Photon counting is an emerging detection technique that is promising for mammography tomosynthesis imagers. In photon counting systems, the value of each image pixel is equal to the number of photons that interact with the detector. In this research, we introduce the design and implementation of a low noise, novel selective photon counting pixel for digital mammography tomosynthesis in crystalline silicon CMOS (complementary metal oxide semiconductor) 0.18 micron technology. The design comprises of a low noise charge amplifier (CA), two low offset voltage comparators, a decision-making unit (DMU), a mode selector, and a pseudo-random counter. Theoretical calculations and simulation results of linearity, gain, and noise of the photon counting pixel are presented.