Mammography screening aims to reduce the number of breast cancer deaths by early detection of the disease, which is one of the leading causes of deaths for middle aged women in the western world. The risk from the x-ray radiation in mammography is relatively low but still a factor in the benefit-risk ratio of screening. The characterization and optimization of a digital mammography system is presented in this thesis. The investigated system is shown to be highly dose efficient by employing a photon counting detector in a scanning multislit geometry. A novel automatic exposure control (AEC) is proposed and validated in clinical practise. The AEC uses the leading detector edge to measure the transmission of the breast. The exposure is modulated by altering the scan velocity during the scan. A W-Al anode-filter combination is proposed. The characterization of the photon counting detector is performed using the detective quantum efficiency. The effect of the photon counting detector and the multislit geometry on the measurement method is studied in detail. It is shown that the detector has a zero-frequency DQE of over 70\% and that it is quantum limited even at very low exposures. Efficient rejection of image-degrading secondary radiation is fundamental for a dose efficient system. The efficiency of the scatter rejection techniques currently used are quantified and compared to the multislit geometry. A system performance metric with its foundation in statistical decision theory is discussed. It is argued that a photon counting multislit system can operate at approximately half the dose compared to several other digital mammography techniques. / QC 20100825