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Introduction:  The COVID-19 pandemic imposed an unimaginable challenge to the healthcare systems worldwide. This online survey captured the impact of the COVID-19 pandemic on nuclear medicine services in Germany comparing 2020 to 2019., Materials and Methods:  A web-based questionnaire was developed to record the 2020 numbers of nuclear medicine procedures and, in particular, the change compared with 2019. The changes in nuclear medicine diagnostics and therapy were queried, as well as the extent to which "Coronavirus SARS-CoV-2" recommendations provided by the DGN were implemented., Results:  91 complete responses were recorded and evaluated. This corresponds to about 20 % of all German nuclear medicine facilities. Nuclear medicine diagnostic tests showed a decrease in scintigraphies for thyroid (15.9 %), bone (8.8 %), lung (7.6 %), sentinel lymph nodes (5.5 %), and myocardium (1.4 %) with small increases in PET/CT examinations (1.2 %) compared with 2019. Among nuclear medicine therapies, reductions were highest for benign indications (benign thyroid 13.3 %, RSO 7.7 %), while changes from 2019 were less pronounced for malignant indications (PRRT: + 2.2 %, PSMA: + 7.4 %, SIRT: -5.9 %, and RJT for thyroid carcinoma -2.4 %). The DGN recommendations for action were fully or partially applied in 90 %., Conclusions:  The initial significant reduction in nuclear medicine procedures in the first three weeks of the COVID-19 pandemic did not continue, but there was no compensation of the previously not performed services. The decrease in diagnostics and therapy procedures of benign diseases was particularly severe., Competing Interests: Lutz Freudenberg and Markus Essler: none.Ken Herrmann reports personal fees from Bayer, personal fees and otherfrom Sofie Biosciences, personal fees from SIRTEX, non-financial supportfrom ABX, personal fees from Adacap, personal fees from Curium, perso-nal fees from Endocyte, grants and personal fees from BTG, personal fees from IPSEN, personal fees from Siemens Healthineers, personal fees fromGE Healthcare, personal fees from Amgen, personal fees from Novartis,personal fees from ymabs, outside the submitted work., (Thieme. All rights reserved.)

Aim: To explain the spectrum and number of in-vivo nuclear medicine examinations and therapies based on official statistics about out-patient and in-patient care. Trends in time of the frequency and spectrum of procedures as well as data on the health care structure for nuclear medicine in Germany should be collected., Methods: Data from the Gesundheitsberichterstattung des Bundes, from the frequency statistics of the statutory health insurance for out-patients and from the Bundesärztekammer were used. Customized queries were performed to analyse temporal changes., Results: Nuclear medicine physicians are more frequently consulted by out-patients over the last years (2008: 2024498; 2009: 2164664) and the number of colleagues in private practice increased. For in-patients, the frequency of conventional nuclear medicine procedures (mainly for brain, lymphatic system, lung and heart) increased since 2008 after a decline in previous years (2009: 323515; +4.6%) and the number of PET(/CT) examinations continued to rise (2009: 25123; +18%), even if changes in OPS keys may hamper comparisons. Nearly 600 gamma cameras and 76 PET(/CT) scanners were installed in hospitals in 2008. Nuclear medicine procedures are increasingly performed as cross sectional imaging like SPECT(/CT) and PET(/CT). With the supply shortfall with 99Mo, the frequency of thyroid scans with 123I iodine increased as well as the use of 18F PET as a substitute for conventional bone scans. The number of radionuclide therapies, in particular non-thyroid treatments, increased since the mid-nineties and stabilized at nearly 50000 cases per year with shorter lengths of stay., Conclusion: The details of the present analysis may help to understand the positive evolution of key numbers for nuclear medicine.