Potential Ways to Address Shortage Situations of ⁹⁹Mo/^99mTc

^99mTc, the most common radioisotope used in nuclear medicine, is produced in a nuclear reactor from the decay of ⁹⁹Mo. There are only a few aging nuclear reactors around the world that produce ⁹⁹Mo, and one of the major contributors, the National Research Universal (Canada), ceased production on October 31, 2016. The National Research Universal produced approximately 40% of the world's ⁹⁹Mo supply, so with its shut down, shortages of ⁹⁹Mo/^99mTc are expected. Methods: Nuclear pharmacies and nuclear medicine departments throughout the United States were contacted and asked to provide their strategies for coping with a shortage of ⁹⁹Mo/^99mTc. Each of these strategies was evaluated on the basis of its effectiveness for conserving ^99mTc while still meeting the needs of the patients. Results: From the responses, the following 6 categories of strategies, in order of importance, were compiled: contractual agreements with commercial nuclear pharmacies, alternative imaging protocols, changes in imaging schedules, software use, generator management, and reduction of ordered doses or elimination of backup doses. Conclusion: The supply chain of ⁹⁹Mo/^99mTc is quite fragile; therefore, being aware of the most appropriate coping strategies is crucial. It is essential to build a strong collaboration between the nuclear pharmacy and nuclear medicine department during a shortage situation. With both nuclear medicine departments and nuclear pharmacies implementing viable strategies, such as the ones proposed, the amount of ^99mTc available during a shortage situation can be maximized.