The Shortage of Technetium-99m and Possible Solutions

Abstract

Following a major shortage of 99Mo in the 2009–2010 period, concern grew that the aging reactor production facilities needed to be replaced. Most producers were using highly enriched 235U (HEU) as the target material. The Organisation for Economic Co-operation and Development and the International Atomic Energy Agency sought to remedy these issues by removing HEU from medical isotope production and implementing full cost recovery to enable new production entities to compete with the existing multipurpose reactor facilities, which were heavily subsidized by their respective governments. This review examines the various approaches to producing 99Mo and/or 99mTc with a critical eye toward their potential success in ( a) producing the medical isotopes and ( b) being able to successfully enter and compete in the market. Because many of the new approaches are adapting existing technologies for commercial businesses, some of the details are of a proprietary nature and not available for in-depth technical review. Expected final online publication date for the Annual Review of Nuclear and Particle Science, Volume 70 is October 19, 2020. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Recent Advances in Radiometals for Combined Imaging and Therapy in Cancer

“…To avoid that, current interest is placed on low-energy β À -emitters (e. g., 177 Lu) that present a lower decay range relative to high-energy β À -emitters (e. g., 90 Y). [12] Alpha particles have high energies (5)(6)(7)(8) and high LET values (approx. 80 keV/μm), giving them a short tissue range (40-100 μm; < 10 cell diameters).…”

“…99m Tc is present in 17 out of the 53 Food and Drug Administration (FDA)-approved radiopharmaceuticals (as of 2020) and is currently used in more than 80 % of all radiodiagnostic procedures. [5] However, a major global shortage of (PSMA = prostate-specific membrane antigen)). However, it is fair to note that the most widely used PET radiotracer in the clinic by far is still 2-deoxy-2-[ 18 F]fluoro-D-glucose ([ 18 F]FDG), which has shown great value in the diagnosis of glucose-avid tumor cells in vivo.…”

Challenges and future options for the production of lutetium-177

“…There are two initiatives to produce 99 Mo by irradiating 100 Mo with a highly energetic photon beam: a photon with more than 10 MeV energy can knock a neutron out of the 100 Mo nucleus, making it a 99 Mo nucleus. NorthStar is nearing completion of a facility in Wisconsin (USA) [ 2 ]. This route also requires a new type of generator specifically designed to be compatible with the 99 Mo that will be produced.…”

“…It is possible to use an accelerator to start the first neutrons, and subsequently use a so-called sub-critical assembly to multiply these neutrons [ 2 ]. This concept is used in the SHINE facility (accelerating deuterium atoms onto tritium atoms to create fusion, initiating neutrons) and in the Niowave facility (accelerating electrons onto a lead/bismuth target, leading to neutron production).…”

“…Upon weighing the options for future production, it will be important to consider all relevant medical applications and their associated isotopes. However, recent discussions and proposed alternative techniques to generate isotopes are almost exclusively focussed at 99 Mo [ 2 ]. Since production of different isotopes poses different technological challenges, this may lead to future situations where not all required isotopes can be produced with sufficient quantity, quality, reliability or geographic spread.…”