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This study aimed to determine the reduction of radiation dose in endovascular peripheral interventions (EPI) using DVA. The DVA imaging tool v6.0 (Kinepict Medical Imaging Tool, version 6.0.4, Kinepict Health Ltd., Budapest, Hungary) was utilized for patients undergoing EPI using digital angiography. EPI normal dose (EPI-ND) protocols were adapted from 1.20 to 0.81 \u00b5Gy\/frame to EPI low dose (EPI-LD) protocols using DVA-LD acquisitions with 0.36 \u00b5Gy\/frame and occasionally 0.24 \u00b5Gy\/frame based on specific examination requirements. The dose area product (DAP) was evaluated and contrast-to-noise ratio (CNR) was measured for each DSA acquisition. Evaluation included 370 EPI-ND and 62 EPI-LD using DVA-LD of three lower extremity regions (mean age: 73\u2009\u00b1\u200911 years, 67% male). LD protocols decreased median DAP of ND protocols significantly by 62.0% in pelvic, 53.8% in femoral and popliteal, and 59.4% in cruro-pedal regions, respectively (<jats:italic>p<\/jats:italic>\u2009&lt;\u2009.005). DVA-LD increased median CNR significantly compared to DSA-LD (<jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001), and was equal to DSA-ND (<jats:italic>p<\/jats:italic>\u2009&gt;\u2009.15). Image quality was enhanced by CNR<jats:sub>DVA\u2212LD<\/jats:sub>\/CNR<jats:sub>DSA\u2212ND<\/jats:sub> ratio of 1.9 in pelvic, 2.4 in femoral and popliteal and in cruro-pedal regions. DVA reveals significant radiation dose reduction in lower extremity EPIs and enhances image contrast while decreasing noise.<\/jats:p>","DOI":"10.1038\/s41598-025-06361-7","type":"journal-article","created":{"date-parts":[[2025,7,10]],"date-time":"2025-07-10T08:48:21Z","timestamp":1752137301000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Radiation exposure reduction in peripheral interventions using digital variance angiography versus conventional angiography"],"prefix":"10.1038","volume":"15","author":[{"given":"Till","family":"Sch\u00fcrmann","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulrich","family":"Beschorner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dirk","family":"Westermann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Zeller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabian","family":"Bamberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher L.","family":"Schlett","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Stein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elias","family":"Noory","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,7,9]]},"reference":[{"key":"6361_CR1","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1177\/15910199000060S102","volume":"6","author":"K Okamoto","year":"2000","unstructured":"Okamoto, K., Ito, J., Sakai, K. & Yoshimura, S. 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