BGH patients left in limbo over isotope shortage

Thursday December 6, 2007
Brantford Expositor
by Susan Gamble
and the Canadian Press, Toronto

Hospitals across country feeling effect of problem

Tests for local cancer patients are being delayed because of the shutdown of a nuclear reactor in Chalk River, Ont.

The reactor produces radioisotopes used for diagnostic imaging in nuclear medicine, to find tumours and other problems.

Rick Woodcock, CEO and president of Brantford General Hospital, said Wednesday that the hospital must cancel about 50 per cent of its scheduled tests. Doctors are determining which patients get tests based on need.

"It seems hard to believe this could happen," Woodcock said. "We've heard nothing from the Ministry of Health and, if it was April Fool's Day, I'd think someone was pulling my leg."

The unprecedented disruption is affecting health-care facilities across North America, causing delays for hundreds of cancer patients and others.

The radioisotopes are usually delivered to BGH several times a day from a supplier in Mississauga. Because of their extremely short shelflife, the isotopes can't be stockpiled and there are few other suppliers in the world. In fact, the Chalk River reactor generates two-thirds of the world's supply.

Woodcock says the isotopes go through a second process where they are refined for medical use and, once completed, the units must be used within hours. the supplier in Mississauga is continuing to do the second-stage prcess, but at a much slower rate and is rationiing the isotopes to various hospitals.

At BGH, thousands of exams each year use the nuclear diagnosis. About seven patients a day are being cancelled.

"We're still getting some deliveries (of the isotopes) but we suspect that's not going to last too long," Woodcock said.

The reactor was closed for repairs two weeks ago, but when inspectors found additional problems, the shutdown was extended. Now it's expected the reactor won't return to full production until early to mid-January.

Federal Health Minister Tony Clement was on the defensive Wednesday in the House of Commmons.

He said there are contingency plans in place but they aren't sufficient because of the short half-life of the isotopes.

"We are working with the industry right now and we are getting emergency supplies for emergency procedures and that will continue," Clement said.

The serious need for the isotopes locally is when someone has a pulmonary embolism. In critical cases, a patient can die within several hours.

Other uses for the radioisotopes are for finding gastrointestinal bleeds, liver scans and cardiac analysis.

Dr. Chris O'Brien, head of nuclear medicine at BGH, is also the president of the Ontario Association of Nuclear Medicine. He has been called on to help deal with the growing isotope shortage.

Radioactive isotopes, which are normally injected into patients to allow imaging equipment to produce detailed scans, have become a critical part of decision making in modern medicine, especially when it comes to cancer, with doctors relying heavily on the scans to formulate treatment plans.

In some cases, diagnostic procedures that do not rely on isotopes such as angiograms and MRIs, can be used instead of nuclear scans. Experts however, warn that a prolonged drought could compromise urgent cases and create undue stress on non-nuclear diagnostics.

"BGH is trying to use other procedures - such as CT scans and angiograms - to deal with the lack of medical isotopes," said Woodcock.

"We go for two days every weekend without nuclear medicine," said Woodcock, "so this is like a three day weekend so far. But if the supply is going to be drastically reduced, it will be a serious siituation."

He said a delay in tests eventually will start backing up patients in the hospital, which is already crowded due to problems getting those ready to be discharged into appropriate settings in the community.

And, with the approaching flu season, Woodcock is concerned. "This is all new to us and we just don't know how serious this is going to get.

The Chalk River reactor, operated by Atomic Energy of Canada Ltd., produces molbdenum ore, a low energy radioactive material, which is purified by MDS Nordion. The company accounts for between 35 and 45 per cent of the world's medical supply.

MDS sends the refined product to suppliers, who put it into a "generator" in which the material breaks down into technecum, which is used for the scans.

The planned maintenance shutdown of the 50-year-old NRU reactor was supposed to last from Nov 18 to Nov. 23, but safety problems persist.

"We hope to get the reactor back into service as soon as possible," said AECL spokesman Dale Coffin. "We're not going to speculate on the timing."

Technecium is much like electricity in that it can't be stored for more than a couple of days, so hospitals have to be able to count on a steady reliable supply stream.

The Chalk River reactor was supposed to be shut down in 2005 but has been kept going because two replacements are a decade behind schedule.