Draft:ARTHUR Reactor

The Advanced Radioisotope Technology for Health Utility Reactor (ARTHUR) is a state-of-the-art nuclear facility proposed for development in North Wales, aimed at significantly enhancing the UK's capacity to produce vital nuclear medicines. Spearheaded by the Welsh Government, with the support of a detailed outline business case and feasibility study, the project is, as of Summer 2024, under consideration by the UK Government . ARTHUR will focus on producing key isotopes such as Technetium-99m (Tc-99m), the most widely used radioisotope in medical diagnostics, essential for imaging in areas such as cardiology and oncology. They are also a key part of future tailored medicines to simultaneously image and treat cancers: termed theranostics. By securing domestic production of these critical medical isotopes, the reactor will play a pivotal role in strengthening the UK’s healthcare infrastructure and reducing reliance on international suppliers, ultimately ensuring a stable and timely supply of life-saving diagnostic tools.

The project was initiated in 2019, after the cessation of the Wylfa Newydd programme by the Welsh Government. The Trawsfynydd site, currently in decommissioning, was chosen after a siting study, owing to its nuclear history, need for economic uplift, existing nuclear licensed site, and proximity to infrastructure. Following a global nuclear medicine supply chain shortage in the late 2010s-2020s, the project has been developed to deliver medicines to the UK market in the early 2030's, just as other supplies are expected to cease, supporting the NHS recommendation .

In the UK, nuclear medicine procedures are a critical component of diagnostic and therapeutic healthcare. As of recent data, it is estimated that approximately 1 million nuclear medicine procedures are carried out annually across the country . This includes a range of diagnostic imaging procedures, such as PET (positron emission tomography) scans and SPECT (single-photon emission computed tomography) scans, as well as therapeutic procedures involving radiopharmaceuticals.

Building from proven technology

The Advanced Radioisotope Technology for Health Utility Reactor (ARTHUR), is set to follow the successful model of Australia’s OPAL reactor, operated by the Australian Nuclear Science and Technology Organisation (ANSTO). Similar to OPAL, ARTHUR will focus on the production of critical nuclear medicines, essential for diagnostic and therapeutic interventions in healthcare. OPAL has positioned Australia as a global leader in nuclear medicine, producing isotopes that benefit millions of patients both domestically and internationally.

ANSTO's OPAL reactor has not only secured a reliable supply of nuclear medicines for the region but also fostered scientific research, industrial innovation, and economic growth. By following this blueprint, ARTHUR aims to replicate these benefits in the UK, ensuring a stable supply of isotopes, boosting healthcare services, and enhancing scientific and technological innovation in the region.

The OPAL reactor was designed and constructed by INVAP.

Supply chain

The supply chain for nuclear medicine, particularly the production and distribution of key radioisotopes like Technetium-99m (Tc-99m) from Mo-99, faces significant challenges globally and in Europe. As these isotopes are critical for diagnostics and treatment in healthcare, any disruption can have far-reaching consequences for patient care.

Supply Chain Challenges

Reliance on aging reactors: Most radioisotopes used in medicine, including Tc-99m, are produced in a small number of aging reactors, such as the HFR (High Flux Reactor) in the Netherlands and the NRU reactor in Canada (now decommissioned). These reactors are over 50 years old, leading to frequent maintenance shutdowns and reliability issues. Global dependency on a few facilities increases the risk of supply shortages.

Global

1. Short Half-Lives of Isotopes: Isotopes like Tc-99m have a very short half-life (around 6 hours), meaning they decay rapidly and cannot be stockpiled. As a result, continuous production is essential, requiring an uninterrupted supply chain. Any disruptions in production or transportation can lead to immediate shortages, affecting healthcare services globally.
2. Geopolitical and Economic Factors: The supply chain for nuclear medicine is also vulnerable to geopolitical tensions, trade restrictions, and economic downturns. Countries with limited domestic production rely on imports, which can be delayed or blocked due to international disputes, tariffs, or logistical issues.
3. Decommissioning of Reactors: Many key isotope-producing reactors are nearing the end of their operational lives, and plans for replacement reactors (such as PALLAS in the Netherlands) face delays due to funding, regulatory approvals, and technological challenges. The shutdown of reactors like Canada’s NRU without sufficient replacements has already contributed to global supply shortages.

European Supply Chain Issues

1. Dependence on a Few Reactors: Europe relies heavily on the HFR reactor in the Netherlands and BR2 in Belgium for the production of medical isotopes. Maintenance or operational halts in these facilities can disrupt supply to hospitals across the continent.
2. Transportation and Regulatory Barriers: Transporting radioisotopes across European borders is subject to strict regulations due to the radioactive nature of the materials. Regulatory inconsistencies between countries, compounded by the need for rapid transit, can cause delays in delivering isotopes to medical facilities.
3. Brexit: The UK's exit from the EU has introduced additional barriers for the UK to access medical isotopes, particularly given that it lacks domestic production capabilities. Importation from EU-based reactors is now more complex due to changes in customs and regulatory frameworks.
4. High Production Costs: The cost of maintaining and upgrading existing reactors is prohibitively high.

The PALLAS reactor in the Netherlands is intended to replace the aging High Flux Reactor (HFR) at Petten, which has been a key facility for the production of medical isotopes. Progress on PALLAS has included securing financing commitments and advancing design and planning stages, though construction has faced delays. Once completed, PALLAS will ensure a steady supply of medical isotopes, vital for nuclear medicine diagnostics and therapies. The project is critical for both European and global healthcare supply chains. Even with this, the demand for nuclear medicines is expected to be far in excess of what will be produced at this facility, due to ageing populations and a growth in demand more generally; ARTHUR provides strength and depth to the supply chain globally, whilst ensuring the UK demand is serviced, bringing costs and improved outcomes for patient care.

Cancer in the UK

The UK’s cancer survival rates generally lag behind those of many high-income countries, including the US, Canada, Australia, and parts of Europe . Factors contributing to this include late diagnosis, variations in healthcare access, and delays in treatment. Survival rates for certain cancers, such as breast and colorectal cancer, are particularly lower in the UK compared to other developed nations. Recent efforts to improve early detection and streamline treatment pathways aim to close this gap, but further investment in healthcare infrastructure, such as the ARTHUR reactor, in combination with improved cancer services is needed to achieve significant improvements.