Medical Isotope Production and Use with a special

Medical Isotope Production and Use -with a special view on the need for ISOLDE and other big science facilities Mikael Jensen Professor , Applied Nuclear Physics Hevesy Lab - Risø-DTU Campus Technical University of Denmark Presented at ISOLDE 50 th Anniversary Workshop CERN- December 2014 DTU-NUTECH

Center for Nuclear Technologies Radioecology Isotope research Radiation physics Radiopharmaceuticals Radiobiology Radiation Therapy Targets Former Risø- an ancient National Laboratory for Reactor Research, then ”Sustainable Energy”

My background: The Hevesy Laboratory- Medical use of accelerators Isotope production Radiation therapy George Hevesy 1885 -1966

5. 5 Me. V protons 1938 Early Isotope Separation on Line – 55 years ago

Isolde – Master of the Isotopes

Application of Radioactive Isotopes: MEDICAL ! “I must confess that one reason we have undertaken this biological work is that we thereby have been able to get financial support for all of the work in the laboratory. As you know, it is much easier to get funds for medical research. ” —Lawrence to Niels Bohr, 1935

Why Radioactive Materials for injection into fellow living beings in 2014 ? 59 years post Hiroshima, 28 years post Chernoby, ……. Fukushima still in clear memory !

Nuclear Medicine in vivo use of radioactivity Isotope uptake, dilution, excretion, Whole Body Counting Diagnostic = Gamma camera, SPECT and PET Therapeutic = Radionuclide Therapy ”The magic bullet” Non invasive Cheap International = Atoms for Peace, IAEA….

The Legacy Technology PUSHED from the National Laboratories or Big Science Cyclotron and artificial radioactivity Radiochemistry Scintillation counters Anger Camera Mo-99/ Tc-99 m generator PET Camera F-18 FDG Isotopes far from stability line … (no medical pull of technology) !

Diagnostic Nuclear Medicine O-15 water Functional Metabolic Molecular Requiring higher specific activity F-18 DOPA

High specific activity A historical development: from 1913 ”indicators, and 1930 ”tracers” To ligands, radiometals for late stage chelation, radioactive antibodies and antibody fragments Requires : transmutation or very effective Slizard-Chalmers or hot atom isotope separators TBq / u. Mol

Halflife- Diagnostic Long enough to circulate and localize Short enough to keep radiation dose low Logistics of production, transport and labelling 200 secs 3 days The generators: • • Mo-99/Tc-99 m (Gamma Camera +SPECT) Rb-81/Kr-81 m (Gamma Camera +SPECT) Ge-68/Ga 68 (PET) Sr-82/Rb 82 • + Some more… Mother isotopes must be produced somewhere

Halflife - Therapeutic Most of dose to be delivered when optimal uptake has taken place T½ < Cell cycle life of target tissue

The clinical problem • Nuclear medicine is about routine use • Our isotope is part of a pharmaceutical • Requires clinical trials and proof of merrit • GMP, Safety and Efficacy • Costly, slow, highly regulated

GMP is the opposite of Research

Preclinical- or Small animal imaging: Solution or Problem ?

PET-CT, a problem ? ”fastest growing medical technology ever…. ” F-18 Fluoride F-18 Fluoro Choline

The problem of economics and scale • Very few (if any) radiopharmaceuticals can carry the full cost of development, registration and post market maintenance • Many radiopharmaceuticals are orphan • A clinical market should be served evenly across nations and territories • No gaps in availability But the cost of the radiopharmaceutical is a surprisingly small part of total cost of a given procedure

Isotopes for nuclear medicine from where ? (1) Neutron rich : by fission or neutron capture Present generation of research reactors getting old and retiring. Acces to high flux, long time and transport difficult. Access to HEU getting difficult

A Mo-99 supply crisis: • In October 2016 NRU in Chalk River, Canada closes • Is it a North American Problem? • No realistic replacements still in sight • Much talk and many Klondyke efforts • Possible results: Migration to CT and MRI Migration to PET A role for Ga-68 ? Worldwide loss of Nuclear Medicine infrastructure • May have effects on other isotopes as well Underlying cause : Goverment neutrons have been too cheap !

Isotopes for nuclear medicine from where ? (2) (p, xn) from Cyclotrons, mostly About 11 Me. V C-11, N-13, O 15, F-18 for local use 16 -18 Me. V F-18 for distribution, all (p, n) products 30 Me. V (p, 2 n) products, high yield In-111, Ga-67, I-123 70 -100 Me. V Sr-82, Ge-68 (shortage) Goverment Linacs

Alpha emitters for nuclear medicine from where ? • natural decay chains • nuclear fuel / weapons cycle • spallation • accelerators - (At-211) Perhaps via generators , mother isotope from • natural decay chains • nuclear fuel / weapons cycle • spallation • accelerators Fast growing interest beacuse of Ra-223 chloride (Alpharadin)

The cottage industry of small cyclotrons • 16 -18 Me. V enough for F 18 and the PET radiometals (Cu-64, Ga 68, Zr-89 ) • Theraputic doses can be made (Er-165) • Tc-99 m is possible in limited amounts • • Logistics more simple Cheap infrastructure Flexible Lead time for changes smaller

2013 PT 600 prototype, Hevesy Lab A 7. 8 Me. V cyclotron F-18 C-11 N-13 perhaps Ga-68 YES ! Coffee makers ? (remember to add 10 t neutron shield) ”Point of demand” produktion

α, β- and Auger radiation 26

Microinjection of cells in culture 27

Direct injection 28

30 Claus E. Andersen

Gamma-H 2 AX assay Counting the number of DSB

Many lanthanides have good therapeutic properties • • Tunable half-life Tunable beta energy Or pure Auger cascade Or alpha (Tb-149 is example) Same chelation chemistry But- carrier free production needed for most Production and chemistry can be difficult Many good isotopes far from stability line

Isotopes for nuclear medicine from ISOLDE ? • Clinical trials require • Spallation by itself is year round supply – for dirty long periods ! • Human use requires high radionuclidic purity • A clinical trial should point to a commercial • Isotope separation future needed , on- or off-line • Scalability, ownership • GBq will be needed at point of use • Ce-134 , Nd-140 recent examples

Help from ISOLDE ? • Rapid Proof-of–principles • Ultimate specific activity • Labelling stability studies (recoil) • Rapid extraction of radioactivity from solid targets ( example Ga-68) • Selection of single isomer ( example Co-58 m) • Isotope production at ESS ? • No ”ISOL” • Thermal and fast neutrons • Perhaps parasitic protons , - but only 100 Me. V needed. For Science, Research and Development in Nuclear Medicine, - we can use ISOLDE

Thank you for your attention, …. . Questions ? 13 -aug-2008 Præsentationens titel 35