the entire community, not just Ontario, but all of Canada."