Heartbeat: Safely managing patients during Technetium-99m shortage

February 1, 2023

At the back end of 2022, there was a global shortage of one of the most commonly used medical radioisotopes used in nuclear medicine and radiopharmacy departments at hospitals across the country including at our Trust.

Technetium-99m is used as a radioactive tracer and can detected in the body by gamma cameras. Having a relatively short half life, the isotope is well suited to a range of diagnostic procedures that give an insight in to the workings of various parts of the body.

“Technetium-99m is attached to a drug which carries it to the part of the body which is to be imaged. This is called a radiopharmaceutical, and the process has to be done on site in our specialist radiopharmacy unit for use the same day” said Joseph O’Brien, Consultant Physicist and Head of Nuclear Medicine.

“After it is injected into the body the radiopharmaceutical allows the team to analyse how the body is functioning.

“There are a wide range of studies it is used for, such as examining how well the stomach processes food, how well the kidneys are working, whether there is a problem with the blood supply to the heart, detecting prostate cancers in the bone, staging breast cancer and assessing for blood clots in lungs.

“In addition to this, surgical procedures for breast surgery rely upon technetium-99m for staging disease.”

During the shortage, the availability of technetium-99m became very restricted. The radiopharmacy team had to prioritise areas such as inpatients and surgical cases whilst other areas were postponed based on clinical condition. A traffic light system, developed during the COVID pandemic, was brought back into use to help prioritisation of patients. As SWB provides a regional radiopharmacy to hospitals in the West Midlands, the technetium-99m had to be shared equitably

“To combat the shortage a plan of action was put together,” explained Jilly Croasdale, Head of Radiopharmacy Department and Associate Director of Healthcare Science.

“We identified studies which could be safely postponed and prioritised studies which must go ahead, and then escalated these to an executive level. After this, we then communicated with patients and introduced weekend working temporarily to cover co-ordination of supply to and from other hospitals. As the situation changed on a weekly basis due to supply constraints, the plan was re-assessed twice a week.

“Our plan also helped to form the basis of national guidance and gave other departments strategies to mitigate shortages. This guidance was published on the British Nuclear Medicine Society website.”

Jilly believes without the swift action of her team and colleagues, the shortage could have been catastrophic for the service.

“In nuclear medicine, around 90 per cent of studies involve technetium-99m and so when there is a shortage it can be really challenging. However I am very lucky to be surrounded by colleagues who are talented, hardworking, who were not fazed by such an issue and are always willing to go beyond the call of duty.

“I must say a special thank you to everyone in the radiopharmacy and nuclear medicine teams, and in particular to Linda Burns, Nuclear Medicine Administrator, Shaun Johns, Radiopharmacy Production Manager, Becky Harrison, Radiopharmacy Quality Manager and Jenny ThompsonPeters, Nuclear Medicine Chief Clinical Technologist as without their due diligence, this would not have been possible.”