Nuclear energy

Nuclear power is one of the fastest growing energy options for countries seeking energy security

and low-emission energy solutions.

Australia has been officially welcomed to the Generation IV International Forum (GIF)

Framework Agreement, a partnership through which we will contribute to international work on

the development of future nuclear energy technologies.

Researchers from around the world, including Australia, are contributing to ITER, the world’s

largest engineering project, to create fusion energy in France. Australia's research contributions to

ITER fall broadly into three areas: diagnostics, plasma theory and modelling, and the development

of advanced materials for extreme environments.

NUCLEAR ENERGY IN THE FIELD OF MEDICINE

Radiation is used in medicine, which helps in giving information about the functioning of a specific

organs in the body. The information given by this method is quick, which helps in accurate

diagnosis of the condition of the patient. For treating certain medical conditions radiation dose is

given to the patient internally, either using intravenous drips or orally. In some rare cases, external

radiation therapy may also be given to the patient. This treatment is often used in treating

conditions like hyperthyroidism, cancer, refractory lymphoma, neuroendocrine tumors, palliative

bone pain treatment, etc. Certain blood disorders can also be treated using nuclear energy. Painful

tumor metastases of the bones can also be treated using radioactive material.

On average, one in two Australians can expect to have a nuclear medicine procedure that uses a

radioisotope for diagnostic or therapeutic purposes at some stage in their life. Nuclear medicine

and radiology are the medical techniques that involve the use of radiation or radioactivity to

diagnose, treat, and prevent disease.

About one-third of all procedures used in modern hospitals involve radiation or radioactivity.

These procedures are safe, effective, and don't require anaesthetic. They are useful in a broad

spectrum of medical specialties: from paediatrics to cardiology to psychiatry.

Perhaps the most significant success story over the past half-century in harnessing radiation to

serve modern humanity is in the field of medicine. Both the quality of life and longevity of citizens

throughout the developed world have improved substantially within the twentieth century, largely

due to dramatic medical advances.

The exploitation of nuclear technology in medical applications began almost from the moment of

Roentgen's discovery of x rays in 1895 and Becquerel's discovery of radioactivity in 1996.J The
importance of x rays in medical diagnosis was immediately apparent and. within months of their

discovery, the bactericidal action of x rays and their ability to destroy tumors were revealed.

Likewise, the effectiveness of the newly discovered radioactive elements of radium and radon in

treatment of certain tumors was discovered early and put to use in medical practice. Today, both

diagnostic and therapeutic medicine as well as medical research depend critically on many clever

and increasingly sophisticated applications of nuclear radiation and radioisotopes.

In diagnostic medicine, the radiologist's ability to produce images of various organs and tissues of

the human body is extremely useful. Beginning with the use of x rays at the start of the twentieth

century to produce shadowgraphs of the bones on film, medical imaging technology has seen

continuous refinement. By the 1920s, barium was in use to provide contrast in x-ray imaging of

the gastrointestinal system. Intravenous contrast media such as iodine compounds were introduced

in the 1930s arid in angiography applications by the 1940s. Fluoroscopic image intensifiers came

into use in the 1950s and rare-earth intensifier screens in the 1960s. Computed tomography (CT),

positron emission tomography (PET), and singlephoton emission tomography (SPECT) saw their

beginnings for clinical use in the 1960s and 1970s. Picture archive and communication systems

(PACS) began to see common use in the 1990s, The 1990s also saw interventional radiology

becoming well established in medical practice, especially in coronary angioplasty procedures.

Along with advances in diagnostic medicine, corresponding advances have been made in using

nuclear technology for therapy. There are three general classes of radiation therapy. In brachy

therapy, direct implants of a radioisotope are made into a tumor to deliver a concentrated dose to

that region. In teletherapy, a beam delivers radiation to a particular region of the body or even to

the whole body. In radionuclide therapy, unsealed radiopharmaceuticals are directly administered

to patients for curative or palliative purposes.

 Table 1. Global use of medical radiology (1991-1996). From UN [2000].

No. per 106

Quantity population
Level I* Global
Physicians
All Physicians 2800 1100
Radiological Physicians 110 80
X-ray Imaging
Equipment: medical 290 110
dental 440 150
mammography 24 7
CT 17 6
Exams per year: medical 920000 330000
dental 310000 90000
Radionuclide Imaging
Equipment: gamma cameras 7.2 2.1
rectilinear scanners 0.9 0.4
PET scanners 0.2 0.05
Exams per year: 19000 5600
Radionuclide Therapy
Patients per year: 170 65
Teletherapy
Equipment: x-ray 2.8 0.9
radionuclide 1.6 0.7
LINAC 3 0.9
Patients per year: 1500 820
Brachytherapy
Afterloading units 1.7 0.7
Patients per year: 200 70
*Level I represents countries with one or more physicians per 1000 population.

Indeed, nuclear applications have become such a routine part of modern medical practice that

almost all of us at one time or another have encountered some of them. Table 14.1 lists personnel

and frequencies for medical radiology and radiation therapy procedures, both globally and in

developed countries. Today we see many changes and new applications of nuclear technology in

medicine. The use of rectilinear scanners is declining rapidly while the use of gamma-ray cameras,
PET and CT scanners is growing. Diagnostic radiology has long been used for imaging and study

of human anatomy. In recent years, using CT, PET, and gamma-ray scanners, as well as MRI

(magnetic resonance imaging), medical science has advanced to imaging the physiology and

metabolism of the human body.

Sterilisation

Radiation kills germs that can cause disease and neutralizes other harmful organisms. Sterilization

with ionizing radiation inactivates microorganisms very efficiently and, when used for product

wrapping, ensures that healthcare products are safe and can be relied upon.

Ever since the advent of germ theory, medical teams have demanded cleanliness as a crucial part

of good practice. Knowing that radiation in high enough quantities can kill microorganisms, the

medical community quickly recognized the potential for employing certain types of radiation

(mainly gamma radiation) to sterilize dressings, surgical gloves, bandages, plastic and rubber

sheets, syringes, catheters, sutures, heart valves, and a myriad of other devices routinely used

during medical procedures. Because radiation is a ‘cold’ process, radiation can be used to sterilize

a range of heatsensitive items such as powders, ointments and solutions, and biological

preparations such as bone, nerve, skin, etc., used in tissue grafts. Today, well over half of all

sterilized medical equipment used in modern hospitals is a direct result of radiation treatment. This

process is safer and cheaper than most other methods (such as steam) because it can be done after

the item is packaged. Hence, the sterile shelf life of the item is then practically indefinite—

provided the package is not broken open.

Many medical products today are sterilised by gamma rays from a Co-60 source, a technique which

generally is much cheaper and more effective than steam heat sterilisation. The disposable syringe
is an example of a product sterilised by gamma rays. Because it is a 'cold' process radiation can be

used to sterilise a range of heat-sensitive items such as powders, ointments, and solutions, as well

as biological preparations such as bone, nerve, and skin to be used in tissue grafts. Large-scale

irradiation facilities for gamma sterilisation are installed in many countries. Smaller gamma

irradiators, often utilising Cs-137, having a longer half-life, are used for treating blood for

transfusions and for other medical applications.

Radiation is a safe and cost-effective method for sterilizing single-use medical devices such as

syringes and surgical gloves. One of its key advantages is that it allows already-packaged products

to be sterilized. A variety of life-saving equipment is sterilized with radiation. More than 160

gamma irradiation plants around the world are operating to sterilize medical devices. Around 12

million m3 of medical devices are sterilized by radiation annually. More than 40 per cent of all

single-use medical devices produced worldwide are sterilized with gamma irradiation. The IAEA

helps its Member States set up radiation facilities and provides guidelines for the use of

sterilization applications that use radiation.

Sterilisation by radiation has several benefits. It is safer and cheaper because it can be done after

the item is packaged. The sterile shelf-life of the item is then practically indefinite provided the

seal is not broken. Apart from syringes, medical products sterilised by radiation include cotton

wool, burn dressings, surgical gloves, heart valves, bandages, plastic, and rubber sheets and

surgical instruments.

Nuclear Medicine Imaging

Nuclear medicine is a branch of medical imaging that uses small amounts of radioactive material

to diagnose and determine the severity of or treat a variety of diseases, including many types of

cancers, heart disease, gastrointestinal, endocrine, neurological disorders and other abnormalities

within the body. Because nuclear medicine procedures are able to pinpoint molecular activity

within the body, they offer the potential to identify disease in its earliest stages as well as a patient’s

immediate response to therapeutic interventions.

Nuclear medicine studies were first performed in the 1950s using special devices called "gamma

cameras." Nuclear medicine studies require the oral or intravenous introduction of very low-level

radioactive chemicals (called radionuclides, radiopharmaceuticals or radiotracers) into the body.

Radiopharmaceuticals are specially formulated to be collected temporarily in the specific part of

the body to be studied. The radionuclides are taken up by the organs in the body and then emit

faint gamma ray signals which are measured by a gamma camera. The gamma camera has a large

crystal detector (called a scintillation crystal). These crystals detect the emitted radiation signal

and convert that signal into faint light. The light is then converted to an electric signal, which is

then digitized (converted into a computer signal) and reconstructed into an image by a computer.

The resulting image is viewed on the system monitor and can be manipulated (post-processed) and

filmed, sent over a network to another location, or saved on a disk.

The nuclear medicine image can either be in grayscale (shades of black and white), for instance in

a bone scan, or they can be color coded to clearly show functional activity, like in a cardiac study.
Diagnosis

Nuclear medicine imaging procedures are noninvasive and, with the exception of intravenous

injections, are usually painless medical tests that help physicians diagnose and evaluate medical

conditions. These imaging scans use radioactive materials called radiopharmaceuticals or

radiotracers.

Depending on the type of nuclear medicine exam, the radiotracer is either injected into the body,

swallowed or inhaled as a gas and eventually accumulates in the organ or area of the body being

examined. Radioactive emissions from the radiotracer are detected by a special camera or imaging

device that produces pictures and provides molecular information.

In many centers, nuclear medicine images can be superimposed with computed tomography (CT)

or magnetic resonance imaging (MRI) to produce special views, a practice known as image fusion

or co-registration. These views allow the information from two different exams to be correlated

and interpreted on one image, leading to more precise information and accurate diagnoses. In

addition, manufacturers are now making single photon emission computed tomography/computed

tomography (SPECT/CT) and positron emission tomography/computed tomography (PET/CT)

units that are able to perform both imaging exams at the same time. An emerging imaging

technology, but not readily available at this time is PET/MRI.

Therapy

Nuclear medicine also offers therapeutic procedures, such as radioactive iodine (I-131) therapy

that use small amounts of radioactive material to treat cancer and other medical conditions

affecting the thyroid gland, as well as treatments for other cancers and medical conditions.
Non-Hodgkin's lymphoma patients who do not respond to chemotherapy may undergo

radioimmunotherapy (RIT).

Radioimmunotherapy (RIT) is a personalized cancer treatment that combines radiation therapy

with the targeting ability of immunotherapy, a treatment that mimics cellular activity in the body's

immune system. See the Radioimmunotherapy (RIT) page for more information.

Diagnostic Imaging

Diagnostic radiology using x rays, both dental and medical, including mammography. dominates

radiology. This is true for both numbers of patients and numbers of procedures. Each year in the

United States, for example, more than 130 million persons annually receive diagnostic x rays [NAS

1980] and more than 250 million examinations are performed [UN 2000]. In the past thirty years,

alternatives to traditional x-ray imaging have become available and are being increasingly used to

image organs and tissues not easily seen by conventional x-ray diagnostics. In the 1970s, digital

methods of processing and displaying x-ray images led to the clinical use of digital radiology and

computed tomography (CT). Positron emission tomography (PET), and single photon emission

computed tomography (SPECT). both radiological procedures, were realized in the 1980s.

Magnetic resonance imaging (MRI) matured and became a widely used medical imaging technique

in the 1990s. MRI does not use x rays or radionuclides; however, it does depend on the unique

spin (angular momentum) properties of the atomic nuclei in the body tissues and also employs the

sophisticated image processing techniques used in nuclear imaging methods. Indeed. PET and

MRI or PET and CT are often used together, with images superimposed to reveal physiological

processes, particularly in the brain.

X-ray Projection Imaging

Projection x-ray imaging is by far the most common diagnostic imaging technique used. In this

met hod, a beam of x rays illuminates some part of the body and a film (or digital imaging detector)

behind the body records the transmitted x rays. Areas of the film behind dense high-Z materials

such as bone, which preferentially absorb x rays, receive little exposure on the film compared to

areas behind soft tissue, which more readily transmit the photons. In essence, an x-ray image

records the "shadows" cast or projected by the irradiated specimen onto the film.

During the fifty years following the discovery of x rays, advances were made in the design and

standardization of x-ray sources, and in the use of contrast agents. Notable advances in design

include the 1913 invention of the hot-cathode x-ray tube by William Coolidge. the invention of

the anti-scatter grid by Gustav Bucky and H.E. Potter in 1917. and the invention of the x-ray image

intensifier by John Coltman in 1948 [Webster 1995]. Contrast agents are fluids containing high-Z

atoms that strongly absorb x rays compared to normal tissues. Barium compounds flooding the

gastrointestinal system were found to give definition in an x-ray image of the volume of the system.

After clearance and distention of the system by gas. residual barium defined the walls of the

system. Similarly, iodine compounds in the blood were found to define the circulatory system in

detail. Advances continue to be made in the availability of contrast agents and in their applications.

Film subtraction angiography. which began in the 1930s, relies on contrast agents. Subtraction

angiography requires two images, one positive, one negative, recorded before and after injection

of a contrast agent. Subtraction of the images by superimposing the two film images reveals

vascular structure, absent interference caused by superposition of extraneous images of bones and

other structures. In recent decades, digital-imaging methods have greatly enhanced the

effectiveness of this application by performing the subtraction digitally.

The X-Ray Source

The production of x-ray photons as bremsstrahlung and fluorescence occurs in any device that

produces high-energy electrons. Devices that can produce significant amounts of x rays are those

in which a high voltage is used to accelerate electrons, which then strike an appropriate target

material. Such is the basic principle of all x-ray tubes used in medical diagnosis and therapy,

industrial applications, and research laboratories.

Although there are many different designs of x-ray sources for different applications, most designs

for low to medium voltage sources (< 180 kV) place the electron source (cathode) and electron

target (anode) in a sealed glass tube. The glass tube acts as both an insulator between the anode

and cathode and a container for the necessary vacuum through which the electrons are accelerated

by the high voltage between the anode and cathode. The anodes of x-ray tubes incorporate a

suitable metal upon which the electrons impinge and generate bremsstrahlung and characteristic x

rays. Most of the electron energy is deposited in the anode as heat rather than being radiated away

as x rays and, thus, heat removal is an important aspect in the design of x-ray tubes. For example,

the x-ray tube shown in Fig. 14.1 has a rotating anode that spreads the heat over a large area and

thereby allows higher beam currents and greater x-ray output.

Tungsten is the most commonly used target material because of its high atomic number and

because of its high melting point, high thermal conductivity, and low vapor pressure. Occasionally,

other target materials are used when different characteristic x-ray energies are desired (see Table

14.2). Generally, the operating conditions of a particular tube (current, voltage, and operating time)

are limited by the rate at which heat can be removed from the anode. For most medical and dental

diagnostic units, voltages between 40 and 150 kV are used, while medical therapy units may use
6 to 150 kV for superficial treatment or 180 kV to 50 MV for treatment requiring very penetrating

radiation.

Figure 1. Schematic diagram of atypical x-ray tube. From Kaelble (1967).

Table 2. Characteristic x-ray properties of two important target materials used in x-ray tubes. The x-ray line

notation refers to the specific electron transition to the K or L shell that produces the characteristic x ray.

The wavelength and energy of the resulting characteristic x ray is listed. The excitation voltage is the energy

required to create (ionize) a shell vacancy whose repopulation generates the x-ray

X-ray Wavelength Energy Excitation

Element line (10-10 m) (keV) voltage (kV)
Tungsten Kα1 0.209 59.3182 69.525
Kβ1 0.1844 67.2443 69.525
Lα1 1.4764 8.3976 10.207
Lβ1 1.2818 9.6724 11.514
Molybdenum Kα1 0.7093 17.4793 20.000
Kβ1 0.6323 19.6083 20.000
Lα1 5.4066 2.2932 2.52

The energy spectrum of x-ray photons emitted from an x-ray tube has a continuous bremsstrahlung

component up to the maximum electron energy (i.e., the maximum voltage applied to the tube). If

the applied voltage is sufficiently high as to cause ionization in the target material, there will also

be characteristic x-ray lines superimposed on the continuous bremsstrahlung spectrum. In Fig. 14.2
two calculated exposure spectra of x rays are shown for the same operating voltage but for different

amounts of beam filtration (i.e., different amounts of material attenuation in the x-ray beam). As

the beam filtration increases, the low-energy x rays are preferentially attenuated and the x-ray

spectrum hardens and becomes more penetrating. Also readily apparent in these spectra are the

tungsten Kα1 and Kβ1 characteristic x rays.

The characteristic x rays may contribute a substantial fraction of the total x-ray emission. For

example, the L-shell radiation from a tungsten target is between 20 and 35% of the total energy

emission when voltages between 15 and 50 kV are used. Above and below this voltage range, the

L component rapidly decreases in importance. However, even a small degree of filtering of the x-

ray beam effectively eliminates the low-energy portion of the spectrum containing the L-shell x

rays. The higher-energy K-series x rays from a tungsten target contribute a maximum of 12% of

the total x-ray exposure for operating voltages between 100 and 200 kV [ICRU 1970].

What are some common uses of the procedure?

Physicians use nuclear medicine imaging procedures to visualize the structure and function of an

organ, tissue, bone or system within the body.

In adults, nuclear medicine is used to:

Heart

 visualize heart blood flow and function (such as a myocardial perfusion scan)

 detect coronary artery disease and the extent of coronary stenosis

  assess damage to the heart following a heart attack

 evaluate treatment options such as bypass heart surgery and angioplasty

 evaluate the results of revascularization (blood flow restoration) procedures

 detect heart transplant rejection

 evaluate heart function before and after chemotherapy (MUGA)

Lungs

 scan lungs for respiratory and blood flow problems

 assess differential lung function for lung reduction or transplant surgery

 detect lung transplant rejection

Bones

 evaluate bones for fractures, infection and arthritis

 evaluate for metastatic bone disease

 evaluate painful prosthetic joints

 evaluate bone tumors

 identify sites for biopsy

Brain

 investigate abnormalities in the brain in patients with certain symptoms or disorders, such

as seizures, memory loss and suspected abnormalities in blood flow

 detect the early onset of neurological disorders such as Alzheimer's disease

 assist in surgical planning and identify the areas of the brain that may be causing seizures
  evaluate for abnormalities in a chemical in the brain involved in controlling movement in

patients with suspected Parkinson's disease or related movement disorders

 evaluation for suspected brain tumor recurrence, surgical or radiation planning or

localization for biopsy

Other Systems

 identify inflammation or abnormal function of the gallbladder

 identify bleeding into the bowel

 assess post-operative complications of gallbladder surgery

 evaluate lymphedema

 evaluate fever of unknown origin

 locate the presence of infection

 measure thyroid function to detect an overactive or underactive thyroid

 help diagnose hyperthyroidism and blood cell disorders

 evaluate for hyperparathyroidism (overactive parathyroid gland)

 evaluate stomach emptying

 evaluate spinal fluid flow and potential spinal fluid leaks

In adults and children, nuclear medicine is also used to:

Cancer

 stage cancer by determining the presence or spread of cancer in various parts of the body

 localize sentinel lymph nodes before surgery in patients with breast cancer or skin and soft

tissue tumors

 plan treatment
  evaluate response to therapy

 detect the recurrence of cancer

 detect rare tumors of the pancreas and adrenal glands

Renal

 analyze native and transplant kidney blood flow and function

 detect urinary tract obstruction

 evaluate for hypertension (high blood pressure) related to the kidney arteries

 evaluate kidneys for infection versus scar

 detect and follow-up urinary reflux

In children, nuclear medicine is also used to:

 investigate abnormalities in the esophagus, such as esophageal reflux or motility disorders

 evaluate the openness of tear ducts

 evaluate the openness of ventricular shunts in the brain

 assess congenital heart disease for shunts and pulmonary blood flow

Nuclear medicine therapies include:

 Radioactive iodine (I-131) therapy used to treat some causes of hyperthyroidism

(overactive thyroid gland, for example, Graves' disease) and thyroid cancer

 Radioactive antibodies used to treat certain forms of lymphoma (cancer of the lymphatic

system)

 Radioactive phosphorus (P-32) used to treat certain blood disorders

 Radioactive materials used to treat painful tumor metastases to the bones

  I-131 MIBG (radioactive iodine labeled with metaiodobenzylguanidine) used to treat

adrenal gland tumors in adults and adrenal gland/nerve tissue tumors in children

How should I prepare?

You may be asked to wear a gown during the exam or you may be allowed to wear your own

clothing.

Women should always inform their physician or technologist if there is any possibility that they

are pregnant or if they are breastfeeding. See the Safety page for more information about pregnancy

and breastfeeding related to nuclear medicine imaging.

You should inform your physician and the technologist performing your exam of any medications

you are taking, including vitamins and herbal supplements. You should also inform them if you

have any allergies and about recent illnesses or other medical conditions.

Jewelry and other metallic accessories should be left at home if possible, or removed prior to the

exam because they may interfere with the procedure.

You will receive specific instructions based on the type of scan you are undergoing.

In some instances, certain medications or procedures may interfere with the examination ordered.

What does the equipment look like?

The special camera and imaging techniques used in nuclear medicine include the gamma camera

and single-photon emission-computed tomography (SPECT).

The gamma camera, also called a scintillation camera, detects radioactive energy that is emitted

from the patient's body and converts it into an image. The gamma camera itself does not emit any

radiation. The gamma camera is composed of radiation detectors, called gamma camera heads,

which are encased in metal and plastic and most often shaped like a box, attached to a round

circular donut shaped gantry. The patient lies on the examination table which slides in between

two parallel gamma camera heads that are positioned above and below the examination table and

located beneath the examination table. Sometimes, the gamma camera heads are oriented at a 90

degree angle and placed over the patient's body.

SPECT involves the rotation of the gamma camera heads around the patient's body to produce

more detailed, three-dimensional images.

A PET scanner is a large machine with a round, doughnut shaped hole in the middle, similar to a

CT or MRI unit. Within this machine are multiple rings of detectors that record the emission of

energy from the radiotracer in your body.

A computer aids in creating the images from the data obtained by the gamma camera.

A probe is a small hand-held device resembling a microphone that can detect and measure the

amount of the radiotracer in a small area of your body.

There is no specialized equipment used during radioactive iodine therapy, but the technologist or

other personnel administering the treatment may cover your clothing and use lead containers to

shield the radioactive material you will be receiving.

How does the procedure work?

The technologist positions the patient and begins a "dual head" nuclear medicine examination. The

devices above and below the patient are the dual gamma cameras and each contains a scintillation

crystal and other image acquisition electronics.

In an x-ray or CT examination, the radiation comes out of the x-ray or CT system and then passes

through the patient's body before being detected and recorded onto film or by a computer. Nuclear
medicine uses the opposite approach: a radioactive material is introduced into the patient, and is

then detected by a machine called a gamma camera. The radiation which is emitted by the body

during nuclear medicine imaging are gamma rays. These gamma rays are similar to x-rays but

have a shorter wavelength.

The radionuclide substances used in nuclear medicine imaging are usually either synthesized

radioactive substances, like technetium, or radioactive forms of elements that are naturally found

in the body, such as iodine. The levels of radiation involved in nuclear medicine studies is usually

considerably lower than a patient would receive in a conventional x-ray study or CT scan.

With ordinary x-ray examinations, an image is made by passing x-rays through the patient's body.

In contrast, nuclear medicine procedures use a radioactive material, called a radiopharmaceutical

or radiotracer, which is injected into the bloodstream, swallowed or inhaled as a gas. This

radioactive material accumulates in the organ or area of your body being examined, where it gives

off a small amount of energy in the form of gamma rays. Special cameras detect this energy, and

with the help of a computer, create pictures offering details on both the structure and function of

organs and tissues in your body.

Unlike other imaging techniques, nuclear medicine imaging exams focus on depicting physiologic

processes within the body, such as rates of metabolism or levels of various other chemical activity,

instead of showing anatomy and structure. Areas of greater intensity, called "hot spots," indicate

where large amounts of the radiotracer have accumulated and where there is a high level of

chemical or metabolic activity. Less intense areas, or "cold spots," indicate a smaller concentration

of radiotracer and less chemical activity.

In radioactive iodine (I-131) therapy for thyroid disease, radioactive iodine (I-131) is swallowed,

absorbed into the bloodstream in the gastrointestinal (GI) tract and absorbed from the blood by the

thyroid gland where it destroys cells within that organ.

Radioimmunotherapy (RIT) is a combination of radiation therapy and immunotherapy. In

immunotherapy, a laboratory-produced molecule called a monoclonal antibody is engineered to

recognize and bind to the surface of cancer cells. Monoclonal antibodies mimic the antibodies

naturally produced by the body's immune system that attack invading foreign substances, such as

bacteria and viruses.

In RIT, a monoclonal antibody is paired with a radioactive material. When injected into the

patient's bloodstream, the antibody travels to and binds to the cancer cells, allowing a high dose of

radiation to be delivered directly to the tumor.

In I-131MIBG therapy for neuroblastoma, the radiotracer is administered by injection into the

blood stream. The radiotracer binds to the cancer cells allowing a high dose of radiation to be

delivered to the tumor.

How is the procedure performed?

Nuclear medicine imaging is usually performed on an outpatient basis, but is often performed on

hospitalized patients as well.

You will be positioned on an examination table. If necessary, a nurse or technologist will insert an

intravenous (IV) catheter into a vein in your hand or arm.

Depending on the type of nuclear medicine exam you are undergoing, the dose of radiotracer is

then injected intravenously, swallowed or inhaled as a gas.

It can take anywhere from several seconds to several days for the radiotracer to travel through your

body and accumulate in the organ or area being studied. As a result, imaging may be done

immediately, a few hours later, or even several days after you have received the radioactive

material.

When it is time for the imaging to begin, the camera or scanner will take a series of images. The

camera may rotate around you or it may stay in one position and you will be asked to change

positions in between images. While the camera is taking pictures, you will need to remain still for

brief periods of time. In some cases, the camera may move very close to your body. This is

necessary to obtain the best quality images. If you are claustrophobic, you should inform the

technologist before your exam begins.

If a probe is used, this small hand-held device will be passed over the area of the body being

studied to measure levels of radioactivity. Other nuclear medicine tests measure radioactivity

levels in blood, urine or breath.

The length of time for nuclear medicine procedures varies greatly, depending on the type of exam.

Actual scanning time for nuclear imaging exams can take from 20 minutes to several hours and

may be conducted over several days.

Young children may require gentle wrapping or sedation to help them hold still. If your doctor

feels sedation is needed for your child, you will receive specific instructions regarding when and

if you can feed your child on the day of the exam. A physician or nurse who specializes in pediatric

anesthesia will be available during the exam to ensure your child's safety while under the effects
of sedation. When scheduling the exam for a young child, ask if a child life specialist is available.

A child life specialist is trained to make your child comfortable and less anxious without sedation

and will help your child to remain still during the examination.

When the examination is completed, you may be asked to wait until the technologist checks the

images in case additional images are needed. Occasionally, more images are obtained for

clarification or better visualization of certain areas or structures. The need for additional images

does not necessarily mean there was a problem with the exam or that something abnormal was

found, and should not be a cause of concern for you.

If you had an intravenous line inserted for the procedure, it will usually be removed unless you are

scheduled for an additional procedure that same day that requires an intravenous line.

For patients with thyroid disease who undergo radioactive iodine (I-131) therapy, which is most

often an outpatient procedure, the radioactive iodine is swallowed, either in capsule or liquid form.

Radioimmunotherapy (RIT), also typically an outpatient procedure, is delivered through injection.

I-131MIBG therapy for neuroblastoma is administered by injection into the blood stream. Children

are admitted to the hospital for treatment as an inpatient and will stay overnight in a specially

prepared room. Special arrangements are made for parents to allow participation in the care of

their child while undergoing this therapy.

What will I experience during and after the procedure?

Except for intravenous injections, most nuclear medicine procedures are painless and are rarely

associated with significant discomfort or side effects.

When the radiotracer is given intravenously, you will feel a slight pin prick when the needle is

inserted into your vein for the intravenous line. When the radioactive material is injected into your

arm, you may feel a cold sensation moving up your arm, but there are generally no other side

effects.

When swallowed, the radiotracer has little or no taste. When inhaled, you should feel no differently

than when breathing room air or holding your breath.

With some procedures, a catheter may be placed into your bladder, which may cause temporary

discomfort.

It is important that you remain still while the images are being recorded. Though nuclear imaging

itself causes no pain, there may be some discomfort from having to remain still or to stay in one

particular position during imaging.

Unless your physician tells you otherwise, you may resume your normal activities after your

nuclear medicine scan. If any special instructions are necessary, you will be informed by a

technologist, nurse or physician before you leave the nuclear medicine department.

Through the natural process of radioactive decay, the small amount of radiotracer in your body

will lose its radioactivity over time. It may also pass out of your body through your urine or stool

during the first few hours or days following the test. You should also drink plenty of water to help

flush the radioactive material out of your body as instructed by the nuclear medicine personnel.

You will be informed as to how often and when you will need to return to the nuclear medicine

department for further procedures.

Who interprets the results and how do I get them?

A radiologist or other physician who has specialized training in nuclear medicine will interpret the

images and send a report to your referring physician.

What are the benefits vs. risks?

Benefits

 Nuclear medicine examinations provide unique information—including details on both

function and anatomic structure of the body that is often unattainable using other imaging

procedures.

 For many diseases, nuclear medicine scans yield the most useful information needed to

make a diagnosis or to determine appropriate treatment, if any.

 Nuclear medicine is less expensive and may yield more precise information than

exploratory surgery.

 Nuclear medicine offers the potential to identify disease in its earliest stage, often before

symptoms occur or abnormalities can be detected with other diagnostic tests.

 By detecting whether lesions are likely benign or malignant, PET scans may eliminate the

need for surgical biopsy or identify the best biopsy location.

 PET scans may provide additional information that is used for radiation therapy planning.

Risks
  Because the doses of radiotracer administered are small, diagnostic nuclear medicine

procedures result in relatively low radiation exposure to the patient, acceptable for

diagnostic exams. Thus, the radiation risk is very low compared with the potential benefits.

 Nuclear medicine diagnostic procedures have been used for more than five decades, and

there are no known long-term adverse effects from such low-dose exposure.

 The risks of the treatment are always weighed against the potential benefits for nuclear

medicine therapeutic procedures. You will be informed of all significant risks prior to the

treatment and have an opportunity to ask questions.

 Allergic reactions to radiopharmaceuticals may occur but are extremely rare and are

usually mild. Nevertheless, you should inform the nuclear medicine personnel of any

allergies you may have or other problems that may have occurred during a previous nuclear

medicine exam.

 Injection of the radiotracer may cause slight pain and redness which should rapidly resolve.

 Women should always inform their physician or radiology technologist if there is any

possibility that they are pregnant or if they are breastfeeding. See the Safety page for more

information about pregnancy, breastfeeding and nuclear medicine exams.

What are the limitations of General Nuclear Medicine?

Nuclear medicine procedures can be time consuming. It can take several hours to days for the

radiotracer to accumulate in the body part of interest and imaging may take up to several hours to

perform, though in some cases, newer equipment is available that can substantially shorten the

procedure time.
The resolution of structures of the body with nuclear medicine may not be as high as with other

imaging techniques, such as CT or MRI. However, nuclear medicine scans are more sensitive than

other techniques for a variety of indications, and the functional information gained from nuclear

medicine exams is often unobtainable by other imaging techniques.

New Drug Testing

It is nearly impossible for today's physicians to effectively deal with severe patient illness without

modern drugs. The pharmaceutical industry has recently skyrocketed in most developed countries

as new drugs are produced to treat previously incurable diseases and anomalies. But in order for

such treatments to be approved by the designated federal agencies and reach the physician’s hands,

substantial testing must be done. Mammoth hurdles must be overcome by the drug companies,

both to determine how a new product attacks the targeted disease and then to ascertain what the

side effects might be. Radioisotopes, due to their unique imaging characteristics (particle

emission), are ideally suited to deal with such questions—including material uptake, metabolism,

distribution, and elimination of unwanted residues from the body.

It is estimated that over 80% of all the new drugs eventually approved for medical use employ

radiation techniques as a crucial component to their success. It should not be surprising, therefore,

that radiation techniques played a key role in 12 of the recent 15 Nobel Prizes awarded in medicine

and physiology. The International Atomic Energy Agency (IAEA) has estimated that between 100

and 300 radiopharmaceuticals are in routine use throughout the world, and most are commercially

available.
Diagnostic Techniques

A crucial part of successful medical practice is to diagnose ailments. There are countless examples

in every corner of the globe where an early and exact diagnosis could have prevented tragic results.

It is this element of medicine where radiation techniques have made their most significant

contribution to enhanced health care. The earliest use of radiation in the medical field was

employing portable x-rays sources in World War I, where such devices helped field surgeons save

many lives. Dental x-rays, chest x-rays, mammograms, and a plethora of other tests are in routine

use today in the medical/dental professions.

But x-rays, useful as they are, provide only a snapshot of a particular piece of the anatomy. The

imaging properties of radioisotopes allow modern nuclear medical specialists to measure the

activity of some specific physiological or biochemical function in the body as a function of time.

This has enormous implications, all the way from determining nutritional deficiencies to locating

and identifying various types of cancer.

Two of the most common approaches used in modern diagnostic nuclear medicine are single

photon emission computed tomography (SPECT) and positron emission tomography (PET).

SPECT is widely used for routine clinical work because it is relatively inexpensive and utilizes

radioisotopes available from nuclear reactors. Technetium-99m, a very popular 140 keV gamma

emitter with a 6-hour half-life, is the most popular radioisotope used in this device. It is derived

from a common nuclear reactor fission product (Molybdenum-99). Mo-99 has a 66 hour half-life

and it decays to Tc-99m. The “generator” consists of a lead pot enclosing a glass tube that contains

Mo-99. When an order for Tc-99m is placed, it is washed out of the lead pot by a saline solution
and prepared for injection into the patient. After about two weeks of use, the generator is returned

for a new batch of Mo-99.

The SPECT system works by placing a solution containing a short-lived radioisotope such as Tc-

99m into the patient. The patient stays in a fixed position and cameras (detector systems) rotate

around the patient, picking up the gamma rays emitted by the Tc-99m circulating in the patient’s

body. By the clever use of microprocessors, the data collected by the cameras can be sorted out

and the location of the Tc-99m radioisotope can be followed as a function of time. If bone cancer

exists, the chemical carrier to which the Tc-99m is attached will tend to collect at the sites of the

tumors, and the “tell-tale” sharp images at those sites clearly reveal the problem. If the physician

is looking for other types of abnormalities, a different chemical carrier is used (one that has a

propensity of accumulating at the suspicious sites). This procedure is now employed so frequently

that one of every three patients that enter a U.S. medical center today directly benefits from nuclear

medicine.

Whereas Tc-99m is by far the most popular radioisotope used for such purposes, some SPECT

systems have been equipped with Flourine-18 embedded in 18F-deoxyglucose (18FDG). F-18 has

a substantially more energetic gamma ray (511keV), thus requiring a different detector system.

Other radioisotopes, generally produced by nuclear reactors for such use, are I-131, Ga-67, and

Tl-210.

PET devices are based on the detection of a pair of photons emitted from positron annihilation.

Very shortly after a positron is emitted from a radioactive substance such as flourine-18, it collides

with an electron and the two particles are literally annihilated. The mass of the two particles is

translated into pure energy and two gamma rays of at least 511 keV each move apart at light speed

in precisely opposite directions. By surrounding the patient into which the radioisotope was
injected with special detectors, the location of the radioisotope can be pinpointed by determining

counts recorded at exactly the same time (coincidence counting) at opposite sides of the patient.

PET systems tend to be more expensive than SPECT systems, partly because of the sophistication

of the counting system and partly because the radioisotopes that emit positrons typically have a

very short half-life (minutes). Hence, they must be produced on-site by accelerators (usually

cyclotrons) and administered to the patient with the proper chemical carrier very quickly. But PET

machines are becoming increasingly popular because they are capable of more precision than most

SPECT devices. Three dimensional PET systems are particularly impressive and can provide the

diagnostician excellent images. Radioisotopes often used in such devices, in addition to F-18,

include carbon-11, nitrogen-13, and oxygen-15.

Nuclear diagnostics are now routinely employed throughout the developed world to determine

anomalies in the heart, brain, kidneys, lungs, liver, breasts, and thyroid glands. Bone and joint

disorders, along with spinal disorders, also benefit directly from this routine use of radioisotopes.

In addition to the accuracy in determining medical abnormalities that nuclear diagnostics provides

to the physician, a great advantage to the patient is that there is no discomfort during the test and

after a short time there is no trace that the test was ever done. The radioisotopes simply decay and

disappear completely. The non-invasive nature of this technology, together with the ability to

observe an organ functioning from outside the body, makes nuclear diagnostics a very powerful

tool.

Therapeutic Approaches
Until recently, the use of radiation to actually cure diseases has been rather limited. One of the first

therapeutic uses of radioisotopes was employing Iodine-131 to cure thyroid cancer. Since the

thyroid gland has a special affinity for iodine, it is a relatively simple and straightforward matter

to have a patient drink a carefully determined amount of I-131 in a chemically palatable form of

solution. The I-131 then preferentially lodges in the thyroid gland and the beta emitting properties

of this radioisotope subsequently target and destroy the thyroid malignancy. Since I-131 has a half-

life of 8 days, it does its job and then effectively disappears within a few weeks.

Another widespread use of radiation is in the treatment of other cancers. Surgery, chemotherapy,

and radiation (often used in combination) constitute the principal venues of cancer treatment today.

Most of the current procedures utilizing radiation to kill cancer in humans are based on delivering

the radiation to the patient externally. This is called teletherapy. Accelerators are used to deliver

either protons to the target (such as the system used for external beam prostate treatment at the

Loma Linda facility in California) or beta particles, which are normally directed onto a target that

secondarily produces x-rays. Whereas substantial benefits can be obtained by such treatment, it is

essentially impossible to keep the radiation from killing or impairing healthy tissue in the

immediate vicinity—especially if the beam must pass through healthy tissue to reach the

malignancy.

The two principal approaches underway to prevent radiation therapy from injuring healthy cells

are 1) creating radioisotopes at the site of the malignancy, and 2) developing a method to deliver

appropriate radioisotopes directly to the cancerous tissue.

An example of the first approach is called boron-neutron capture therapy (BNCT). Boron is placed

into the patient as part of a special chemical carrier such that it preferentially concentrates at the
tumor site. A neutron beam is then focused on the boron, producing alpha particles that destroy

the malignant cells only in the immediate vicinity of the concentrated boron. Since alpha particles

are stopped at a very short distance from their point of origin (typically about one human cell), the

intense radiation damage is very localized. Some damage may be done to healthy cells through

which the neutrons must pass to reach the malignancy, but special “beam tailoring” can be done

to minimize this concern. An example of the second approach is celldirected radiation therapy. In

order to attain the localized damage desired, either beta or alpha emitters are needed. For solid

tumors, one method of getting the radioisotope to the target is direct injection, assuming the tumor

is accessible.

An example of this approach is Brachytherapy. One well-founded application of this technique is

treating prostate cancer. This is accomplished by encapsulating a small amount of a radionuclide

such as I-125 or Pd-103 within a titanium capsule about the size of a grain of rice. These “seeds”

are then placed directly into the prostate gland where they remain for life.

Another approach to cell-directed radiation therapy is to find a chemical that has a special affinity

for the malignancy, and then attach the radioisotope to this special carrier. This is called the

monoclonal antibody (or "smart bullet") approach. It is also sometimes called targeted alpha

therapy (TAT), since much of this research is focused on the use of alpha particles. Such an

approach is particularly suited for treating malignancies that are not confined to a particular spot.

Leukemia and Non-Hodgkin’s diseases are examples. Recent work employing the “smart bullet”

approach has revealed some very impressive results. End stage Hodgkin's disease has been treated

with Yttrium-90 (a beta emitter), with a positive response rate of over 80% (for patients who have

failed all other known treatments). Patients with advanced stages of B cell lymphomas treated with
Iodine-131 have a demonstrated survival rate of over 90%. Recent trials using an alpha emitter

(Bismuth-213) have shown remarkable results in treating leukemia.

Several specialized areas of treating specific abnormalities are developing on almost a constant

basis. Most people are aware of the procedure called angioplasty (that of inserting a “balloon” into

a clogged artery and passing it through in a “roto-rooter” manner to unclog it). Whereas this

procedure has a high success rate, and has prevented a plethora of heart attacks, there are several

cases where the arteries slowly become re-blocked. Several years ago, it was discovered that lining

the “balloon” with rehenium-86 made a huge impact in preventing re-closure of the arteries.

Another example of a specialty area is the treatment of arterio-venous malformation (AVM). This

condition is a malformation of blood vessels characterized by a mass of unwanted arteries in the

brain. A special mixture containing a radioactive powder is injected into the artery, causing an

arterial occlusion, thereby stopping the blood flow into the unwanted vessels. This is but one

example of numerous applications of radioactivity to somewhat unique conditions.

Although many of the above results are still in relatively early trial stages, the potential for success

is enormous. Given that cancer remains a major concern in most areas of the world, and that it is

the most prevalent childhood disease in the Western World, the incentive for further harnessing

radiation in the field of medicine remains huge.

Radioisotopes in Medicine
  Nuclear medicine uses radiation to provide diagnostic information about the

functioning of a person's specific organs, or to treat them. Diagnostic procedures

using radioisotopes are now routine.

 Radiotherapy can be used to treat some medical conditions, especially cancer, using

radiation to weaken or destroy particular targeted cells.

 Over 40 million nuclear medicine procedures are performed each year, and demand

for radioisotopes is increasing at up to 5% annually.

 Sterilization of medical equipment is also an important use of radioisotopes.

The attributes of naturally decaying atoms, known as radioisotopes, give rise to several

applications across many aspects of modern day life (see also information paper on The Many

Uses of Nuclear Technology).

There is widespread awareness of the use of radiation and radioisotopes in medicine, particularly

for diagnosis (identification) and therapy (treatment) of various medical conditions. In developed

countries (a quarter of the world population) about one person in 50 uses diagnostic nuclear

medicine each year, and the frequency of therapy with radioisotopes is about one-tenth of this.

Nuclear medicine uses radiation to provide information about the functioning of a person's specific

organs, or to treat disease. In most cases, the information is used by physicians to make a quick

diagnosis of the patient's illness. The thyroid, bones, heart, liver, and many other organs can be

easily imaged, and disorders in their function revealed. In some cases radiation can be used to treat

diseased organs, or tumors. Five Nobel Laureates have been closely involved with the use of

radioactive tracers in medicine.

Over 10,000 hospitals worldwide use radioisotopes in medicine, and about 90% of the procedures

are for diagnosis. The most common radioisotope used in diagnosis is technetium-99 (Tc-99), with

some 40 million procedures per year, accounting for about 80% of all nuclear medicine procedures

worldwide.

In developed countries (26% of world population) the frequency of diagnostic nuclear medicine is

1.9% per year, and the frequency of therapy with radioisotopes is about one-tenth of this. In the

USA there are over 20 million nuclear medicine procedures per year, and in Europe about 10

million. In Australia there are about 560,000 per year, 470,000 of these using reactor isotopes. The

use of radiopharmaceuticals in diagnosis is growing at over 10% per year.

The global radioisotope market was valued at $9.6 billion in 2016, with medical radioisotopes

accounting for about 80% of this, and it is poised to reach about $17 billion by 2021. North

America is the dominant market for diagnostic radioisotopes with close to half of the market share,

while Europe accounts for about 20%.

Nuclear medicine was developed in the 1950s by physicians with an endocrine emphasis, initially

using iodine-131 to diagnose and then treat thyroid disease. In recent years specialists have also

come from radiology, as dual positron emission tomography/computed tomography (PET/CT)

procedures have become established, increasing the role of accelerators in radioisotope production.

However, the main radioisotopes such as Tc-99m cannot effectively be produced without

reactors.*

* Some Tc-99m is produced in accelerators but it is of lower quality and at higher cost.

Nuclear medicine diagnosis

Radioisotopes are an essential part of medical diagnostic procedures. In combination with imaging

devices which register the gamma rays emitted from within, they can study the dynamic processes

taking place in various parts of the body.

In using radiopharmaceuticals for diagnosis, a radioactive dose is given to the patient and the

activity in the organ can then be studied either as a two dimensional picture or, using tomography,

as a three dimensional picture. Diagnostic techniques in nuclear medicine use radioactive tracers

which emit gamma rays from within the body. These tracers are generally short-lived isotopes

linked to chemical compounds which permit specific physiological processes to be scrutinised.

They can be given by injection, inhalation, or orally. The earliest technique developed uses single

photons detected by a gamma camera which can view organs from many different angles. The

camera builds up an image from the points from which radiation is emitted; this image is enhanced

by a computer and viewed on a monitor for indications of abnormal conditions. Single photon

emission computerised tomography (SPECT) is the current major scanning technology to diagnose

and monitor a wide range of medical conditions.

A more recent development is positron emission tomography (PET) which is a more precise and

sophisticated technique using isotopes produced in a cyclotron. A positron-emitting radionuclide

is introduced, usually by injection, and accumulates in the target tissue. As it decays it emits a

positron, which promptly combines with a nearby electron resulting in the simultaneous emission

of two identifiable gamma rays in opposite directions. These are detected by a PET camera and

give very precise indications of their origin. PET's most important clinical role is in oncology, with

fluorine-18 as the tracer, since it has proven to be the most accurate non-invasive method of

detecting and evaluating most cancers. It is also well used in cardiac and brain imaging.
New procedures combine PET with computed X-ray tomography (CT) scans to give co-

registration of the two images (PET-CT), enabling 30% better diagnosis than with a traditional

gamma camera alone. It is a very powerful and significant tool which provides unique information

on a wide variety of diseases from dementia to cardiovascular disease and cancer.

Positioning of the radiation source within (rather than external to) the body is the fundamental

difference between nuclear medicine imaging and other imaging techniques such as X-rays.

Gamma imaging by either method described provides a view of the position and concentration of

the radioisotope within the body. Organ malfunction can be indicated if the isotope is either

partially taken up in the organ (cold spot), or taken up in excess (hot spot). If a series of images is

taken over a period of time, an unusual pattern or rate of isotope movement could indicate

malfunction in the organ.

A distinct advantage of nuclear imaging over X-ray techniques is that both bone and soft tissue

can be imaged very successfully. This has led to its common use in developed countries where the

probability of anyone having such a test is about one in two and rising.

Diagnostic radiopharmaceuticals

Every organ in our bodies acts differently from a chemical point of view. Doctors and chemists

have identified a number of chemicals which are absorbed by specific organs. The thyroid, for

example, takes up iodine, whilst the brain consumes quantities of glucose. With this knowledge,

radiopharmacists are able to attach various radioisotopes to biologically active substances. Once a

radioactive form of one of these substances enters the body, it is incorporated into the normal

biological processes and excreted in the usual ways.

Diagnostic radiopharmaceuticals can be used to examine blood flow to the brain, functioning of

the liver, lungs, heart, or kidneys, to assess bone growth, and to confirm other diagnostic

procedures. Another important use is to predict the effects of surgery and assess changes since

treatment.

The amount of the radiopharmaceutical given to a patient is just sufficient to obtain the required

information before its decay. The radiation dose received is medically insignificant. The patient

experiences no discomfort during the test and after a short time there is no trace that the test was

ever done. The non-invasive nature of this technology, together with the ability to observe an organ

functioning from outside the body, makes this technique a powerful diagnostic tool.

A radioisotope used for diagnosis must emit gamma rays of sufficient energy to escape from the

body and it must have a half-life short enough for it to decay away soon after imaging is completed.

The radioisotope most widely used in medicine is Tc-99, employed in some 80% of all nuclear

medicine procedures. It is an isotope of the artificially-produced element technetium and it has

almost ideal characteristics for a nuclear medicine scan, such as with SPECT. These are:

 It has a half-life of six hours which is long enough to examine metabolic processes yet

short enough to minimize the radiation dose to the patient.

 It decays by an 'isomeric' process, which involves the emitting of gamma rays and low

energy electrons. Since there is no high-energy beta emission the radiation dose to the

patient is low.

 The low-energy gamma rays it emits easily escape the human body and are accurately

detected by a gamma camera.

  The chemistry of technetium is so versatile it can form tracers by being incorporated into

a range of biologically-active substances that ensure it concentrates in the tissue or organ

of interest.

Its logistics also favour its use. Technetium generators – a lead pot enclosing a glass tube

containing the radioisotope – are supplied to hospitals from the nuclear reactor where the isotopes

are made. They contain molybdenum-99 (Mo-99), with a half-life of 66 hours, which progressively

decays to Tc-99. The Tc-99 is washed out of the lead pot by saline solution when it is required.

After two weeks or less the generator is returned for recharging.

A similar generator system is used to produce rubidium-82 for PET imaging from strontium-82 –

which has a half-life of 25 days.

Myocardial perfusion imaging (MPI) uses thallium-201 chloride or Tc-99 and is important for

detection and prognosis of coronary artery disease.

For PET imaging, the main radiopharmaceutical is fluoro-deoxy glucose (FDG) incorporating F-

18 – with a half-life of just under two hours – as a tracer. The FDG is readily incorporated into the

cell without being broken down, and is a good indicator of cell metabolism.

In diagnostic medicine, there is a strong trend towards using more cyclotron-produced isotopes

such as F-18, as PET and CT/PET become more widely available. However, the procedure needs

to be undertaken within two hours' reach of a cyclotron, which limits their utility compared with

Mo/Tc-99.

Nuclear medicine therapy

The uses of radioisotopes in therapy are comparatively few, but nevertheless important. Cancerous

growths are sensitive to damage by radiation. For this reason, some cancerous growths can be

controlled or eliminated by irradiating the area containing the growth.

External irradiation (sometimes called teletherapy) can be carried out using a gamma beam from

a radioactive cobalt-60 source, though in developed countries the much more versatile linear

accelerators are now being used as high-energy X-ray sources (gamma and X-rays are much the

same). An external radiation procedure is known as gamma knife radiosurgery, and involves

focusing gamma radiation from 201 sources of Co-60 on a precise area of the brain with a

cancerous tumour. Worldwide, over 30,000 patients are treated annually, generally as outpatients.

Teletherapy is effective in the ablation of tumours rather than their removal; it is not finely tuned.

Internal radionuclide therapy is administered by planting a small radiation source, usually a gamma

or beta emitter, in the target area. Short-range radiotherapy is known as brachytherapy, and this is

becoming the main means of treatment. Iodine-131 is commonly used to treat thyroid cancer,

probably the most successful kind of cancer treatment. It is also used to treat non-malignant thyroid

disorders. Iridium-192 implants are used especially in the head and breast. They are produced in

wire form and are introduced through a catheter to the target area. After administering the correct

dose, the implant wire is removed to shielded storage. Permanent implant seeds (40 to 100) of

iodine-125 or palladium-103 are used in brachytherapy for early stage prostate cancer.

Alternatively, needles with more-radioactive Ir-192 may be inserted for up to 15 minutes, two or

three times. Brachytherapy procedures give less overall radiation to the body, are more localized

to the target tumour, and are cost-effective.

Treating leukaemia may involve a bone marrow transplant, in which case the defective bone

marrow will first be killed off with a massive (and otherwise lethal) dose of radiation before being

replaced with healthy bone marrow from a donor.

Many therapeutic procedures are palliative, usually to relieve pain. For instance, strontium-89 and

(increasingly) samarium-153 are used for the relief of cancer-induced bone pain. Rhenium-186 is

a newer product for this.

Lutetium-177 dotatate or octreotate is used to treat tumours such as neuroendocrine ones, and is

effective where other treatments fail. A series of four treatments delivers 32 GBq. After about four

to six hours, the exposure rate of the patient has fallen to less than 25 microsieverts per hour at one

metre and the patients can be discharged from hospital. Lu-177 is essentially a low-energy beta-

emitter (with some gamma) and the carrier attaches to the surface of the tumour.

A new field is targeted alpha therapy (TAT) or alpha radioimmunotherapy, especially for the

control of dispersed cancers. The short range of very energetic alpha emissions in tissue means

that a large fraction of that radiative energy goes into the targeted cancer cells, once a carrier such

as a monoclonal antibody has taken the alpha-emitting radionuclide such as bismuth-213 to the

areas of concern. Clinical trials for leukaemia, cystic glioma, and melanoma are underway. TAT

using lead-212 is increasingly important for treating pancreatic, ovarian, and melanoma cancers.

An experimental development of this is boron neutron capture therapy using boron-10 which

concentrates in malignant brain tumours. The patient is then irradiated with thermal neutrons

which are strongly absorbed by the boron, producing high-energy alpha particles which kill the

cancer. This requires the patient to be brought to a nuclear reactor, rather than the radioisotopes

being taken to the patient.

Radionuclide therapy has progressively become more successful in treating persistent disease and

doing so with low toxic side-effects. With any therapeutic procedure the aim is to confine the

radiation to well-defined target volumes of the patient. The doses per therapeutic procedure are

typically 20-60 Gy.

Treatment may involve significant radioactivity (e.g. 4.4 GBq is quoted as an average dose of I-

131 for thyroid ablation, and up to 11 GBq for patients with advanced metastatic disease).

According to US regulatory guidelines for I-131, the patient can be released if the activity is below

1.2 GBq, or 0.07 mSv/hr at 1 metre. Meanwhile a lot of I-131 is flushed down the hospital toilet

and plumbing needs to be shielded accordingly.

Therapeutic radiopharmaceuticals

For some medical conditions, it is useful to destroy or weaken malfunctioning cells using radiation.

The radioisotope that generates the radiation can be localised in the required organ in the same

way it is used for diagnosis – through a radioactive element following its usual biological path, or

through the element being attached to a suitable biological compound. In most cases, it is beta

radiation which causes the destruction of the damaged cells. This is radionuclide therapy (RNT)

or radiotherapy. Short-range radiotherapy is known as brachytherapy, and this is becoming the

main means of treatment.

Although radiotherapy is less common than diagnostic use of radioactive material in medicine, it

is nevertheless widespread, important, and growing. An ideal therapeutic radioisotope is a strong

beta emitter with just enough gamma to enable imaging (e.g. lutetium-177 ). This is prepared from

ytterbium-176 which is irradiated to become Yb-177 (which decays rapidly to Lu-177). Yttrium-

90 is used for treatment of cancer, particularly non-Hodgkin's lymphoma and liver cancer, and it
is being used more widely, including for arthritis treatment. Lu-177 and Y-90 are becoming the

main RNT agents.

Iodine-131, samarium-153, and phosphorus-32 are also used for therapy. I-131 is used to treat the

thyroid for cancers and other abnormal conditions such as hyperthyroidism (over-active thyroid).

In a disease called Polycythemia vera, an excess of red blood cells is produced in the bone marrow.

P-32 is used to control this excess.

Caesium-131, palladium-103, and radium-223 are also used for brachytherapy, all being Auger

(soft) X-ray emitters, and having half-lives of 9.7 days, 17 days, and 11.4 days, respectively, much

less than the 60 days of I-125 which they replace.

A new and still experimental procedure uses boron-10, which concentrates in the tumour. The

patient is then irradiated with neutrons which are strongly absorbed by the boron, to produce high-

energy alpha particles which kill the cancer. This is boron neutron capture therapy.

For targeted alpha therapy (TAT), actinium-225 is readily available, from which the daughter

bismuth-213 can be obtained (via three alpha decays) to label targeting molecules. The bismuth is

obtained by elution from an Ac-225/Bi-213 generator similar to the Mo-99/Tc-99 one. Bi-213 has

a 46-minute half-life. The Ac-225 (half-life 10 days) is formed from radioactive decay of radium-

225, the decay product of long-lived thorium-229, which is obtained from decay of uranium-233,

which in turn is formed from thorium-232 by neutron capture in a nuclear reactor.

Another radionuclide recovered from Th-232, but by natural decay via thorium-228, is Pb-212,

with a half-life of 10.6 hours. Pb-212 can be attached to monoclonal antibodies for cancer

treatment by TAT. A Ra-224/Pb-212 generator system similar to the Mo-99/Tc-99 one is used to

provide Pb-212 from Ra-224 (via Ra-220 and polonium-216 (po-216)). Pb-212 has a half-life of
10.6 hours, and beta decays to Bi-212 (1 hour half-life), then most beta decays to Po-212. The

alpha decays of Bi-212 and Po-212 are the active ones destroying cancer cells over a couple of

hours. Stable Pb-208 results, via Tl-208 for the bismuth decay.

Considerable medical research is being conducted worldwide into the use of radionuclides attached

to highly specific biological chemicals such as immunoglobulin molecules (monoclonal

antibodies). The eventual tagging of these cells with a therapeutic dose of radiation may lead to

the regression – or even cure – of some diseases.

Supply of radioisotopes

The main world isotope suppliers are Curium (France & USA), MDS

Nordion (Canada), IRE (Europe), NTP (South Africa), Isotop-NIIAR (Russia),

and ANM (ANSTO Australia).

Most medical radioisotopes made in nuclear reactors are sourced from relatively few research

reactors, including:

 HFR at Petten in Netherlands (supplied via IRE and Curium).

 BR-2 at Mol in Belgium (supplied via IRE and Curium).

 Maria in Poland (supplied via Curium).

 Orphee at Saclay in France (supplied via IRE).

 FRJ-2/FRM-2 at Julich in Germany (supplied via IRE).

 LWR-15 at Rez in Czech Republic.

 HFETR at Chengdu in China.

 Safari in South Africa (supplied from NTP).

  OPAL in Australia (supplied from ANM).

 ETRR-2 in Egypt (forthcoming: supplied to domestic market).

 Dimitrovgrad in Russia (Isotop-NIIAR).

 NRU at Chalk River in Canada (supplied via MDS Nordion) ceased production in October

2016, and the reactor closed down in March 2018.

Of fission radioisotopes, the vast majority of demand is for of Mo-99 (for Tc-99m), and the world

market is some $550 million per year. About 40% of it is supplied by MDS Nordion, 25%

from Mallinckrodt (formerly Covidien), 17% from IRE, and 10% from NTP. For some years,

three-quarters of the Mo-99 was made in three reactors: NRU in Canada (30-40%), HFR in

Netherlands (30%) and BR-2 in Belgium (10%). However, NRU ceased production in October

2016, and the other two have limited remaining service life. In 2017, production was: HFR in the

Netherlands (40%), BR-2 in Belgium (20%), Maria in Poland (5%), Safari-1 in South Africa

(15%), Opal in Australia (15% increasing to 24% from mid-2018) and LWR-15 in the Czech

Republic (5%). Output from each varies due to maintenance schedules. Opal’s 15% was 4200 six-

day TBq/yr in 2017 (2200 six-day Ci/week, increasing to 3500 in mid-2018).

Supply capacity is always substantially (e.g. 50%) above demand, due to decay of Mo-99 in transit,

despite the six-day TBq/Ci quantification. One challenge is the delivery of fresh supplies in

weekdays, in line with demand, to minimise waste.

Russia is keen to increase its share of world supply, and in 2012 some 66% of its radioisotope

production was exported. For I-131, 75% is from IRE, 25% from NTP.

World demand for Mo-99 was 23,000 six-day TBq/yr* in 2012, but has apparently dropped back

to about 18,500 since. Mo-99 is mostly produced by fission of U-235 targets in a nuclear research
reactor, much of this (75% in 2016) using high-enriched uranium (HEU) targets. The targets are

then processed to separate the Mo-99 and also to recover I-131. OPAL, Safari, and increasingly

other reactors such as Maria, use low-enriched uranium (LEU) targets, which adds about 20% to

production costs. However, in medical imaging, the cost of Mo-99 itself is small relative to

hospital costs. Mo-99 can also be made by bombarding Mo-98 with neutrons in a reactor.

However, this activation Mo-99 has relatively low specific activity, with a maximum of 74 GBq/g

(depending on the neutron flux available in the reactor), compared with 185 TBq/g or more for

conventional fission-produced Mo-99.

* 23,000 TBq is on basis of activity at 6 days from production reference point, ie 22% of nearly

100,000 TBq required in production processing (given 66 hour half-life). This is still about two

days from the end of irradiation, so some 167,000 TBq/yr must be made in the actual reactors to

allow for cooling, processing and decay en route to the users.

There are three ways to produce Mo-99. The most common and effective method is by fission of

uranium in a target foil, followed by chemical separation of the Mo. This is done in research

reactors. A second method is neutron activation, where Mo-98 in target material captures a

neutron. This is done in power reactors, usually RBMK or Candu. A third method is by proton

bombardment of Mo-100 in an accelerator of some kind. There are plans to produce it by fission

in a subcritical assembly in an accelerator.

Threatened supply constraints

A number of incidents in 2008 pointed out shortcomings and unreliability in the supply of medical

isotopes, particular technetium. In September 2008 the World Council on Isotopes was set up,

based in South Korea, to promote isotope technologies.

As indicated above, most of the world's supply of Mo-99 for this comes from only five reactors,

all of them 49 to 58 years old (in mid-2016). The Canadian and Netherlands reactors required

major repairs over 2009-10 and were out of action for some time. Osiris was due to shut down in

2015 but apparently continued to at least 2016. NRU at Chalk River was re-licensed to October

2016 when it ceased production, and was fully retired in March 2018. A new 15 MW South Korean

reactor at Busan – KJRR – is expected to be operating in 2017. An increasing supply shortfall of

technetium-99 was forecast from 2010, and the IAEA encouraged new producers. Also, the

processing and distribution of isotopes is complex and constrained, which can be critical when the

isotopes concerned are short-lived. A need for increased production capacity and more reliable

distribution is evident. The Mo-99 market is about $5 billion per year, according to NECSA.

In 2009 the NEA set up the High-level Group on the Security of Supply of Medical Radioisotopes

(HLG-MR) to strengthen the reliability of Mo-99 and Tc-99 supply in the short, medium, and long

term. It reviewed the Mo-99 supply chain to identify the key areas of vulnerability, the issues that

need to be addressed, and the mechanisms that could be used to help resolve them. It requested an

economic study of the supply chain, and this was published in 2010 by the NEA. The

report identifies possible changes needed. The historical development of the market had an impact

on the economic situation, which was unsustainable. The supply chain’s economic structure

therefore had to be changed to attract additional investment in production capacity as well as the

necessary reserve capacity, and all supply chain participants worldwide need to agree on and

implement the required changes.

The NEA report predicts supply shortages from 2016, not simply from reactors but due to

processing limitations too. Historically reactor irradiation prices have been too low to attract new

investment, and full cost recovery is needed to encourage new infrastructure. This will have little

impact on end prices since irradiation only accounts for about 1% of product cost. Transport

regulation and denial of shipment impede reliable supply. HEU use needs to be minimised, though

conversion to LEU targets will reduce capacity. Outage reserve capacity needs to be sourced,

valued, and paid for by the supply chain. Fission is the most efficient and reliable means of

production, but Canada and Japan are developing better accelerator-based techniques.

The supply situation led, in December 2014, to the NEA Joint Declaration on the Security of

Supply of Medical Radioisotopes, focused on Mo-99, supported by 13 countries: Australia,

Canada, France, Germany, Japan, the Netherlands, Poland, South Korea, Russia, South Africa,

Spain, the UK, and the USA. A review of the situation in mid-2017 showed that the market had

substantially restructured following the 2009-2010 supply crisis, and that restructuring had led to

increased efficiencies in the use of material at the different layers in the supply chain. The latest

NEA data confirms a relatively flat market demand of around 333 six-day TBq Mo-99 per week

at the end of radiochemical processing. In addition, several sources of supply had ramped up

production to lift the baseline supply capacity for the 2017 and 2018 periods to a level safely above

the revised market demand.

US supply initiatives for molybdenum-99

The US Congress has called for all Mo-99 to be supplied by reactors running on low-enriched

uranium (LEU), instead of high-enriched uranium (HEU). Also it called for proposals for an LEU-

based supply of Mo-99 for the US market, reaching 111 six-day TBq per week by mid-2013, a
quarter of world demand. Tenders for this closed in June 2010, but evidently no immediate

progress was made. In December 2012 Congress passed the American Medical Isotope Production

Act of 2011 to establish a technology-neutral program to support the production of Mo-99 for

medical uses in the USA by non-federal entities.

In the USA, NorthStar Medical Technologies, founded in 2006, is using the University of Missouri

research reactor (MURR) to irradiate Mo-98 targets with neutrons, producing activation Mo-99.

Such Mo-99 has relatively low specific activity, and there are complications then in separating the

Tc-99. The company received approval to begin routine production in August 2015, and aims

eventually to meet half of US demand with 110 six-day TBq per week. Production was envisaged

from mid-2014, rising to meet half of US demand. In November 2013 Northstar was awarded a

$21.8 million cooperative agreement half-funded by NNSA to support its “non-uranium based Mo-

99 production by neutron capture”. Further grants from NNSA have totalled $25 million under a

$50 million cooperative agreement for Mo-99 production without use of HEU. MURR runs on

low-enriched uranium. Longer-term NorthStar is considering a non-reactor approach – see below.

In 2014 another plan using the US University Reactor Network was announced. Northwest

Medical Isotopes (NWMI) planned to produce half of North America’s demand for Mo-99 from

2017, using LEU targets. It has licensed the process for small Triga reactors from Oregon State

University, which operates one of the 35 in the USA, a Triga Mk II of 1.1 MW. It is setting up its

44,600 square metre radioisotope production facility at the University of Missouri’s Research Park

at Columbia, Missouri. The NRC approved the plans in May 2017. It is not clear whether the

project involves the University of Missouri research reactor (MURR).

In 2015, NorthStar Medical Radioisotopes signed an agreement with Westinghouse to investigate

production of Mo-99 in nuclear power reactors using its Incore Instrumentation System. In
December 2016 Exelon planned to produce Mo-99 by irradiation of Mo-98 in one of its power

reactors, the targets being inserted into fuel assembly thimbles. They would be processed offsite

by NorthStar.

In February 2015, Nordion and its US parent Sterigenics International announced a new

arrangement with the University of Missouri research reactor (MURR) and General Atomics to

produce Mo-99 from LEU targets from 2018 using the 10 MW pool-type reactor. By December

2016 the project was funded to $25 million by NNSA. This new medical isotope supply is to be

produced using General Atomics’ innovative Selective Gaseous Extraction (SGE) technology to

extract the molybdenum from the targets. Output will replace that from NRU at Chalk River in

Canada. A licence application was submitted to the NRC in March 2017, with a view to meeting

half of US demand for Mo-99. Nordion expects supplies from 2018.

In the USA Coquí Pharmaceuticals has signed a contract with Argentinian nuclear engineering

company INVAP to build an open-pool reactor similar to Australia’s Opal, using LEU targets, and

a Mo-99 production facility at Alachua county, Florida.

An earlier proposal for Mo-99 production involving an innovative reactor and separation

technology has lapsed. In January 2009 Babcock & Wilcox (B&W) announced an agreement with

international isotope supplier Covidien to produce Mo-99 sufficient for half of US demand, if a

new process was successful. They planned to use Aqueous Homogeneous Reactor (AHR)

technology with LEU in small 100-200 kW units where the fuel is mixed with the moderator and

the U-235 forms both the fuel and the irradiation target.* A single production facility could have

four such reactors. B&W and Covidien expected a five-year lead time to first production. B&W

received $9 million towards this Medical Isotope Production System (MIPS) in 2010 from the US

government and completed the R&D and conceptual design phase in 2012. However, in October
2012 Covidien pulled out of the joint venture with B&W “after learning that the time and cost

involved with the project would be greater than originally expected.” Covidien said that it was

"making significant long-term capital investment in a new Tc-99m generator facility at our US

plant, and conversion from HEU- to LEU-based Mo-99 production at our processing plant in the

Netherlands.” B&W appears to have dropped the MIPS.

* LEU is dissolved in acid then brought to criticality in a 200-litre vessel. As fission proceeds the

solution is circulated through an extraction facility to remove the fission products with Mo-99 and

then back into the reactor vessel, which is at low temperature and pressure.

In mid-2013 Los Alamos National Laboratory announced that it had recovered Mo-99 from low-

enriched sulphate reactor fuel in solution, raising the prospect of this process becoming associated

with commercial reprocessing plants as at La Hague in France.

Russian supply intitiatives for Mo-99

In Russia, the Research Institute of Atomic Reactors (NIIAR or RIAR, with three reactors for

isotope production) and Trans-regional Izotop Association (becoming JSC Isotope in 2008)

established a joint venture, Isotop-NIIAR, to produce Mo-99 at Dimitrovgrad from 2010. Phase 1

of the Mo-99 production complex with capacity of 1700 TBq/yr was commissioned in December

2010, and Phase 2 was commissioned in June 2012 taking total capacity to 1480 TBq/yr (evidently

6-day activity). Earlier reports quoted 4800 TBq/yr, and Rosatom aimed for 20% of the world Mo-

99 market by 2014, supplied internationally through Nordion. In September 2010 JSC Isotope

signed a framework agreement with MDS Nordion to explore commercial opportunities outside

Russia on the basis of this Isotop-NIIAR JV, initially over ten years.
Since 2009, JSC Isotope has been authorised by Rosatom to control all isotope production and

radiological devices such as RTGs in Russia. A second production facility is Karpov IPC. Its

product portfolio includes more than 60 radioisotopes produced in cyclotrons, nuclear reactors by

irradiation of targets, or recovered from spent nuclear fuel, as well as hundreds of types of ionizing

radiation sources and compounds tagged with radioactive isotopes. It has more than 10,000

scientific and industrial customers for industrial isotopes in Russia. Karpov gets some supply from

Leningrad nuclear power plant.

Mo-99 is also produced in significant amounts at the Leningrad nuclear power plant. In February

2018, Rosatom stated that the Mo-99 produced from the plant in 2017 will be enough for 5000

medical procedures.

At Russia's Kurchatov Institute the 20 kW ARGUS Aqueous Homogeneous Reactor (AHR) has

operated since 1981, and R&D on producing Mo-99 from it is ongoing.

Other reactor supply intitiatives for Mo-99

Australia's Opal reactor has the capacity to produce half the world supply of Mo-99, and with the

ANSTO Nuclear Medicine Project will be able to supply at least one-quarter of world demand

from 2019. ANSTO is building a substantial Mo-99 production facility to ramp up quickly to 130

six-day TBq per week (6500 per year), or 10 million Tc-99m doses per year, with exports to the

USA, Japan, China, and Korea. ANSTO increased production from 30 to 80 six-day TBq/wk (1500

to 4000 per year) from July 2016.

During the 2009-10 supply crisis, South Africa's (NECSA) Safari was able to supply over 25% of

the world's Mo-99.

Areva and Bruce Power are aiming to produce Mo-99 among other isotopes in the latter’s Candu

power reactors – see below.

In June 2018 it was announced that Ontario Power Generation's Darlington plant will begin

production of Mo-99 by the end of 2019.

Non-reactor technetium

Tc-99m or Mo-99 can also be produced in small quantities from cyclotrons and accelerators, in a

cyclotron by bombarding a Mo-100 target with a proton beam to produce Tc-99m directly, or in a

linear accelerator to generate Mo-99 by bombarding an Mo-100 target with high-energy X-rays. It

is generally considered that non-reactor methods of producing large quantities of useful Tc-99 are

some years away. At present the cost is at least three times and up to ten times that of the reactor

route, and Mo-100 is available only from Russia. If Tc-99 is produced directly in a cyclotron, it

needs to be used quickly, and the co-product isotopes are a problem.

In the USA, SHINE Medical Technologies is developing an advanced accelerator technology for

the production of Mo-99 as a fission product. It has been awarded $25 million in grants from

NNSA to December 2016, and it has a $125 million debt financing package from healthcare

investment firm Deerfield Management. A LEU target solution is irradiated with low-energy

neutrons in a subcritical assembly – not a nuclear reactor. SHINE is an acronym for Subcritical

Hybrid Intense Neutron Emitter. A plant at Janesville, Wisconsin, is planned eventually to supply

half of the US demand for Mo-99, and in February 2016 the NRC authorised a construction permit

for the project. In June 2016 China's largest producer and distributor of medical radioisotopes,

HTA, entered a strategic agreement for the supply of SHINE’s Mo-99. Construction commenced

in August 2017 and commercial production is expected in 2020.

In Canada the government has an Isotope Technology Acceleration Program (ITAP) to promote

R&D on non-reactor based isotope production, particularly through the Medical Isotope Program

(MIP). Canada Light Source Inc (CLS) in Saskatoon is using a linear accelerator to bombard Mo-

100 targets with x-rays, and has produced some Mo-99 for MIP.

NorthStar plans to produce Mo-99 from Mo-100 in an accelerator, and in December 2016 received

$11 million from NNSA for this. The award advances a $50 million cooperative agreement

between the two organizations in which NorthStar raises $25 million, matched by NNSA upon full

funding of the agreement.

Main Mo-99 production reactors

Reactor Targets Capacity* Start Est. stop

Belgium BR-2 HEU 289 1961 2026

Netherlands HFR HEU 173 1961 2022

Czech Rep LVR-15 HEU 104 1989 2028

Poland Maria LEU 71 1974 2030

Canada NRU HEU 173 1957 2016

Australia OPAL LEU 37 2006 2030+

France OSIRIS HEU 44 1966 2015+

Argentina RA-3 LEU 15 1967 2027

 Reactor Targets Capacity* Start Est. stop

Russia RIAR: three HEU 33 1961-70

South Africa Safari-1 LEU 111 1965 2025

Total 1050

Planned Mo-99 production reactors

Reactor Targets Capacity* Start

Russia RIAR LEU 67-74 2013

USA B&W MIPS LEU 163 2015?

Germany FRM-II LEU 72 2016

Australia OPAL LEU 133+ (111 export) 2016

China CARR LEU 37 2017

USA Cocqui LEU 259 2017

* Six-day TBq/week

Source: Annex 1, 2 & 3, Supply of Medical Radioisotopes, March 2013, OECD-NEA

Other medical radioisotopes

Co-60 has mostly come from Candu power reactors by irradiation of Co-59 in special rods for up

to three years, and production is being expanded. Production sites include: Bruce B and Pickering
in Canada (70% of world supply, expanding to Bruce A and Darlington); Embalse in Argentina;

Qinshan Phase III units 1 and 2 in China; Wolsong 1 and 2 in South Korea (all Candu); and

Leningrad 1 in Russia (RBMK). In 2017 production commenced at Smolensk 1 (RBMK) in

Russia. Most of this Co-60 is used for sterilization, with high-specific-activity Co-60 for cancer

treatment. Mainly this radioisotope was made in Canada’s NRU at Chalk River until it closed in

October 2016. Bruce B nuclear power plant has increased its output for Co-60 and the rest is

supplied through Nordion.

Under an August 2017 agreement between Areva NP and Bruce Power, Areva will design and

supply equipment to be installed in the existing Bruce Candu units to add online production at

commercial scale of “a wide range of isotopes for use in both health care and industry.” In

particular, this will enable the plant to produce short half-life isotopes such as Mo-99, lutetium-

177 and iridium-192 using a system that inserts and removes targets with little impact on the

normal operation of the power reactors. The process will use Areva NP's patent-pending method

of producing radioisotopes using a heavy water nuclear power plant.

Areva Med built a small plant at Bessines-sur-Gartempe in France to provide Pb-212 from

irradiated thorium, and this came online in 2013. A second plant has been built at Plano in Texas,

operating from 2016, and a new industrial-scale plant is planned for Caen in France. A radium-

224/Pb-212 generator similar to the Mo-99/Tc-99 one enables the Pb-212 to be eluted as required

for targeted alpha therapy (TAT). Ra-224 is a natural decay product of Th-228, and indirectly, of

Th-232.

Some iodine-131 is produced at Leningrad nuclear power plant from tellurium oxide, using

irradiation channels in the RBMK reactors. A contract with the Karpov Institute of Physical

Chemistry provides for delivery of 2.6-3.0 TBq of I-131 per week. The plant also produces Co-60,
I-125, and Mo-99 for Karpov IPC. In 2017 Rosatom announced the establishment of a

radiopharmaceutical production plant at the Institute of Reactor Materials (IRM), which had

started with lutetium-177, producing 24 TBq of it in 2016 (650 Ci). The IRM will also produce

iodine-125 and iridium-192, and its products will be distributed through Isotop.

Isotopes used in medicine

Many radioisotopes are made in nuclear reactors, some in cyclotrons. Generally neutron-rich ones

and those resulting from nuclear fission need to be made in reactors; neutron-depleted ones are

made in cyclotrons. There are about 40 activation product radioisotopes and five fission product

ones made in reactors.

Reactor radioisotopes

Bismuth-213 (half-life: 46 min):

Used for targeted alpha therapy (TAT), especially cancers, as it has a high energy (8.4 MeV).

Caesium-131 (9.7 d):

Used for brachytherapy, emits soft x-rays.

Caesium-137 (30 yr):

Used for low-intensity sterilisation of blood.

Chromium-51 (28 d):

Used to label red blood cells for monitoring, and to quantify gastro-intestinal protein loss or

bleeding.

Cobalt-60 (5.27 yr):

Formerly used for external beam radiotherapy, now almost universally used for sterilising. High-

specific-activity (HSA) Co-60 is used for brain cancer treatment.

Dysprosium-165 (2 h):

Used as an aggregated hydroxide for synovectomy treatment of arthritis.

Erbium-169 (9.4 d):

Used for relieving arthritis pain in synovial joints.

Holmium-166 (26 h):

Being developed for diagnosis and treatment of liver tumours.

Iodine-125 (60 d):

Used in cancer brachytherapy (prostate and brain), also diagnostically to evaluate the filtration rate

of kidneys and to diagnose deep vein thrombosis in the leg. It is also widely used in radioimmuno-

assays to show the presence of hormones in tiny quantities.

Iodine-131 (8 d)*:

Widely used in treating thyroid cancer and in imaging the thyroid; also in diagnosis of abnormal

liver function, renal (kidney) blood flow, and urinary tract obstruction. A strong gamma emitter,

but used for beta therapy.

Iridium-192 (74 d):

Supplied in wire form for use as an internal radiotherapy source for cancer treatment (used then

removed), e.g. for prostate cancer. Strong beta emitter for high dose-rate brachytherapy.

Iron-59 (46 d):

Used in studies of iron metabolism in the spleen.

Lead-212 (10.6 h):

Used in TAT for cancers or alpha radioimmunotherapy, with decay products Bi-212 (1 h) and Po-

212 delivering the alpha particles. Used especially for melanoma, breast cancer and ovarian cancer.

Demand is increasing.

Lutetium-177 (6.7 d):

Lu-177 is increasingly important as it emits just enough gamma for imaging while the beta

radiation does the therapy on small (eg endocrine) tumours. Its half-life is long enough to allow

sophisticated preparation for use. It is usually produced by neutron activation of natural or

enriched lutetium-176 targets.

Molybdenum-99 (66 h)*:

Used as the 'parent' in a generator to produce technetium-99m.

Palladium-103 (17 d):

Used to make brachytherapy permanent implant seeds for early stage prostate cancer. Emits soft

x-rays.

Phosphorus-32 (14 d):

Used in the treatment of polycythemia vera (excess red blood cells). Beta emitter.

Potassium-42 (12 h):

Used for the determination of exchangeable potassium in coronary blood flow.

Radium-223 (11.4 d):

Used for brachytherapy, emits soft x-rays.

Rhenium-186 (3.8 d):

Used for pain relief in bone cancer. Beta emitter with weak gamma for imaging.

Rhenium-188 (17 h):

Used to beta irradiate coronary arteries from an angioplasty balloon.

Samarium-153 (47 h):

Sm-153 is very effective in relieving the pain of secondary cancers lodged in the bone, sold as

Quadramet. Also very effective for prostate and breast cancer. Beta emitter.

Selenium-75 (120 d):

Used in the form of seleno-methionine to study the production of digestive enzymes.

Sodium-24 (15 h):

For studies of electrolytes within the body.

Strontium-89 (50 d)*:

Very effective in reducing the pain of prostate and bone cancer. Beta emitter.

Technetium-99m (6 h):

Used in to image the skeleton and heart muscle in particular, but also for brain, thyroid, lungs

(perfusion and ventilation), liver, spleen, kidney (structure and filtration rate), gall bladder, bone

marrow, salivary and lacrimal glands, heart blood pool, infection, and numerous specialised

medical studies. Produced from Mo-99 in a generator. The most common radioisotope for

diagnosis, accounting for over 80% of scans.

Xenon-133 (5 d)*:

Used for pulmonary (lung) ventilation studies.

Ytterbium-169 (32 d):

Used for cerebrospinal fluid studies in the brain.

Ytterbium-177 (1.9 h):

Progenitor of Lu-177.

Yttrium-90 (64 h)*:

Used for cancer brachytherapy and as silicate colloid for the relieving the pain of arthritis in larger

synovial joints. Pure beta emitter and of growing significance in therapy, especially liver cancer.

Radioisotopes of gold and ruthenium are also used in brachytherapy.

* fission product

Cyclotron radioisotopes

Carbon-11, Nitrogen-13, Oxygen-15, Fluorine-18:

These are positron emitters used in PET for studying brain physiology and pathology, in particular

for localising epileptic focus, and in dementia, psychiatry, and neuropharmacology studies. They

also have a significant role in cardiology. F-18 in FDG (fluorodeoxyglucose) has become very

important in detection of cancers and the monitoring of progress in their treatment, using PET.

Cobalt-57 (272 d):

Used as a marker to estimate organ size and for in-vitro diagnostic kits.
Copper-64 (13 h):

Used to study genetic diseases affecting copper metabolism, such as Wilson's and Menke's

diseases, for PET imaging of tumours, and also cancer therapy.

Copper-67 (2.6 d):

Beta emitter, used in therapy.

Fluorine-18 (110 min) as FLT (fluorothymidine), F-miso (fluoromisonidazole), 18F-choline:

It decays with positron emission, so used as tracer with PET, for imaging malignant tumours.

Gallium-67 (78 h):

Used for tumour imaging and locating inflammatory lesions (infections).

Gallium-68 (68 min):

Positron emitter used in PET and PET-CT units. Derived from germanium-68 in a generator.

Germanium-68 (271 d):

Used as the 'parent' in a generator to produce Ga-68.

Indium-111 (2.8 d):

Used for specialist diagnostic studies, e.g. brain studies, infection and colon transit studies. Also

for locating blood clots, inflammation and rare cancers.

Iodine-123 (13 h):

Increasingly used for diagnosis of thyroid function, it is a gamma emitter without the beta radiation

of I-131.
Iodine-124 (4.2 d):

Tracer, with longer life than F-18, one-quarter of decays are positron emission so used with PET.

Also used to image the thyroid using PET.

Krypton-81m (13 sec) from rubidium-81 (4.6 h):

Kr-81m gas can yield functional images of pulmonary ventilation, e.g. in asthmatic patients, and

for the early diagnosis of lung diseases and function.

Rubidium-82 (1.26 min):

Convenient PET agent in myocardial perfusion imaging.

Strontium-82 (25 d):

Used as the 'parent' in a generator to produce Rb-82.

Thallium-201 (73 h):

Used for diagnosis of coronary artery disease other heart conditions such as heart muscle death

and for location of low-grade lymphomas. It is the most commonly used substitute for technetium-

99 in cardiac-stress tests.
NUCLEAR ENERGY IN THE INDUSTRY

Nuclear energy can be used for various industrial applications, such as seawater desalination,

hydrogen production, district heating or cooling, the extraction of tertiary oil resources and process

heat applications such as cogeneration, coal to liquids conversion and assistance in the synthesis

of chemical feedstock. A large demand for nuclear energy for industrial applications is expected

to grow rapidly on account of steadily increasing energy consumption, the finite availability of

fossil fuels and the increased sensitivity to the environmental impacts of fossil fuel combustion.

With increasing prices for conventional oil, unconventional oil resources are increasingly utilized

to meet such growing demand, especially for transport. Nuclear energy offers a low carbon

alternative and has important potential advantages over other sources being considered for future

energy. There are no technological impediments to extracting heat and steam from a nuclear power

plant. This has been proven for low temperatures (<200°C) with nuclear assisted district heating

and desalination with an experience of approximately 750 reactor operation years from around 70

nuclear power plants. Detailed site specific analyses are essential for determining the best energy

option. The development of small and medium sized reactors would therefore be better suited for

cogeneration and would facilitate non-electric applications of nuclear energy. The possibility of

large scale distribution systems for heat, steam and electricity supplied from a central nuclear heat

source (e.g. a multiproduct energy centre) could attract and serve different kinds of consumers

concentrated in industrial parks.

A vast array of industries, from agriculture to manufacturing, use radionuclides to assess materials,

products, and processes. Just as a medical X-ray allows a doctor to obtain a detailed picture of a

bone fracture, an industrial X-ray or gamma-ray examination can provide a foundry worker with

a detailed picture of an internal crack in a metal casting.

Irradiation of a silicon ingot in a reactor accurately changes its semi-conducting properties.

Bombarding silicon with neutrons for precise periods converts some silicon atoms to phosphorus.

The computer and electronic industries have a strong demand for this precisely “doped” silicon,

whose enhanced properties make it invaluable for use in high-quality electronics, such as those in

satellites.

Desalination

 Potable water is in short supply in many parts of the world. Lack of it is set to become

a constraint on development in some areas.

 Nuclear energy is already being used for desalination, and has the potential for much

greater use.

 Nuclear desalination is generally very cost-competitive with using fossil fuels. "Only

nuclear reactors are capable of delivering the copious quantities of energy required

for large-scale desalination projects" in the future (IAEA 2015).

 As well as desalination of brackish or sea water, treatment of urban waste water is

increasingly undertaken.

It is estimated that one-fifth of the world's population does not have access to safe drinking water,

and that this proportion will increase due to population growth relative to water resources. The

worst-affected areas are the arid and semiarid regions of Asia and North Africa. A UNESCO report

in 2002 said that the freshwater shortfall worldwide was then running at some 230 billion m 3/yr
and would rise to 2000 billion m3/yr by 2025. Wars over access to water, not simply energy and

mineral resources, are conceivable.

A World Economic Forum report in January 2015 highlighted the problem and said that shortage

of fresh water may be the main global threat in the next decade.

Fresh water is a major priority in sustainable development. Where it cannot be obtained from

streams and aquifers, desalination of seawater, mineralised groundwater or urban waste water is

required. A study in 2006 by the UN's International Atomic Energy Agency (IAEA) showed that

2.3 billion people lived in water-stressed areas, 1.7 billion of them having access to less than 1000

m3 of potable water per year. With population growth, these figures will increase substantially.

Water can be stored, while electricity at utility scale cannot. This suggests two synergies with base-

load power generation for electrically-driven desalination: undertaking it mainly in off-peak times

of the day and week, and load-shedding in unusually high peak times.

World Energy Outlook 2016 reported that in 2015, there were about 19,000 desalination plants

worldwide, to provide water to both municipal and industrial users. Almost half of global installed

desalination capacity was in the Middle East, followed by the European Union with 13%, the USA

with 9%, and North Africa with 8%. Globally, seawater is the most common feedwater type,

supplying about 60% of installed capacity, followed by brackish water at over 20%.

WEO 2016 also reported on energy consumption for desalination. The UAE used 556 TJ/yr,

followed by Saudi Arabia 168 TJ/yr, Qatar 118 TJ/yr, and Kuwait 76 TJ/yr.

Cumulative investment in desalination plants reached about $21.4 billion in 2015 and is expected

at least to double by 2020 according to a 2016 report by market analyst, Research and Markets.

The report, Seawater and Brackish Water Desalination, includes a prediction that investment by
2020 should top $48 billion showing a compound annual growth rate of 17.6%. The report assesses

the market for large industrial or municipal facilities with a capacity greater than 1,000 m³/day

(m3/d). It highlights a growing gap between freshwater resources and demand from all sectors.

Desalination

Most desalination today uses fossil fuels, and thus contributes to increased levels of greenhouse

gases. Total world capacity in 2016 was 88.6 million m3/d (32,300 GL/yr) of potable water, in

almost 19,000 plants. Of this, 73% is membrane desalination, and 27% thermal, though in the year

to mid-2016, 93% of new capacity contracted was membrane. In 2015, over 65% of global installed

desalination capacity was RO. A majority of the plants is in the Middle East and north

Africa. Combining power generation and water production by desalination is economically

advantageous and is widely used in the Middle East.

In December 2015 the "Global Clean Water Desalination Alliance – H2O minus CO2" initiative

was launched at the COP 21 climate talks in Paris, and called on its 17-nation membership to use

clean energy to power new desalination plants. The call was part of the alliance's aim to tackle the

water-energy nexus and climate change.

The largest desalination plant – the $3.8 billion Al-Jubail 2 in Saudi Arabia – has 948,000 m3/d

(346 GL/yr) MED-TVC capacity, plus 2745 MWe power generation using gas turbines. The Saudi

Saline Water Conversion Corporation (SWCC) takes about 62% of output to supply Riyadh. China

is building a 1 million m3/d RO plant to supply Beijing. Two-thirds of the world capacity is

processing seawater, and one-third uses brackish artesian water.

Desalination technologies

The two major types of desalination technologies used around the world can be broadly classified

as either thermal processes, in which feedwater is boiled and the vapour condensed as pure water

(distillate), or membrane desalination processes, in which feedwater is pumped through semi-

permeable membranes to filter out the dissolved solids. The main thermal processes are multi-

stage flash (MSF) distillation, multi-effect distillation (MED) and vapour compression variants –

thermal and mechanical (TVC, MVC). The main membrane process is reverse osmosis (RO).

Singapore is investing in electro-deionisation (EDI) as a low-energy option.

More than three-quarters of the capacity is MSF and RO, but MED is increasing rapidly, according

to the International Desalination Association.

The major technology in use and being built today is reverse osmosis (RO) driven by electric

pumps which pressurise water and force it through a semi-permeable membrane against its osmotic

pressure*. This accounted for 65% of 2016 world capacity, up from only 10% in 1999. With

brackish water, RO is much more cost-effective, though MSF gives purer water than RO. RO relies

on electricity to drive the actual process and requires clean (filtered) feedwater.

* IAEA 2015 states that operating pressure for osmosis ranges from 17 to 27 bars for brackish

water and from 55 to 82 bars (5500 to 8200 kPa) for seawater. The energy efficiency of seawater

RO heavily depends on recovering the energy from the pressurized reject brine. In large plants, the

reject brine pressure energy is recovered by a turbine; commonly a Peloton wheel turbine

recovering 20% to 40% of the consumed energy.

Hybrid thermal-membrane plants have a more flexible power-to-water ratio, efficient operation

even with significant seasonal and daily fluctuations of the electricity and water demand, less
primary energy consumption and an increase of plant efficiency, thus improving economics and

reducing environmental impacts. MSF+RO or MED-TVC+RO hybrid plants exploit the best

features of each technology for different quality products or a blended product.

Several thermal distillation processes capable of using waste heat from power generation are in

use: multi-stage flash (MSF) distillation process using steam, was earlier prominent. It works by

flashing a portion of the water into steam in multiple stages of what are essentially countercurrent

heat exchangers and it accounted for 23% of world capacity in 2012. It is more energy-intensive

than MED, but it can cope with suspended solids and any degree of salinity. The Japan Atomic

Energy Agency (JAEA) has designed a 600 MWt HTR called the GTHTR300 which produces 300

MWe and uses the waste heat in MSF desalination, the projected water cost being half that of using

gas-fired CCGT.

An increasing number of plants use multi-effect distillation (MED) with 8% world capacity in

2012, or multi-effect vapour compression (MVC or VCD) distillation or a combination of

these, e.g. MED-TVC with thermal vapour compression. Multiple-effect distillation (MED) is the

low temperature thermal process of obtaining fresh water by recovering the vapour of boiling

seawater in a sequence of vessels (called effects), each maintained at a lower temperature than the

last. Because the boiling point of water decreases as pressure decreases, the vapour boiled off in

one vessel can be used to heat the next one, and only the first one (at the highest pressure) requires

an external source of heat, such as that from the condenser circuit of a power plant. It is higher-

cost than RO but can cope with any degree of salinity. For Kuwait, MED was selected because no

pre-treatment of feedwater was required, in an area with algal blooms and organic matter.

Membrane distillation (MD) is an emerging process which is thermally-driven.

Electro-deionisation (EDI) uses an electric field to pull dissolved salts from water. Singapore has

plans to scale up the technology and demonstrate it at a 3,800 m3/d facility at Tuas. Energy

consumption of 1.65 kWh/m3 has been demonstrated at a 50 m3/d pilot plant.

Desalination is energy-intensive. RO needs up to 6 kWh of electricity per cubic metre of water

(depending on both process and its original salt content), though the latest RO plants such as in

Perth, Western Australia, and Singapore use 3.5 kWh/m3, or 4 kWh/m3 including pumping for

distribution. Hence 1 MWe continuous will produce about 4000 to 6000 m3 per day from seawater.

MSF and MED require heat at 70-130°C and use about 38 kWh/m3 thermal input, plus 3.5

kWh/m3 electrical for MSF and 1.5 kWh/m3 for MED-TVC. (IAEA 2015 quotes 100 kWh/m3

thermal input, plus 3.5 kWh/m3 electrical for MSF and 50 kWh/m3 thermal input, plus 2.5

kWh/m3 electrical for MED.) A variety of low-temperature and waste heat sources may be used,

including solar energy (especially for MED), so the above kilowatt-hour figures are not properly

comparable. For brackish water and reclamation of municipal wastewater RO requires only about

1 kWh/m3. The choice of process generally depends on the relative economic values of fresh water

and particular fuels, and whether cogeneration is a possibility. Thermal processes are more capital-

intensive.

Forward osmosis (FO) may be used in conjunction with a subsequent process for desalination.

The FO draws water through a membrane from a feed solution into a more concentrated draw

solution, which is then desalinated without the problems of fouling, such as often encountered with

simple RO. FO plants operate in Gibraltar and Oman.

Desalination dependence

About three-quarters of Israel's water is desalinated, and one large RO plant provides water at 58

cents per cubic metre, claimed to be the world's cheapest. Until 2013 it also claimed to have the

world’s largest seawater RO plant at Soreq, producing 627,000 m3/d. In 2015 Israel and Jordan

signed a $900 million agreement for a new desalination plant at Aqaba on the Red Sea, supported

by the World Bank and based on a 2013 agreement. The new agreement involves desalination of

80 million m3 per year/220,000 m3/d at the Aqaba plant, with Israel buying half of that amount for

use in its southern port town of Eilat and the Arava region – both desert areas with a chronic water

shortage. Jordan will get half the water for the arid southern part of that country. As part of the

deal, Israel will supply an additional 50 million m3 of water for the central and northern parts of

Jordan from its Lake Kinneret. In addition to the desalination, over 100 million m3 of concentrated

brine will be pumped 180 km north to replenish the Dead Sea.

Malta gets two-thirds of its potable water from RO, and this takes 4% of its electricity supply.

At the end of 2016 desalination met 25% of Singapore’s water demand, as one of the island state's

Four National Taps, along with local catchment water, imported water, and NEWater, Singapore's

own recycled wastewater. In 2016, 55% of water was imported from Malaysia. A further 228,000

m3/d plant was due online in 2016, supplying potable water at US 22¢/m3 (compared with US 49

cents and 36 cents for the first and second plants). Singapore wants to increase the proportion of

water it gets from desalination and wastewater reuse from 45% today, to 85% by 2060, by which

time, industrial use is expected to account for 70% of water demand. Its 137,000 m3/d Marina East

desalination plant being built by Keppel is designed to treat seawater and reservoir water. The raw

water intake from both sources goes through a dual flow chamber, with pre-treatment using
flocculation and dissolved air flotation, then ultrafiltration. This is followed by a two-pass RO

system, and post-treatment using ultraviolet disinfection.

Saudi Arabia in 2011 obtained 3.3 million m3/d from 27 government-owned (SWCC) seawater

desalination plants, 70% of the country’s requirements. Twelve plants, accounting for most of

production, use MSF and 7 plants use MED, in both cases the plants are integrated with power

plants (cogeneration plants), using steam from the power generation as a source of energy for

desalination. Eight plants are single-purpose plants that use RO technology and power from the

grid. The UAE is heavily dependent on seawater desalination, much of it with cogeneration plants.

Algeria in mid 2013 had 2.1 million m3/d capacity and another 400,000 m3/d is envisaged.

In February 2012 China's State Council announced that it aimed to have 2.2 to 2.6 million m3/d

seawater desalination capacity operating by 2015, and early in 2015 the target under the

government’s Special Plan for Seawater Utilisation was 4 million m3/d. However, a 2017 report

from the State Oceanic Administration said that the total capacity in 2016 was 1.18 million

m3/d. The cost ranged from CNY 5 to 8/m3 ($0.74 to 1.18/m3). Two-thirds was used for industrial

purposes. Some 400 of the 668 largest cities in China are reported to experience water scarcity.

The Kwinana desalination plant near Perth, Western Australia, has been running since early 2007

and produces about 140,000 m3/d (45 GL/yr) of potable water, requiring 24 MWe of power for

this, hence 576,000 kWh/day, or 4.1 kWh/m3 overall, and about 3.7 kWh/m3 across the

membranes. The plant has pre-treatment, then 12 seawater RO trains with capacity of 160,000

m3/d which feed six secondary trains producing 144,000 m3/d of water with 50 mg/L total

dissolved solids. The cost is estimated at A$ 1.20/m3. Discharge flow is about 7% salt. Future WA

desalination plants will have more sophisticated pre-treatment to increase efficiency. In August

2011 the state government decided to double the size of its new Southern Water Desal Plant at
Binningup plant near Perth to 100 GL/yr, taking the cost to about $1.45 billion. Stage 1 of 50

GL/yr was within the A$ 955 million budget.

Nuclear desalination studies

Small and medium sized nuclear reactors are suitable for desalination, often with cogeneration of

electricity using low-pressure steam from the turbine and hot seawater feed from the final cooling

system. The main opportunities for nuclear plants have been identified as the 80-100,000 m3/d and

200-500,000 m3/d ranges. US Navy nuclear powered aircraft carriers reportedly desalinate 1500

m3/d each for use onboard.

Desalination can provide a way to vary substantially the amount of electricity supplied to the grid

by a plant operating continuously at full power, in response to varying demand. Surplus power is

fed to a RO desalination plant when it is available. The potable water can be stored much more

readily than electricity.

A 2006 IAEA report based on country case studies showed that costs would be in the range ($US)

50 to 94 cents/m3for RO, 60 to 96 c/m3 for MED and $1.18 to 1.48/m3 for MSF processes, with

marked economies of scale. These figures are consistent with later reports. Nuclear power was

very competitive at 2006 gas and oil prices. A French study for Tunisia compared four nuclear

power options with combined cycle gas turbine and found that nuclear desalination costs were

about half those of the gas plant for MED technology and about one-third less for RO. With all

energy sources, desalination costs with RO were lower than MED costs.

At the April 2010 Global Water Summit in Paris, the prospect of desalination plants being co-

located with nuclear power plants was supported by leading international water experts.
As seawater desalination technologies are rapidly evolving and more countries are opting for dual-

purpose integrated power plants (i.e. cogeneration), the need for advanced technologies suitable

for coupling to nuclear power plants and leading to more efficient and economic nuclear

desalination systems is obvious. The IAEA Coordinated Research Program (CRP) New

Technologies for Seawater Desalination using Nuclear Energy was organized in the framework of

a Technical Working Group on Nuclear Desalination that was established in 2008. The CRP ran

over 2009-2011 to review innovative technologies for seawater desalination which could be

coupled to main types of existing nuclear power plant. The CRP focused on low temperature

horizontal tube MED, heat recovery systems using heat pipe based heat exchangers, and zero brine

discharge systems.

An IAEA preliminary feasibility study on nuclear desalination in Algeria was published in 2015,

for Skikda on the Mediterranean coast, using cogeneration. The nuclear energy option was very

competitive compared with fossil fuels.

Desalination: nuclear experience and plans

The feasibility of integrated nuclear desalination plants has been proven with over 150 reactor-

years of experience, chiefly in Kazakhstan, India and Japan. Large-scale deployment of nuclear

desalination on a commercial basis will depend primarily on economic factors. Indicative costs are

US$ 70-90 cents per cubic metre, much the same as fossil-fuelled plants in the same areas.

One obvious strategy is to use power reactors which run at full capacity, but with all the electricity

applied to meeting grid load when that is high and part of it to drive pumps for RO desalination

when the grid demand is low.

The BN-350 fast reactor at Aktau, in Kazakhstan, successfully supplied up to 135 MWe of electric

power while producing 80,000 m3/d of potable water over some 27 years to 1999, about 60% of

its power being used for heat and desalination. The plant was designed as 1000 MWt but never

operated at more than 750 MWt, but it established the feasibility and reliability of such

cogeneration plants. (In fact, oil/gas boilers were used in conjunction with it, and total desalination

capacity through ten MED units was 120,000 m3/d.)

In Japan, some ten desalination facilities linked to pressurised water reactors operating for

electricity production yield some 14,000 m3/d of potable water, and over 100 reactor-years of

experience have accrued. MSF was initially employed, but MED and RO have been found to be

more efficient there. South Korea has some MED plants associated with PWRs. The water is used

for the reactors' own cooling systems.

India has been engaged in desalination research since the 1970s. In 2002 a demonstration plant

coupled to twin 170 MWe nuclear power reactors (PHWR) was set up at the Madras Atomic Power

Station, Kalpakkam, in southeast India. This hybrid Nuclear Desalination Demonstration Project

(NDDP) comprises a RO unit with 1800 m3/d capacity and a MSF plant unit of 4500 m3/d costing

about 25% more, plus a recently-added barge-mounted RO unit. This is the largest nuclear

desalination plant based on hybrid MSF-RO technology using low-pressure steam and seawater

from a nuclear power station. They incur a 4 MWe loss in power from the plant.

In 2009 a 10,200 m3/d MVCplant was set up at Kudankulam to supply fresh water for the new

plant. It has four stages in each of four streams. An RO plant there supplied the plant's township

initially. The full MVC plant was commissioned in mid-2012, with quoted capacity of 7200 m3/d

to supply the plant’s primary and secondary coolant and the local town. The cost is quoted at INR

0.05 per litre (USD 0.9/m3).

Since 2010 Russia’s Rostov nuclear power plant at Volgodonsk has produced make-up water using

MED, now at 9600 m3/d. Other plants also use MED and RO for desalination.

Egypt’s Nuclear Power Plant Authority plans a two-unit AES-2006 nuclear power plant with

desalination facility at El-Dabaa, on the Mediterranean coast, 290 km west of Cairo.

Atomstroyexport quotes the El Dabaa reactors as 3200 MWt, 1190 MWe gross for power

generation only, using warm seawater for cooling. However, with desalination (MED + RO) taking

432 MWt from the secondary circuit, they would be 1050 MWe gross, 927 MWe net and each

produce 170,000 m3/d at a cost of less than $1/m3.

In August 2017 a cooperation agreement between Saudi Technology Development Corporation

and China Nuclear Engineering & Construction Group (CNEC) set up a partnership project for

“developing desalination projects using high-temperature gas-cooled nuclear reactors.”

A low temperature (LTE) nuclear desalination plant uses waste heat from the nuclear research

reactor at Trombay has operated since about 2004 to supply make-up water in the reactor.

Pakistan in 2010 commissioned a 4800 m3/d MED desalination plant, coupled to the Karachi

Nuclear Power Plant (KANUPP-1, a 125 MWe PHWR) near Karachi, though in 2014 it was quoted

as 1600 m3/d. It has been operating a 454 m3/d RO plant for its own use.

China General Nuclear Power (CGN) has commissioned a 10,080 m3/d seawater desalination plant

using waste heat to provide cooling water at its new Hongyanhe project at Dalian in the northeast

Liaoning province.

Much relevant experience comes from nuclear plants in Russia, Eastern Europe and Canada where

district heating is a by-product.

Large-scale deployment of nuclear desalination on a commercial basis will depend primarily on

economic factors. The IAEA is fostering research and collaboration on the issue. In the 1960s the

US Atomic Energy Commission investigated using nuclear plants up to 10,000 MWt for

desalination on the west coast.

In 2014 Rusatom Overseas said it was planning to promote thermal desalination plants using

nuclear power on a BOO (build-own-operate) basis. The first meeting of the Rusatom Overseas

International Expert Council on Desalination took place in September 2014 in Moscow.

In California, a county’s Drought Task Force is teaming up with Diablo Canyon nuclear plant

owner Pacific Gas and Electric with a view to using the site's 5700 m3/d RO desalination plant to

supply up to 3100 m3/d surplus water for county residents.

In South Africa, due to acute water shortages in the region, Eskom announced in May 2017 that it

would install a small groundwater desalination plant at its Koeberg nuclear power plant. It

produces water solely for the plant, but Eskom is collaborating with Cape Town authorities on a

seawater desalination plant, which would produce 2,500 to 5,000 m3/d as a demonstration plant

for a larger project.

Small nuclear reactors suitable for desalination

SMART: South Korea has developed a small nuclear reactor design for cogeneration of electricity

and potable water. The 330 MWt SMART reactor (an integral PWR) has a long design life and

needs refuelling only every three years. The main concept has the SMART reactor coupled to four

MED units, each with thermal-vapour compressor (MED-TVC) and producing total 40,000 m3/d,

with 90 MWe.
CAREM: Argentina has designed an integral 100 MWt PWR suitable for cogeneration or

desalination alone, and a prototype in being built next to Atucha. A larger version is envisaged,

which may be built in Saudi Arabia.

NHR-200: China's INET has developed this, based on a 5 MW pilot plant.

Floating nuclear power plant (FNPP) from Russia, with two KLT-40S reactors derived from

Russian icebreakers, or other designs for desalination. (If primarily for desalination the twin KLT-

40 set-up is known as APVS-80.) ATETs-80 is a twin-reactor cogeneration unit using KLT-40 and

may be floating or land-based, producing 85 MWe plus 120,000 m3/d of potable water. The small

ABV-6 reactor is 38 MW thermal, and a pair mounted on a 97-metre barge is known as Volnolom

floating NPP, producing 12 MWe plus 40,000 m3/d of potable water by RO. A larger concept has

two VBER-300 reactors in the central pontoon of a 170 m long barge, with ancillary equipment

on two side pontoons, the whole vessel being 49,000 dwt. The plant is designed to be overhauled

every 20 years and have a service life of 60 years. Another design, PAES-150, has a single VBER-

300 unit on a 25,000 dwt catamaran barge.

See also: Small Nuclear Power Reactors paper.

Wastewater and groundwater treatment for irrigation

In the Middle East, a major requirement is for irrigation water for crops and landscapes. This need

not be potable quality, but must be treated and with reasonably low dissolved solids.

In Oman, the 76,000 m3/d first stage of a submerged membrane bioreactor (SMBR) desalination

plant was opened in 2011. Eventual plant capacity will be 220,000 m3/d. This is a low-cost

wastewater treatment plant using both physical and biological processes and which produces

effluent of high-enough quality for some domestic uses or reinjection into aquifers.
In Australia AGL plans to install a 2000 m3/d RO desal plant to treat water from fracking in its

Gloucester coal seam gas project. This will be used for irrigation, rather than being potable

quality. Also in Australia the Commonwealth Scientific and Industrial Research Organisation

(CSIRO) has found that the addition of nutrients could make desalinated water more financially

attractive to farmers, who normally pay 20 cents/kilolitre for irrigation water, whereas most desal

groundwater costs more than A$1/kL.

New desalination projects

Algeria has undertaken a study on nuclear power generation and desalination using RO and MED.

The 500,000 m3/d Magtaa seawater RO desal plant at Oran costing $495 million was

commissioned in November 2014, following the 120,000 m3/d Fouka seawater RO desal plant at

Tipaza near Algiers in 2011, costing $185 million. The country is also considering MSF

desalination for two new plants in addition to the 91,000 m3/d Arzew MSF plant now

operating. Total capacity is 2.3 million m3/d.

Argentina: A 3000 m3/d seawater RO plant is being built at Puerto Deseado, Santa Cruz, about

1800 km south of Buenos Aries.

Australia: Six major seawater RO plants were commissioned at a cost of A$ 12 billion between

2006 and 2012. However, the Kurnell plant near Sydney is not used but costs some A$500,000 per

day on care and maintenance.

In Victoria, a 440,000 m3/d (150 GL/yr) RO desalination plant near Wonthaggi built by Degremont

was commissioned in 2012 to supply Melbourne. It claims to use 90 to 120 MWe of renewable

energy, and is expandable to 200 GL/yr. However, it has never been used since 2012 completion

and remained on standby to 2017. Melbourne Water’s A$ 18 billion in repayments due over 27
years from 2015 is proposed to be spread over 60 years. The A$ 607 million pa maintenance cost

is billed to customers. The state government in 2016 ordered 50 GL of water costing A$ 27 million

(over the maintenance figure) by mid-2017, and then a further 15 GL before the plant returned to

standby.

Adelaide's 100,000 m3/d (36 GL/yr) plant started operation in 2011, with plans to expand it to 100

GL/yr. A 200-280,000 m3/d desalination plant to serve the expanded Olympic Dam mine in South

Australia has environmental approval but now may not proceed.

Perth has two RO seawater desal plants, a 123,000 m3/d (45 GL/yr) one (costing A$ 387 million)

completed in 2006 powered by a wind farm, and a 100 GL/yr one powered by 65 MWe of

dedicated renewable energy, which together provide half the city’s needs. Following extensive

trials, the city plans a groundwater replenishment scheme from treated wastewater which is

expected to be half the cost and use half the energy of seawater desalination. It will include a new

Advanced Water Recycling Plant and provide 7 GL/yr from 2016 and 28 GL/yr eventually about

2022.

Brazil: In Ceara state the water utility Cagece is planning to build a 86,400 m3/d seawater

desalination plant to service the capital, Fortaleza. Suez has an agreement for water reuse for the

state.

Chile: The main focus is on the Antofagasta region in the north, and the Atacama region

immediately south of it. Both extend from the coast inland to the border. The Atacama Desert is

in both regions.

Several mining projects in the high-altitude Atacama desert of northern Chile rely on seawater

desalination at the coast to supply their water. In November 2015 the Chilean state copper
commission Cochilco said that desalination will provide half of the water demand for the country’s

copper mines by 2026 – 924,000 m3/d. There are 16 mining-related desalination projects worth

US$10 billion planned or under construction in the country, and nine are already operating.

BHP Billiton and Rio Tinto have built a $3.43 billion, 220,000 m3/d (79 GL/yr) RO seawater

desalination plant with twin 1.07 m diameter pipes and pumps for their Escondida copper mine in

the Atacama Desert in the Antofagasta region. Seawater is pumped 170 km inland to a reservoir

near the mine, 3200 m above sea level and 185 km inland. It requires over 1000 MWe from the

grid for desalination alone and was commissioned early in 2017. Doosan built the plant at Caleta

Coloso under Bechtel supervision.

Escondida water desalination project, Antofagasta, Chile (image: Black & Veatch)
BHP’s 2017 commitment to a $2.5 billion expansion of its Spence copper mine 1710 m above sea

level involves an $800 million, 86,400 m3/d desalination plant at Mejillones, 60 km north of

Antofagasta. It will be built by Caitan, a 50:50 joint venture of Mitsui and Tedagua. Saipam,

through its Cobra Montajes subsidiary, will build the 155 km x 900 mm pipeline and three pumping

stations. The project is expected to be operational by mid-2020.

Chilean state copper company Codelco is seeking a BOOT (build-own-operate-transfer)

agreement to build a 54,000 m3/d plant expandable to 145,000 m3/d for its Chuquicamata,

Radomiro Tomic, Ministro Hales, and Gabriela Mistra mines – inland in the Antofagasta region.

The $1.2 billion project includes a 160 km pipeline and pumping system.

A 104,000 m3/d seawater RO plant is planned to serve the districts of Caldera, Chañaral, Copiapó,

and Tierra Amarilla, in the northern half of the Atacama region, costing $250 million. State-owned

utility Econssa awarded an initial contract to a consortium of Spain's GS Inima and Claro Vicuna

Valenzuela of Chile in October 2017, with planned operation of the first phase in 2020.

Energias y Aguas del Pacifico (ENAPAC) is a proposed solar-powered 126,000 m3/d seawater RO

desalination plant and water transport project which aims to support expansion of several mining

operations in the Atacama region. Five pumping stations on twin 1.4 m diameter pies will take the

water 72 km to a reservoir at Copiapo, 700 m above sea level. The RO process itself will require

3.5 kWh/m3, including pre and post treatment, and about the same again to deliver the water inland.

The whole project will be powered about 80% by a 100 MWe solar PV plant, as well as off-peak

grid power.

China built 112 seawater desalination plants in 2014, with total output of 927,000 m3/d, according

to the State Oceanic Administration.

It is looking at the feasibility of a nuclear seawater desalination plant in the Yantai area of

Shandong Peninsula, producing 80-160,000 m3/d by MED process, using a 200 MWt NHR-200

reactor. A 100,000 m3/d seawater RO plant supplied by Abengoa of Spain started operating early

in 2013 at Qingdao in Shandong province. Another project is for a 330,000 m3/d plant near Daya

Bay.

A 50,000 m3/d Aqualyng plant was completed in October 2011 at Caofeidian on Bohai Bay in

Hebei province, and a second stage doubled this in 2012. The Hong Kong based Beijing

Enterprises Water Group (BEWG) with Aqualyng is building a 1 million m3/d RO plant at

Caofeidian for CNY 7 billion to supply Beijing through a 270 km pipeline by 2019, and a 3 million

m3/d plant is planned to expand this to supply the capital, providing about one-third of its needs.

The pipeline, itself a major part of the project, will cost about CNY 10 billion, and supply

desalinated water at CNY 8/m3 ($1.28/m3).

In March 2013 the National Development and Reform Commission announced new plans for

seawater desalination, including for the cities of Shenzhen and Zhoushan, Luxixiang Island in

Zhejiang Province, Binhai New Area in Tianjin, Bohai New Area in Hebei, and several industrial

parks and companies. The cost is likely to be some CNY 21 billion ($3.35 billion). China aimed

to produce 2.2 million m3/d of desalinated water by 2015, more than three times the 2011 level,

but only reached 1.18 million in 2016. More than half of the freshwater channelled to islands and

more than 15% of water delivered to coastal factories would come from the sea by 2015, according

to the plan.

The Luo Fang Wastewater Treatment Plant in Shenzhen is to be equipped with membrane

bioreactor technology from GE Water & Process Technologies, adding 150,000 m3/d and taking

capacity to 400,000 m3/d.

A 300,000 m3/d seawater desal plant at Tianjin is under construction and will be the first zero-

liquid discharge (ZLD) plant in the world. It is due to supply petrochemical plants from 2017.

Cyprus’s Water Development Department is calling for bids to build a 15,000 m3/d RO

desalination plant in Kouklia, Paphos, on a build-own-operate-transfer (BOOT) basis. This will

augment existing desalination capacity of 220,000 m3/d. The country aims to produce 30% of

water from desalination by 2020, while the goal for reuse water is 20% by 2020, and 30% by 2025,

mainly for irrigation.

Egypt’s Nuclear Power Plant Authority plans a two-unit AES-2006 nuclear power plant with

desalination facility at El-Dabaa, on the Mediterranean coast, 290 km west of Cairo. See section

above.

The former largest desalination plant, 24,000 m3/d RO, at Marsa Matrouh in the northwest has

pressure exchanger (PX) energy-recovery devices by Energy Recovery Inc of California.

In 2016 FCC Aqualia won a contract to build a 150,000 m3/d desalination plant at El Alamein. In

2017 the Engineering Authority of the Armed Forces (EAAF) of Egypt announced plans for three

150,000 m3/d capacity facilities in Al-Alamain, Al-Jamila, and East Port Said, involving “large

French and German companies”. Its Ain Sokhna 164,000 m3/d plant in the Suez Canal Zone is part

of an integrated water and power project being built on a BOO basis by Hyflux for delivery in

2018. A small plant is also planned at Najila, Matruh.

FCC Aqualia and Orascom in 2017 won a $320 million contract to build and operate the 1.6 million

m3/d Abu Rawash wastewater reuse plant for Cairo, to produce potable water. It is financed by the

African Development Bank.

A $15.6 billion project including four desalination plants on the Sinai Peninsula was announced in

April 2018.

Ghana: Abengoa has built a 60,000 m3/d seawater RO plant at Nungua to supply Accra. The $125

million contract covers operation and maintenance for 25 years.

In India, further plants delivering 45,000 m3 per day are envisaged, using both MSF and RO

desalination technology, and building on the extensive experience outlined above. For Chennai,

the 100,000 m3/d Minjur RO seawater desalination plant was commissioned in 2010, the 100,000

m3/d Nemmeli RO seawater desalination plant was commissioned in 2013, and bids for a 150,000

m3/d plant there were received in 2017. A 400,000 m3/d plant is planned at Penur nearby, to open

in 2025, also serving Chennai. Also in Tamil Nadu, two 60,000 m3/d seawater RO plants are being

built at Kuthiraimozhi in Ramanathapuram and Alanthalai in the port city of Tuticorin to supply

potable water.

In Karnataka four new desalination plants are planned for a satellite city to Bengaluru, comprising

a $380 million plant at Mangaluru, a $110 million plant at Udupi, one of $23 million at Kundapura,

and at Saligrama, a $12 million plant. IDE Technology and Vagas are likely to build them.

Indonesia: South Korea investigated the feasibility of building a SMART nuclear reactor with

cogeneration unit employing MSF desalination technology for Madura Island, and later studies

have been on larger-scale PWR cogeneration by Batan.

Iran: A 200,000 m3/d MSF desalination plant was designed for operation with the Bushehr nuclear

power plant in Iran in 1977, but initially lapsed due to prolonged construction delays. It is being

completed by AEOI subsequently.

In June 2016 Doosan signed a $186 milllion agreement to build a 200,000 m3/d seawater RO plant

at Bandar Abbas.

Iraq: Basrah has 400,000 m3/d desalination for saline river water, and a Hitachi-led consortium is

building a new 199,000 m3/d RO plant there, for completion in 2016.

Israel has four desal plants including the 627,000 m3/d seawater RO plant at Soreq. It plans further

capacity, including purchase of about 35-40 GL/yr from a planned plant at Aqaba jointly run with

Jordan.

Jordan has a 'water deficit' of about 1.4 million m3 per day and is actively looking at nuclear power

to address this, as well as supplying electricity. A small (15,000 m3/d) seawater RO plant on the

Gulf of Aqaba commenced operation in April 2017. In July 2018 Jordan announced plans for a

$2.82 billion public-private partnership development north of Aqaba including a 329,000 m3/d

seawater RO desalination plant, with 55,000 m3/d first stage.

Kenya has awarded contracts for two desalination plants near Mombasa, total 130,000 m3/d, to

come online in 2019. A further 140,000 m3/d is envisaged.

Kuwait has been considering cogeneration schemes up to a 1000 MWe reactor coupled to a

140,000 m3/d desalination plant. Meanwhile Hyundai and a Veolia subsidiary in November 2016

commissioned the $1.7 billion Az-Zour North gas-fired combined cycle 1500 MWe power plant

and 486,000 m3/d MED plant. It accounts for about 10% of Kuwait’s power capacity and 20% of

its desalination capacity. Stage 2 of the Az-Zour Independent Power and Water Project is out to

tender until March 2017. The whole project is 40% privately-owned, largely by Sumitomo and

Engie.
Libya: in mid 2007 a memorandum of understanding was signed with France related to building a

mid-sized nuclear plant for seawater desalination. Areva TA would supply this. Libya is also

considering adapting the Tajoura research reactor for a nuclear desalination demonstration plant

with a hybrid MED-RO system.

Mexico has a 21,000 m3/d El Salitral plant in operation from the end of 2013, and has begun

construction of a 22,000 m3/d plant at San Quintin in Baja California, and another similar one at

Ensenada, both using public-private partnerships. A consortium of Spain's FCC Aqualia and

Aqualia Mexico won a contract to build and operate a 17,300 m3/d desalination plant project in

Sonora from mid-2018 as a public-private partnership.

A 379,000 m3/d seawater RO desalination plant is contracted at Rosarito Beach, in Baja California

near the US border, with 189,500 m3/d as phase 1 from 2019, and phase 2 by 2024, which would

make it the largest desalination plant in the Western hemisphere. Expected cost including 37 years'

operation and maintenance is $490 million, offset by $56 million annual revenue. Ownership

would transfer to the state in the late 2050s. It would serve both Mexico and California (Otay

Water District). However it is now in doubt due to political and economic changes, and will require

a tariff increase to proceed.

Morocco has completed a pre-project study with China, at Tan-Tan on the Atlantic coast, using a

10 MWt heating reactor which produces 8000 m3/d of potable water by distillation (MED). The

government had plans for building an initial nuclear power plant in 2016-17 at Sidi Boulbra, and

Atomstroyexport was assisting with feasibility studies for this.

In 2014 Abengoa was awarded a contract to build and run for 20 years a 100,000 m 3/d seawater

RO desal plant in Agadir, 45 km from that city. The capital cost is €82 million. This project was
then expanded in two stages: first to increase capacity to 150,000 m3/d; and second to provide

125,000 m3/d irrigation water. In addition, a further increase to 450,000 m3/d is envisaged. The

value of the project is now €309 million, including €250 million for the actual desalination

facilities. The cost of potable water will be about $0.52/m3.

Oman relies on large-scale desalination for 76% of its water (20% is from wells). It has had a

128,000 m3/d plant at Sur since 2009. It commissioned a 45,460 m3/d seawater RO plant at Barka

in November 2013 as a BOO independent water project (IWP), expanding an existing facility to

136,000 m3/d. Barka 2 will add 120,000 m3/d. Another BOO project is the 191,000 m3/d Muscat

RO plant with commercial operation from February 2016, replacing the old Ghubrah plant serving

the city. The Salalah plant was opened in May 2013 – a 69,000 m3/d seawater desal plant with 445

MWe gas-fired generation. Another seawater RO plant at Sohar is planned to produce 250,000

m3/d, on top of 150,000 m3/d since 2007. Oman Power & Water Procurement Company (OPWP)

awarded a BOO contract to Hyflux for a 200,000 m3/d IWP at Qurayyat, to be operating by May

2017. The 225,000 m3/d Suwaiq IWP is planned and will bring supplies to over 1.2 million m3/d.

Contracts for Salalah III were expected in 2016, followed by Salalah IV of 100,000 m3/d. In

January 2018 Fisia Italimpianti in a consortium led by ACWA, with Veolia and others, in a joint

venture with Abengoa, announced a $100 million contract for a 113,650 m3/d RO desalination

plant to serve Salalah.

Pakistan: A 10,000 m3/d RO plant costing US$ 3 million has been commissioned in the drought-

ridden Sindh province, where the government is installing 300 RO plants of about 40 m3/d.

A 2000 m3/d plant was commissioned in 2015 at Karwat, for Gwadar city, Balochistan, 700 km

west of Karachi. In October 2017 China Pak Investment Corporation acquired the Port City project

in Gwadar, a gated community for 500,000 Chinese professionals expected by 2020, and including
a 23,000 m3/d seawater desalination plant. This is part of the China-Pakistan Economic Corridor

(CPEC). Another RO plant of 189,000 m3/d is planned there, 90% funded by China.

Qatar has been considering nuclear power and desalination for its needs, and water demand

reached about 1.3 million m3/d in 2010. The Ras Abu Fontas A2 144,000 m3/d MSF seawater

desalination plant built by Mitsubishi Corporation for $504 million was commissioned in 2015.

The $467 million Ras Abu Fontas A3 project – with a 164,000 m3/d RO plant also built by

Mitsubishi is due to operate from March 2017 as the country’s first large RO plant. In May 2015

Qatar General Electricity and Water Corporation (QEWC, Kahramaa) selected a Japanese

consortium of Mitsubishi Corporation and Tokyo Electric Power Company (Tepco), named K1

Energy, to build an electricity and water plant comprising a 620,000 m3/d desalination facility and

a 2.4 GW gas-fired power station at Umm Al Houl, 20km south of Doha, to come online in 2018.

Russia: A new 10,000 m3/d seawater RO plant is being built offshore near Vladivostok, for

commissioning over 2011-12. It is designed for severe climatic conditions.

Saudi Arabia's Saline Water Conversion Corporation (SWCC) operated 5.1million m3/d of

desalinated water capacity in 2017 and is aiming for 7.3 million m3/d by 2020. Coupling

desalination plants with power generation so as to use reject heat reduces energy requirements for

desalination by about half. Hence dual-purpose or hybrid plants are favoured, as independent water

and power production (IWPP) facilities. Most are on a build-own-operate (BOO) basis. In 2016

the government said it would sell SWCC’s entire portfolio of 29 desalination plants with capacity

of 4.6 million m3/d and 7305 MWe on the east and west coasts. It would then build seven new

projects totalling 2.6 million m3/d through public-private partnerships by 2020. The largest of these

are (in million m3/d): Jubail – 1.17; Rabigh 3 – 0.6; Yanbu – 0.45; and Shuqaiq – 0.38.
Shuaibah/Shoaiba. Capacity of 850,000 m3/d MSF and 150,000 m3/d RO is in place here on the

Red Sea coast 90 km south of Jeddah. In April 2017 Abengoa was contracted to build a 250,000

m3/d RO plant at Shoaiba 3 for $257 million on a build-own-operate (BOO) basis. At the same

time Doosan was awarded a $422 million EPC contract by SWCC for a 400,000 m 3/d RO plant

here. This will make Shuaibah/Shoaiba 3 into the world’s largest desalination complex.

Ras Al Khair. The 1,025,0003/d Ras Al Khair (Ras Azzour) MSF project northwest of Jubail on

the Gulf coast, cost SAR 27 billion ($7.2 billion) and was built by Doosan from 2010. The project

includes a 2.6 GWe power plant. The hybrid desalination facility has a capacity of 727,000 m 3/d

MSF evaporation and 307,000 m3/d RO membrane filtration. It will supply water to 3.5 million

people in the Riyadh area.

Yanbu. SWCC was expanding its Yanbu desalination plant on the Red Sea to supply the Medina

region. Phase 1 is a 146,000 m3/d hybrid plant, mostly MSF using heat recovered from a gas turbine

power plant, but with two RO units. Phase 2 upgraded this and added a 68,000 m 3/d MED plant

from Doosan using the heat from an associated 690 MWe power plant, all costing over $1 billion.

It became the world's largest MED plant. From 2012 Doosan also built Yanbu 3, a 550,000 m3/d

MSF plant. Samsung Engineering had the $1.4 billion EPC contract for 3100 MWe turbines in

connection with this, but that contract was cancelled at the end of 2016. In May 2017 Sepco III

Electric Power & Construction from China took over the 60% complete work.

Shuqaiq. This is a 212,000 m3/d RO plant with 850 MWe power generation on the southern Red

Sea coast, due to be more than doubled in size.

Rabigh 3. The 134,000 m3/d plant with 360 MWe generating capacity and steam production on

the Red Sea near Yanbu is being expanded with 600,000 m3/d RO.
Marafiq/Jubail. Capacity of 800,000 m3/d with 2743 MWe of generating capacity is in place here.

Veolia has a $402 million contact to build a 178,600 m3/d ultrafiltration and RO plant for Marafiq

at the $19.3 billion Sadara petrochemical complex on the Gulf coast, to come online in mid-2015.

The water will be for two cooling towers and as boiler feedwater. A further 1.17 million m3/d

capacity is planned here.

Khafji. The first of three phases of the King Abdullah Initiative for Solar Water Desalination was

operating by 2014. Phase 1 involved construction of two solar plants to generate 10 MWe of power

for a 30,000 m3/d reverse-osmosis (RO) desalination plant at Al Khafji, near the Kuwait border.

Phase 2 involves construction of a 60,000 m3/d RO desalination plant over three years to 2018 by

Abengoa, supplied by 15 MWe of polycrystalline PV. The RO plan will have six trains, allowing

best use of variable power input. The third phase aims to implement the solar water initiative

throughout Saudi Arabia, with the eventual target of seeing all the country's desalination plants

powered by solar energy by 2020. One of the main objectives of this initiative under King Abdullah

City for Science & Technology (KACST) is to desalinate seawater at a cost of less than Riyal

1.5/m3 (US$ 0.40/m3) compared with the current cost of thermal desalination, which KACST says

is in the range Riyal 2.0-5.5/m3 (US$ 0.53-1.47/m3), and desalination by RO, which is Riyal 2.5-

5.5/m3 (US$ 0.67-1.47/m3) for a desalination plant producing 30,000 m3/d.

Saudi Arabia's General Establishment for Water Desalination (GEWD) is, over the four years to

2019, implementing new projects with a total production capacity of up to 2.5 million m³/d in the

Makkah region and the eastern province.

SWCC is setting up three 50,000 m3/d floating desalination plants in the Red Sea. These can be

moved around to supplement any coastal RO plants as required. They are expected in operation at

Shuqaiq for Jazan and Asir provinces about October 2019.

Singapore's water agency PUB in 2005 commissioned a large SingSpring RO seawater

desalination plant supplying 136,000 m3/d – 10% of needs, at 49 US cents per cubic metre, and in

2013 commissioned the 318,500 m3/d Tuaspring RO plant as the second desalination plant on a

build-own-operate (BOO) basis, costing US$ 700 million, to provide water at 36 ¢/m 3. It has run

at a loss. Both plants are operated by Hyflux. A third desalination plant, the $217 million Tuas

137,000 m3/d plant using RO and other membrane technology was built by HSL and opened in

mid-2018. It is owned and operated by PUB and draws on both seawater and reclaimed sources

(NEWater). The fourth desalination plant will be at Marina East, a 137,000 m3/d BOO project built

by Keppel, to supply water to PUB at a first-year price of SGD 1.08/m3 from both seawater and

reservoirs. The fifth desalination plant will be 137,000 m3/d, on Jurong Island. PUB also has the

228,000 m3/d Changi Water Reclamation Plant opened in mid-2009, which uses RO to produce

NEWater from sewerage. It is the largest of several NEWater plants on the island and is planned

to triple in size. It was built by an 80% subsidiary of Beijing Enterprises Water Group on a BOO

basis for 25 years at a first-year price of SGD 0.276/m³ (US$ 0.22).

South Africa: Veolia is building a 1700 m3/d seawater desalination plant at Lamberts Bay,

Cederberg municipality, upgradable to5000 m3/d. This will be the seventh plant along the west

and south Cape coasts installed by Veolia. A 450,000 m3/d plant costing $1.23 billion is planned

for Koeberg, near Cape Town.

Spain is building 20 RO plants in the southeast to supply over 1% of the country's water. Spain

has 40 years of desalination experience in the Canary Islands, where some 1.1 million m3/d is

provided.

Tunisia opened its first desalination plant, of 50,000 m3/d, on the island of Djerba in May 2018.

The water utility SONEDE is looking at the feasibility of a cogeneration (electricity-desalination)

plant in the southeast of the country, treating slightly saline groundwater. It plans a tender for a

100,000 m3/d plant at Sfax and signed a loan agreement for this in July 2017. A further 50,000

m3/d plant capable of doubling in size by 2027 is planned for Zarat, in the Gabes district, by 2021.

The UAE uses a lot of MSF capacity compared with others. It is planning a 68,000 m3/d plant at

Ras Al Kaimah. Sembcorp is expanding the Fujairah 1 RO plant of 136,000 m3/d, to bring its UAE

capacity to 591,000 m3/d of which 307,000 m3/d is RO and 284,000 m3/d is MSF. Also the

Shuweihat S2 IPP and seawater desal plant at Al Ruwais started full operation in 2011 and provides

1510 MWe and 454,000 m3/d by MSF. The Fujairah 2 plant is hybrid SWRO-MED and produces

454,600 m3/d. The Taweelah A1 cogeneration plant produces 1430 MWe and 385,000 m3/d and

Umm Al Nar produces 394,000 m3/d. The 91,000 m3/d Al Hamriya RO desal plant with 400 MWe

power station opened in June 2014 to supply Sharjah near Dubai, as part of a 636,000 m3/d and

2500 MWe complex. The 136,400 m3/d Al Zawra seawater desal plant is planned at Ajman. GdF

Suez has a 25-year power and water supply agreement with Abu Dhabi for the Mirfa project,

including a new 136,380 m3/d RO plant and 1100 MWe power plant, costing $1.5 billion,

alongside three existing 34,095 m3/d MSF units and a power plant.

The Emirates' Federal Electricity and Water Authority (FEWA) announced in April 2016 that it

plans four further desalination facilities at a cost of more than Dh 3 billion ($750 million) to

produce 600,000 m3/d, all on a public-private partnership (PPP) basis. The first RO plant of

205,000 m3/d and costing $260 million will be in Umm Al Quwain emirate for operation from

2020. The second will be 136,000 m3/d costing $170 million in Ajman emirate, also to start in

2020 (this may be the same as mentioned above for Al Zawra). The third will be identical, taking

capacity at Ghalilah in Ras Al Khaimah emirate from 68,000 to 205,000 m3/dand to operate from
2026. The fourth is planned as a 180,000 m3/d, $260 million plant operating from 2023 with

location to be determined.

In Dubai the Jebel Ali M cogeneration plant opened in 2013 with 6x243 MWe gas turbines and 8

MSF units providing 640,000 m3/d. Policy then shifted to decoupling power production from

desalination, and using solar energy plus waste heat for the latter. In March 2018 the Dubai

Electricity and Water Authority (DEWA) awarded a $237 million contract to Acciona Agua and

Besix for a 182,000 m3/d brownfield RO plant at Jebel Ali. The target for RO by 2030 is 1.4 million

m3/d out of a total 3.4 million m3/d anticipated by then. Earlier, Dubai invited bids for constructing

a 450,000 m3/d seawater desalination plant as part of its Hassyan independent power project, but

then announced its deferral.

In the UK, a 150,000 m3/d RO plant is proposed for the lower Thames estuary, utilising brackish

water.

USA-Mexico: The 375,000 m3/d Rosarito seawater plant in Baja, California, is to supply potable

water on both sides of the border. A 22,000 m3/d seawater desalination plant is contracted for San

Quintín, Baja.

USA: San Antonio, Texas, is building a 60,000 m3/d RO desal plant for brackish water from

aquifers, to operate from 2016 and costing $193 million. Additions are planned to take capacity to

150,000 m3/d by 2026.

A $1 billion, 200,000 m3/d salt water desal plant at Carlsbad, California, opened in 2015. It will

require about 40 MWe in full operation and can provide 10% of the San Diego county’s potable

water. San Diego has ordered a 415,000 m3/d RO wastewater treatment plant costing $3.5 billion.
It is expected to meet one-third of the city’s daily drinking water requirement by 2035, making it

the second largest potable reuse plant in the USA.

Most or all these have requested technical assistance from IAEA under its technical cooperation

project on nuclear power and desalination. A coordinated IAEA research project initiated in 1998

reviewed reactor designs intended for coupling with desalination systems as well as advanced

desalination technologies. This programme, involving more than 20 countries, is expected to

enable further cost reductions of nuclear desalination.

Other CO2-free desalination

Renewable energy sources are able to be used for desalination more readily than for most

electricity supply, since the product can be stored on any scale, unlike electricity. Also electricity

can be borrowed from the grid and repaid when the wind is blowing or the sun shining. A 45 GL/yr

RO plant at Perth, Western Australia is powered by electricity ostensibly from a wind farm. A new

100 GL/yr RO plant is powered by 65 MWe of dedicated renewable energy (10 MWe solar PV,

55 MWe wind).