"We compensated by lowering our doses slightly… you can maintain the same quality by slightly increasing the time of imaging," Schraml says. "We were able to continue business as usual, essentially."
Eventually, the shortage abated, and the hospital resumed its original dosages and dosage times.
Regarding the current shortage reports, "I don't know how dire things will be," Schraml says. "I put a lot of reliance on my technologists and my manager. They seem to always come through, so if the shortage isn't any worse than it was a couple of years ago, then I think we'll be fine."
The PET Alternative
Technetium-99 is used between 70,000 and 80,000 times per day in U.S. healthcare, primarily as a cardiac perfusion imaging agent, says Paul Crowe, chairman and chief executive officer at NuView Life Sciences, based in Dallas.
"It actually shows how well the blood is being moved through the heart, and it is a clinical assessment for the doctor to determine the cardiac output by ability of the muscle, and to help the physician diagnose a patient's condition," Crowe says.
Technetium-99 has been used for decades by clinicians in private offices that have their own nuclear medicine cameras, as well as in hospitals. "Over the last 10 years, there [have] been intermittent shortages of the product that cause cancellations of patient procedures," he says.
One alternative in use is a product of rubidium-82, a PET biomarker. "The difference is that the cameras that utilize the rubidium are larger, they're much more expensive, [and] you have limited facilities in the United States that offer these services for cardiac imaging," says Crowe.
"Most PET imaging cameras are used for staging cancer and observing response to therapy. But there's a growing demand for rubidium as a PET perfusion imaging agent for the heart, because it has higher image quality. It has less artifact that may or may not influence the accuracy of the diagnosis," he says. "Also, the imaging times are lower."
Another reason rubidium-82 could make inroads: MRI and PET cameras are being integrated, aiding earlier detection of heart tumor or plaque, Crowe says.
Scott Mace is the former senior technology editor for HealthLeaders Media. He is now the senior editor, custom content at H3.Group.