Questionnaire survey of hospitals in Saitama Prefecture regarding the shortage of 99mTc-labeled radiopharmaceuticals and 99Mo/99mTc generators

Objective and methods A questionnaire survey was conducted at all 32 hospitals in Saitama Prefecture to investigate the current difficult situation in terms of nuclear medicine management in the face of the 99m Tc shortage due to insufficient supply, and 29 hospitals (90.6%) replied. Results Of the 29, 15 (51.7%) reported a reduction in the number of nuclear medicine studies performed due to the shortage of supply, although the reduction was small. The decrease per month was less than 20 studies in 73% of the institutions. Of the nuclear medicine studies that involve the use of 99m Tc, the studies whose reduction in number most seriously affected patient management were, in decreasing order: 99m Tc-MAA lung perfusion scans, 99m Tc-MAG 3 , 99m Tc-DTPA, or 99m Tc-DMSA renoscans, 99m Tc-MDP bone scans, 99m Tc-HMPAO or ECD brain SPECT studies, 99m Tc-MIBI or tetrofosmin myocardial SPECT studies, 99m Tc-radiocolloid sentinel lymphoscintigraphy, 99m Tc-HSA-D or pyrophosphate bleeding scans, 99m Tc-GSA hepatic function reserve scans, and 99m Tc-MIBI parathyroid scans. The reduction is probably ascribable to factors such as cancellations of emergency studies, absence of substitute studies, sequential studies using the same radiopharmaceutical, and higher cost of the syringe-type products than the vial-type products. Substitutes for 99m Tc studies were performed at 52% (15/29) of the institutions. Myocardial perfusion imaging with 201 Tl chloride was the most common substitute study. Conclusions The results of this survey suggested the several procedures to resolve the issues related to the shortage. The staffs at all institutions except one gave the impression that their nuclear medicine ordering systems had been greatly affected by the shortage of supply. This adverse circumstance, however, may provide a good opportunity to educate the public about nuclear medicine studies that use 99m Tc and SPECT, with which citizen are now unfamiliar.