Coronavirus disease 2019 (COVID-19) is a global and international public health emergency. The COVID-19 pandemic is having a profound impact on patient care and nuclear medicine practice, especially lung ventilation scans. There is still a lack of evidence whether the lung ventilation scan should be considered as an aerosol-generating procedure. However, since infection from COVID-19 is mainly transmitted by respiratory droplets and close contact, both test personnel and patients are at risk of transmission of COVID-19 during lung ventilation scans. In the inhalation procedure, the patient releases respiratory fluids in the form of droplets, which may carry the virus and transmit infection. For this reason, several recent papers suggest that a ventilation scan can be omitted and it can be replaced with perfusion-only single-photon emission tomography (SPECT)/computed tomography (CT) for the diagnosis of pulmonary embolism [1][2][3].With the advent of hybrid SPECT/CT, it is possible to evaluate the pulmonary perfusion status in three-dimensional space, and when combined with the segmental anatomical information of each patient determined based on the CT scan, it offers a more accurate diagnosis [4]. Co-registered low-dose CT scans can directly assess the structural abnormality of the airways, lung parenchyma, and pleura, and areas with reduced perfusion without corresponding structural abnormalities are likely indicative of pulmonary embolism. Several studies have reported the diagnostic performance of perfusion-only SPECT/CT in the diagnosis of pulmonary thromboembolic disease [5][6][7][8][9][10][11] (Table 1). In common, perfusion-only SPECT/CT showed high sensitivity ranging from 88 to 100%, and a high negative predictive value of 91-100%. However, the specificity was reported to vary from as low as * Minseok Suh