In 1982 the first prototype high density avalanche chamber (HIDAC) positron camera became operational in the Division of Nuclear Medicine of Geneva University Hospital. The camera consisted of dual 20 cm × 20 cm HIDAC detectors mounted on a rotating gantry. In 1984, these detectors were replaced by 30 cm × 30 cm detectors with improved performance and reliability. Since then, the larger detectors have undergone clinical evaluation. This article discusses certain aspects of the evaluation program and the conclusions that can be drawn from the results. The potential of the HIDAC camera for quantitative positron emission tomography (PET) is critically examined, and its performance compared with a state-of-the-art, commercial ring camera. Guidelines for the design of a future HIDAC camera are suggested.