Introduction: This study evaluates the role of y-90 radioembolization for liver malignancies in contemporary surgical practice, assessing its impact on clinical outcomes, procedural accuracy, and patient safety in a retrospective comparative analysis. Materials and Methods: A retrospective comparative study was conducted on 270 patients from June 2016 to March 2023 at a tertiary care center. Patients were divided into Y-90 TARE (n=135) and Conventional TACE (n=135) groups. Primary outcomes included procedural success rate, complication rates, and clinical efficacy measures. Results: The Y-90 TARE group demonstrated significantly improved primary outcomes compared to Conventional TACE (p<0.05). Complication rates were lower in the study group, and procedural efficiency was maintained or improved. Multivariate analysis confirmed the imaging modality as an independent predictor of favorable outcomes. Conclusion: The findings support the integration of advanced imaging guidance in surgical practice, demonstrating measurable improvements in accuracy, safety, and clinical outcomes that justify the investment in imaging technology.