Liver cirrhosis is the major risk factor for hepatocellular carcinoma (HCC). All etiologic forms of liver cirrhosis may be complicated by HCC but the risk is higher in patients with hepatitis B or C viral infection. Patients at high risk for developing HCC should be included in surveillance programs. Groups at high risk are: all cirrhotic patients; non-cirrhotic patients with chronic hepatitis C and advanced liver fibrosis (F3), non-cirrhotic HBV carriers with active hepatitis. Current guidelines issued by AASLD and EASL recommend surveillance among high-risk patients by ultrasound (with or without alpha-fetoprotein) every 6 months. The aim of ultrasound screening and surveillance is to detect HCC at an early stage, when it is amenable to curative therapy, to reduce mortality. For good results, ultrasound examination must be done by highly experienced personnel, with extensive experience in the field of hepatic ultrasound.