A method for the determination of optimal operating points of digital mammography systems is described. The digital mammography equipment uses a flat panel detector and a bi-metal molybdenum/rhodium x-ray tube. An operating point is defined by the selection of the x-ray tube target material, x-ray filtration, kVp and detector entrance dose. Breast thickness and composition are estimated from a low dose pre-exposure, then used to index tables containing sets of operating points. The operating points are determined using a model of the image chain, which computes contrast to noise ratio (CNR) and average glandular dose (AGD) for all possible exposure conditions and breast thickness and composition combinations. The selected operating points are those which provide the required CNR for the lowest AGD. An AGD reduction of 30% to 50% can be achieved for comparable Image Quality, relative to current operating points. Resulting from the optimization process, the rhodium target is used in more than 75% of cases. Measurements of CNR and AGD have been performed on various tissue equivalent materials with good agreement between calculated and measured values. The proposed method provides full Image Quality benefit of digital mammography while minimizing dose to patients in a controlled and predictive way.