The decay product of the medical isotope molybdenum-99 (Mo-99), technetium-99m (Tc-99m), and associated medical isotopes iodine-131 (I-131) and xenon-133 (Xe-133) are used worldwide for medical diagnostic imaging or therapy. The United States consumes about half of the world's supply of Mo-99, but there has been no domestic (i.e., U.S.-based) production of this isotope since the late 1980s. The United States imports Mo-99 for domestic use from Australia, Canada, Europe, and South Africa. Mo-99 and Tc-99m cannot be stockpiled for use because of their short half-lives. Consequently, they must be routinely produced and delivered to medical imaging centers. Almost all Mo-99 for medical use is produced by irradiating highly enriched uranium (HEU) targets in research reactors, several of which are over 50 years old and are approaching the end of their operating lives. Unanticipated and extended shutdowns of some of these old reactors have resulted in severe Mo-99 supply shortages in the United States and other countries. Some of these shortages have disrupted the delivery of medical care. Molybdenum-99 for Medical Imaging examines the production and utilization of Mo-99 and associated medical isotopes, and provides recommendations for medical use. Table of ContentsFront MatterExecutive SummarySummary1 Background and Study Task2 Medical Isotope Production and Utilization3 Global Production of Molybdenum-99 and Future Prospects4 Progress Toward Establishing Domestic Production of Molybdenum-99 and Associated Medical Isotopes5 Progress in Eliminating Highly Enriched Uranium and Remaining Obstacles6 Molybdenum-99/Technetium-99m Historic and Projected Demand7 Molybdenum-99/Technetium-99m SupplyReferencesAppendix A: The American Medical Isotopes Production Act of 2012Appendix B: Committee and Staff BiographiesAppendix C: Presentations and Site VisitsAppendix D: List of Radiopharmaceuticals and Associated Codes Used in the Committee's Medicare Data and Nuclear Pharmacy Data AnalysesAppendix E: Acronyms
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