Blessed by the Potato

Not too long ago, there was a considerable political stink raised when the NRU in Chalk River went down for maintenance and was found to not have the proper emergency power supplies, etc., in place. The outage caused a significant ripple in the medical community, as the NRU provides about half of the Tc-99m used in the world, the most commonly used isotope in nuclear medicine. Indeed, it was pressure from patients and the health care community that made the government take the incredible step of over-ruling the nuclear safety watchdog.

The restart and upgrades to the NRU are really just stop-gap measures though: that reactor is a bit of a dinosaur, and due for replacement. Long in the works, the twin MAPLE reactors were supposed to be that replacement, but recently it was announced that their continued development was going to be cancelled. They had been almost completed, when it was found that their reaction characteristics were not as expected, and years of tinkering and experimenting were not able to find or fix the design flaw. For now, things will muddle on: the NRU has a license to operate until 2011 and can probably continue operating for a few years beyond that.

But the simple fact remains that Canada has no long-term plan for the supply of isotopes for nuclear medicine. And that means, essentially, that half the world doesn’t have a long-term plan for medical isotopes. One thing we can say for certain is that nuclear medicine is about to become a whole lot more expensive. All along, the costs of the NRU have not, AFAIK, been passed on to customers. Money was not being collected to fund the construction of MAPLE reactors. The Canadian government was essentially subsidizing the cost of nuclear medicine the world over. I’m all for subsidizing it in Canada, don’t get me wrong, but my understanding is that our exports of nuclear material did not fully recover the true costs (granted, including money sunk into research in the 50’s/60’s).

An alternative option for many (but not all) present nuclear medicine scans is the use of PET. PET is not currently paid for by OHIP, largely because it is seen as too expensive, even though it offers advantages for some types of imaging (e.g.: cancer). However, that cost disadvantage is partly artificial: a PET scanner requires a ~$10 Million cyclotron facility within about 2 hours of driving distance, which adds up to a fair number of cyclotrons needed across the province. However, traditional nuclear medicine requires a billion dollar+ reactor, which just happens to be subsidized by the Canadian government.

It’s hard to say at this point what the future will hold for nuclear medicine. Maybe it will get more expensive, as a private group (or another country, like the US) builds a reactor to replace the NRU, and tries to run it at a profit. Maybe it will change quite rapidly over to PET imaging if the end of the NRU is seen with no replacement in sight. Or perhaps nuclear medicine will go away, except for a small number of truly needy cases who might warrant bringing isotopes across the Atlantic.