Scintimammography, or single gamma nuclear imaging of the breast, has shown promise as a way of characterizing certain biological properties of suspicious breast masses. Conventional scintimammography, performed using large clinical gamma cameras and prone patient positioning suffers from several drawbacks including poor sensitivity for small (< 1 cm) lesions and no reliable method for correlating scintigraphic findings with those of other imaging modalities. We are developing a system designed to overcome some of these problems. The system combines x-ray mammography with scintimammography on a common gantry. The x-ray and gamma ray images are obtained in quick succession, with the breast in a common configuration under mild compression. A digital x-ray detector is used, permitting rapid assessment of lesion location prior to gamma imaging, and enabling fusion of the x-ray transmission and gamma emission information in a single digital image. In a pilot clinical diagnostic study, the system has demonstrated high pathology-proven accuracy in differentiating benign and malignant masses.