Radiofrequency ablation (RFA) was first introduced into clinical practice in 1993 by Rossi et al. marking a significant advancement in minimally invasive treatments. Since then, a substantial body of literature has emerged evaluating the long-term outcomes of percutaneous interventional radiology (IR) therapies for hepatocellular carcinoma (HCC). Various staging systems have been developed to guide clinical decision-making and treatment selection, factoring in tumor extent, liver function, and patient performance status. Among these, the Barcelona Clinic Liver Cancer (BCLC) staging system remains the most widely endorsed by international hepatic societies. When managing early and very early-stage HCC (tumors typically between 3 and 5 cm), therapeutic options are relatively limited and primarily include surgical resection, liver transplantation, and percutaneous ablation. In patients classified as BCLC stage A, ablation is particularly valued for preserving healthy liver tissue and minimizing surgical complications. Moreover, IR-based treatments have an important role beyond what is outlined in standard guidelines, offering effective and generally well-tolerated options across different stages of HCC. Procedures such as ablation and embolization, whether used individually or in combination, also serve critical roles in downstaging or bridging patients toward potential curative treatments like surgery or transplantation. Although the significance of IR procedures in the management of HCC is well recognized, there is inequality in the use of IR in low/middle-income countries (LMICs) compared to high-income countries (HICs) due to several factors. Most of LMICs experience paucity in the percutaneous IR services for HCC. Most of the causes for lacking such services are the non-availability of IR tools, logistical and affordability issues. Along with the financial issues and insurance obstacles for most of the residents of low-income countries, the lack of IR training and multidisciplinary team experience adds to the delay of getting benefit from such procedures, as it is available to a limited number of patients and confined to a certain modality such as percutaneous ethanol injection. This leads to more deterioration in the results of the patient’s management, which is reflected in the patient’s survival. The role of IR in the management of HCC is discussed in this chapter.