Medical Isotope Production Without Highly Enriched Uranium (2009) / Chapter Skim
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5 Molybdenum-99/Technetium-99m Demand
5 Molybdenum-99/Technetium-99m Demand
Pages 66-79
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From page 66... ...
The committee's o bjective is to address explicitly the first part of the second charge of its statement of task (Sidebar 1.2) to assess the "current and projected demand and availability of medical isotopes in regular current domestic use." The second part of this charge on availability of medical isotopes was addressed in Chapter 3.
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From page 67... ...
The commercially available market analyses are based on information provided by Mo-99 producers, technetium generator manufacturers, pharmaceutical companies, and hospitals. Mo-99 producers and technetium generator manufacturers use these market analyses and other information to develop their own projected demand estimates for business planning purposes.
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From page 68... ...
are slightly lower that the growth estimates nuclear medicine procedure is a medical procedure that utilizes medical isotopes such A as Tc-99m. The terms "procedures" and "studies" are used interchangeably.
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From page 69... ...
U.S. Demand for Nuclear Medicine Procedures, Tc-99m Procedures, and Tc-99m Doses Tc-99m Total nuclear Annual growth procedures as Annual growth medicine rate of nuclear Total Tc-99m % of nuclear Annual growth Total Tc-99m rate of Tc-99m procedures medicine procedures medicine rate of Tc-99m doses utilized dose utilization Year (millions)
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From page 70... ...
FACTORS THAT COULD AFFECT PROJECTED DEMAND There are several factors that could affect the projected demand growth for Mo-99/Tc-99m in the United States. For example: • Radiopharmaceutical market changes could affect supplies of (or prices for)
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From page 71... ...
Limits on Medicare and private insurance reimbursements for diagnostic imaging procedures may help to moderate future price increases for technetium generators and Tc-99m. Reimbursements for diagnostic imaging procedures are made directly to hospitals and clinics; these organizations, in turn, are responsible for allocating the costs of those procedures for materials, for example, Tc-99m, labor, and facility usage.
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From page 72... ...
Bio-Tech Systems (2006) estimates that this myocardial imaging comprises almost 60 percent of all Tc-99m based diagnostic imaging procedures.
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From page 73... ...
Displacement by Other Diagnostic Imaging Modalities There are alternative imaging modalities that could potentially reduce the future demand for Tc-99m based radiopharmaceuticals. Some potentially important alternatives are discussed in this section.
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From page 74... ...
However, there is no compelling reason for the current levels of Tl-201 use to markedly increase in nuclear cardiology applications except when there are prolonged shortages of Tc-99m generators. Positron Emission Tomography (PET)
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From page 75... ...
The bulk of nuclear cardiology procedures are performed in the offices of specially trained cardiologists, who have expertise in the use of the gamma camera and Tc-99m compounds, but have not extended their practice to PET. In addition, the economic cost of replacing the less expensive and clinically well-accepted gamma camera and technetium perfusion agents with PET is usually not cost-effective for the relatively low procedure volume that is common in many private cardiology practices.
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From page 76... ...
The committee judges that before Tc-99m bone scanning will be replaced, the important technical, regulatory, and reimbursement hurdles described above will need to be addressed. Other Imaging Modalities Intra-arterial contrast coronary angiography has been considered the gold standard for detecting coronary artery disease.
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From page 77... ...
Because of its high negative predictive value, Tc-99m perfusion imaging is usually done prior to intra-arterial coronary angiography to reduce the number of patients who need this more complicated procedure. An advantage of Tc-99m perfusion imaging is the recent discovery that the site of blockage in acute coronary syndromes is often in arteries that are subcritical in terms of their stenosis,13 often a 30 to 40 percent reduction in diameter of the involved vessel.
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From page 78... ...
These estimates assume that there are no major disruptions in Mo-99/Tc-99m supplies and no major changes in health care policies or practices. • The demand growth for diagnostic imaging modalities will likely continue over the long term as the U.S.
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From page 79... ...
Although these impacts are likely to occur on timescales that are beyond the 5-year focus of this report, they should be of intense interest to Mo-99 producers who are contemplating conversion from highly enriched uranium (HEU) - to low enriched uranium (LEU)
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