An effective quality assurance (QA) program in X-ray mammography units is a challenge and should be practical to harmonize practices and routine work. A standard operating protocol (SOP) must be in place to ensure that all the relevant objectives and subjective metrics of the imaging chain are operating properly. Identify the challenges and difficulties of daily practice and determine the requirements that are needed. In this study, the quality assurance (QA) in X-ray mammography was evaluated to identify and analyze the protocol currently available in hospitals according to the requirements of the Egyptian regulatory authority at the Ministry of Health. This will provide useful guidance to implement and develop an Egyptian quality assurance (QA) program in X-ray mammography units. A quality assurance program was studied and implemented at three x-ray mammography units to ensure diagnostic accuracy. The values of all the parameters undergoing measurement are compared with the limiting values given by international protocols. The parameters described have been studied and analyzed in detail since the quality control program in mammography was implemented. Such parameters as reproducibility and accuracy of kVp, half-value layer (HVL), tube output, and compression test were measured, and the results were summarized. The values obtained prove the constant and correct functioning of the equipment. The results obtained indicate that more efforts are needed to increase the management of breast cancer with improved radiological safety for patients.