# Radiation exposure reduction in peripheral interventions using digital variance angiography versus conventional angiography

## TL;DR

This study shows that digital variance angiography significantly reduces radiation exposure during peripheral interventions while maintaining or improving image quality.

## Contribution

The study introduces a new low-dose protocol using digital variance angiography that reduces radiation exposure in endovascular procedures.

## Key findings

- DVA-LD protocols reduced radiation dose by over 50% in all lower extremity regions.
- DVA-LD improved contrast-to-noise ratio compared to low-dose DSA and matched normal-dose DSA.
- Image quality was enhanced with a 1.9 to 2.4 improvement in contrast-to-noise ratio.

## Abstract

Digital variance angiography (DVA) exhibits promising prospects with respect to radiation exposure in digital subtraction angiography (DSA). 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 µGy/frame to EPI low dose (EPI-LD) protocols using DVA-LD acquisitions with 0.36 µGy/frame and occasionally 0.24 µGy/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 ± 11 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 (p < .005). DVA-LD increased median CNR significantly compared to DSA-LD (p < .001), and was equal to DSA-ND (p > .15). Image quality was enhanced by CNRDVA−LD/CNRDSA−ND 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.