Last year's isotope crisis left Canadian medicine "teetering on the brink of disaster" a report has said. It recommended new reactors in Canada to assure supply.
|A valuable istope of molybdenum was in
short supply after an unplanned outage
The report was written by an ad-hoc group of nuclear medicine experts gathered by the Canadian minister of health in early December last year. This was a response to a growing shortage of the molybdenum-99 raw material used to enable diagnostic procedures after a prolonged and unplanned shutdown of the world's main production reactor.
Atomic Energy of Canada Ltd (AECL) was told to shut down the National Research Universal (NRU) reactor at Chalk River by the Canadian Nuclear Safety Commission (CNSC) in order to complete some overdue upgrades. In the end the affair saw the CNSC effectively overruled by the Canadian government, which also removed Linda Keen from her role as president of the commission.
The report, entitled Lessons learned from the shutdown of the Chalk River reactor and released by Health Canada, paints a dramatic picture of the worsening situation in health facilities as supplies ran dangerously short.
Medical officials first learned of an extension to a planned shutdown of NRU around 27 November 2007 through their supplier, MDS Nordion. Initial shortages had appeared to be temporary, but by 3 December it became clear the problem was more serious. Two days later an emergency teleconference was held by the Canadian Society of Nuclear Medicine (CSNM). "At that time, there were no lines of communication with AECL, the CNSC or the federal government," the report states, explaining that the CSNM chose to communicate through press releases.
The doctors go on to note that by 12 December emergency services in some regions were compromised and in the province of Saskatchewan "virtually no medical isotopes were available." The disruption to vital treatment caused significant stress to seriously ill and worried patients as well as their carers.
The doctors wrote: "Each morning brought more bad news: enough isotopes for six patients, and 14 people booked. Who would get their diagnosis? Their treatment? What about tomorrow? Rebook? Try another facility? Who can make do? Who must be treated? Should we use another method? Wait? Act? Wait Act?"
After catching their breath, the report authors listed a number of lessons learned and recommendations. At the top of the list were requests for improved risk communication and increased involvement of doctors with respect to any future supply problems.
Second came measures to improve reliability of supply. "Canada needs reactors that are designed to expand their production capabilities quickly in response to an emergency" (ie an unplanned outage at another production facility), the report said, while the possibility that other research reactors in Canada could help by producing medical raw materials should be studied. Canada boasts some eight other research reactors besides NRU - including the 5 MWt MNR unit at McMaster University that already produces certain medical isotopes. However, the remaining seven are only of 20 kWt capacity or less.
The government should also review the risks and benefits of sourcing raw materials from abroad, although the preferred solution would be one "made-in-Canada". The government should also plan a replacement for NRU, which is now 50 years old, one suggestion being to quickly bring into service the two MAPLE research reactors at Chalk River, meant to take over from NRU some years ago. The report was sadly written before AECL's recent announcement that it had given up on the units.