Purpose To compare the image quality produced by kinetic imaging in x-ray angiography and the current reference standard digital subtraction angiography (DSA). Materials and Methods This prospective observational crossover study enrolled 42 patients undergoing lower limb x-ray angiography between February and June 2017 (mean age, 68.7 years; age range, 49-89 years; 32 men [mean age, 67.1 years; age range, 49-89 years] and 10 women [mean age, 75 years; age range, 57-85 years]). Signal-to-noise ratios (SNRs) of DSA and kinetic image pairs were compared. Visual quality comparisons were also performed by specialists who used an online questionnaire. Interrater agreement was characterized by percent agreement and Fleiss k. Results A total of 1902 regions of interest were carefully selected in 110 image pairs to calculate and compare the SNRs. Median SNR in raw kinetic images was 3.3-fold and 2.3-fold higher than raw and postprocessed DSA images, respectively. A total of 232 pairs of raw and postprocessed kinetic images were compared. It was indicated that postprocessing improved the quality of kinetic images in 63.9% (2668 of 4176) of the comparisons. Interrater agreement was 75% and Fleiss k was 0.12 (P < .001). Also, 238 pairs of kinetic and DSA images were compared. Kinetic imaging was judged to have provided higher quality images than DSA in 69.0% (2462 of 3570) of the comparisons. The interrater agreement was 81% and Fleiss k was 0.17 (P < .001). Conclusion Kinetic imaging helps to view the same structures as digital subtraction angiography but offers better image quality. The improved signal-to-noise ratio suggests that this approach could reduce radiation exposure and improve the ability to view smaller vessels. © RSNA, 2018 Online supplemental material is available for this article.