Potential Ways to Address Shortage Situations of (99)Mo/(99m)Tc.

(99m)Tc, the most common radioisotope used in nuclear medicine, is produced in a nuclear reactor from the decay of (99)Mo. There are only a few aging nuclear reactors around the world that produce (99)Mo, and one of the major contributors, the National Research Universal (Canada), ceased production on October 31, 2016. The National Research Universal produced approximately 40% of the world's (99)Mo supply, so with its shut down, shortages of (99)Mo/(99m)Tc are expected. Methods: Nuclear pharmacies and nuclear medicine departments throughout the United States were contacted and asked to provide their strategies for coping with a shortage of (99)Mo/(99m)Tc. Each of these strategies was evaluated on the basis of its effectiveness for conserving (99m)Tc while still meeting the needs of the patients. Results: From the responses, the following 6 categories of strategies, in order of importance, were compiled: contractual agreements with commercial nuclear pharmacies, alternative imaging protocols, changes in imaging schedules, software use, generator management, and reduction of ordered doses or elimination of backup doses. Conclusion: The supply chain of (99)Mo/(99m)Tc is quite fragile; therefore, being aware of the most appropriate coping strategies is crucial. It is essential to build a strong collaboration between the nuclear pharmacy and nuclear medicine department during a shortage situation. With both nuclear medicine departments and nuclear pharmacies implementing viable strategies, such as the ones proposed, the amount of (99m)Tc available during a shortage situation can be maximized.