Thank you, Mr. Chair and committee members, for the opportunity to appear before you today.
As you know, I'm Karen Gulenchyn. I'm a specialist in nuclear medicine and internal medicine, and I've worked in this field since 1979. I'm currently the medical chief of the Department of Nuclear Medicine at Hamilton Health Sciences and at St. Joseph's Healthcare, and I am an associate professor in the departments of radiology and medicine at the Faculty of Health Sciences at McMaster University. I am also a member of the group of experts that was called together last December by the Minister of Health to provide advice on the medical isotope supply.
I thought I'd take a minute to explain nuclear medicine, a specialty I'm very proud to practise. Nuclear medicine is concerned with the use of radioactive materials, which are known as radiopharmaceuticals, for the diagnosis and treatment of a wide number of diseases. The majority of our diagnostic tests are applied to heart disease and cancer. The majority of treatments are for thyroid disease and thyroid cancer. Approximately 30,000 diagnostic and 300 therapeutic doses of medical isotopes are administered across Canada each week.
Technetium-99m is the most widely used isotope. It is the radioactive daughter of the parent molybdenum-99, the material that is produced in the reactor at Chalk River. Molybdenum-99 is transported from Chalk River to MDS Nordion in Canada for processing and is subsequently transported to the companies that make generators. Those companies are located in multiple countries, but the majority of the molybdenum is actually shipped to the U.S.A.
Because molybdenum-99 is radioactive and has a relatively short half-life of 66 hours, transportation of this product requires special and detailed arrangements to ensure the safety and reliability of supply. The generators are purchased by imaging facilities, hospitals, and radiopharmacies, and those generators continue to make technetium during their lifetimes, which is washed from the generator column by sterile saline and then compounded into a series of radiopharmaceutical doses that are administered to patients in the morning. Those radiopharmaceutical doses have a half-life of about six hours, the half-life of technetium. And it's quite a production in the morning to get all the radiopharmaceuticals ready. It's a very interesting thing to observe.
Of course, smaller and more remotely situated nuclear medicine departments usually receive a single generator weekly, and that renders them more vulnerable to disruption in supply than a large central facility that has on hand a large number of generators that are received at intervals through the week. I'm telling you this because I think this illustrates both the complexity and also the tenuous line of supply that exists between the manufacturers and the patients.
My involvement in this matter, firstly, was as the medical chief of the Department of Nuclear Medicine in Hamilton. Throughout this disruption of supply, I was responsible for triaging patients and for arranging alternate isotopes, specifically sodium fluoride, for bone scans, which we can produce with our own cyclotron at Hamilton Health Sciences. In fact, working with colleagues at the Cross Cancer Institute in Alberta, we were prepared and ready to implement a protocol to use that material should the shortage of isotopes have continued through to the end of January, which at one point was what we were hearing.
As well, I was responsible for communicating to medical staff and the public regarding the limitation of supply. As a member of Ontario's PET Steering Committee, I was responsible for providing advice to the Ontario government as to how other radiopharmaceuticals produced at Ontario's three medical cyclotrons might fill some of the gaps in isotope supply. And finally, as an adviser to Health Canada, I was providing advice on the impact on patient care and advice regarding alternative diagnostics and treatments.
So what was the impact on patient care? Well, we gathered information from colleagues in my own region, in the provinces, and from across the country. And we observed that there was a variable adverse impact on patient care, with the most severe occurring in eastern Canada, in smaller centres, and in rural areas without access to alternative technologies or the ability to access alternate supplies of isotopes.
We estimated that about 10% of the examinations being deferred because of this supply disruption could result in serious harm to the patient, and an additional 50% of deferred examinations could result in delays in treatment or in additional unnecessary pain and suffering to the patient. Finally, we concluded that the last 40% of diagnostic tests could in fact be safely deferred. But it must be noted that the deferral would then impact on an already over-stressed and over-burdened health care system.
I guess to many observers it might not have appeared that there was a crisis. I think this was largely due to the talented and dedicated staff who work in Canada's 245 nuclear medicine facilities and radiopharmacies. Patients were booked and rebooked to make the best use of radiopharmaceuticals. In fact, in my department the heroes were the three girls who sit on the front desk and talk to the patients every day.
Partially spent generators were transferred from centres like the Edmonton Radiopharmaceutical to more remote hospitals in order to meet the needs of the most urgent cases. In Vancouver, hospitals with a supply of technetium actually transported doses to those lacking supply so that the triage that was occurring right across the city would meet the need of the most urgent cases. However, despite those measures, had the Chalk River reactor not come online, we believe that unmanageable shortages would have occurred within a week of Parliament's decision.
We also know there was an impact outside Canada. From our colleagues in the American Society of Nuclear Medicine we learned that 84% of those surveyed indicated that their practice or facility was being impacted by the molybdenum shortage, and 62% of those facilities reported that they did not have access to an alternate supply of technetium.
I will turn to another issue. It became clear early on that there were communications issues that exacerbated the situation. There wasn't clear or timely information given to the medical community on the length of the shutdown at Chalk River or about the level of supply and impending shortages. The medical community, and especially those from the nuclear medicine community, believe there is room for improvement in when and how they are engaged and in how information is communicated to them.
I understand this committee's current study is focused on nuclear safety in Canada. However, because the members are also hearing testimony concerning the health impact of the closing of the Chalk River plant, I would hope you will consider including recommendations that will ensure the security of the supply of medical isotopes for the future.
Finally, the Canadian nuclear medicine community has taken considerable pride in the fact that Canada supplies the majority of the world's medical isotopes. At present, through our affiliation with the American Society of Nuclear Medicine, we are aware that both the National Academy of Sciences and the U.S. Congress are advocating for a domestic supply of medical isotopes. That position is of course strongly supported by the Society of Nuclear Medicine, and I believe Canada's leading role in this field has been placed at risk.
In closing, I would like to thank the committee for the opportunity to appear, and I would be pleased to answer any questions you might have.
