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Patients were randomized to normal dose (ND) DSA (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200935) or ultra-low dose (ULD) DSA (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200935), with the latter reducing target detector dose by 72% for stationary acquisitions only. Radiation dose analysis was limited to stationary acquisitions, as only these series were acquired using the modified low-dose protocol. Dose-area product (DAP), contrast-to-noise ratios (CNR), and visual image quality of DSA and DVA images were compared. Three experienced interventional radiologists conducted a randomized, blinded 5-point Likert evaluation of large and small vessels, tissue blush, and background noise. Statistical analysis included Mann-Whitney tests, Spearman correlation, Kendall Tau B, and Bangdiwala\u2019s B for interrater agreement.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The ULD protocol reduced stationary acquisition-related DAP by up to 80% compared to controls (580\u2009\u00b1\u200966 vs 2872\u2009\u00b1\u2009396\u2009\u00b5Gym\u00b2\/patient,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). DVA showed significantly higher CNR in both groups, with median CNR\n                      <jats:sub>DVA<\/jats:sub>\n                      \/CNR\n                      <jats:sub>DSA<\/jats:sub>\n                      ratios of 3.85 in ND and 4.60 in ULD. DVA images achieved significantly higher scores for small vessels and tissue blush visualization (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001; CNR: 4.10 vs 2.88; Likert rating: 2.79 vs 1.58).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>DVA enables substantial radiation dose reduction in PAE while maintaining superior image quality versus DSA, potentially improving angiographic safety and efficacy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key Points<\/jats:title>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Question<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>DVA is useful in reducing dose and enhancing image quality, yet it was not validated for complex angiographic procedures<\/jats:italic>\n                      .\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Findings<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>DVA provides better qualitative and quantitative image quality than DSA with reduced dose for prostatic artery embolizations<\/jats:italic>\n                      .\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Clinical relevance<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>DVA significantly improves image quality in Prostatic Artery Embolization compared to DSA, which allows up to 80% reduction in radiation burden to patients and interventionalists alike, while it also maintains diagnostic image quality<\/jats:italic>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00330-025-12235-3","type":"journal-article","created":{"date-parts":[[2026,1,3]],"date-time":"2026-01-03T09:40:38Z","timestamp":1767433238000},"page":"4682-4692","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Digital variance angiography enables up to 80% reduction in stationary acquisition radiation dose during prostatic artery embolization: a prospective randomized trial"],"prefix":"10.1007","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8141-7454","authenticated-orcid":false,"given":"Leona S.","family":"Alizadeh","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas 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Szabolcs Osvath is a shareholder of the company.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"One of the authors has significant statistical expertise.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Statistics and biometry"}},{"value":"Only if the study is on human subjects: written informed consent was obtained from all subjects (patients) in this study.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"Institutional Review Board approval was obtained.","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"None of the results of this study has been reported so far.","order":7,"name":"Ethics","group":{"name":"EthicsHeading","label":"Study subjects or cohorts overlap"}},{"order":8,"name":"Ethics","group":{"name":"EthicsHeading","label":"Methodology"}}]}}