All commonly used medical radioisotopes can be produced without using nuclear reactors or enriching uranium, or can be replaced with other isotopes that can be produced without a fission reaction, or by alternative technologies.
Reactors not using natural uranium fuel require uranium enrichment, therefore justifying enrichment facilities that can be used for the production of weapons-usable highly enriched uranium (HEU). All reactors also produce weapons-usable plutonium as a byproduct of normal operation, although those using natural uranium fuel produce the most.
These reactors and enrichment facilities are not necessary for medical isotope production. Particle accelerators currently produce many medical isotopes. This report shows that all commonly used medical isotopes currently produced in reactors can be produced in accelerators, or replaced with accelerator-produced isotopes or alternative technologies. None of the accelerator options discussed herein would involve significant proliferation risk.
The extensive literature on production alternatives for the world’s most widely used medical isotope, technetium-99m, makes possible an analysis of the cost and security aspects of these alternatives. While there is a good deal of uncertainty associated with cost data, since commercial accelerator production of Mo-99/Tc-99m has not yet commenced, the data suggest that accelerator production has the potential to be cheaper than reactor production, and at the very least will not prove prohibitively expensive.
For commonly used isotopes other than technetium-99m, a detailed cost estimate for accelerator production is beyond the scope of this paper. Nevertheless, it is clear that such alternatives are feasible. It seems unlikely that in the aggregate these alternatives would be prohibitively expensive. More R&D would support a full transition to commercial supply of isotopes other than Tc-99m using accelerator-based processes. Targeted investments in R&D for commercial production of the other isotopes, through contracts by NIH or DOE, could have substantial impact on the commercial availability of accelerator-produced medical isotopes, both in the US and abroad.