A retrospective analysis finds that automated injection for [18F]fluorocholine PET/CT is associated with higher venous retention, lower SUVmax values, and reduced diagnostic confidence compared with manual injection. The performance differences appear tied to injection dynamics that can affect tracer distribution and signal strength. The results raise practical questions for sites adopting automation in radiopharmaceutical administration. For parathyroid imaging stakeholders, the paper highlights the need to validate automated protocols against manual baselines, particularly where diagnostic confidence drives surgical decision-making.