Good morning, honourable members. It is a pleasure to be here today. We are honoured to be invited to present to the committee on this important topic of nuclear medical isotope supply from an industry perspective.
My name is Cyrille Villeneuve, and I am vice-president and general manager for Lantheus. Bill Dawes is with me as the vice-president of manufacturing and supply chain.
In our time here today, I would like to give you a very brief overview of Lantheus Medical Imaging, our operations in Canada, and an update on our perspective on the nuclear medical isotope supply situation and its impact on our customers and the patients they serve. Both Mr. Dawes and I will be available to answer your questions afterwards.
Lantheus Medical Imaging is a global, privately held U.S. company, based in North Billerica, Massachusetts. We specialize in providing medical imaging diagnostic products for heart and vascular disease. The company has been a leader in the nuclear medicine industry for more than 50 years, most recently as a division of Bristol-Myers Squibb.
We brought to market pioneer medical isotope products such as thallium and Cardiolite, both of which are used in nuclear medicine to diagnose patients for cardiovascular disease. We believe they are the leading products serving the field today. Cardiolite is most widely used in cardiac imaging, and is the only technetium-labelled myocardial perfusion that has been used to image more than 40 million patients in the United States alone.
In addition to having ten products on the market, Lantheus has a rich pipeline of cardiovascular imaging agents in development for the detection of coronary artery disease and heart failure, and they are also based on medical isotopes.
Lantheus employs more than 600 employees worldwide. We are a fully integrated company with strong research and development capabilities, world-wide manufacturing facilities, a strong distribution network, and dedicated employees. As a global company, we have operations not only in the U.S. but also in Canada, Puerto Rico, and Australia.
[Translation]
In Canada, the head office of Lantheus Medical Imaging is in Montreal. Lantheus employs more than 80 Canadians, including sales and marketing staff, customer service representatives and radiopharmacy staff. Lantheus' international operations are managed from Canada, by Canadian staff.
In addition, Lantheus operates five radiopharmacies in Quebec City, Montreal, Mississauga, Hamilton and Vancouver. At those radiopharmacies, we prepare single doses, injection-ready doses, and we deliver them twice daily to nuclear medicine departments and clinics located near our facilities. We are also currently creating a network of radiopharmacy sites for positron emission tomography or PET, which will allow the distribution of PET products to Canadians.
As you may already know, Lantheus and other manufacturers need medical isotopes called molybdenum-99 in order to produce the daughter isotope called technetium-99m. Technetium-99m is the most used medical isotope in the world. On an annual basis, it makes up 82% of radiopharmaceutical injections used for diagnoses, which is over 18.5 million doses per year. Technetium is a critical component for many medical exams, including cardiac pool scans, brain scans, bone, kidney and various tumour scans.
At Lantheus Medical Imaging, we use technetium in our TechneLite generators. These generators are distributed to hospitals and radiopharmacies as sources of technetium for diagnostic imaging. Technetium is also used with Cardiolite in cardiac imaging, in order to assist in the diagnosis of coronary disease in those who might be suffering from it.
All this to say that a serious and extended shortage of medical isotopes can have serious repercussions on the health and well-being of a great many patients. The fact that the Chalk River NRU reactor has been closed for repair since May 2009 has had a significant impact on our operations and clients in North America.
Lantheus has had the privilege of having a very diversified supply chain, and we are doing everything possible to meet the needs of our clients and the medical community in Canada and the United States given the worldwide shortage of molybdenum-99.
The company has amended its production schedule in order to be ready, upon request, once the supply becomes available. We are working 7 days a week, 24 hours a day, and during holidays, in order to provide technetium generators to our clients. We also have the advantage of having cyclotrons, in the U.S., and we have greatly increased our thallium production so that doctors can have access to an alternative imaging product if they are unable to have access to technetium.
We are working in close cooperation with our clients in order to advise them of current and short-term supply, through direct communication and updates that we publish on our website. Furthermore, we are in almost constant contact with our customers and the medical community on the issue of logistics and distribution.
A number of nuclear medicine departments have amended their schedule, in order to maximize the quantity of technetium that is delivered to them. They are using alternative imaging products such as thallium. They are being forced to prioritize, sometimes postponing exams and sometimes even restricting the number of patients.
[English]
Since the beginning of the medical isotope supply shortage, Lantheus' Canadian operation has had one objective: to ensure that as many patients as possible receive their treatments or diagnostic tests. To achieve this goal, we have identified and implemented a number of actions.
We are working closely with Health Canada and the other companies that operate commercial radiopharmacies to ensure that technetium generators and unit doses are utilized equitably. We coordinate distribution of unit doses to all customers to make sure that all customers have some product for imaging.
We continue to collaborate with provincial health authorities to try to provide a similar level of available unit doses to health institutions that do not have radiopharmacy service.
To maximize unit dose availability, we have extended our radiopharmacy working hours to include evening and weekend production to maximize the quantity of technetium that is available.
We have substantially increased the availability of thallium, a product manufactured in a cyclotron, as an effective substitute to technetium-based cardiac agents such as Cardiolite. A vast majority of our customers have switched to thallium in periods of technetium shortage, assuring us that a baseline level of cardiac testing for patients has been maintained.
The significant efforts that Lantheus is making to develop a network of positron emitting radiopharmaceutical, or PER, manufacturing sites across Canada will not only have an important impact on the availability of existing Health Canada approved PET products for the Canadian health care community, but it will also prepare the market for the introduction of future innovative PER technologies and effective research PERs, such as sodium fluoride and other F18-based compounds that could be made available in a CTA environment.
The isotope supply crisis has also raised interest in other newer technologies and imaging modalities such as PET imaging. Lantheus already distributes GLUDEF, F18 fludeoxyglucose, a product used in the evaluation of patients with suspected cancers. We manufacture GLUDEF through a manufacturing partnership with the University of Sherbrooke. Lantheus is in the process of expanding the availability of GLUDEF to other parts of the country, and it is actively working on commissioning two other production sites, at the Montreal Neurological Institute and the Lantheus Mississauga radiopharmacy. Our strategy is to expand the PER pharmacy network to other parts of Canada to more broadly serve the needs of the Canadian medical community in the future.
[Translation]
Since our international operations are located in Montreal, Lantheus has a number of major clients in Canada. We are extremely determined to meet the needs of the Canadian market and we are doing everything possible to ensure that Canada receives the largest possible share of available technetium during this difficult time of reduced supply of medical isotopes. However, many of the solutions we have already discussed are short-term measures intended as stop gaps until isotope supply becomes accessible once again.
Having the NRU reactor come back online would greatly assist in reducing the impact of the world isotope shortage, particularly in North America. Since the HFR reactor in the Netherlands was closed at the same time as the NRU reactor, the medical isotope shortage is being felt all the more, which demonstrates the importance of having access to accessible and diversified sources of supply throughout the world as well as the importance of cooperation between industry, regulatory bodies and project promoters.
We believe that the short- and medium-term solution to ensuring stable medical isotope supply for Canadians is to repair the NRU reactor as quickly as possible and to provide financial support to efforts to ensure that the licence is renewed until 2016.
At Lantheus Medical Imaging, we are extremely determined to work with our clients and their patients, our suppliers and government agencies in order to ensure a more stable supply of medical isotopes in both the short and long term for the medical community and for patients, for whom we are all working.
Thank you for giving us the opportunity to speak with you today. We greatly appreciate this privilege and we would be pleased to answer any questions you may have.
My presentation will be quite brief, so as to allow a lot of time for questions. I imagine that you have many.
For almost a year now, we have been dealing with the isotope shortage in Sherbrooke and throughout Quebec. Approximately 30% of the shortage is a result of the shutdown of the NRU reactor. There have been benefits for the health care system, but it has also caused problems.
With regard to the benefits, I am referring mainly to the optimum usage of medical isotopes. Isotopes were no longer wasted if a patient failed to show up, we called the next person on the waiting list. One dose could be cut in half, which allowed it to be used for two patients. Since this product has a short life and we had it evenings and even weekends, we were able during that same period to really maximize usage. That is the positive impact of the shortage.
However, the alternatives created in response to the shortage are problematic. We are talking a lot about thallium, which is used in myocardial perfusion. We are using it as a substitute for MIBI, but it is not the best substitute. In comparison to the radioactive tracer, this product generates a much higher dose of radiation in patients and it is not as effective in overweight individuals. For people who are very overweight, the images generated are of lower quality. Ultimately, this has consequences on the health care system.
Other technologies can also be used, such as magnetic resonance and CT scans. However, even if these technologies are available, they are relatively costly. The use of such technologies has already been maximized. If we transfer people needing nuclear medicine exams to magnetic resonance imaging, for example, we're only moving the problem around. The equipment cannot deal with the surplus.
On the other hand, many new alternatives have been tried. Today, there is a lot of interest in positron emission tomography. A number of specialists and I believe that it is really the technology of the future. The problem is that, approximately 31 of these devices are available in Canada and 15 of them are in Quebec. The geographic distribution of this technology is not sufficient. It can be very well used in Quebec. We use it a lot. I would say that, in Quebec, the crisis has likely hit us less, given the availability of these positron emission tomography machines. Thanks to them we can do bone scans, myocardial perfusion studies and many other examinations. In my opinion, it is really a technology we should look to and we must encourage its development.
Doctors believe that patients should never be deprived of an examination. The NRU alone is responsible for 30% of the shortage in global production, but no patient has really suffered from the shortage. Some exams have been postponed, but everyone has been able to have an exam and no one has really suffered.
However, the Dutch reactor is now being repaired and the isotope shortage has reached 60%. As a result, the shortage will be felt, and I truly fear that some patients will not be able to get an exam in time. We will rack our brains and try to find solutions, but I can tell you that, at present, there are few solutions. Furthermore, we don't really have the time to find new ones.
The floor is now yours.
We're hearing reports this week, as we've heard reinforced this morning, of dramatically dwindling supplies of medical isotopes. We're also hearing numerous reports coming out of testing for cancer and treatment for heart disease being cancelled or postponed. We can imagine what a dramatic impact this must be having on patients and their families.
As recently as last Friday, when I asked the Conservative government in question period, they continued to deny that there's a growing crisis in relation to medical isotopes.
You may be aware that Dr. Jean-Luc Urbain, who is president of the Canadian Association of Nuclear Medicine, said the supply of isotopes will slip to about 25% on average, and of course the patients will feel the crunch. He's in fact talking about having to cut service. We've heard a bit of that this morning as well.
The Society of Nuclear Medicine in the United States is describing the shortage as “one of the most significant disruptions ever”, and supplies are expected to be scarce in Canada for about two weeks, according to nuclear medicine specialists. Perhaps we can hear more on that.
Hamilton Health Sciences experts say they expect to see the isotope supply drop to 15% by Friday.
The Ottawa Heart Institute has cancelled seven patients who were booked for appointments today: “Hospitals are being affected to varying degrees depending on their arrangements with isotope suppliers.”
So I guess I'd like to hear more from Mr. Turcotte.
[Translation]
First, I would like Dr. Turcotte to tell us about his personal experience, in his position, and the challenges that he and his colleagues face in managing this crisis.
That is an excellent question. There are major challenges. At present, we are being asked to do the impossible with a bare minimum. Among the major challenges, there is the fact that the shortage varies from one day to the next. It is extremely difficult to schedule exams, even within a 24-hour window. Since I don't know how much radioactive products my department will receive the next day, it's difficult to tell a patient the night before to get ready for a given exam. It's really a logistics problem. Sometimes patients are asked to come to the hospital, but then there isn't any radioactive product to use for their exams. That is really the number one problem.
Second, there is the issue of priority. When you only have 15% or 20% of a component needed for exams, it's clear that the most urgent cases get priority. However, it is difficult to determine which cases are the most urgent. In some cases, it may be a matter of life or death. We have to rely on common sense. It is essential to always determine whether the patient's exam can be postponed a few days or whether it is really essential, for example if the patient is about to undergo surgery or chemotherapy in the next few hours. It's a logistics issue. In order to compensate for this, we need to be able to operate on evenings and weekends, to ensure that the department is open when the product is available.
Third it is a matter of looking at the choices that can be provided to patients. The myocardial perfusion can be done to check blood vessels. Coronary angiographies or angiograms allow us to see blood vessels. The main advantage of nuclear medicine is that these exams are not invasive. Injecting radioactive products is the most invasive part of our exams. However, the proposed alternatives are sometimes more invasive. It may be necessary to put a patient on a gurney and use special injection products. Ultimately, the alternative may carry a higher risk of mortality than the nuclear medicine exam. Furthermore, diagnostic sensitivity can be decreased when using alternatives.
We provide other choices while ensuring that they will enable good diagnostic results and that they will not be harmful, while trying to do the utmost for our nuclear medicine patients. This is a daily challenge.
:
The question is also very relevant.
Since the situation began a year ago, hospitals have learned to live with the 30% shortage created by the shutdown of the NRU. Clearly, this has generated increased stress for staff and doctors, because operating hours vary widely. In the past year it was possible to practise very good medicine and to take good care of patients. The current problem relates to the Dutch reactor's breakdown, which has added an additional 30% shortage, which really hurts. The delicate balance that we had achieved at 70% of operating capacity has dropped to less than 30%. This is a major problem.
With regard to the NRU's repair, clearly, the fact that its repair is being done at the same time as that of the Petten reactor means that the situation remains problematic. At present, things are even worse, since maintenace work is being done on other nuclear reactors during the week. This has worsened the crisis for us. In reality, as long as there is a shortage at the two major reactors, the situation will remain extremely precarious with regard to our exams.
As for announcements about the progress in repairs to the NRU reactor, honestly, in medical circles, it has almost become a joke to get an AECL report talking about 30%, 35% or 40%. Medically speaking, this is irrelevant. We only want the reactor to become operational again. The repeated postponements that have been announced since January have meant that we no longer take AECL seriously.
We continue to hope that the reactor will resume operations by fall. It is likely more realistic to think that it will happen in the fall rather than in the spring.
I want to thank our witnesses for coming.
You know, this situation is of great concern. Every week, we hear about the sick and people who are worried.
Dr. Turcotte, you said that examinations were continuing but that you could cite cases where some exams were postponed, mainly for seniors, in your region. It remains of grave concern no matter who it is.
Mr. Villeneuve, you said that the Chalk River reactor shutdown had a significant impact on you. You told us how you had managed to adjust to the situation. I would like to have more details on the consequences.
I would like to ask you another question. You said that your thallium production had increased. Dr. Jean-Luc Urbain, President of the Canadian Nuclear Medicine Association, told us that this was a 20th century technology, meaning a technology that could be used for now but that was nonetheless out-of-date.
How do you see the future of thallium? Is it really simply an alternative or do you think that, in the long term, this will be a future solution, if the shortage continues and Chalk River remains closed for a long period of time?
:
The beauty of positron technology is that, first of all, it does not depend on nuclear reactors whatsoever. To produce isotopes, we need a cyclotron. Hospitals and universities have one. There is one at the Molecular Imaging Centre in Sherbrooke, one at the Montreal Neurological Institute, one belonging to a private company called Pharmalogic in Montreal. There are also several in Ontario. This equipment uses electricity. So we establish a target, turn on the electricity to the cyclotron and isotopes are produced.
The disadvantage of isotopes produced using the cyclotron is that these isotopes have short half-lives, half lives of 10 minutes, 20 minutes, 110 minutes, 3 hours. This is far from technetium's 6 hours or even further from molybdenum's 66 hours. As a result, these isotopes need to be produced each day they are used.
What else do we need, in addition to cyclotrons, for positron imagery? We need special equipment. We cannot use the SPECT devices, the gamma-cameras that use technetium, in order to use the positron. This means that the some 600 SPECT devices available in Canada cannot be used with positrons. We are really limited to the 30 devices available. These are relatively costly devices. We are talking about technology worth approximately $2.2 million. SPECT technology, a 2010 technology, which uses technetium, costs $1.1 million. The PET device is only twice as expensive.
The results are far better in terms of diagnoses. Exams are much shorter. A bone scan exam using nuclear medicine may last four hours. The patient must then spend four hours at the hospital in order to undergo the exam. The same exam done using sodium fluoride positron technology will last 45 minutes. So there are a number of advantages, including better resolution, better diagnoses, much less time spent in the hospital, and many more patients can be diagnosed each day. That is why this technology, in 10 or 15 years, will become the preferred technology. However, we are not there yet. We do not have enough cyclotrons.
Furthermore, I would like to stress that these famous cyclotrons can produce isotopes using positrons. The cyclotrons are really helping us survive this shortage to some extent. They are producing thallium and gallium-67. The nuclear reactor is producing iodine-131 and technetium-99, by using molybdenum and nuclear medicine. The remaining isotopes are produced using cyclotrons. So it is a good hybrid technology that can produce old isotopes one day and new ones the next.
My questions are for Dr. Turcotte.
Dr. Turcotte, I have a short time. Please give brief answers if possible, because I have several questions. Let me do my first group of three questions, and then answer those, and if we have time, we'll do a little more.
I'm trying to understand why--this is in the broader context of the report of the expert panel, not all of which you touched on today--given the high cost, of at least $0.5 billion or maybe $1 billion, and the long timeline of a multi-purpose research reactor, the panel's report appeared to emphasize that option. Did the cost you considered include the permanent storage of nuclear waste?
Given the projected excess capacity in the longer term, as opposed to the short-term shortages that we have now, why is there such a long-term and expensive option, given the long lead time before production? Did the environmental and security risks posed by nuclear waste factor into the panel's decision? When considering the cost of a new reactor, did the panel look at the significant cost overruns that have traditionally occurred to a huge degree in reactor refurbishments or new reactors?
We've previously had other expert witnesses before this panel who have been much more sanguine about the thoughts of linear accelerators or cyclotrons rather than about using the traditional nuclear technology.
Could you answer those questions, please?
:
Let me start with the where and with a kind of timeframe for production. I think many who have studied this topic are familiar with the global supply chain. There are global suppliers of molybdenum around the world. These are the reactor producers or reactor-based suppliers. They include Nordion, through their relationship with AECL in Canada; IRE, through their relationship with three reactors in Europe; and Covidien, through their relationship with a number of reactors in Europe. Also, there are folks down in South Africa operating the SAFARI reactor, and the name of that firm is NTP.
There's a new reactor that has come online in Poland and is offering some promise of additional supply to the global medical isotope community. Also, there's a new reactor that has been built and is in the process of having its production ramped up so that it can also be a contributor to the global supply of molybdenum.
That's what the reactor supply chain looks like today.
As we look at the medium term, we see a number of solutions that we hope will come online in the future. There are solutions in various geographic locations, with some proposed in the United States that are in the medium term to the long term. Others are proposed in other geographies of the world. Either these exist today and will go online in the future to potentially produce molybdenum, or they are others that will be built in new geographies.
Looking at the timeframe for molybdenum production, or technetium production, as in our case, it is really a real-time supply chain. At Lantheus, what we see during normal times is a five-times weekly basis, and during less than normal times, it's something less than that. What we see is ourselves sourcing material from these global suppliers. In the event the materials come in from Canada, it takes about an hour and a half for us to transport material to our site from the finishing site at Nordion. In the case of NTP and South Africa, it takes in excess of 24 hours to transport that material from the reactor site following the finishing process to our site just outside of Boston.
Once that material is delivered to our site, at either eight o'clock in the morning or eight o'clock in the evening, depending on the run time or the start time of our run, it then takes us about eight to twelve hours, depending on the size of the run and different parts of the manufacturing process, to produce, perform quality testing, and then release those generators. Those then go into our distributional logistics system and are then distributed to locations throughout North America--to include Canada--and then also to some small number of international locations.
That supply chain, and the logistics portion of the supply chain, brings us full circle in most cases to where, ideally, we can see a patient dose being delivered to a patient only 24 hours after our first manufacturing step conducted at the home office at the Billerica site. Doses that started being manufactured as a generator at eight o'clock in the morning on a Monday, as an example, could go into a patient as early as eight o'clock in the morning on Tuesday.
It is very, very much a real-time supply chain. It is one where we carry no inventory because of the half-life and decay of the product and one that needs to be very reliable in order to ensure that we're getting the patients what they need and getting the doctors, ultimately, what they need to do their job for the medical imaging community.
When we look at how we guarantee the supply to Canada, I think it's important for everyone to understand that we have a very, very significant Canadian business as part of our portfolio at Lantheus. That part of the business in Canada is a very, very important part of our business. We work extremely hard across our customer base, both in the United States and in Canada, and for some of those global locations that I described, to ensure that we are equitably distributing the material that we are able to source from these global reactor producers.
We have that approach of equitability regardless of where that supply is coming from. We're really working to ensure that the maximum number of our customers and, ultimately, their patients can be supplied under any of the supply chain circumstances that may exist at any given time.
Could you restate the last question for me?
:
As the chair said, my name is Daniel Banks, and I'm here to testify as an individual, and more specifically, as an individual who is part of a grassroots group of volunteers known as CREATE. With me today is Gord Tapp, who's also a member of CREATE.
First, let me tell you what CREATE is. CREATE stands for Chalk River Employees Ad-hoc TaskforcE for a national laboratory. Some call it an awkward acronym, but I prefer to call it a creative one.
CREATE is, as I said, a grassroots, non-partisan group of volunteers. It includes current and former employees at Chalk River. I emphasize that each one speaks for himself and not for his employer. In May, Natural Resources Canada announced that AECL would be restructured. A few months later, CREATE was established as a grassroots effort to propose a vision for the future of Chalk River as a national laboratory that would include a new multi-purpose research reactor.
In the fall, CREATE developed and proposed its concept for the future mission of Chalk River, and we solicited support for our concept through consultations with other staff at Chalk River and vetted it with experts. We revised our vision as a result of those consultations and the feedback we received from the community and from staff. The results of this work are presented in our report, which is available on our website, “www.futurecrl.ca”. We've given some copies of the report to the committee clerk.
I would like to briefly present that vision.
The future Chalk River National Laboratory, or CRNL as I will call it, would be a vehicle for mobilizing science and technology to Canada's advantage by greatly broadening its scope. As a national laboratory, it would serve Canada, rather than serving one corporation as a company laboratory. We envision that CRNL would be Canada's premier laboratory for nuclear and related sciences.
Incidentally, I want to interrupt my presentation to comment that TRIUMF, which is also represented here today, is Canada's national laboratory for nuclear physics and particle physics, and although that may sound a lot like what we're presenting, it's quite different in practice. Chalk River and TRIUMF are complementary facilities rather than redundant ones. I just wanted to be clear on that.
Back to Chalk River National Laboratory—it would be a resource for researchers from across a broad spectrum, from fundamental sciences to industrial applications, including but not limited to research in development that supports the nuclear energy sector in Canada. Compared to the Chalk River of today, CRNL would be much more outward-looking by partnering and impacting at all levels of Canadian society. That outward focus includes several new functions—new to Chalk River—which includes leading diverse research programs beyond nuclear energy; partnering broadly with universities, industries, and government; as well as commercializing knowledge through high-tech spinoff companies incubated at Chalk River, or knowledge that is commercialized through transfer to industry partners and encouraging entrepreneurial investment in that sense.
In addition, by partnering with post-secondary education, CRNL will serve as a training ground for Canada's future generation of scientists and engineers by providing them with a creative research environment as well as world-class research equipment.
Such a national laboratory will also be a powerful tool for encouraging young people to seek science-based careers and for fostering a science and technology culture.
In summary, CRNL will be a major player in a greater mosaic of institutions across Canada that will help to build a sustainable national competitive advantage based on science and technology.
We see that the opportunity has arrived to begin a transition of Chalk River into this Chalk River national laboratory by establishing a future direction, such as we have proposed, with a suitable governance and business model to go along with that, in consultation with potential partners and clients.
In parallel to all of this, we also believe it's important to begin detailed planning for a new multi-purpose research reactor for research and isotope production that can take over and expand the functions of the aging NRU reactor over the long term. We believe the question of that new multi-purpose reactor is very closely related to the question of the future of Chalk River as a whole. It's difficult to consider those concepts in isolation.
Now that I have set out CREATE's vision, I want to emphasize a few points.
First, as a national laboratory, Chalk River would require baseline federal funding, but it would also attract revenue from various streams. Sources of revenue would include research partnerships with industries, including the commercial CANDU business that would result from the restructuring of AECL. It would also include full cost-recovery fees for access to its resources for proprietary research, waste management, or isotope production. We think this is indeed an important change. The practice of recovering full costs for proprietary access to the facilities would be a major step towards ensuring sustainability in a global supply network based on sound economics for isotope production.
Secondly, the future of Chalk River is a much larger question than the question of isotope supply. Of course, medical isotope supply is important to Canada, but it's only one of the issues. This was in effect recognized by the NRCan expert panel on medical isotopes, when it stated that “a multi-purpose research reactor represents the best primary option to create a sustainable source of Mo-99, recognizing that the reactor's other missions would also play a role in justifying the costs”.
Let me talk about the business model a bit more, because CREATE believes the other missions justify the costs.
Nuclear energy research and development will remain a key area. Canada's investment in the NRU reactor has been paid back significantly by spawning the Canadian nuclear energy industry, which is currently an enterprise of $6 billion per year, with significant room for growth. But even if no nuclear power reactors are built in Canada, R and D is needed to support the existing fleet of CANDU power reactors around the world.
For example, a research reactor would be used to obtain more precise knowledge of the conditions of materials inside nuclear power reactors that cannot be obtained by other means. It is likely the increased precision of that knowledge could allow Canada to safely extend the life of its reactors. Life extension of the fleet for even a few years would likely save Canada billions of dollars in electricity generation costs.
However, nuclear power is likely to be an even greater part of Canada's energy portfolio in the future than it is today, in part because we need clean sources of energy to replace depleting supplies of conventional fuels. In that case, nuclear R and D will be essential to take advantage of the energy available in our uranium deposits.
There are then all the other benefits of research in other areas, from biotechnology and nanotechnology to improving the reliability of aircraft components and bridges. There are also benefits in attracting and training highly skilled people. These benefits are more than the substantial economic impacts. They're also in health, energy, security, education, the environment, and the general well-being of Canada and the world.
:
Thank you for the opportunity to be here, Mr. Chairman and distinguished members of the committee.
I want to compliment you on the organization of these panels. The first panel focused on emergency response and first aid. As witnesses, we're looking a little bit further down the road.
I'd also like to thank the citizens of Canada for their vote of confidence in TRIUMF with the announcement of core operating funds in budget 2010. It really sets TRIUMF up to make a big difference for the future.
We're discussing today the present state and future vision for medical isotopes in Canada. I'm here to say that repairing the NRU reactor is only half the story. We need, and Canada needs, more than a return to business as usual.
Some may remember the oil crises of the 1960s and 1970s. These incidents gave the western world a glimpse of the fragility and the vulnerability of the oil-based energy supplies of the day. Although there's not a direct parallel, the current crisis in supply of reactor-based medical isotopes should open our eyes. Yes, a return to operation for the NRU is urgently needed, but is there a broader lesson?
Fortunately, Canada is rich with alternatives for making and using medical isotopes and there are promising moves forward to exploit this. In fact, Canada has a global advantage that we can use to save lives and maintain a dominant role in a billion-dollar global market. You've heard about some of these alternatives from my distinguished colleagues.
Let me say something about TRIUMF's role in this. As a national laboratory owned and operated by 15 of Canada's great universities, we are committed to developing short- and medium-term solutions, as well as a long-term vision for nuclear medicine in Canada. You've heard some of that from the other folks this morning.
We have a 30-year partnership working with MDS Nordion in Vancouver, which generates 15% of the medical isotopes exported by Canada each year. This amounts to about 2.5 million patient doses.
TRIUMF is a centre of excellence for the physics, chemistry, and biology of medical isotopes. We are fundamentally a basic research and development laboratory. Deployment of technologies we do with commercial partners. TRIUMF is not in the business of producing isotopes for commercial sale; we're in the business of generating the ideas and the technologies that true business people can use.
Our short-term solution examines the viability of using existing medical isotope cyclotrons around Canada for direct production of technetium-99m. That's the isotope actually used in the radiopharmaceuticals.
Dr. Turcotte referred you to this brief earlier. He is part of a collaboration that was funded in October of last year for $1.3 million, with support from NSERC and CIHR, to examine this technology. TRIUMF and the B.C. Cancer Agency are leading this effort. The collaborating institutions include Sherbrooke with Dr. Turcotte, Cross Cancer Institute in Edmonton, as well as Lawson Health Research Institute in London, Ontario, and there is a small company involved as well.
This technology would use proton beams from existing commercial cyclotrons to irradiate a new target material, known as molybdenum-100, to produce the technetium. The advantage of this technology is that we'll be conducting human clinical trials within 18 months and it could be deployed without significant changes to the equipment already in place around Canada.
The disadvantages, some of which you've already heard, are that the medical isotope cyclotrons in Canada are limited, and by directly producing technetium, which has a six-hour half-life, you're limited to how far you can transport this medical isotope. However, as the regular adage goes, most of Canada is concentrated within a few hundred kilometres of the major population centres.
Another advantage is that this technology, if proven in the laboratory, is easily licensed in the private sector. The participating institutions are using cyclotrons manufactured in Canada, as well as models manufactured by General Electric. So this technology could not only work in Canada but also be licensed around the world.
TRIUMF is also investigating a more sophisticated medium-term solution, known as photofission, about which you've heard several times, and Dr. Turcotte referred to it earlier. This builds on Canadian breakthroughs in accelerator technology and proposes to integrate almost seamlessly with the current supply chain for molybdenum-99 generators.
We used to use reactors as the most intense source of particles for experiments. The world is moving to using accelerators for some of these applications because they can be easier and cheaper to license and operate.
With support from CFI—the Canada Foundation for Innovation—and other agencies, TRIUMF is constructing a new multi-purpose research accelerator. This device, known as the e-linac, or superconducting electron linear accelerator, will be used to validate the proposal of creating molybdenum-99 with a linear accelerator using natural uranium.
So there are two distinguishing features of this technology. It does not use weapons-grade uranium. It does not use diluted weapons-grade uranium. It's actually using U238, the isotope most naturally abundant and occurring in the ground, for instance in Saskatchewan. The second element of this technology is that the current competitive advantage that Canada enjoys in producing moly-99 is based on the partnership between AECL and MDS Nordion in separating out the moly-99 from the uranium and the rest of the junk. Thus, linear accelerator photofission technology would use that same mechanical and chemical separation.
Now, TRIUMF is in the business of fundamental research. This is a technology demonstration, which will be the first experiment we run on this new accelerator. If this demonstration lives up to its promise, the technology could be commercialized and licensed by about 2015. We're working with MDS Nordion to benchmark the business case.
It's key to point out that there's been some confusion about this technology and its generation of radioactive waste. It does use electricity, not a nuclear power reactor. In fact, a more powerful accelerator being built in Switzerland using similar technology is going to be powered entirely by windmills. It's possible. B.C., of course, is plentiful in hydro power. We're also working with other solutions that span the space of short and medium term.
Now, our long-term vision asks the question: the medical isotope crisis is really a supply and demand issue, how long will the global demand for moly-99 last? And you've heard some of the expert opinions on that. Our assertion is that the market dominance of molybdenum-99 is going to last for about a decade and probably not much longer. The future is being driven by the so-called PET isotopes and technologies, about which you've heard quite a lot from both Lantheus Medical Imaging and Dr. Turcotte.
PET isotopes offer lower radiation doses to the patient, improved sensitivity resolution, and, perhaps not as well known, much more sophisticated probing of biological and pathological pathways within the body. As we've heard, the challenge is deploying the production infrastructure and the scanning infrastructure. There are 31 PET scanners in Canada. In terms of the scanners for using technetium, there are about 2,000. However, for the first time in the last 40 years, the new sales of PET scanners have surpassed the new sales of the technetium scanners. So we are on the cusp of a market shift.
Canadians are in a tough spot presently, with the shutdown of the NRU and the HFR reactor. Our health care providers and nuclear medicine specialists have been incredibly resourceful to help us get through this time period.
There are a number of exciting paths forward. New developments are quite promising, such as the $48 million in federal funds announced in budget 2010, which will be dedicated to research and development for diversifying the supply of medical isotopes. The future is bright, and there is much work to do.
Thank you, again, for your time.
:
I apologize for that paragraph being confusing, but the reference to 10 years was to mean that it may take a decade or so to actually set up and implement the vision that we're talking about.
When you're talking about recovering full costs for things like isotope production, you recognize that you have waste management issues and costs of processing the isotopes on site. All those costs are unique to the isotope production mission, so all of them have to be recovered; otherwise, you're subsidizing that mission.
The NRCan expert review panel specified that you'd recover about 10% to 15% of your reactor costs from isotope production. That's where the multi-purpose nature of the facility is an advantage, because when you're looking at capital operating costs, you divide them among the various missions. You're not recovering all those costs necessarily from that mission; most of those costs are in support of, or would be recovered through, the other missions.
However, all the costs that are unique to isotope production have to be covered. We're not in a position to present the business plan, per se, of how all that would work, but we do know that the costs of production are only about a tenth of the end user market price, so there's significant room to grow without greatly affecting the end users if the business model around that changes.
We mention informally that in order to recover those costs, there would be an increase in the price by a factor of about three at the production standpoint. Essentially what we're saying is that whatever those costs are, let's charge it. We're not in a position to do the calculations and determine that it's going to cost a certain amount and then what the price would be; whatever the price is, let's charge it. That's operating on a sound business model.
:
Thank you. That's an excellent question.
There are philosophers of technology and science who will say that any true substitution for basic logistics takes generations, because those of us who grew up with one technology have to retire out of the workforce. I mean, retiring a steam engine in the coal-fired power plants certainly takes time. We've been working on the hydrogen highway for how many years? Hybrid cars are part of that bridge.
So I just want to point out that the resistance to moving from technetium-based SPECT technology, which I will define in a moment, toward the next generation of PET technology is not bottlenecked with any particular element of the business practice or the clinical practice. It's really the precautionary movements about the medical community and the regulatory bodies, which are serving the best interest of Canadians.
What we're saying is that we are at that cusp where the future technology is going to become the predominant element. The challenge with PET technology, as we've heard from the previous experts, is that right now it's twice as expensive to obtain the imaging equipment in the clinic. That's a challenge for health care systems that have burgeoning costs. However, the payoffs of using that technology would be tens of thousands of dollars per patient if fully implemented. That's where it takes these cancer care delivery agencies in Quebec and British Columbia and some of the other provinces to really push the envelope.
Other challenges within the medical community are establishing the correct basis for prescribing the new types of scans. Doctors like Sandy McEwan at Cross Cancer Institute are some of the pioneers in that area of looking at how to integrate that fully into the clinical practice.
My view is that resistance is really.... It took me a long time to learn how to program my VCR. That's both my fault and the fault of Sony and Panasonic for having complicated instruction manuals. But now I do it from the web.
The second point is how a PET scanner actually works, and whether that influences this resistance in adopting the new technology.
As I said, there are physics, chemistry, and biology here, and the basic difference here is in the physics. When we talk about a medical isotope, we're talking about an unstable, or some would say a radioactive, atom. There's a nucleus, and it decays by emitting a particle. In the technetium-based imaging products, we have a nucleus that decays and emits a photon, which is a small particle of light that exits the body and can be picked up by a camera.
In PET isotopes, “P” is for positron. When a PET isotope decays, it emits a piece of antimatter. It's an anti-electron. When that anti-electron annihilates, as we all know from Star Trek and Angels and Demons--Tom Hanks has not yet come to TRIUMF--matter and antimatter annihilate. When that positron meets its neighbouring electron within a few micrometres, it annihilates and what's emitted are two photons. So already the physics is different. One medical isotope of technetium gives you one photon; one medical isotope of a PET isotope gives you two photons.
Now, there's an advantage there, which is twice the count rate, but also some physics governs the emission of those photons, so you have a lot more information about the geometry of where was that medical isotope.
That's the basis of scanning. It's identifying where is the medical isotope.