Natural Resources Committee on June 9th, 2009

[Dr. Jean-Luc Urbain]

We gave that recommendation to the Minister of Health of Ontario in 2003.

[Bradley Trost, Conservative, Saskatoon—Humboldt, SK]

Thank you.

Dr. Lyons, do you want to comment about other diagnostic tests or so forth that could be relatively quickly implemented?

[Dr. Edward Lyons]

The other imaging studies, such as CT and MRI, are mostly structural, but as the technology increases and improves, they become faster and faster and also then give you functional information. So there is beginning to be a bit of a crossover.

[Bradley Trost, Conservative, Saskatoon—Humboldt, SK]

But can we do that in the short term? I'm not talking about two or three years, but about 2009.

Again I'm getting nods, but....

[Dr. Edward Lyons]

Yes, that's correct. The new technology that is out for the high-speed CT and MRs is available. Again, there's the waiting list, but with appropriate prioritization we could divert—

[Bradley Trost, Conservative, Saskatoon—Humboldt, SK]

Have patients go to vet colleges and things of that nature. There are always the jokes about your being able to get an MRI scan if you're a dog, but not if you're a human being.

Could we then divert the private sources, the vet clinics, over to use for human patients?

[Dr. Edward Lyons]

Probably we could not. I think the vet clinics—again I don't know this—use a relatively small bore, rather than the larger bores that are required in humans.

But I think the equipment is available and also that the equipment today is not being run 24/7. The capacity is generally available. But remember that nuclear medicine is primarily a functional technology, whereas MRI and CT is mostly structural.

I'll give Dr. Lévesque a chance to speak.

[Dr. Jacques Lévesque, Vice-President, Canadian Association of Radiologists]

Just to complement your answer, it's very clear in my mind that right now there are short-term problems, and you want a short-term answer.

I can give you a very good example of where there has been coordination before. Let's think about the equipment when we made the deal on the equipment in Canada to change our radiology equipment. We do that right now in nuclear medicine. But we have done it also with Infoways and the use of fax. On the prospect of imaging specialists, I think the problem right now is a problem of coordination, to get the number of isotopes you need and coordination among the federal government bodies.

I think that in the right places, replacement procedures for imaging can be implemented. Radiology will not replace nuclear medicine, but clinicians can now apply replacement mechanisms. For example, the multiplanar CAT scans with 250 slices can now be used to make excellent heart anatomy studies. I think that we need the collaboration of all the participants. It is crucial for associations, and not for individuals to be at the table.

Today, you are meeting with three associations. They are truly representative of technological and scientific thought. You will obtain your answers through the associations. This was demonstrated with Infoway, with the Pacs and the pooling of radiological equipment. I think that we must do the same thing now with isotopes.

[The Chair, Conservative, Leon Benoit]

Thank you, Mr. Trost.

We go now for five minutes—

[Dr. Karen Gulenchyn]

Mr. Chair, this is Dr. Gulenchyn.

[The Chair, Conservative, Leon Benoit]

Oh, go ahead. I was looking to see who was speaking.

Go ahead.

[Dr. Karen Gulenchyn]

I'm terribly sorry; it must be a little odd. But I wanted to respond to the question regarding the roll-out of PET in other provinces.

Dr. Urbain will not have been aware of the fact that literally as I walked into this teleconference room today, the Ontario government responded to our request to implement sodium fluoride imaging in the province in selected cases and is moving in fact to make it available to its citizens. Dr. Urbain had no way of knowing that, because it literally appeared on my BlackBerry as I walked into the room.

[The Chair, Conservative, Leon Benoit]

Thank you, Dr. Gulenchyn.

We go now to Mr. Allen for up to five minutes.

[Mike Allen, Conservative, Tobique—Mactaquac, NB]

Thank you, Mr. Chair.

There are a couple of questions I would like to ask. I'm trying to sum this up in terms of the alternatives out there. What I'm hearing is that with the PET we can probably get to 20% or maybe 25% of our requirements, and I'm assuming also, with the other existing technologies we have today, that perhaps with some investment in it we could probably replace some other isotope usage in our system.

Is it a fair statement that we could do that rather than build a new reactor?

[Dr. Jean-Luc Urbain]

I think it's a fair statement, but don't make a connection between new technology and the reactor. We don't know what these new technologies will use tomorrow.

[Mike Allen, Conservative, Tobique—Mactaquac, NB]

Right. So the bottom line out of this is that for the foreseeable future, the medical isotopes that come from these five reactors and any new ones on line will be playing a significant role in the imaging testing that we do—at least two-thirds.

[Dr. Jean-Luc Urbain]

We expect, with personalized medicine coming, with the human genome and personal genome projects, that isotopes will play an increasing role, maybe for more specific indications. They will definitely be there for a long time.

[Mike Allen, Conservative, Tobique—Mactaquac, NB]

Okay.

Can either Dr. Urbain or Dr. Gulenchyn talk to the difference in cost to the system between the PET and the isotope? What is the difference? Is there a great difference?

[Dr. Jean-Luc Urbain]

I'm very well connected with Dr. Gulenchyn, but not to her BlackBerry, so I will pass the response to her.

[Dr. Karen Gulenchyn]

I should have forwarded it to you, Jean-Luc.

As part of my program, I operate the cyclotron at McMaster University Medical Centre. They are expensive to operate. A dose of fluorodeoxyglucose, if we were operating at full capacity and therefore using the system to its fullest availability, would probably be in the range of about $250 to $300. It actually now costs us about $600 to produce a dose, as compared to something like, I believe, $15 to $20 for a dose of a technetium-based product, although it can sometimes be up to $50 for a technetium-based product. Sodium fluoride will be less expensive because it doesn't have the complex chemistry associated with it. It would probably also be in the range of about $175 to $250 a dose, so it is also a much more expensive product.

[Mike Allen, Conservative, Tobique—Mactaquac, NB]

Okay. Thank you.

My last question is to Dr. Gulenchyn. In your briefing and in your speaking notes you mention that as adviser to the Minister of Health, you provided information to assist in the preparation of a document outlining strategies to maximize the use of any existing radiopharmaceutical supply. I think I heard you say that you were certain of what you were doing in Ontario and in your facility, but not so sure of what they were doing in other places. How widely distributed was that information-sharing in the document that you did for the Minister of Health?

[Dr. Karen Gulenchyn]

I certainly know that the federal health ministry has been meeting on an ongoing basis with provincial and territorial counterparts, and there has been information-sharing at that level. I believe it has gone through the process in Alberta, and it has been relatively widely disseminated in Alberta. Dr. Hollet could perhaps comment on whether they heard about it in Newfoundland. I believe it has been reasonably well distributed.

[Dr. Peter Hollet]

It's been distributed and talked about, but it's a little like talking about some mythical beast. We don't have PET scanning largely available in Atlantic Canada, so the guidelines didn't have much application for us.

[Mike Allen, Conservative, Tobique—Mactaquac, NB]

Okay.

Thank you, Mr. Chair.

[The Chair, Conservative, Leon Benoit]

Thank you, Mr. Allen.

I'll just see how much time we have left on the clock.

We have to end the meeting at this time. We will dismiss the witnesses, but I ask the members to stay around, because we have to quickly vote on the budget to cover the cost for the witnesses to come here.

I thank all the witnesses for appearing. Thank you very much for the information you've given to the committee. It has helped considerably. Thank you very much.

We will suspend for a minute and get right to the issue of the budget.