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The Dutch reactor picking up the slack in supplying medical isotopes since Chalk River's NRU facility was shut down goes offline next week. That leaves health-care providers scrambling as the world's two largest isotope producers are out of commission.

Together, the Petten reactor in the Netherlands and Canada's NRU normally are responsible for more than two-thirds of the world's technetium, the isotope used in such vital procedures as bone scans.

When the NRU went down in May because of a heavy-water leak, Petten ramped up production by 50 per cent. After severe isotope shortages in early June, Canadian hospitals have been able to stabilize supplies and get cancer patients the vital diagnostic imaging that the radioactive material provides.

But they're bracing for daily shortages starting next week.

The aging Petten reactor was scheduled for maintenance this month. A Belgian reactor that is expected to come online should pick up some of the slack, but its normal output is tiny – less than a third of what Petten and Chalk River each produce. Hospitals have been told to expect only a quarter of their required supplies, said Christopher O'Brien, president of the Ontario Association of Nuclear Medicine.

“It'll all depend whether the Belgian reactor comes on as we hope it will,” he said. “If the Belgian reactor does not come on and Petten is down, we will be in dire straits. ... The plan is just to muddle on.”

It's still unclear where the extra isotopes will come from, said Sandy McEwan, the Edmonton nuclear oncologist appointed last month to advise Natural Resources Minister Lisa Raitt on the isotope crisis. Isotopes from Australia's newly operational OPAL reactor have been approved for use in Canada, but may not be ready for export – at least not in large enough batches.

“Projections that I've seen for the next little while suggest that we're going to be tight, but okay, and I'm waiting to find out what the final projections will be when Petten goes down ... how everybody's going to be able to cope,” Dr. McEwan said.

“I think that, because they've known this is going to be bad, ... the reactors in Europe have been working very closely together to try to get the best strategy to fill the Petten gap.”

In the meantime, health-care providers across the country are struggling to cope with skyrocketing costs for the increasingly rare isotopes.

In some cases, hospitals are paying three times what they normally would for technetium, forcing them to dip into their budgets to make up the difference.

“We're not sure how long the hospitals can continue to draw on their global budgets without any bridging funding coming in federally or provincially,” Dr. O'Brien said.

What is clear is that the Chalk River reactor won't be up and running any time soon.

When the reactor was first shut down in May, Atomic Energy of Canada Ltd., the Crown corporation that runs the reactor, said it would take at least three months to get it going again. Now, staff members are less than a third of the way through a meticulous inspection of the inside of the partially drained vessel. They know external corrosion created the small hole behind the leak. But they don't know how best to fix it, or how long that will take.

“We know what the problem is, it's more the repair options and how long that will take – that's what we're working on identifying now,” said AECL spokesman Dale Coffin.