Thank you, Mr. Chairman.
I want to make one correction: I'm the immediate past president of the Society of Nuclear Medicine, and Michael Graham from the University of Iowa is our current president. But I have been tasked, starting with Dr. McEwan's presidency, with leading a task group responsible for addressing the problems we've been having with the supply of these critical medical isotopes.
My background is that I have a Ph.D. in nuclear chemistry and I'm a radiopharmaceutical chemist. I work at Los Alamos National Lab and I have a joint appointment in the College of Pharmacy at the University of New Mexico.
I want to address specifically some of the issues associated with the outage at the NRU at Chalk River. Approximately 50% of the material that we use in the U.S. is produced by that reactor, and it presents a huge problem for us whenever that reactor is not functioning.
In addition, that reactor also has more excess capacity than the other four reactors currently producing 95% of the world market of molybdenum-99. So whenever any of those other reactors go off-line, the NRU has the capacity to make up for a substantial percentage of the market it supplies. So there's a double whammy whenever the NRU goes down; not only is its normal production lost, but also the excess capacity this reactor produces when the other major reactors in the world are off-line.
Of the imaging procedures we do in nuclear medicine in the United States, 80% use technetium-99m, the daughter product of molybdenum-99. These procedures include cardiac studies and cancer studies, which in our case are about 80% of the imaging procedures. And then we do a number of other procedures for gastrointestinal problems, genito-urinary problems, and other issues associated with neurological problems, infection, etc. So we are imaging patients across the board using nuclear medicine procedures--in particular, nuclear medicine procedures utilizing this critical radioisotope we get from the reactor at Chalk River.
One of the problems with not having technetium-99m available is we then have to use other imaging procedures, which present one of four complications as far as the patient is concerned. One is that the radiation dose they receive from the procedure is higher. Another is that the accuracy of the procedure isn't as good as the one we would get from using a technetium-based imaging procedure. We've also seen an increase in cost as a result of the technetium-99m not being available. Finally, in many cases we use a much more invasive procedure, which presents a danger to the patient of increased morbidity and, potentially, mortality.
In the U.S. in particular, we have a problem because we use a technetium-based radiopharmaceutical to do bone scans of patients who have lung cancer, breast cancer, and prostate cancer and have a very high likelihood that the cancer may spread to the bone. We have asked our centre for medicare and medicaid services to cover sodium fluoride PET imaging for bone scans, but to date we have not received permission to charge for those procedures. So for those patients with these critical cancers, we currently don't have any alternatives in terms of imaging procedures.
In addition, for patients with breast cancer, we use a technetium-based test to find the lymph node that's closest to that tumour so that the surgeon can excise that lymph node, send it to pathology, and determine whether it has spread beyond the primary tumour in that patient. If we detect there is such a spread of that cancer, those patients go on to chemotherapy and other procedures to try to keep that cancer under control. So it's a very important part of the staging procedure for patients who are undergoing surgery for a tumour.
In addition, for cardiac patients who are obese, we get much better imaging procedures from using technetium-99m than we do from an alternative radioisotope, thallium-201.
Finally, pediatricians have expressed concern about the impact on a program called Image Gently in the U.S., which tries to reduce the radiation dose the pediatric population gets from imaging procedures. Those patients who are not availed of a technetium-based radiopharmaceutical for their imaging procedures often need to have procedures that involve much greater doses and much less accuracy as far as their staging goes. So another critical population is impacted by having this material not available.
So that in summary gives you a clear idea of the U.S. practice of nuclear medicine, the problems we have when a reactor such as NRU goes offline for what appears to be an extended period of time, and the problems associated with the alternatives we are looking at in using the technetium-based imaging procedures.
Thank you.