Canadian Isotope Landscape

The year 2018 marked the end of an era for medical isotope production in Canada, as the NRU reactor was taken out of services after six decades of supplying medical isotopes to the world. Nevertheless, Canada continues to play an important role on the global stage as a large scale producer and exporter of several key medical isotopes including Cobalt-60, Palladium-103, and Iodine-125. At home, new cyclotron facilities across the nation are increasing Canadians’ access to PET imaging, while active clinical and laboratory research programs are working with world-class GMP production facilities to bring new medical isotopes – and medical isotope-based diagnostics and therapies – to patients in Canada and around the world.

There are various reactor designs used globally, but they typically fall into two categories — research reactors, such as the NRU reactor found at Chalk River, ON., and McMaster University; and power reactors, such as those used by Bruce Power and Ontario Power Generation to produce electricity. Reactor production capabilities are defined by their neutron energy and flux. Accelerators fall into several categories that are defined by the type of particle (i.e. proton vs electron), the method (circular or linear), energy (in millions of electron volts, MeV) and intensity (in ampheres) of particle acceleration. In Canada, there are two primary types of accelerators used for medical isotope production — proton cyclotrons and electron linear accelerators (elinacs). Proton cyclotrons operate at low (<16 MeV, <100 μA), medium (16-24 MeV, 100 to 500 μA), intermediate (29-70 MeV, 100 to 1000 μA) and high (>100 MeV, >100 μA) capacity. All can be used to produce various medical isotopes. Hospital-based machines are typically low to medium capacity.

The landscape of medical isotope production in Canada is diverse, due in part, to the long-standing and world-class research into reactor and accelerator research. Canada is a leader in reactor construction and application for the production of medical isotopes that have been used globally for the past several decades. Canada relies on both domestic production and the global supply chain to provide medical isotopes to our hospitals.

History of Medical Isotopes and Nuclear Medicine

1901

The first use of a medical isotope was reported, only five years after the discovery of radioactivity. Using the naturally occurring isotope radium-226, physicians successfully cured a tuberculosis patient of previously untreatable skin lesions.

1931

Invention of the cyclotron — a small, circular particle accelerator.

August 18, 1944

Chalk River site officially chosen for the new National Research Council of Canada (later transferred to AECL) nuclear laboratory.

1946

Iodine-131 halted the growth of thyroid cancer and was found to be a useful tool in diagnosing thyroid diseases. This new method of organ imaging was invaluable and marked the beginning of a new era in medical history.

1947

The NRX reactor at Chalk River, Ontario began operating providing an ongoing supply of radioisotopes.

1948

Canadian radioisotopes were exported to the United States for the first time — radium needles used to treat cancer.

July 15, 1949

Cobalt-60 cancer therapy first proposed.

October 27, 1951

The world’s first cancer treatment with Cobalt-60 radiation took place at Victoria Hospital in London, ON. This marked an important milestone for both the fight against cancer and Canada’s emergence as a leader in the field of radiotherapy. To date, approximately 35-million cancer patients worldwide have benefited from this ground-breaking technology.

November 8, 1951

First cancer patient treated with Co-60 in Saskatoon, SK., with Harold Johns’ beam therapy unit. {I&I}

1954

Government approval for the first Canadian power reactor.

April 10, 1959

McMaster University reactor officially opened.

September 1959

Official announcement of the construction of the Douglas Point reactor.

1968

TRIUMF founded. TRIUMF is a national university-owned and operated multidisciplinary facility with decades of experience in medical isotope research, development and production.

May 1, 1970

NRU production of molybdenum-99 began.

1971

Ontario Power Generation (previously Ontario Hydro) produces Co-60 first Cobalt-60 (Co-60) at Pickering NGS.

1978

Collaboration between TRIUMF and AECL-CP establishes isotope laboratory facilities.

1980s

Cardiac imaging using isotopes becomes prominent.

1981

First commercial cyclotron CP42 officially commissioned.

1990s

McMaster begins production of I-125.

1990

Ontario Power Generation (previously Ontario Hydro) produces Tritium (H-3) for commercial sale.

1991

NRU began conversion from high-enriched (HEU) to low-enriched (LEU) fuel. Completed in 1992.

May 18, 2009

NRU leak causes extended outage (>1 month). This is an interruption of a major supplier of medical isotopes (esp. Mo-99 for Tc-99m imaging diagnostics).

November 30, 2009

Report of the Expert Review Panel on Medical Isotopes Production released.

June 9, 2014

Canadian team with members from TRIUMF, BC Cancer, the Centre for Probe Development & Commercialization, and Lawson Health Research Institute announced that they have dramatically advanced technology for addressing the medical isotope crisis. The key medical isotope, Technetium-99m (Tc-99m), can now be produced in meaningful quantities on the world’s most popular cyclotrons, many of which are already installed across Canada and around the world.

August 2015

Canada is a signing member of the Joint Declaration on the Security of Supply of Medical Isotopes. “WE, the Ministers and representatives of Australia, Belgium, Canada, France, Germany, Japan, the Republic of Korea, the Netherlands, Poland, the Russian Federation, South Africa, Spain, the United Kingdom and the United States of America, SHARE a common interest in ensuring

December 2015

The Government of Canada and the bipartisan Standing Committee on Natural Resources declares Ontario’s nuclear innovations a success story, recognizing the critical role that medical isotopes play in the global community and stated its intention to work with industry, the national health-care community and provincial/territorial governments to ensure that the Canadian supply of isotopes is brought to the next level.

October 31, 2016

Canadian Nuclear Laboratories’ routine production of Molybdenum-99 at Chalk River Laboratories (CRL) draws to a close.

March 31, 2018

The National Research Universal Reactor at Chalk River, ON is turned off.

April 2018

Canadian Nuclear Isotope Council established.

November 1, 2018

Prime Minister Justin Trudeau announced $10.23 million in federal funding to build a new nuclear medicine hub — the first of its kind in Canada — at TRIUMF to be named The Institute for Advance Medical Isotopes (IAMI). The construction of IAMI is valued at $31.8 million. Other contributors include the province of British Columbia with a contribution of $12.25 million, TRIUMF with $5.35 million, and BC Cancer and UBC each contributing $2 million. The IAMI facility will become a national hub of innovative cancer therapeutic research and development to find new solutions and to change outcomes for those facing an advanced cancer diagnosis.

March 2019

Bruce Power completes first successful harvest of High Specific Activity (HSA) Cobalt.

April 2019

McMaster/CPDC spinoff Fusion Pharmaceuticals financing for US$105M announced to support innovation and research. They have raised over US$150M for innovative Ac-225 based therapeutic for cancer treatment.

“As Canada’s nuclear university and home to the country’s only research reactor, McMaster is a leader in radioisotope R&D and innovation, and the world’s largest supplier of Iodine-125 one of the top 10 medical radioisotopes. Our integrated suite of research facilities enables discoveries in medicine, clean energy, nuclear safety, materials and environmental science.”

Karen Mossman, Vice-President, Research, McMaster University

Canada’s Isotope Supply Chain

For more than 30 years, the four reactors at Bruce Power’s Bruce B station have been a reliable Cobalt-60 supply for Nordion, an Ottawa-based company. Bruce Power’s supply of Cobalt-60 helps to sterilize 40 per cent of the world’s single-use medical devices, including sutures, syringes, masks, gloves and more. The company recently began producing medical-grade Cobalt-60 with the first harvest being completed in March 2019.

 

BWXT Isotope Technologies provides its customers, who conduct life-saving medical procedures for patients around the world, the benefit of decades of experience in the development, manufacturing, packaging and delivery of medical isotopes and radiopharmaceuticals. Headquartered in Kanata, Ontario, BWXT Isotope Technologies employs over 150 highly skilled people in Kanata and Vancouver, British Columbia. BWXT Isotope Technologies is part of the BWXT nuclear power segment (NPG) of BWX Technologies, Inc.

Though it no longer directly produces significant quantities of isotopes, the Chalk River site of Canadian Nuclear Laboratories is actively involved in researching the processing and application of isotopes for medical purposes. It is well positioned to contribute to the advancement of isotope processing and finding new applications, as well as the design of new isotope production facilities.

Centre for Probe Development and Commercialization (CPDC) operates three cyclotron facilities in Ontario, located in Hamilton, Toronto (CanProbe, a joint venture between the University Health Network and the CPDC), and Ottawa (at the University of Ottawa Heart Institute).

CPDC has established a robust and reliable global supply of innovative diagnostic and therapeutic radiopharmaceuticals used daily for the detection and treatment of human diseases such as cancer. To date, CPDC manufactures and supplies 15 radiopharmaceuticals for clinical and commercial supply, and CPDC’s products collectively have helped with the diagnosis and treatment of more than 80,000 patients. These products include F-18, Lu-177, In-111, Ac-225, Ga-68, Tc-99m, Zr-89 and I-131.

McMaster University is Canada’s pre-eminent nuclear research institution. The Hamilton-based post-secondary institution is home to a unique suite of world-class nuclear research facilities that are anchored by the five-megawatt McMaster Nuclear Reactor (MNR). With the closure of Chalk River’s National Research Universal (NRU) reactor, MNR is now Canada’s only major neutron source and therefore a key national research resource. Medical Isotopes from McMaster treat more than 70,000 patients globally per year.

For decades, Ontario Power Generation’s (OPG) nuclear stations have not only provided clean, low-cost power for Ontarians, they have also been a world-leading source of life-saving medical isotopes. Since the 1970s, OPG has been successfully harvesting Cobalt-60 from reactors at its Pickering Nuclear GS. The Darlington Nuclear Generating Station east of Toronto is poised to become a major producer of a nuclear isotope used in the detection of heart disease and cancer. Ontario Power Generation announced that, pending regulatory approval, the facility would begin generation of Molybdenum-99 in 2021.

TRIUMF is a national university-owned and operated multidisciplinary facility with programs in particle and nuclear physics, accelerator science, quantum materials and life sciences. With 20 Canadian member universities, as well as dozens of collaborators and partners across the country and around the world, TRIUMF is a global hub for accelerator-based science. A critical component of the national isotope network, TRIUMF provides Canada with strategic advantage over growing global competition. Presently, approximately two-million doses of life-saving medical isotopes produced at TRIUMF each year are distributed to more than a dozen countries around the world.