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When was the last time you opened a textbook? When was the last time you read a paper journal? For many people in this digital age, these occurrences are happening less frequently. Gone are the days of medical students filling their white coats pockets with handbooks, textbooks, and flashcards and alternatively, learners are now adept at using smartphones and digital devices to obtain information. According to reports, 5.19 billion people, or 67% of the world's population accesses the internet through a mobile phone. Around the world, people spend an average of 6 hours and 43 minutes on the internet each day, and as of January 2020 access from mobile devices exceeded 50%. As the people receive more and more information from the internet and mobile phones, the processing demands on the brain increase daily. Sweller described this phenomenon, called the cognitive load theory, as the ability of working memory to effectively process information. He further explained that when information is not presented in an intuitive, organized manner, there is a risk of overwhelming the cognitive load for the learner. Using these principles, the AASLD has reimagined the AASLD.org website, the AASLD Journals app, and LiverLearning® to optimize the learning and gathering of information for its members.

The Ultrasound Liver Imaging Reporting and Data Systems (LI-RADS) provides standardized terminology and reporting for ultrasound (US) examinations performed for hepatocellular cancer (HCC) screening. However, there are no recommendations regarding follow up imaging for visualization scores with suboptimal visualization. Therefore, the aim of this study is to examine follow up imaging practices in the setting of US studies scored as B (moderate limitations) and C (severe limitations).A single center retrospective analysis of studies from 2017 to 2021 with HCC US screening visualization scores of B and C was performed. Follow up imaging with US, CT, or MRI within 6 months with visualization score B or C on initial US were included.Five hundred and sixty HCC US studies with suboptimal imaging were reviewed. Of those with follow up imaging, patients with a visualization score of B underwent US in more than half (58%) of the cases while those with visualization score of C underwent more CT/MRI studies (62.5%, P = .12) Patients with visualization score of B had more MRI exams performed (55%) while patients with a visualization score of C underwent more CT exams (70%, P = .16).Currently, there are no guidelines instructing follow up imaging on HCC screening ultrasounds with poor visualization, and the data suggests that providers have taken a heterogeneous approach. This suggests a need for society recommendations on how to approach HCC screening ultrasounds in patients with suboptimal studies.