Mo-99 conservation
brochure to learn more about what you can do to maintain patient scheduling during the shortage .
Suggestions to maintain patient scheduling during the Mo-99 shortage
Because the supply shortage is a worldwide problem, all hospitals and clinics are being asked to take measures to conserve supply. Additionally, the advanced warnings of these planned shutdowns have helped the industry prepare for the shortages by discovering alternative methods of meeting demands. Read more about alternative measures you can take in your department.
Use Tl-201 thallous chloride (Thallium)
Implement Stress-only Scanning
Decrease patient dosage
Shift Tc-99m unit dosage calibration/delivery times
Adjust patient schedules
Communicate Frequently
Use Tl-201 thallous chloride (Thallium)
Where appropriate, using Tl-201 may enable your facility to maintain your Myocardial Perfusion Imaging (MPI) studies each day when Tc-99m supplies are reduced. Whether you perform dual isotope studies or follow a Tl-201/Tl-201 protocol, the amount of Tc-99m made available for patient dosages can be substantial.
Implement Stress-only Scanning
For patients you determine appropriate, a normal stress test using a 20-25mCi Tc-99m agent should not require a rest scan. If the stress portion is abnormal, the subsequent rest scan can be done the following day with an equal dosage of 20-25mCi Tc-99m agent.
This option has limitations and is only appropriate if the patient condition meets certain criteria and may require additional pre-screening of the patient. Also note that reimbursement may be affected. Check with your carrier for reimbursement for reimbursement guidelines. For further information on stress-only protocols, refer to the American Society of Nuclear Cardiology (ASNC) at www.asnc.org.
Decrease patient dosage
Consider the impact of lowering the dosage of a Tc-99m Myocardial Perfusion Imaging (MPI) procedure from 10mCi and 30mCi to 8mCi and 25mCi. This represents a savings of 7mCi per patient plus precalibration. Multiply that by a patient load of six per day and one medium-sized cardiac clinic can save over 42mCi of activity which may be enough for one extra patient in our community to get the stress test her or she may need.
To further reduce patient dosage, consider using new imaging technology such as UltraSPECT® WBR™ technology. The Xpress.Cardiac™ and Xpress3.Cardiac™ applications should allow you to greatly reduce the amount of Tc-99m needed to perform routine MPI procedures. Additional information can be found at www.ultraspect.com.
Shift Tc-99m unit dosage calibration/delivery times
Moving calibration times closer to delivery time should stretch the limited supply of Tc-99m. A 30mCi dosage calibrated for 1pm that a department requests to be delivered at 6am requires 67mCi of activity. Now consider that same 30mCi dosage being delivered on a later delivery which arrives at the facility at 10am which is still three full hours before patient administration. This dosage requires 42mCi of activity. Multiply this mCi savings by the same six patients a day and the clinic could help their nuclear pharmacy save 50mCi of Tc-99m that could be used for other patients. Making a change as small as this can free up enough activity in our community to scan multiple patients in a day.
Adjust patient schedules
Afternoon and evening scheduling
Most nuclear studies are performed during the morning and early afternoon hours. As a result, the highest Tc-99m activity demand occurs during these times. Scheduling patients during the “nonpeak” hours (afternoon and evening) can provide for a more consistent supply of Tc-99m throughout the day. This helps us stretch available Tc-99m supply and should provide more Tc-99m unit dosage product in a given day for the entire community. You can discuss these options with your local pharmacy and set up the appropriate delivery times to ensure additional activity is not lost through the decay process.
Weekend scheduling
Most hospitals and clinics do not perform their full nuclear case load on Saturdays and Sundays. As a result, the local pharmacies usually have unused Tc-99m capacity on these days. Being able to adjust your schedules and offer patients a weekend option is a great way to avoid scheduling delays and procedure cancellations.
Communicate Frequently
The most fundamental thing we can do to avoid many of the issues that go along with these shortages is to communicate. Communicate with your local pharmacy every day. Understand the supply logistics for the upcoming week and work with them to establish a plan for your facility. Understanding and planning for events a week or more ahead of time will give you the ability to communicate with and schedule your patients accordingly. Discuss your options with your local pharmacy and together determine the best plan for your facility.
Cardinal Health is committed to working with manufacturers, customers and other global partners to find immediate and long-term solutions to this ongoing crisis.
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