Niazi Journal of Medical & Dental SciencesXXXX-XXXX2024-12-311142210.58398/0007.000003articleNaveed AkhterRomaisa Fatima AbrarAyesha ShahzadRai Medical College, Sargodha, PakistanRai Medical College, Sargodha, PakistanRai Medical College, Sargodha, PakistanProper patient positioning is important in digital mammography, as even minor deviations can compromise image quality, increase retake rates, and increase radiation exposure. This study aimed to evaluate the influence of conventional versus optimized positioning techniques on image clarity, radiation dose, and retake frequency in women undergoing routine mammographic screening. This comparative study was conducted over ten months at a private hospital and a diagnostic center in Sargodha and included 60 women aged 40 to 60 years who were undergoing digital mammography by using both conventional and optimized positioning techniques during the same session. Image quality was independently assessed by two blinded radiologists using a standardized five-point scale adapted from the perfect, good, moderate, inadequate (PGMI) classification (5 = perfect, 4 = good, 3 = moderate, 2 = suboptimal, 1 = inadequate), and the radiation dose per image and retake rates were recorded. The results of this study revealed that compared with the conventional technique, optimized positioning significantly improved the image quality score (mean: 4.28 ± 0.51 versus 3.62 ± 0.67; p < 0.001). The percentage of images rated as “perfect” or “good” increased under the optimized method, particularly in mediolateral oblique (MLO) views. Although the optimized technique resulted in a slight, nonsignificant increase in the radiation dose [2.11 ± 0.26 milligray (mGy) versus 2.04 ± 0.30 mGy; p = 0.139], it significantly reduced retake rates from 13.3% to 3.3% (McNemar exact p = 0.021). No significant period or carryover effect was detected between the two application-order subgroups (Mann–Whitney p = 0.16 for dose and p = 0.57 for image quality), supporting the adequacy of the 5-minute wash-out and the validity of the paired comparison. The study concluded that optimized patient positioning enhances image quality and reduces the need for repeat exposures without significantly increasing the radiation dose.