Survey shows effects of isotope supply disruption on nuclear medicine sites in Canada

Ottawa, ON – The number of nuclear medicine exams on Canadian patients for cardiac, bone and lung diagnostic tests had decreased by 21.8% in October 2009 compared to October 2008, according to a survey conducted by the Canadian Institute for Health Information (CIHI) in February 2010. This represents about 12,000 fewer exams over this period among participating nuclear medicine sites.

The survey also found that most nuclear medicine departments implemented mitigation strategies such as rescheduling patient exams and setting up new ways to prioritize patients. This was in response to a global medical isotope supply disruption caused by the May 2009 Chalk River Reactor shutdown and heightened by the planned temporary shutdown in August of a reactor in the Netherlands. The disruption also resulted in changes to staff scheduling and decreased staff morale within the participating nuclear medicine sites.

Two-thirds of nuclear medicine sites participated in the survey, representing 75% of all nuclear medicine exams performed in Canada. The survey looked at the impact of the supply disruption of the isotope technetium (Tc-99m) on the three types of nuclear medicine exams that account for more than 80% of the use of Tc-99m: bone exams, lung perfusion exams, and cardiac perfusion/function and MUGA exams (cardiac tests). The survey examined the volume of exams performed during three distinct periods in 2009 to capture the impact of the disruption over the course of last year. In addition, a year-over-year comparison was done to adjust for seasonal differences, as the volume of diagnostic exams typically decreases during summer months.

– February 2009: Even before the shutdown in May 2009, there was a slight decrease in the number of selected nuclear medicine exams performed when compared to February 2008. Depending on the type of exam, the decreases ranged from 3% for lung perfusion exams to 5% for bone and cardiac tests.

– August 2009: In addition to Chalk River, the Dutch reactor Petten was also temporarily out of service at this point. The survey found a significant decline in the number of selected exams that cannot be attributed to just seasonal variations. Depending on the type of nuclear medicine exam, the comparison between August 2008 and August 2009 showed decreases ranging from 18% for lung perfusion and bone exams to 25% for cardiac tests. Other factors may also have contributed to the decline, such as a change in practice around the ordering of exams.

– October 2009: The Petten reactor had re-opened, but Chalk River remained closed. During this month, the number of selected nuclear medicine exams across Canada increased from August 2009 levels but decreased significantly when compared to October 2008. Depending on the type of exam, the comparison between October 2008 and October 2009 showed decreases ranging from 16% for lung perfusion exams to 22% for bone and cardiac tests.
About two-thirds of respondents reported that they experienced an increase in the cost of isotopes and that they were managing but exceeding their budget due to vendor surcharges. Only 2% reported that the isotope supply disruptions had no economic impact. The strategies most commonly used to deal with the supply disruption included re-prioritizing exams, optimizing the isotope material available and re-scheduling patients to deal with the supply disruption. Other possible solutions, such as referring patients to other sites or scheduling alternative tests, were used less frequently.

This one-time, voluntary survey reflects a snapshot of nuclear medicine activity in Canada at three distinct points in time in 2009. The CIHI says the findings of the survey may not be representative of the current situation, which is constantly evolving. More information is available at www.cihi.ca.