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Introduction In the UK, national standards recommend 6-monthly ultrasound surveillance for patients with cirrhosis to detect early-stage hepatocellular carcinoma (HCC). 1 The Ultrasound Liver Imaging Reporting and Data System (US LI-RADS) is a framework to standardise US reporting in HCC surveillance. Images are categorised by visualisation: VIS-A (no/minimal limitations), VIS-B (moderate limitation), or VIS-C (severe limitation) and observation: US-1 (no lesions), US-2 (observation <10mm; short-interval scan), or US-3 (observation >=10mm/new thrombus; contrast-enhanced imaging).2 This study reviewed the implementation of US LI-RADS at the Newcastle-upon-Tyne Foundation Trust following its adoption in September 2024.Methods All HCC surveillance ultrasounds performed between September 2024 and May 2025 were analysed. Electronic patient records were used to review the actions taken for any scans with suboptimal visualisation (non-VIS-A) or significant observations (non-US-1).VIS-Score Results A total of 1152 HCC surveillance ultrasound scans were reported in the analysis period. VIS-A and VIS-B score was reported in 74% (n=848) and 22% (n=254) of cases respectively. VIS-C occurred in 4% (n=50) cases, of these, 62% (n=31) were referred for further imaging within 3-months.US-Score Results US-2 score was reported in 2.4% of cases (n=28), with 43% of these (n=12) referred for repeat US within 3-months. 39% (n=11) had contrast-enhanced imaging, despite 73% (n=8) of these having VIS-A scores reported in their original US. In 14% (n=4) of cases with an original US-2 score, 6-monthly US screening was reinstated, following stable observations across scans.US-3 observation was reported in 2.2% (n=25) of cases. All US-3 cases were referred for contrast enhanced imaging, irrespective of VIS score. MRI liver was performed in 52% (n=13) cases, contrast-enhanced ultrasound in 24% (n=6) and CT in 20% (n=5). No HCCs have been diagnosed from the US-3 scans at the time of analysis, but 24% (n=6) have requested further imaging pending.Abstract P71 Table 1Distribution of US LI-RADS scores in 1152 scans analysedConclusions The majority of HCC surveillance US scans using LI-RADS standardisation report no/minimal limitations, comparable to published data in the United States (VIS-A=76.8%). 3 For severe limitations, clinical practice varies significantly on follow-up imaging interval and modality. US-3 observations consistently prompt alternative imaging, aligning with international standards.2 Our analysis showed varied current practice for US-2 findings; many patients had contrast-enhanced imaging after one US-2 result, rather than repeat US at 3–6 months as per LI-RADS standards. This potentially reflects low clinician confidence with LI-RADS guidance. Long-term US-2/VIS-C outcome data and subsequent education are needed for standardised patient follow-up and optimal resource use.References National Institute for Health and Care Excellence (NICE). Quality standard [QS152]: Chronic liver disease – Surveillance for hepatocellular carcinoma. NICE. Updated July 2017. Accessed June 2, 2025. https://www.nice.org.uk/guidance/qs152/chapter/Qualitystatement-4-Surveillance-for-hepatocellular-carcinomaAmerican College of Radiology. Liver Imaging Reporting and Data System (LI-RADS). American College of Radiology 2011. Accessed June 2, 2025. https://www.acr.org/Clinical-Resources/Reporting-and-Data-Systems/LI-RADSAmerican College of Radiology. ACR Ultrasound Liver Reporting and Data System. J Am. Coll Radiol. 2019;16(10):1421–1428. doi:10.1016/j.jacr.2019.06.015.