Hepatocellular carcinoma represents the most common liver cancer and the third main cause of cancer-related deaths. HCC diagnosis is typically only made at an advanced stage of the disease, when survival is dismal (5-year survival < 5%). If the disease is detected at an earlier stage, when patients are still candidates for curative organ transplantation, surgical resection, or percutaneous ablation, a substantial improvement in survival is observed (5-year survival between 40% and 70%). Despite the increasing incidence of HCC in the United States, the effectiveness of HCC surveillance programs remains largely unknown. Randomized clinical trial and several non-randomized trials have found a survival benefit, but due to the intensity of the proposed programs (liver ultrasound to be performed every 6 months), compliance has been challenging. The overall objective of the proposed project is to develop an infra-structure and establish a future cohort population to be appropriately followed up for HCC early detection program. This will improve patient adherence by combining risk stratification with annual alpha-fetoprotein (AFP) and image-based surveillance.