04 Jul Supply of Technetium-99m For Cardiac Stress Testing Constricted By Regulations and Aging Reactors
MedicalResearch.com Interview with:
Venkatesh Locharla Murthy MD,
PhD, FACC, FASNC
Assistant Professor, Internal Medicine
Frankel Cardiovascular Center
University of Michigan
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Technetium-99m, which is very commonly used for cardiac stress testing, has had multiple supply disruptions due to aging nuclear reactors where it is produced coupled with changing regulations to minimize the risk of nuclear proliferation. The most severe of these disruptions occurred over six months in 2010.
We asked whether this disruption lead to changes in patterns of care among Medicare beneficiaries. We found that during this time, use of technetium-99m in nuclear stress testing fell from 64% to 49%, reflecting a shift towards thallium-201, which has higher radiation exposure and lower diagnostic specificity. This was reflected in a 9% increase in the rate of cardiac catheterization after a nuclear stress test during the study period, implying nearly 6,000 additional, possibly unnecessary, catheterizations during that time.
MedicalResearch.com: What should readers take away from your report?
Response: Future disruptions in the supply chain for technetium-99m have the potential to increase radiation exposure to Americans undergoing stress testing while also decreasing diagnostic accuracy and increasing costs due to additional heart catheterizations. In order to avoid recurrences of this lose-lose-lose scenario, continued attention from policy makers and the medical community will be essential.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: Further investigation into the real world factors affecting cardiac stress testing, one of the commonest and most costly types of diagnostic testing, would be very helpful and likely would yield clinically relevant and actionable insights. Additional research into methods to stabilize the technetium-99m supply chain is critical and should be supported.
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Cardiac Stress Testing and the Radiotracer Supply Chain: Nuclear Freeze
Venkatesh L. Murthy MD, PhD, Jessica Lehrich MS, Brahmajee K. Nallamothu MD, MPH
JAMA Cardiology Published online June 29, 2016
Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.
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