Key medical procedures for patients with life-threatening illnesses are being put on hold this week because Canadian clinics are operating with less than a quarter of the usual amount of medical isotopes - a problem that has been exacerbated by yet another delay in the restart of the Canadian reactor that produces them.
The country's nuclear-medicine specialists barely coped with a reduced supply of technetium-99, the isotope used in most nuclear diagnoses and treatments, after the National Research Universal (NRU) reactor at Chalk River, Ont., which produces a third of the world's supply was shut down for repairs last May.
But the additional closure of the world's other large isotope-producing reactor has created "a true scarcity," Eric Turcotte, a nuclear medicine researcher from the University of Sherbrooke, told the House of Commons' natural resources committee yesterday.
"I believe some patients will not get their scans in time," said Dr. Turcotte, one of the four members of an expert panel appointed by the federal government last year to explore ways of securing a reliable supply of the radioactive material.
"When we have 15 to 20 per cent of the product that we need for the exams, we know we have to focus on the most urgent cases and then we have to figure out who are the most urgent patients. Sometimes it's a matter of life and death," he said.
Jean-Luc Urbain, the president of the Canadian Society of Nuclear Medicine, said in a telephone interview that the shortage of isotopes is forcing doctors to cancel procedures. "At this point in time, we cannot guarantee that people are getting what they need for their health care," Dr. Urbain said.
The current critical shortage of technetium is expected to last at least until the second week of April but could go on for many more months.
The restart of the NRU, which is owned by Atomic Energy of Canada Ltd. (AECL), has continually been postponed and the Crown corporation issued a release yesterday saying it had been delayed yet again, this time by more than two months.
"AECL, with the advice of outside experts, has conducted a thorough review of the schedule with the result that it is now projected that the NRU will resume isotope supply by the end of July," said the corporation.
"With respect to announcing a new timeline, now it's almost a farce as far as we're concerned," Dr. Turcotte said. "Since January the date keeps getting pushed back and pushed back and we don't take it seriously any more."
With the supply of technetium significantly reduced, many specialists have turned to thallium, another type of isotope. But "it is not really a desirable alternative. It has too high a level of radiation," Dr. Turcotte said. Nor does it give as clear a diagnosis.
The report that Dr. Turcotte and his colleagues produced for the government recommends building a new reactor to replace the NRU. The document was completed last December but the Minister of Natural Resources has offered no comment, Dr. Turcotte told the committee.
"We are disappointed with delay and we are eager to see what the response will be because it will have a direct impact on how doctors operate and how we care for patients in Canada," he said.
A spokeswoman for Natural Resources Minister Christian Paradis said the government is currently studying the report and will be releasing its official response in the coming weeks.
Prime Minister Stephen Harper has said Canada will get out of the business of producing isotopes when the licence of the NRU expires in 2016.
Dr. Francois Lamoureux, president of the Quebec Association of Nuclear Medicine Specialists, said in an interview with a Quebec newspaper this week that the federal government has handled the isotope file badly "to the point where it has created a crisis everywhere in the world."
Dr. Lamoureux said it is time for an independent international commission to examine whether two mothballed reactors that were built as replacements for the NRU could be salvaged.