"“We have lent a huge amount of money to the U.S. Of course we are concerned about the safety of our assets. To be honest, I am definitely a little worried.” "

Chinese premier Wen Jiabao 12th March 2009

""We have a financial system that is run by private shareholders, managed by private institutions, and we'd like to do our best to preserve that system."

Timothy Geithner US Secretary of the Treasury, previously President of the Federal Reserve Bank of New York.1/3/2009

Saturday, September 06, 2008

Molybdenum shortages cause immediate and nearby shortages / crises / concerns / worries worldwide especially for medical imaging

Molybdenum is not a mineral that hits the headlines but there are two reasons why there is concern over the metal.

By "roasting" molybdenum, producers refine raw minerals into a marketable powder or pellet, and current world capacity is about 320 million pounds per year, just sufficient to meet current world demand.

Global demand is expected to grow at 3% in the West but CIS and China (and maybe India) expect to use 10% more. This is due to ;

1. Hydroprocessing catalysts are becoming essential for crude oil.
2. Increase in nuclear reactor construction. There are known 48 nuclear reactors to be built by 2013 (not including the UK 's alleged 6) , and approximately 100 are to be built by 2020.

Reactors contain mountains of very high specification Stainlesss Steel - short falls are expected starting like ...er .. now. On September 4th The London Metal Exchange announced they will start trading cobalt and molybdenum futures next year. Prices have averaged US$30 per pound for the last 3 years but have recently edged up to US$33 a pound.

Mr Jonathan George CEO of Creston said that "Molybdenum is trading at around USD 33.85 per pound but we see it moving up into the USD 40 per pound range in 2009 because there is a stranglehold on molybdenum supply."

Medical Imaging facing immediate shortage and/or crisis

On top of this an unexpected crisis (being much downplayed) has hit nuclear medicine. Molybdenum 99 is the parent of technetium and has a half life of some 66 hours so cannot be stockpiled. This is used as a target in body imaging - injected into patients - especially for cancers, Alzheimers and Parkinson's disease.

Reactors shutdown

There are 5 reactors that can produce the stuff worldwide and last week the High Flux Reactor facility at Petten in the Netherlands went down. A spokesman for the unit's operator, NRG, said an anomaly was spotted during the inspection at the end of August's operational run, and operation in September was cancelled for checks to take place.

The other four were on scheduled shutdowns . The BR-2 reactor at the Institut des Radioelements at the Belgian Nuclear Research Centre near Charleroi (50 Km south of Brussels) is shut down for refuelling - although there has been a problem locally with the release of an Iodine isotope locally This has led to a oublic instruction not to consume local produce within a radius of 5 Km of the plant - since reduced to 3 Km. BBC PA AFP Forbes French-language Belgian newspaper Le Soir reported last Saturday that Belgian and French nuclear safety authorities had found security lapses at the lab in a joint audit in November 2007.

The Osiris unit at Saclay in France is also shut for refuelling. South Africa's Safari-1 unit has modified its operating schedule. Operator Necsa said on August 28th that Safari-1 is operating at its maximum 20 MW capacity, but it will be shut down for maintenance on 30 August. The shutdown has been put back by 12 hours, as has its restart on 4 September, to help manage tightness in isotope supply.

As a result says the Society for Nuclear Medicine (SNM), "there is a distinct possibility that worldwide production of Mo-99 could completely cease for a prolonged period, with devastating results".

"A combination of anticipated outages at other production reactors, coupled with unanticipated shutdowns, is simply devastating... Following the shutdown of Canada's Chalk River facility late last year, we simply cannot afford to sit and wait as the situation continues to worsen."

Isotopes such as Mo-99 are used in diagnostic techniques, where they are taken into the body by injection or ingestion and absorbed by certain body cells and tissues. Technicians can then track the cells' movement by the trace radioactivity the isotopes give off. The isotopes are seen as essential tools against various kinds of cancer, nervous diseases like Alzheimer's and Parkinson's and cardiac complaints.

The Chalk River plant in Canada - which supplies about half the world's medical isotope needs - was eventually reopened on government orders following safety disputes last year, but is currently undergoing a planned shutdown. It's expected to re-open this week, but reports indicate that there will still be shortages of supply due to the unexpected outage at Petten.

Paradoxically the US , due to concerns over terrorists obtaining radioactive isotopes does not produce any and is entirely dependent on imports. The High Flux Isotope Reactor (or HFIR) located at Oak Ridge National Laboratory is purely a research facility.

Threates of terrorism have as a consequence also slowed down new isotope production capacity.

"This is a serious problem," said Michael Graham, SNM President-Elect. "Now, more than ever, it is critical that the United States, along with other countries, take the lead on recommending alternatives to ensure consistent access to mission-critical isotopes, which are essential to hospitals and their ability to provide patient care.

"SNM has serious concerns about this most recent outage," said SNM President Robert W. Atcher, Ph.D., M.B.A. "A combination of anticipated outages at other production reactors, coupled with unanticipated shutdowns, is simply devastating. The impact on the patients who are in need of diagnostic tests using these radioisotopes is very serious. The United States and other countries are not prepared to adequately deal with the current situation - let alone anticipate other situations as they continue to arise. Following the shutdown of Canada's Chalk River facility late last year, we simply cannot afford to sit and wait as the situation continues to worsen," added the emerging medical technology team leader at the Los Alamos National Laboratory in New Mexico.

In a conversation in February 2008 Alexander McEwan, MD, president of the Society of Nuclear Medicine and director of oncologic imaging at the Cross Cancer Institute in Edmonton, Alberta, spokeabout last November's shutdown of a nuclear reactor in Chalk River, Ontario, and its subsequent impact on US hospitals and patients.

The United States gets its supply from two main manufacturers, Covidien and BMS (Bristol-Myers Squibb Medical Imaging). They receive it raw from the reactor from Chalk River, process it, and then it is sent to hospitals and radiopharmacies. It's a fairly complex supply chain. So if the reactor at the front of this chain breaks down, then you lose your supply of molybdenum and Technetium.

About 40% of hospitals were imaging at 50%. Because Covidien gets some of its supply from Europe, it was able to supply European molybdenum. Pharmacies that BMS supplied were the ones that were hit the hardest.

In the United States, there are about 19 million imaging facilities a year using molybdenum, so about a million and a half facilities use it per month. (in the US alone)

The Society of Nuclear Medicine has identified for 10 years that this is a problem. There is no US supplier of Technetium, and we as a society are working very hard to get a US reactor into supply. But obviously, that is expensive.

Suppliers of medical molybdenum 99 isotopes meet

Following the shutdowns of the isotope reactor HFR, Netherlands, and the IRE production site, Belgium, both providing Molybdenum (Mo99), the Association of Imaging and Production Equipment Suppliers ( AIPES )organized a meeting on September 3rd in Brussels, assembling all stakeholders, from reactor operators to physicians, represented through the EANM, to ensure isotope delivery and minimize patient discomfort.

Although the Canadian and South African reactors are maximizing their output and after evaluating all alternative solutions, there will still be a shortage in delivery of Tc99 in Europe for 4 to 6 weeks.

Technetium (Tc99), end product of the Mo99, is used for tumor detection, myocardial infarct evaluation, to investigate brain diseases and other pathologies.

The reduction in Tc99 delivery could be up to 30% and will likely be evenly spread across the European nuclear medicine centers.

AIPES and EANM are currently working on recommendations for the nuclear medicine physicians on replacement isotopes readily available for certain types of examinations, which would thus permit to lessen the impact of the shortage on patients.

Due to their sensitivity and specificity, radio-isotopes labeled molecules are used in nuclear medicine for:

1. Diagnostic imaging in oncology (smallest lesion detection), cardiology, neurology and many other types of pathologies.
2. Therapy with some type of cancers and pain relief.
3. As tracers for Molecular Healthcare applications and research in latest healthcare technologies.

Despite the efforts made to overcome this temporary shortage, a long term strategy to replace the very old isotope reactors needs to be implemented at EU level as amtter of urgency.

AIPES had already started an independent assessment of future isotope needs and required production capacity which will be presented to all stakeholders upon its completion in the coming months.

........... and what is the betting that the price of M099 canisters has gone up ? It hasnt hit the TV screens yet - but it will.

Saturday am Independent "Global shortage of isotopes puts hundreds of cancer scans in doubt"..."Professor Alan Perkins, honorary secretary of the British Nuclear Medicine Society, said: "The expected number of people who will be affected is quite difficult to determine ... but we are certainly talking about hundreds. The procedures include cardiac blood-flow imaging, bone scanning for secondary tumours, lymph-node detection in breast cancer cases and renal function monitoring, which is commonly done in children"

With deadpan insousiance the spokesman for the Department of Health said: "Trusts will be working to ensure that patient care is not compromised. Urgent patients will continue to be prioritised [but] routine patients may need to wait a little longer until supply comes back online."

Scotsman - Cancer scan delay fears over isotope shortages

Telegraph - Patients 'facing scan delays because of radiation shortage'

PA - Hundreds facing scan delays - which is evidently the source of the above 3 stories and the other 147 Google produces.

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