Surgery for primary hyperparathyroidism (pHPT) is usually highly rewarding both for the surgeon and for the patient. Successful parathyroid surgery cures the disease1 and improves kidney and skeletal function.2 Finding the diseased gland(s) can be difficult, however, and even high-volume, experienced surgeons are sometimes unable to cure their patients.3 Accurate preoperative localization improves outcomes, shortens operation times, and simplifies operation room planning.3 Yet, there is still no imaging modality that in all patients identifies all diseased parathyroid glands. In the meta-analysis by Lee et al,4 positron emission tomography with the radiotracer 18F-fluoromethyl-dimethyl-2-hydroxyethyl-ammonium combined with positron emission tomography and computed tomography (FCH PET/CT) was demonstrated to have superior accuracy in identifying diseased parathyroid glands, both on the lesion and on the patient level.