A long-running shortage of medical isotopes has attracted startup and government investment in alternative production technologies, but the industry's history suggests that turning new production methods into reliable commercial supply remains the bigger challenge.

Around 40,000 times a day in the United States, hospitals use technetium-99m to scan patients' hearts, bones and organs, according to the Department of Energy. The isotope is the decay product of molybdenum-99, or Mo-99, and its short half-life leaves little room for disruption anywhere in the supply chain.

Technetium-99m, or Tc-99m, has a half-life of about six hours, while its parent isotope Mo-99 has a half-life of about 66 hours. That means Tc-99m must be prepared close to the time of use, while Mo-99 also has to move through the supply chain quickly. It cannot be stockpiled or produced far ahead of demand, so disruptions at the production or transport stage can quickly affect hospitals. More than 30 million patients worldwide are diagnosed each year using Tc-99m, according to published clinical research.

Most global Mo-99 production is concentrated in a small number of government-owned research reactors overseas, many of them decades old. In 2024, two reactors went offline at the same time, one for scheduled maintenance and another unexpectedly, causing what the Department of Energy described as significant effects on U.S. hospitals. Similar outages in the Netherlands and Canada over the past decade have exposed the same weakness: a limited number of facilities supplying a widely used medical isotope with little room to absorb disruptions.

The reactor model is straining under an aging supply base

Much of the existing Mo-99 infrastructure was designed decades ago for research rather than today's commercial medical market. Individual facilities are generally set up around specific isotopes, while demand is expanding toward a wider range of materials used in cancer imaging and treatment.

Transportation adds another constraint because roughly a third of Mo-99 can be lost to decay during cross-continental shipping from overseas reactors to the United States. The country has not had a continuous domestic commercial source of Mo-99 since the 1980s, and after Canada's Chalk River reactor shut down in 2016, U.S. hospitals became more dependent on material flown in from Europe and South Africa.

The supply challenge is also changing with the market. Newer therapeutic isotopes, including alpha-emitters used in targeted radiotherapy, are gaining importance in cancer treatment, while commercial supplies of some of these materials remain limited.

Startup capital is moving into the supply gap

The combination of fragile supply and rising demand has attracted new investment into alternative production. Companies including SHINE Technologies in Wisconsin, Nucleus RadioPharma in Minnesota, Astral Systems in England and StandardX in London have collectively raised hundreds of millions of dollars in venture and government funding to develop additional capacity.

The latest funding illustrates the interest. In September 2026, StandardX emerged from stealth with a £10 million seed round led by Vsquared Ventures and East X Ventures. The London-based company is developing an accelerator-based isotope refinery and says it plans to supply its first isotopes to a medical research partner in 2027, with industrial-scale production targeted from 2029.

Its co-founder, Richard Pearson, has cited projections that new cancer cases could increase 67% by 2050 and argued that existing isotope infrastructure will struggle to meet future demand. The companies are taking different technological approaches. SHINE is developing an accelerator-based process designed to produce Mo-99 at commercial scale without highly enriched uranium, while StandardX is pursuing a similar accelerator approach that aims to produce several isotope types from one industrial footprint.

Astral Systems is betting on fusion technology, while Nucleus RadioPharma is building manufacturing capacity for radiopharmaceutical treatments. Nucleus also has a supply agreement with NorthStar Medical Radioisotopes for actinium-225, an alpha-emitting isotope used in targeted cancer therapies.

That range of approaches matters because there is still no established alternative that has demonstrated it can fully replace the reactor-based supply chain at commercial scale.

Governments are helping reshape the economics

Public funding is supporting some of the industry's new production projects. In April 2026, the Department of Energy's Office of Energy Dominance Financing issued SHINE a conditional commitment for a loan of up to $263 million to support construction of its medical-isotope facility. The company has also received federal support through the National Nuclear Security Administration.

Payment policy is also changing the economics of domestic production.

Beginning Jan. 1, 2026, the Centers for Medicare & Medicaid Services added a $10-per-dose payment for Tc-99m derived from domestically produced Mo-99, subject to eligibility requirements including a minimum domestic share of the Mo-99 used in the generator. The policy is intended to address the higher cost of domestic production and encourage a domestic supply.

The policy shift reflects a broader economic problem. CMS said foreign Mo-99 production has historically benefited from government subsidies, creating prices that could discourage investment in domestic production. The interest is not limited to startups. Novartis is separately developing in-house isotope production for its radiotherapies, showing that supply availability is becoming a strategic issue for established pharmaceutical companies as well.

Those measures could make domestic production more attractive, but they do not remove the underlying technical and commercial risks. A company still has to build the facility, secure regulatory approval, produce consistently and compete on price.

Commercial production is proving harder than the technology

The industry's recent history offers a warning. NorthStar received FDA approval in 2018 for its RadioGenix system and non-uranium Mo-99 production technology, representing an important step toward domestic production. But regulatory approval alone did not solve the economics of the market.