In our institute, we took measures such as making the original manual and co-medical stuffs education to prevent barium aspiration before using high-density, low-viscosity barium from March 2003. We checked 57, 773 persons who had undergone upper gastrointestinal series from April 2003 to March 2005, and found 14 persons who aspirated barium. The aspiration rate was 0.024%, the mean age was 53 years old, and the range was 35-80. The older group aspiration rate (over 65 years old) was 0.050%, and that of younger group was 0.021%. But there was no significance.
The aspiration rate in the nursing-home was remarkably high than others (in nursing-home: 0.82% others: 0.018% p<0.05) from April 2003 to March 2004. For the purpose of decreasing the aspiration rate in the nursing-home, we added the other preventive measures such as using the paper cup with cut so as not to strike nose when leaning it and so on. After these new measures, the aspiration rate in the nursing-home became 0.43%. And it was reported that using high-density, low-viscosity barium improved accuracy in indirect radiography, but the aspiration rate rose. We think there is a possibility that aspiration rate can be decreased by taking preventive measures.

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The cases judged to require detailed examination in the abdominal ultrasonographic mass screening were classified under categories III to V and were investigated later in detail. About 66,000 examinees examined in 2004 were classified under categories I to V concerning the possibility of cancer. There were 504 category-III cases, 29 category-IV, 24 category-V, and 557 (0.84%) requiring detailed examination (categoriesIII to V). Nine (2%) cancer cases were detected in category III, 9 (31%) in category IV,. and 9 (37%) in category V. The incidence of malignant tumor rose with the ordinal number of the category. It would have been possible to classify the cases in category III which were actually malignant as category V, if we had judged the cases more accurately. There were 4 cases which were classified as category V but were actually benign diseases. Compared with more experienced screeners, the screeners with less experience tended to classify malignant cases under lower categories. The cases in category V which were actually benign were extremely rare.

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Proprietors have a duty to conduct health check-ups for workers and have the right to hold the related data. Private organizations for health check-ups are generally used to perform the examinations. Our institute belongs to the health insurance organization of an electric company and is required to implement measures for primary medical prevention, to manage mass screenings for cancer or other health check-up programs in worksites, and to conduct diagnostic examinations following mass screenings. The personal information protection law restricts allocation of personal information in the field of mass screening. To cope with this problem, an agreement has been obtained between the proprietor, the private health check-up organization and those of us who hold various data concerning health check-ups and mass screenings. All workers are notified of this agreement through our homepage on the Internet and print leaflets.
Measures to protect personal information are also required. Entrance to the rooms where medical records are stored or computer servers containing databases for mass screening and health checkups are located is restricted and reallocation of such data is forbidden.
This law prohibits obtaining the result of a diagnostic examination from a mass screening program without the permission of the relevant individual in the case that an examinee undergoes the examination at a medical facility other than ours. This poses a problem for conducting accuracy control for the mass screening. On the other hand, the law allows communities to investigate the results of diagnostic examinations without any permission. It would be necessary to remodel the mass screening system in cooperation with communities in order to conduct accuracy controls in worksites.

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