Many previous studies have clarified the relationship between H. pylori infection and gastric and duodenal diseases, such as gastric cancer. In 1994, the author started the research on "H. pylori infection and the occurrence of gastric and duodenal diseases" at Hiroshima University and the eradication of H. pylori for the patients with peptic ulcer diseases and chronic active gastritis. In particular, our previous researches focused on histological gastritis, the relation of atrophic gastritis, intestinal metaplasia, nodular gastritis with the development of gastric cancer. Now, the previous research is beneficial for today's gastric cancer screening programs.

In 2002, the joint study between Kawasaki Medical School and the Okayama Prefectural Health Promotion Foundation was started, and the diagnosis of H. pylori gastritis using gastric X-ray examination was newly introduced in gastric cancer screening. In recent years, the endoscopic diagnosis of H. pylori infection status has attracted great attention. In 2014 the "Kyoto Classification of Gastritis" was published, bringing further light to gastritis diagnosis and gastric cancer risk assessment in endoscopic gastric cancer screening.

We examined the effect of additional radiography on the accuracy of interpretation assistance by radiological technologists using the "Interpretation category assessment Classification for Gastric X-ray Screening" by the Japanese Gastrointestinal Cancer Screening Society.

The sensitivity (65.2%) with additional radiography was significantly higher than the sensitivity (49.7%) without additional radiography (P<0.01). The rate of category 3b as an indefinite assessment was 19.5% in case of the additional radiography and 17.6% in these without.

The overcategorization rate in nonmalignant cases was 42.1% with additional radiography. The analysis, which was adjusted for technologist's knowledge and experience, demonstrated a significantly higher sensitivity with additional radiography than without in all classes of technologists. However, there was no difference in the assignment rate of the uncertain assessment Category 3b. The overcategorization rate in nonmalignant cases was higher in the technologist instructors with extensive knowledge and experience (57.1%) than that in other groups.

For the purpose of basic examination of the dose evaluation of upper gastrointestinal tract radiography (upper GI), this study was conducted on 331 subjects undergoing upper GI by the Miyagi Cancer Society Association based on Reference Imaging Method II and by four radiological technologists (BMI, body fat percentage, abdominal girth). The years of experience of the technicians in charge of the inspection and the entrance surface dose (ESD) were compared. As a result, the ESD in photography exhibited a strong positive correlation with BMI, and the incident surface dose in fluoroscopy strongly influenced individual differences among technicians rather than the body shape of the subject. In addition, the ESD in fluoroscopy of experienced technicians is larger than those of experienced technicians, and under the conditions of this study, the ESD per examination accounted for 70% to 80% of the ESD per perspective. In this study, we confirmed that fluoroscopy in the ESD of upper GI is large, and in a study showing that reviewing X-ray conditions and reducing fluoroscopic dose for high BMI subjects are effective for dose reduction is there.

There were 478 candidates, who underwent not only a barium X-ray examination but also a combination test of serum anti-Helicobacter pylori IgG antibody (H.pylori test) and serum pepsinogen level by PG method, which is called the test of risk stratification for gastric cancer. The cut-off level was less than 4.0 U/mL for H.pylori test (Wako Pure Chemical Corporation), and Miki's criteria was adopted for PG method. The candidates were divided into five groups, A (−/−) 312, B (+/−) 78, C (+/+) 28, D (−/+) 3, and E (57), depending on the results of H.pylori and PG test (H.pylori /PG) or whether there is a previous history of eradication therapy. The group A by this method is seemingly expected to have non gastritis. The candidates in group A, however, were divided into two groups depending on the X-ray results. One group (252, 81%) comprises candidates with no gastritis, and the other group (60, 19%) comprises those who have. The latter group, with 60 candidates, may be called pseudo-group A. Twelve candidates in pseudo-group A exhibited a high level of PGII, which is more than 14 ng/mL, or a low level of PGI/PGII, which is less than 5 ng/mL. When those candidates were excluded from group A, pseudo-group A decreased in number.

OBJECTIVES: Total colonoscopy (TCS) is the first choice for workup examinations of a person with positive fecal occult blood test. There are only few endoscopists in rural areas and remote islands. Therefore, we cannot offer sufficient workup examinations for local inhabitants. In areas where there are difficulties in TCS, we inspect whether CT colonography (CTC), as a workup examination, is equal to TCS.

METHODS: The results from people with positive fecal occult blood test in two medical offices were analyzed from April 2014 to March 2018. Lesion discovery rate, cancer discovery rate, positive predictive value (PPV), and the rate of accidental troubles in 169 cases who received CTC and 273 patients who received TCS were compared.

RESULTS: In the case of CTC, we had lesions with a diameter of more than 6 mm pointed out in 58 cases (34.3%). Forty-seven cases (81%) shifted to TCS, and the PPV was 93.6%. There were three cases of colon cancer. In the case of TCS in the hospital, we had lesions with a diameter of more than 6 mm pointed out in 70 cases (25.6%). There were 11 cases of colon cancer. The lesion discovery rate, the cancer discovery rate, and the rate of accidental troubles did not exhibit a significant difference between the groups.

CONCLUSION: In areas where there are difficulties in TCS, CTC can be used as a workup examination.

In order to evaluate the effectiveness of abdominal ultrasound cancer screening using the "Manual for Abdominal Ultrasound in Cancer Screening and Health Checkups," we examined the detection rate of malignant tumors in category (C) -3, C-4, and C-5 in 17,274 people who underwent abdominal ultrasonography screening from January 2015 to December 2016. Malignant tumors were found in two of 389 pancreatic C-3 patients; therefore, the malignant tumor detection rate was 0.5%. Malignant liver tumors from C-4 were found in 5 out of 50 cases (malignant tumor detection rate: 10%); biliary tract, 2 out of 18 cases (malignant tumor detection rate: 11.1%); pancreas, 3 out of 14 cases (malignant tumor detection rate: 21.4%); and kidney, 4 out of 12 cases (malignant tumor detection rate: 33.3%). Whole malignant tumors from C-4 were found in 14 of 94 cases (malignant tumor detection rate: 14.9%). Malignant tumors from C-5 were found in 6 out of 6 cases (pancreas, 3 out of 3 cases; kidney, 3 out of 3 cases (malignant tumor detection rate: 100%) ). Further, in order to evaluate the degree of malignancy of each "ultrasound image finding" of C-4, we classified C-4 into C-4a (low suspicion of malignancy) and C-4b (moderate suspicion of malignancy). Ultrasound image findings of "solid lesions, with a maximum diameter of 15 mm or more," in the liver were significantly less likely to be malignant than other ultrasonic image findings in C-4.

In the pancreas, it was suggested that ultrasound image findings of "main pancreatic duct dilatation, nodule in the main pancreatic duct" are more likely to be malignant than other ultrasound image findings in C-4. Similarly, in the kidney, ultrasound image findings of "solid lesions, accompanied by either an internal non-echo area, a marginal low echo band, or lateral shadow," are more likely to be malignant.

We should consider the differences in the possibility of malignant findings for each ultrasound finding in Category 4