Breast cancer remains a leading cause of death among women throughout the world. The incidence is increasing globally and the disease remains a significant public health problem. Mammography is currently the best method to detect early breast cancer before it becomes clinically palpable. The use of mammography results in a 25% to 30% decreased mortality rate in screened women compared with controls after 5 to 7 years. Today's dedicated mammographic equipment with specially designed X-ray screen/film combinations coupled with controlled film processing produces excellent image quality mammograms. It is important to produce reliable high-contrast, high-resolution images for mammography. Both the American College of Radiology Mammography Accreditation Program and the Mammography Quality Standards Act have had significant impact on the technical quality of mammographic images in the USA and worldwide. The recent development in digital mammography has opened the possibility for improving diagnosis and novel applications. This article reviews the major technical developments that led to today's high quality mammograms.