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Possible Solutions to a Shortage of Medical Radioisotopes

Submitted by François Couillard
Chief Executive Officer
Canadian Association of Medical Radiation Technologists

The Canadian Association of Medical Radiation Technologists (CAMRT) has identified the risk of a global shortage of medical radioisotopes as an emerging issue of concern in the near to medium term, particularly for the international community of nuclear medicine specialists and their patients.  Technetium-99m (99mTc) is used in over 80% of nuclear medicine procedures- more than 30-40 million examinations worldwide yearly. This is the “bread and butter” of nuclear medicine. Ongoing reliable supply of this critical isotope appears to be questionable.

The CAMRT is working with a number of stakeholders to define the issue more specifically and propose    solutions that mitigate the impact of a diminished supply of medical isotopes, to provide decision makers with the details they need to make an informed decision.

Defining the issue

In order to understand the issue, it is necessary to understand the current supply chain:

Uranium –> Reactors –> 99Mo processing facility –> 99mTc processing facility –> Hospitals

Uranium targets are irradiated in a nuclear reactor. They are then processed to extract 99Mo. This product is shipped to facilities where “generators” are assembled. These generators are then sent to hospitals all over the world. The two most critical steps in the process are the irradiation of uranium target in reactors and the processing of these targets to produce 99Mo. Any disruption can hurt the supply chain downstream.

There are several issues that threaten the supply of this critical isotope:

  • Demand is expected to continue to grow at a rate of about 2% per year worldwide until at least 2020 (ref. NEA-OECD report).
  • 2 of the 9 reactors used in this supply chain are scheduled to stop production in 2016 (the Canadian NRU and French OSIRIS reactors). Together, they account for over 25% of the potential annual production capacity.1 The Canadian government has indicated that it will not extend NRU production beyond 2016.
  • All other major existing producing reactors, except for OPAL in Australia, are aging and scheduled to shut down by 2030.
  • OECD countries have agreed to substitute the use of High Enriched Uranium (HEU) in reactors with Low Enriched Uranium (LEU) (HEU can be used to make nuclear bombs). The transformation is proving technically challenging and expensive in light of the short expected life of existing reactors.
  • The 99Mo processing capacity in the world is at high risk of being insufficient to meet demand. One of the largest processor, Nordion, will cease 99Mo processing after NRU stops production, creating a gap until new projects like Australia’s ANSTO new facility are fully operational.
  • The future price of 99mTc is likely to rise due to the above challenges and the exit of Nordion.

Possible solutions:

There are 3 ways to address these issues:

  1. Increase production capacity
  2. Optimize distribution and utilization
  3. Substitute tests with other tracers or modalities

The last major disruption in supply forced health providers to collaborate to find creative ways to share limited 99mTc supplies. It also encouraged substitution to other modalities, often at higher cost and/or with compromised quality. Most health jurisdictions in Canada now have contingency plans in place.

The ideal situation would be to have new irradiation and processing capacity in place by 2016 to ensure a seamless transition away from the NRU and OSIRIS reactors and associated processing facilities. There are over 11 new irradiator projects underway (mainly reactors) and almost as many new processing facility projects. Canada is also experimenting with 3 cyclotron/linear accelerator schemes to replace reactor supplied 99mTc. These Canadian projects are promising but they are still years away from full approval by Health Canada and pricing and distribution scenarios remain uncertain.

At this point we have been unable to get industry reassurance that a sufficient number of these projects will be fully operational on time to ensure a steady and reliable supply of 99mTc. Getting a clear picture of the situation post-NRU is proving very challenging. The best information available is from the April 2014 OECD report which concludes that “clearly, insufficient processing capacity will be a major risk for secure supply in the next 5 years”. Capacity should stabilize after 2020, provided additional capacity is added to replace the 6 reactors scheduled for shutdown between 2024 and 2030.

 Progress to date

The CAMRT is monitoring the situation closely, and coordinating ongoing investigation of the situation through dialogue and information sharing with CAMRT members, international colleagues and other national healthcare associations.

We are currently engaged in discussions with Health Canada, with provincial and territorial government representatives, and various industry players.  Our goal is to monitor the situation closely and stimulate the emergence of mitigation strategies, if required, through constant engagement with our members, producers, governments and other stakeholders.

We welcome partners, questions, suggestions and any new information you would like to share with us.

References

[1] The supply of medical isotopes; medical isotope supply in the future: production capacity and demand forecast for the 99Mo/99mTc market,2015-2020. April 2014 NEA/SEN/HLGMR(2014)2 www.oecd-nea.org

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CNA Fall Energy Seminar Features Release of 2015 Life-Cycle Analysis of Canadian Electricity Options

fall-seminarWith climate change as a top priority for decisions about electricity generation, it is more valuable now than ever to understand the carbon impact of our energy activities, from construction to decommissioning.

A life-cycle analysis of a technology takes into account all the activities required for its function – not just during operation. It is easy to point out that fossil fuels emit greenhouse gases, and compare nuclear and renewable sources as comparatively zero-emissions – but doing so disregards the carbon impact of mining, construction, and other non-operational activities.

This fall, on October 7-8, the CNA will hold its inaugural Fall Energy Seminar at the Hilton Toronto. We will debut our latest life-cycle study, and discuss its conclusions in the pursuit of a cleaner electricity future.

Registration is affordably priced and is open to everyone.
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Environment International Nuclear Policy

All may not be Lost on Global Heating

By John Stewart
Director, Policy and Research
Canadian Nuclear Association

The UN’s 69th General Assembly opened today in New York. On the agenda is “stemming the existential threat of climate change,” along with a litany of other crises from Ebola to ISIS.

I commented six months ago that only a “Poland moment” – the arrival of real, widespread fear for our way of life – might get climate change recognized as an “existential threat.” Let alone get it “stemmed.” I doubt that we are there yet.

But as catastrophic as the outlook seems on carbon emissions, I am not completely pessimistic. Governments do face up to, and act to mitigate, grave threats, even at times when doing so is costly and defies electoral arithmetic. The record of improving air and water quality in developed areas of the globe since the 1960s attests to this. So do many other international efforts to improve human health and security.

While it takes time, our governments have shown they can act to address environmental challenges. Source: http://www.ec.gc.ca/air/default.asp?lang=En&n=8ABC14B4-1&offset=2&toc=show

While it takes time, our governments have shown they can act to address environmental challenges. Source: Environment Canada.

How hopeful can we dare to be that a child born today will not witness hundreds of millions of people being displaced by rising seas and desertification due to climate change? Or at least, that he or she will live to see a substantial turnaround of this process?

Here are what I see as the negatives that support a pessimistic view:

  • Lack of action by major national governments so far – except for grasping at fake “solutions” that are politically expedient (such as farm subsidies dressed up as “biofuels”), are subsidy-based and therefore inefficient and unsustainable (much wind and solar). All of which create new vested interests faster than they decarbonize our lifestyles. Slightly less bad is watching government jump into solutions that may work out, but are too far down the road to be useful in the near-term climate battle (such as technology development funds).
  • A global policymaking environment of crises upon crises – to take just a few examples: for Europeans, the Eurozone economic crisis followed by Ukraine; for Arabs, the Arab Spring followed by Egypt and Syria; for Americans, financial crisis followed by politico-fiscal paralysis, military withdrawals, and now a new war.
  • The long financial crisis and sluggish world economy – putting a continuing drag on governments’ fiscal capacity, and also slowing the rate at which infrastructure can be rebuilt on lower-carbon technologies.

On the other hand, here are some major positives, raising hope that something can be done:

  • Real concern at the top – the UN Secretary-General, the US President, and many other top political, business and intellectual leaders appear to recognize the threat posed by climate change.
  • Steps forward by smaller players – large companies, industry associations and sub-national governments have been willing to be early movers, and some of those moves seem to have worked well.
  • Leadership in the high-growth regions – while dense emerging markets like China and India may remain far behind the West in many aspects of environmental quality, their high rates of infrastructure investment give them once-in-a-century opportunities to build lower-carbon systems in electric power, transportation and urban design. In fits and starts, they are seizing it.

The ecosphere will benefit if high-growth countries make good choices (as China does when it invests in fifty or seventy nuclear power plants instead of coal-fired units), and stable economies such as ours continue to rely on nuclear.

Weighing the scales, my own view is that the odds that we can still act to mitigate climate change are better than bleak.

Environment

Nuclear is the No. 3 Contributor to Climate Change Mitigation: The Economist

Ahead of the September 23 UN meeting of world leaders to discuss climate change, The Economist magazine decided to do something they claim has never been attempted before.

The magazine has compiled a list of the top 20 climate change mitigation measures put in place globally.

Not surprising, nuclear power ranked third overall and was credited for reducing 2.2 billion tonnes of C02 annually, behind the Montreal Protocol and hydro power. Nuclear’s climate change mitigation was estimated to be four times greater than all non-hydro renewable energy sources combined.

To slash or to trim

“According to the International Atomic Energy Agency, nuclear power avoided the production of 2.2 billion tonnes of carbon dioxide in 2010—that is, emissions would have been 2.2 billion tonnes higher if the same amount of electricity had been produced by non-nuclear plants,” The Economist reported.

It added that the high rate at which new wind and solar capacity is being built will eat into this lead of nuclear and hydro “but it will take some time to overturn it.”

You can read the full Economist article here.

Uncategorized

Here’s to Heather

Heather Kleb

Heather Kleb

CNA Vice-President Heather Kleb left the CNA on September 12 to join Bruce Power.
Kleb will be taking up a position as senior program manager in the regulatory program with Bruce starting in Ottawa in late September.
”Working at the CNA has allowed me to meet so many of the great people who make up the nuclear industry,” said Kleb. “I hope to continue to run into all of you in my new role. And I plan to cheer the CNA on from the sidelines as they advocate for our industry.”
Kleb joined the CNA in 2010 as director of regulatory affairs and served as acting CNA president from October 2012 to October 2013.
“Heather will always be a most welcome friend of CNA; we very much hope to benefit from her advice on regulatory and environmental affairs,” said CNA President John Barrett. “Her expertise in these matters is most valuable, not only to the CNA but also to the nuclear industry at large.”
Heather has a background in environmental science with a Master of Science in Ecology and over 20 years of experience working on multi-million dollar projects supporting a variety of industries. She has held a number of positions at Atomic Energy of Canada Limited, including Manager, Regulatory Affairs, for the cleanup and long-term management of historic low-level radioactive waste in Port Hope and Clarington, Ontario.
She is also currently enrolled in the EMBA program at Queen’s University.
Good luck, Heather!

Uncategorized

Step Outside – How Many Electric Cars do you See?

By John Stewart
Director, Policy and Research
Canadian Nuclear Association

Originally published in Policy Options, September 2014

Anyone purporting seriously to project the global future of energy should first ask themselves this simple question: How much do you think your family’s energy supply will change in the next four decades? (1) Dramatically? (2) Substantially? (3) Hardly at all?

If you’re at least as old as I am (born in 1960), you’ve lived through a good deal of public discussion of energy issues in North America since the mid-1970s, just after the first great oil price shock. Though its roots lay mostly in political causes (a war in the Middle East), the 1973 jump in oil prices spawned a sea change in energy attitudes driven by widespread notions that the world was running out of natural resources.

Many of us were convinced that our energy systems were in for a dramatic shift. If asked then, most of us would probably have said that radical change would occur by the end of the 20th century. We were sure that oil would have become unaffordable. Homes, we thought, would be solar- or garbage-incinerator powered. Cars would be fewer, or electric, and we would likely be driving them much less.

Had you told my generation in 1974 that our sources and uses of energy — and the lifestyles built around them — would be more or less unchanged, not just 20 but 40 years later, those of us who thought we understood energy issues simply would not have believed you.

The lesson is sobering: quick propagation of new technology does not happen in energy supply systems.

The lesson is sobering: quick propagation of new technology does not happen in energy supply systems. Other technologies lend a distorted view of the speed of change, particularly computers and other digital technologies. Our phones, modems, computers and routers get replaced in three- to five-year cycles, while service offerings around them, such as texting, e-mail and social media, seem to be ever-expanding and advancing.

But the energy infrastructure is heavier and more durable (and involves greater safety implications: your computer or phone cannot easily kill you). Light bulbs are about the only thing we can change in three years. Appliances like televisions, fridges and stoves take 10 to 20 years to turn over. Power stations, transmission gear and pipelines last 25 to 50 years; manufacturing equipment 10 to 40; heavy vehicles 10 to 30. Buildings stay in service 40 to 120 years, with much of their embodied infrastructure (elevators, heating and cooling systems) changing just a few times in that period.

With this kind of durability, relatively little of North America, Japan or Europe’s energy-supply hardware is upgraded in a given decade. Add to this the fact that it’s increasingly difficult to get regulatory approval to build infrastructure in our societies (notably pipelines or power lines), and the turnover time is longer still. Yes, you’ll see new technology installed in new neighbourhoods, but not so much in the old ones, at least not for a long time.

So what? Well, two “so whats.” First, if we have a new energy technology that helps to solve an urgent problem such as climate change, adopting that technology on an urgent basis is going to be very, very expensive. If we need to change the system in less than 10 years (and remember, the system hardware has an average lifespan of 30 years) then we have to buy new gear long before we’ve finished paying for the old. That hurts, and in many cases it can’t realistically be financed.

Light bulbs are about the only thing we can change in three years.

Second, note that I said: “if.” Many of our current projections of future energy systems presume the availability of technical solutions that, in many cases, aren’t available yet.

I recently joined a national group that brings together leaders from the electric power industry. These are the executives and engineers who design and build North America’s energy hardware and software, including turbines, wires, transformers and controls. Few are more qualified than these people to talk about what our electric power grid can do and what we can make it do.

In recent conversations I listened to them tiptoe around the gap that exists between rhetoric and reality concerning the future of our electric grid. While they do not discourage efforts to speed up technology innovation (their companies get interesting contracts for pilot projects), they’re aware that many of these innovations are much further out than the general public realizes.

Consider grid-scale energy storage, which is indispensable for intermittent power sources such as wind and solar.

Knowledgeable realists understand that even if wind and solar become economic power sources on the scale necessary to clean up our electricity supply (which isn’t a given), the next big challenge will be to have that power available when it’s needed. At this time, energy storage on a large enough scale doesn’t exist — and won’t exist for at least several decades.

Without storage capacity, intermittent energy sources must be backed up by other sources that can be raised and lowered quickly, such as hydroelectricity or natural gas. If that backup is natural gas, as is increasingly the case, then renewables without storage are not low-carbon and are not an answer to our problem.

There is not yet a good, proven, economic, and widely applicable solution to the problem of grid-scale energy storage. Yes, government funds are being invested in storage technologies. Yes, there are pilot projects. But these shouldn’t be mistaken for signs of an imminent shift in our power system. Ninety-eight percent of installed energy storage capacity in the world today is a tried-and-true technology: pumped hydro. The other 2 percent (including flywheels, batteries and compressed air) are at various stages of development. In all cases, there are significant losses in storing and retrieving the power, with the result that these storage methods are useful only in niche applications where high costs are tolerable.

Stewart ad

Another innovation with some distance to go is a workable system whereby those energy customers able to generate small amounts of power from time to time can sell it to the grid (or alternatively, sell stored power, such as from their parked electric vehicles). Considered one of the pillars of the “smart grid,” this is a promising development — unless you are an operator of an actual power grid.

Electrical system operators need to achieve a near-perfect balance between supply and demand. According to a February 2014 article from the Electric Power Research Institute, “The Integrated Grid,” the “electric power grid, especially its distribution systems, was not designed to accommodate a high penetration of distributed energy resources while sustaining high levels of electric quality and reliability.” Bollen and Hassan’s 2011 engineering text, Integration of Distributed Generation in the Power System, tells us that the problems include increased risk of overload and increased losses, increased risk of overvoltages, increased levels of power-quality disturbances, and impacts on power-system stability and operation.  If enthusiasts for our smart-grid future dig into such material, they don’t reflect it.

This is not to say that engineers believe these problems are insoluble. They simply believe solving them will take a long time and a lot of investment. It is unlikely that a proven, economic solution will be available in a time frame that lives up to current optimism about smart grids and a future based predominantly on renewable energy.

As in 1974, there are four main barriers standing between us and a dramatically different energy system:

  • Engineering feasibility — or the physical problem. Finding new energy solutions is not just a matter of making a public policy decision and pouring millions of dollars into a technology development fund. Many technical problems are simply not amenable to human will.
  • Verification — or the standards problem. Performance and safety need to be validated before infrastructure investment can begin. For new technologies, just creating evaluation processes and design standards can be a huge undertaking, and we’re not nearly there yet.
  • Infrastructure feasibility — or the time problem. While climate change demands an immediate solution, the scale of our energy system and the rate at which we rebuild it will necessitate an investment time frame in the area of two to four decades — longer if economic growth slows.
  • Economic feasibility — or the customer/voter problem. However quickly you and I want a solution (like a mostly renewable power supply) to a big problem (like global warming), quick solutions to big problems are almost always expensive. So while voters generally embrace the solution in the planning stages, they tend to lash out when the bills arrive. The policy may survive or be reversed; the political party may survive or be rejected. But a legacy of large costs is guaranteed.

The engineering reality is that among the low-carbon ways to generate electric power, nonhydro renewables such as wind and solar probably won’t supply more than 5 to 10 percent of our power a decade from now, and 10 to 15 percent in 20 years. Another engineering reality is that the smart grid — so far — is mainly a set of measures to trim consumption and flatten out the peaks and valleys that occur throughout the day. Progress may very well be made on energy storage and the smart grid, but in both cases they’re going to take time.

Let me be clear: I’d like nothing better than a smart grid fuelled by low-emitting generation. Replacing -fossil-fuelled vehicles with electric ones would be wonderful for my grandchildren’s ecosphere. I don’t discourage a vision of an energy system that is very different from the one we have today, any more than I underestimate the competence of the engineers I’ve met. I only maintain that realistic time frames need to be considered.

If we agree that global warming is real and the need to decarbonize our energy system is urgent, then we need to institute a lower carbon system on a very large scale as soon as possible. Unfortunately, the list of available ways to do this is very short. The list does not include natural gas, except as a stepping-stone where it is replacing coal or oil (which is the only case where natural gas can be considered lower-carbon). And the list does not include wishful thinking about new technologies we don’t have or big engineering challenges that haven’t been solved. The 60- or 100-year solutions are good and should be pursued. Just don’t be under the illusion that they can help us right now.