The purpose of this study was to evaluate and compare microcalcification detectability of two commercial full-field digital mammography (DM) systems. The first unit was a flat panel based DM system (FFDM) which employed an anti-scatter grid method to reject scatter, and the second unit was a charge-coupled device-based DM system (SSDM) which used scanning slot imaging geometry to reduce scatter radiation. Both systems have comparable scatter-to-primary ratios. In this study, 125–160 and calcium carbonate grains were used to simulate microcalcifications and imaged by both DM systems. The calcium carbonate grains were overlapped with a -thick 50% adipose/50% glandular simulated breast tissue slab and an anthropomorphic breast phantom (RMI 165, Gammex) for imaging at two different mean glandular dose levels: 0.87 and . A reading study was conducted with seven board certified mammographers with images displayed on review workstations. A five-point confidence level rating was used to score each detection task. Receiver operating characteristic (ROC) analysis was performed and the area under the ROC curve was used to quantify and compare the performances of these two systems. The results showed that with the simulated breast tissue slab (uniform background), the SSDM system resulted in higher 's than the FFDM system at both MGD levels with the difference statistically significant at only. With the anthropomorphic breast phantom (tissue structure background), the SSDM system performed better than the FFDM system at but worse at . However, the differences were not found to be statistically significant.