Technetium-99m (99mTc) is a metastable nuclear isomer of technetium-99 (itself an isotope of technetium), symbolized as 99mTc, that is used in tens of millions of medical diagnostic procedures annually, making it the most commonly used medical radioisotope in the world.
Technetium-99m is used as a radioactive tracer and can be detected in the body by medical equipment (gamma cameras). It is well suited to the role, because it emits readily detectable gamma rays with a photon energy of 140.5 keV (within the range emitted by conventional X-ray diagnostic equipment) and its half-life is 6.0066 hours (meaning 93.7% of it decays to 99Tc in 24 hours). The relatively short physical half-life of the isotope and its biological half-life of 1 day (in terms of human activity and metabolism) allows for scanning procedures which collect data rapidly but keep total patient radiation exposure low. The same characteristics make the isotope unsuitable for therapeutic use because Technetium-99m emits penetrating gamma rays and decays quickly, so it cannot deliver a strong, localized dose to destroy diseased tissue.
Technetium-99m was discovered as a product of cyclotron bombardment of molybdenum. This procedure produced molybdenum-99, a radionuclide with a longer half-life (2.75 days), which decays to 99mTc. This longer decay time allows for 99Mo to be shipped to medical facilities, where 99mTc is extracted from the sample as it is produced. In turn, the 99Mo is usually created by fission of highly enriched uranium in a small number of research and material testing nuclear reactors in several countries.
History Discovery In 1938, Emilio Segrè and Glenn T. Seaborg isolated for the first time the metastable isotope technetium-99m, after bombarding natural molybdenum with 8 MeV deuterons in the cyclotron of Ernest Orlando Lawrence's Radiation laboratory. In 1970 Seaborg explained that:
Later in 1940, Emilio Segrè and Chien-Shiung Wu published experimental results of an analysis of fission products of uranium-235, including molybdenum-99, and detected the presence of an isomer of element 43 with a 6-hour half-life, later labelled as technetium-99m.
Early medical applications in the United States
99mTc remained a scientific curiosity until the 1950s when Powell Richards realized the potential of technetium-99m as a medical radiotracer and promoted its use among the medical community. While Richards was in charge of the radioisotope production at the Hot Lab Division of the Brookhaven National Laboratory, Walter Tucker and Margaret Greene were working on how to improve the separation process purity of the short-lived eluted daughter product iodine-132 from its parent, tellurium-132 (with a half-life of 3.2 days), produced in the Brookhaven Graphite Research Reactor. They detected a trace contaminant which proved to be 99mTc, which was coming from 99Mo and was following tellurium in the chemistry of the separation process for other fission products. Based on the similarities between the chemistry of the tellurium-iodine parent-daughter pair, Tucker and Greene developed the first technetium-99m generator in 1958. It was not until 1960 that Richards became the first to suggest the idea of using technetium as a medical tracer.
The first US publication to report on medical scanning of 99mTc appeared in August 1963. Sorensen and Archambault demonstrated that intravenously injected carrier-free 99Mo selectively and efficiently concentrated in the liver, becoming an internal generator of 99mTc. After build-up of 99mTc, they could visualize the liver using the 140 keV gamma ray emission.
Worldwide expansion The production and medical use of 99mTc rapidly expanded across the world in the 1960s, benefiting from the development and continuous improvements of the gamma cameras.
Americas Between 1963 and 1966, numerous scientific studies demonstrated the use of 99mTc as radiotracer or diagnostic tool. As a consequence the demand for 99mTc grew exponentially and by 1966, Brookhaven National Laboratory was unable to cope with the demand. Production and distribution of 99mTc generators were transferred to private companies. "TechneKow-CS generator", the first commercial 99mTc generator, was produced by Nuclear Consultants, Inc. (St. Louis, Missouri) and Union Carbide Nuclear Corporation (Tuxedo, New York). From 1967 to 1984, 99Mo was produced for Mallinckrodt Nuclear Company at the Missouri University Research Reactor (MURR).
Union Carbide actively developed a process to produce and separate useful isotopes like 99Mo from mixed fission products that resulted from the irradiation of highly enriched uranium (HEU) targets in nuclear reactors developed from 1968 to 1972 at the Cintichem facility (formerly the Union Carbide Research Center built in the Sterling forest in Tuxedo, New York ()). The Cintichem process originally used 93% highly enriched U-235 deposited as UO2 on the inside of a cylindrical target.
At the end of the 1970s, of total fission product radiation were extracted weekly from 20 to 30 reactor bombarded HEU capsules, using the so-called "Cintichem [chemical isolation] process." The research facility with its 1961 5-MW pool-type research reactor was later sold to Hoffman-LaRoche and became Cintichem Inc. In 1980, Cintichem, Inc. began the production/isolation of 99Mo in its reactor, and became the single U.S. producer of 99Mo during the 1980s. However, in 1989, Cintichem detected an underground leak of radioactive products that led to the reactor shutdown and decommissioning, putting an end to the commercial production of 99Mo in the USA.
The production of 99Mo started in Canada in the early 1970s and was shifted to the NRU reactor in the mid-1970s. By 1978 the reactor provided technetium-99m in large enough quantities that were processed by AECL's radiochemical division, which was privatized in 1988 as Nordion, now MDS Nordion. In the 1990s a substitution for the aging NRU reactor for production of radioisotopes was planned. The Multipurpose Applied Physics Lattice Experiment (MAPLE) was designed as a dedicated isotope-production facility. Initially, two identical MAPLE reactors were to be built at Chalk River Laboratories, each capable of supplying 100% of the world's medical isotope demand. However, problems with the MAPLE 1 reactor, most notably a positive power co-efficient of reactivity, led to the cancellation of the project in 2008.
The first commercial 99mTc generators were produced in Argentina in 1967, with 99Mo produced in the CNEA's RA-1 Enrico Fermi reactor. Besides its domestic market CNEA supplies 99Mo to some South American countries.
Oceania In 1967, the first 99mTc procedures were carried out in Auckland, New Zealand. 99Mo was initially supplied by Amersham, UK, then by the Australian Nuclear Science and Technology Organisation (ANSTO) in Lucas Heights, Australia.
Europe In May 1963, Scheer and Maier-Borst were the first to introduce the use of 99mTc for medical applications. In 1968, Philips-Duphar (later Mallinckrodt, today Covidien) marketed the first technetium-99m generator produced in Europe and distributed from Petten, the Netherlands.
Shortage Global shortages of technetium-99m emerged in the late 2000s because two aging nuclear reactors (NRU and HFR) that provided about two-thirds of the world's supply of molybdenum-99, which itself has a half-life of only 2.75 days, were shut down repeatedly for extended maintenance periods.. In May 2009, the Atomic Energy of Canada Limited announced the detection of a small leak of heavy water in the NRU reactor that remained out of service until completion of the repairs in August 2010.
After the observation of gas bubble jets released from one of the deformations of primary cooling water circuits in August 2008, the HFR reactor was stopped for a thorough safety investigation. NRG received in February 2009 a temporary license to operate HFR only when necessary for medical radioisotope production. HFR stopped for repairs at the beginning of 2010 and was restarted in September 2010.
Two replacement Canadian reactors (see MAPLE Reactor) constructed in the 1990s were closed before beginning operation, for safety reasons. A construction permit for a new production facility to be built in Columbia, MO was issued in May 2018.
Nuclear properties Technetium-99m is a metastable nuclear isomer, as indicated by the "m" after its mass number 99. This means it is a nuclide in an excited (metastable) state that lasts much longer than is typical. The nucleus will eventually relax (i.e., de-excite) to its ground state through the emission of gamma rays or internal conversion electrons. These decays do not change the number of protons or neutrons, but only give them a lower-energy 'arrangement', which here is the ground state.
The excitation energy above the ground state is 142.7 keV, but 99% of the time, it relaxes first to a slightly lower state (140.5 keV) by internal conversion (and the rate of this transition determines the uncertainty in half-life), which decays at once. In total, 99mTc decays about 89% by gamma emission (99mTc → 99Tc + γ) and almost all of the time, this results in a 140.5 keV gamma ray and only rarely in a 142.7 keV (1 in 4,000) as the latter decay, too, is very largely converted. and ENSDF file therein; displayed more readably at the IAEA Chart of Nuclides. The remaining 11% of decays are completed entirely by conversion and not of diagnostic utility, though still contributing to internal radiation dose.
These gammas are the radiations that are picked up by a gamma camera when 99mTc is used as a radioactive tracer for medical imaging. Pure gamma emission is the desirable decay mode for medical imaging because other particles deposit more energy in the patient body (radiation dose) relatively to that in the camera. Metastable isomeric transition is the only nuclear decay mode that approaches pure gamma emission.
99mTc's half-life of 6.0066 hours is considerably longer (by 14 orders of magnitude, at least) than most nuclear isomers, though not unique. This is still a short half-life relative to many other known modes of radioactive decay and it is in the middle of the range of half-lives for radiopharmaceuticals used for medical imaging.
After gamma emission or internal conversion, the resulting ground-state technetium-99 then decays with a half-life of 211,000 years to stable ruthenium-99. This process emits soft beta radiation and no gamma; the radiation for this is comparatively insignificant because of the long half-life ratio and such low residual radioactivity is a desirable feature for radiopharmaceuticals.
Production Production of 99Mo in nuclear reactors Neutron irradiation of uranium-235 targets The parent nuclide of 99mTc, 99Mo, is mainly extracted for medical purposes from the fission products created in neutron-irradiated uranium-235 targets, the majority of which is produced in five nuclear research reactors around the world using highly enriched uranium (HEU) targets. Smaller amounts of 99Mo are produced from low-enriched uranium in at least three reactors.
+ Nuclear reactors producing 99Mo from 235U targets. The year indicates the date of the first criticality of the reactor.TypeReactorLocationTarget/FuelYearLarge-scale producers NRU (Decommissioned) Canada HEU/LEU 1957 BR2 Belgium HEU/HEU1961 SAFARI-1South Africa LEU/LEU1965 HFR the Netherlands HEU/LEU1961 Osiris reactor (decommissioned 2015) France LEU/HEU1966Regional producersOPAL Australia LEU/LEU2006 MPR RSG-GAS Indonesia LEU/LEU1987 RA-3 Argentina LEU/LEU1961 MARIA PolandHEU/HEU1974 LVR-15Czech RepublicHEU/HEU1957
Neutron activation of 98Mo