Certain embodiments of the present invention provide methods and systems for calibrating a pixel spacing attribute value for X-ray mammography imaging based on a patient-specific breast thickness value. Certain embodiments provide a method for patient specific pixel spacing calibration for mammography X-ray imaging. The method includes determining a patient specific breast thickness value for a particular patient being imaged by a mammography X-ray device having a radiation source and a detector and an associated imager pixel spacing value. The method also includes calibrating a pixel spacing attribute for a mammography X-ray image based on the patient specific breast thickness value, a radiation source to detector distance in the mammography X-ray device, and the image pixel spacing value.