Thank you, Madam Chair and committee members, for allowing me the opportunity to appear before you today.
I am a pharmacist specializing in nuclear medicine and radiopharmaceuticals and I am the director of the Edmonton Radiopharmaceutical Centre at the Cross Cancer Institute. I'm currently president of the CSNM and I am also a member of the ad hoc committee that was brought together to advise on the isotope shortage.
I would like to provide some very brief background on nuclear medicine and radiopharmacy. I won't go into as much detail as Mr. Malkoske did, so you won't be bored twice in a row.
Nuclear medicine uses many different isotopes for the diagnosis and treatment of a wide variety of diseases. The majority of the diagnostic tests are for heart disease and cancer, although many other disease states are impacted by a shortage. The majority of therapeutic applications are for thyroid-related diseases, but a growing number of therapies are in development and showing much promise.
However, although the number varies with different sources, about 80% to 85% of diagnostic procedures in nuclear medicine use technetium-99m radiopharmaceuticals. This is a short-lived isotope that is conveniently derived from a much longer-lived isotope called molybdenum-99. The isotope shortage reflected the decreased supply of molybdenum-99 when the NRU reactor shutdown was extended beyond the original planned date.
As technetium-99m has only a half-life of six hours and most radiopharmaceuticals have only a 12-hour shelf life, these products are prepared on a daily basis and cannot be stockpiled. This shortcoming is offset by the use of a generator system in which the longer-lived molybdenum-99, which has a 66-hour half-life, or about three days, can be used as the supply for the technetium-99m. These generator systems can be used for up to two weeks.
Alberta was relatively unscathed by this crisis, as the three major centres in Edmonton, Red Deer, and Calgary all get their technetium-99m generators from Covidien, which sources most of its isotopes from Holland. However, as noted previously, the impact was very patchy and many small clinics within Alberta were using generators from BMS, which relies on the NRU reactor supply.
My involvement was to facilitate supply to as many smaller centres as possible, which we did through discussions with Health Canada. Our major efforts were to extend the lifetime of generators after their normal expiry date, facilitate transport of used generators to smaller centres, and look into the use of alternate isotopes.
I think I'll end there. I won't go into too much detail because I suspect I'll get questions asking me for more detail.