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Nuclear medicine relies heavily on technetium-99m (Tc-99m), a decay product of molybdenum-99 (Mo-99), to perform several procedures, in particular for single-photon computed tomography (SPECT). Around 80% of all nuclear medicine procedures worldwide rely on this isotope. The supply chain of this isotope produces and distributes Mo-99 to hospital pharmacies through irradiation of a highly enriched uranium (HEU) or low-enriched uranium (LEU) target in a reactor, liquid separation of the Mo-99 from the target, creation of generators Tc-99m, and various time critical transports. Both demand and supply in this supply chain are subject to variability and uncertainty. Different from other supply chains, the means to buffer these uncertainties through either inventory (storage), time, or excess capacity are all heavily constrained. The first objective of this project will be to gather the state-of-the-art data of each step in the supply chain so that an as accurate as possible process map can be made. The process map should therefore be complemented with information about the constraints imposed on each activity by safety regulations and procedures. This information will be gathered through interviews and on-site observations where-ever possible with the various entities along the supply chain. The second objective of this project is to build a stochastic model of supply chain operations with multiple sources and a decaying products to identify bottlenecks and opportunities for supply chain efficiency while respecting security and reliability constraints. The model is targeted to be analytical (using e.g. stochastic network representations and/or Markov decision process formulations) and in the form of discrete event simulations if necessary. The concluding objective of this topic is to provide recommendations for the different stake-holders involved in the Mo-99 supply chain to improve coordination and efficiency which may include alignment of incentives, reductions in supply chain inefficiencies, and changes to government regulations.
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