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IntroductionScreening and diagnostic mammography are associated with some risk of radiation-induced breast cancer. This study was conducted to establish the National Diagnostic Reference Levels (NDRLs) for digital diagnostic and screening mammography in Uganda to achieve breast radiation dose optimization.MethodsA cross-sectional study was conducted among female participants recruited by consecutive sampling from three selected hospitals with digital mammography in Uganda. The study variables extracted from the mammography machines were exposure factors, compressed breast thickness (CBT), and Average Glandular Dose (AGD) of two standard mammogram views. The stratified National DRL was derived by calculating the 75th percentile of the AGD across all the samples at various CBT ranges for both screening and diagnostic mammography in craniocaudal (CC) and mediolateral oblique (MLO) views.ResultsWe included 300 participants with mean ages of 50.28±9.32 and 47.45±13.45 years for the screening and diagnostic mammography, respectively. There were statistically significant positive correlations between AGD and exposure factors (mAs, kVp) (all p-valuesConclusionThe NDRLs for digital screening and diagnostic mammography in Uganda have been proposed for the first time. The NDRL values in mammography should be specific to CBT ranges and mammographic views for both diagnostic and screening mammography.