Purpose: 18F-fluorocholine PET (FCH-PET) is a new and emerging method for localising parathyroid adenomas, which allows for a minimally invasive parathyroidectomy, improving surgical recovery and reducing complication rates. FCH-PET is currently used in our institution as a second- or third-line investigation in complex pre-surgical localization for persistent or recurrent hyperparathyroidism cases. This study aims to examine the localisation rates of FCH-PET in our institution. Methodology: A search for all patients who had FCH-PET scans done in Fiona Stanley Hospital from its first use until the start of the audit was performed, and patients who did not have surgery and thus no histological or surgical confirmation of the localisation were excluded. The results of the FCH-PET scan were compared with intraoperative findings and the histopathology report. The accuracy of the localisation was also compared to 4DCT and sestamibi scans if the patient had those as well. Results: 52 patients had an FCH-PET from 15 Aug 2016 to 5 Aug 2025. A total of 17 patients from this population proceeded to surgery. FCH-PET localised the adenoma correctly 58.8% of the time, which was comparable with those that had 4DCT (60%). Both were superior to sestamibi which had a localisation rate of 33.3%. Conclusion: The localisation rates in our cohort for FCH-PET, 4DCT and sestambi are lower than globally reported rates, and this is due to the inherently complicated nature of the cases used in this study. FCH-PET is used as a second- or third-line modality in our institution, hence patients in this study were of a complex case history – usually due to prior parathyroid surgeries, and discordant or non-convincing first line imaging. Nonetheless, FCH-PET seems to be a promising modality for localising missed or ectopic parathyroid adenomas comparable with 4DCT, and warrants a deeper look into its efficacy and its potential role in enabling successful focused re-operative parathyroidectomy.