Building a high-performing yttrium-90 radioembolization practice: from evidence to experience

Abstract Yttrium-90 ( 90 Y) radioembolization has evolved into a guideline-endorsed liver-directed therapy with curative, bridging, downstaging, and palliative applications in selected patients with hepatocellular carcinoma (HCC) and liver-dominant malignancies. Advances in selective delivery, personalized dosimetry, and post-treatment imaging have improved efficacy and reproducibility. However, the success of a 90 Y radioembolization program depends on more than technical capability; it depends on whether the institution can deliver it safely, consistently, and in alignment with multidisciplinary goals. Establishing a durable practice requires multidisciplinary alignment, standardized workflows, meaningful quality metrics, leadership support, and patient-centered communication supported by dedicated care coordination. This paper provides a practical framework for building and sustaining a high-performing 90 Y radioembolization program across diverse practice environments, while emphasizing balanced treatment selection within the broader liver cancer armamentarium.