*** URGENT *** Tc-99m Generator Advisory Monday Oct 29, 2018 12:00hrs

To briefly summarise the situation:

a) We are approaching a scheduled maintenance shutdown of the OPAL reactor and therefore also rapidly approaching the period following the shutdown when no local Mo99 is produced by ANSTO (compounded by the shutdown impacting the LMI supply);

b) At this stage, in the first week to feel the impact (W/C Mon Nov 5) it appears that we will have close to 100% of normal supply (nonetheless, potential changes to this status may impact a small number of departments);

c) Similarly as things come back to normal in the 3rd week (W/C Mon Nov 19) supply should be close to normal (more detailed mapping will occur in coming weeks and any change to this status notified ASAP).

The middle week (W/C Nov 12) will see VERY LIMITED supply. At this stage the estimates are that there will only be around 40% of the normal supply of Mo-99 available for generators and only 40% of the total number of generators Australia needs weekly.

The Working Group has considered how to advise ANSTO to distribute the limited number of generators in the most equitable approach possible. In arriving at the suggested strategy below, the Working Group considered how communities rather than specific departments could be best served and believe the following approach ensures the best coverage of services to the Australian community. We suggest that practices plan for this week as best they can with the following considerations:

? All practices should expect no more than 40% of normal Tc-99m availability in the week commencing November 12;

? All routine bookings be brought forward, postponed or cancelled and only urgent cases accepted in this week;

? No generators will be supplied to metropolitan practices. All metropolitan sites will be supplied with unit doses from GMS – with a cap on both the numbers of unit doses available to any one site and reduced amount of radioactivity in each unit dose;

? Some sites geographically outside metropolitan areas that currently receive a generator, but which can practically be supplied by GMS, will be asked to do so & forego their usual generator;

? Regional and rural communities with more than one practice within a reasonable distance for transport between sites will be allocated one generator to be shared between the sites. Preference will be given to the local site with an on-call service with the expectation that they will provide to the other practices nearby in a fair and equitable manner;

? Sites should continue to use their week 1 generator into week 2 – possibly to support on-call service or urgent scans within hours;

? A very limited number of “spare” used generators at the end of week 1 from GMS will be put into circulation for a limited number of regional sites;

? Communities serviced by a single nuclear medicine department will be asked to either share with nearby communities or, in cases where this is not possible, a site may receive a generator with substantially reduced activity;

? Sites should plan to reduce the number of working days in week 2 (W/C Nov 12) by scheduling preventative maintenance on equipment, annual leave, etc.

ANSTO normally supplies approximately 140 locally produced generators per week to Australia and, at this stage, the estimate is that we will only have around 55 generators in Week 2, compounded by reduced activity in each.

We hope that giving this advanced notice to our members will help to mitigate the impact in Week 2 of the post OPAL shutdown period. This situation of cyclic low activity weeks will remain in place until ANSTO returns to full domestic production. However, based on current advice from ANSTO the return to full domestic production does not appear likely this year.

NB: This document contains the advice given to ANSTO by the Working Group of AANMS/ANZSNM/RAINS. They are not required to follow any or all of the group’s suggestions. AANMS / ANZSNM / RAINS