Nuclear medicine: Concern for patients

The UK is due to quit the Euratom Treaty, which covers the distribution of radioactive materials and the associated safeguarding procedures, as part of Brexit. Ionising radiation includes X-rays and other procedures that use radioactive materials. Any significant reduction in the supply chains for these materials could impact radiologists’ ability to provide the range of diagnostic tests and radiotherapies on which clinicians rely.

Ironically, the impending departure from the Euratom Treaty is an unintended consequence of the UK’s decision to leave the EU.

As part of its Brexit planning, the government has been preparing to replace provisions of the Treaty with laws to be enacted in the UK. In November last year, the government agreed the terms of the UK’s departure from Euratom with the European Commission as part of the negotiated settlement. Whether, or how, these agreements would survive a no-deal Brexit is unclear. During negotiations, attempts have been made to maintain as many of the UK’s relationships with the other Euratom members as possible.

At present the inspectors responsible for overseeing the safeguarding are warranted by Euratom. The inspectors are responsible for ensuring that all procedures are conducted safely and in accordance with the relevant laws and protocols. In the event of Brexit, the appointment, training and management of these inspectors would pass to the Office for Nuclear Regulation but as the training of inspectors takes four to five years, there is potentially a challenge in a shorter transition.

In the run up to the previously earmarked March 29 departure date, efforts were made to stockpile crucial materials to avoid disruption at hospitals. These were hampered by the challenges of dealing with commonly used isotopes, some of which have half-lives measured in hours. Because of its short half-life, Technetium, which is widely used in medical applications, is usually made within radiology units from Molybdenum ‘generators’ immediately before use. Euratom member producers of this isotope include France, Poland, the Czech Republic, Belgium and the Netherlands – but not the UK.

The majority of UK hospitals’ requirements for radioisotopes are imported, though material used for PET/CT scanning is manufactured in the UK and not at risk. Radioactive materials are not popular with airlines, as they have to be moved inside very heavy thick lead pots; nor are airports keen on providing the extra handling facilities needed.

The Royal College of Radiologists has been working with the government to prepare for the eventuality of a departure.

In reply to a Parliamentary question from Oxford West and Abingdon MP and physics graduate Layla Moran, on June 27, 2017, asking about the potential effect of the UK leaving the Euratom treaty on energy suppliers and on the availability of radioisotopes for the NHS, Jo Johnson, then Minister for Universities, Science, Research and Innovation, replied:

“We have discussed the UK’s exit from Euratom across the Government and with key stakeholders. Our objective is to ensure that leaving Euratom has no adverse impact on energy suppliers or on our international commitments on nuclear non-proliferation.

“Medical radioisotopes are not special fissile nuclear material, and are not subject to international nuclear safeguards. Therefore, their availability should not be impacted by the UK’s exit from Euratom. As the hon. Lady will have seen, the Queen’s Speech announced the Government’s intention to legislate to establish a domestic nuclear safeguards regime.”

Since 2017, there have been further efforts to seek clarity about whether the UK’s steps will address supply chain issues. In response to questions from TechTribe Oxford about continuity of supply, Curium, global specialists in nuclear medicine and importers into the UK of radioisotopes, issued the statement:

“Curium has been working closely with the Department of Health and Social Care to ensure medical radioisotope supply should be uninterrupted by using air freight ahead of a possible ‘no deal’ EU exit.

“We are directly working with providers in the NHS to discuss any changes to deliveries and to minimise any possible impacts these may have on services.”

Clarifying its current understanding of the situation, Dr Richard Graham, radionuclide lead for The Royal College of Radiologists, said:

“Radioisotope suppliers have been trialing increased air freight, with generally good results – though we are aware one supplier has experienced some difficulties with airport logistics and onward distribution.

“Currently, our supplies of radioisotopes from European nuclear sites are reliable, and providers continue to use a mix of road, ferry and air transport.”

But Dr Graham also warned of the possibility of hospitals not receiving supplies ‘in good time’ and additional costs being passed on to patients.  He pointed out:

“If a ‘disorderly’ Brexit or other circumstances disrupt supply for a prolonged period of weeks – and providers have to switch entirely to airfreight to avoid road and ferry congestion – we remain concerned that logistical and administrative snags could build up and lead to hospitals not getting vital supplies in good time.”

“We recognise and appreciate that the nuclear medicine industry has been taking the issue of EU imports of radioisotopes extremely seriously, and has spent considerable time, effort and money exploring supply contingencies.

“However, the additional costs associated with those contingency measures will likely be – at least in part – passed on to NHS customers, and stand to increase further depending on the logistical fallout of Brexit.”

About the Author

Antony David

A chemistry graduate, Antony spent most of his career using and then making equipment for the music and broadcast industries. He was managing director of Oxford-based electronics and software company, Solid State Logic.