Proper 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 cross-sectional study was conducted for ten months at two tertiary care hospitals in Lahore and included 60 women from 40 to 60 years 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 5-point Likert scale and radiation dose per image and retake rates were recorded. Results of study highlighted that optimized positioning significantly improved image quality scores (mean: 4.28 ± 0.51) compared to conventional technique (3.62 ± 0.67; p < 0.001). The rate of images rated as “Perfect” or “Good” increased under the optimized method, particularly in mediolateral oblique views. Although the optimized technique showed a slight, non-significant increase in radiation dose (2.11 ± 0.27 mGy vs. 2.04 ± 0.31 mGy; p = 0.092), it significantly reduced retake rates from 13.3% to 3.3% (p = 0.014). The study concluded that optimized patient positioning enhances image quality and reduces the need for repeat exposures without significantly increasing radiation dose.