Overview
Initiative type
Model of Care
Status
Deliver
Published
June 2026
Summary
Intestinal ultrasound is highly effective for Inflammatory Bowel Disease (IBD)monitoring, improving patient experience, clinical decision-making and avoiding invasive investigations.
Dates: January 2025 - February 2026
Implementation sites: Townsville University Hospital
Aim
To evaluate patient experience, clinical effectiveness, and system impact after integrating intestinal ultrasound (IUS) into routine IBD care at Townsville University Hospital.
Outcomes
- Patient acceptability and experience: 98.1% (51/52) reported IUS was comfortable and would recommend IUS to others.
- Preference over invasive tests: 90.4% (47/52) preferred IUS over colonoscopy where appropriate.
- Reduced anxiety and improved understanding: 88.5% (46/52) reported reduced anxiety after IUS; 86.5% (45/52) understood more about their condition because of IUS.
- Clinician confidence: image quality adequate in 96.0% and clinicians confident in 90.0% of scans
- System impact: endoscopy avoided in 44.0%; cross-sectional imaging avoided in 30.0%; IUS contributed to management change in 34.0% of cases.
Background
Inflammatory bowel disease (IBD) is a chronic, relapsing condition that requires repeated assessment of disease activity to guide treatment, prevent complications, and support shared decisions with patients. In routine practice, monitoring often relies on colonoscopy/sigmoidoscopy and cross-sectional imaging such as computed tomography (CT) or magnetic resonance imaging (MRI). While effective, these investigations can be invasive, resource-intensive, and burdensome for patients—particularly in regional settings where access may be limited and additional appointments, travel, and waiting times can delay decision-making and increase anxiety.
Intestinal ultrasound (IUS) is a non-invasive, radiation-free imaging modality that allows real-time assessment of bowel inflammation at the point of care. It can be performed during the clinic visit, enabling immediate discussion of findings and next steps with patients. International evidence supports its diagnostic accuracy and correlation with established investigations; however, local implementation and evaluation are important to confirm feasibility, acceptability, and impact within Queensland Health services, particularly outside metropolitan centres.
Until September 2025, Townsville University Hospital did not have an IUS service for IBD monitoring, and care pathways relied on traditional modalities. In September 2025, we implemented a point-of-care IUS service with the aims of improving patient experience, enabling timely treatment decisions in clinic, and reducing reliance on invasive procedures and cross-sectional imaging where appropriate. We undertook a prospective service evaluation to quantify patient, clinician, and system outcomes following implementation.
Methods
A prospective service evaluation was conducted from September 2025 to February 2026 following implementation of IUS into routine IBD clinics at Townsville University Hospital. Consecutive patients attending clinic for IUS monitoring were eligible to participate. Patient-reported outcomes were collected prospectively using brief electronic surveys accessed via QR codes. Patients were invited to complete a pre-scan survey while waiting for their appointment and a post-scan survey immediately after the IUS was performed. QR codes were displayed in the clinic area and offered by staff at the point of care; surveys were completed on personal mobile devices.
Participation was voluntary and anonymous, and completion implied consent under a low-risk quality assurance framework. The pre-scan survey (n=69 responders) assessed baseline understanding of IUS perceived acceptability compared with other investigations, and confidence explaining the purpose of IUS to someone else. The post-scan survey (n=52 responders) assessed experience and perceived impact of IUS, including comfort, privacy/dignity, willingness to undergo IUS again if recommended, recommendation of IUS to others, change in anxiety/uncertainty, perceived understanding of their condition after IUS, and preference compared with colonoscopy where appropriate.
Responses were analysed descriptively at group level; pre- and post-scan responses were not consistently paired because surveys were anonymous and completion of either survey was optional. Clinician-reported outcomes were collected prospectively using a structured survey completed after each scan by one of two gastroenterologists trained in IUS (n=50). Items captured whether image quality was adequate to assess disease activity, clinician confidence in findings, whether IUS avoided an endoscopic procedure, whether IUS avoided cross-sectional imaging (CT/MR), and whether IUS contributed to a change in management (e.g., escalation, de-escalation, or switching therapy). Free-text comments were reviewed to identify recurring themes regarding clinical utility and service impact. Survey items used 5-point Likert scales (1=strongly disagree to 5=strongly agree) and yes/no items where appropriate. Likert outcomes are reported as the proportion selecting 4–5 (agree/strongly agree) alongside absolute counts (n). Clinician “management change” was defined as any response other than “no change.” Data were summarised using counts and percentages.
Discussion
This evaluation demonstrates that implementing point-of-care IUS in a regional tertiary hospital can deliver meaningful benefits for patients, clinicians, and the health system. Patients reported overwhelmingly positive experiences. Post-scan surveys showed IUS was comfortable for 98.1% (51/52), and 98.1% (51/52) would both undergo IUS again if recommended and recommend it to others. In addition, IUS reduced anxiety or uncertainty in 88.5% (46/52) and improved patients’ understanding of their condition in 86.5% (45/52). Preference for IUS over more invasive monitoring was also high, with 90.4% (47/52) preferring IUS over colonoscopy where appropriate. Together, these findings align with the intended purpose of point-of-care ultrasound: providing timely, understandable information during the clinic visit while reducing the emotional burden and inconvenience ssociated with waiting for invasive investigations.
Pre-scan surveys identified an opportunity to strengthen patient education. While most respondents agreed they understood what IUS is (82.6% [57/69]) and why they were having it (91.3% [63/69]), fewer felt confident they could explain IUS to someone else (62.3% [43/69]). This suggests that standardised pre-scan education (e.g., a brief script, brochure, or QR-code video) could further improve patient confidence and support informed participation in monitoring decisions. Clinician surveys indicated strong feasibility and clinical utility. Image quality was adequate to assess disease activity in 96.0% (48/50) of scans and clinicians reported confidence in findings in 90.0% (45/50). Importantly, IUS produced measurable downstream impacts: an endoscopic procedure was avoided in 44.0% (22/50), cross-sectional imaging was avoided in 30.0% (15/50), and IUS contributed to a change in management in 34.0% (17/50). These outcomes suggest that IUS is not only acceptable but also clinically useful in guiding real-time treatment decisions and reducing reliance on resource-intensive investigations. Key enablers included clinician training, integration of IUS into routine clinic workflows, and immediate discussion of findings with patients at the point of care. Limitations include the single-centre design, descriptive analysis, and incomplete pairing of pre- and post-scan surveys.
Future work will evaluate longer-term outcomes, including downstream utilisation of endoscopy and cross-sectional imaging, time to treatment optimisation and flare detection, and the cost-effectiveness of IUS, alongside expanding local training capacity to support sustainability. This model has strong potential for scale and spread across Queensland Health services where improving access, reducing invasive testing, and supporting timely decisions are priority needs.
References
1. Maaser C, Sturm A, Vavricka SR, et al. ECCO-ESGAR Guideline for Diagnostic Assessment in IBD Part 1: Initial diagnosis, monitoring of known IBD, detection of complications. Journal of Crohn's and Colitis. 2019;13(2):144-164K. doi: 10.1093/ecco-jcc/jjy113.
2. Dolinger MT, Kayal M. Intestinal ultrasound as a non-invasive tool to monitor inflammatory bowel disease activity and guide clinical decision making. World J Gastroenterol. 2023;29(15):2272-2282. doi:10.3748/wjg.v29.i15.2272
3. Pruijt MJ, de Voogd FAE, Montazeri NSM, van Etten-Jamaludin FS, D'Haens GR, Gecse KB. Diagnostic Accuracy of Intestinal Ultrasound in the Detection of Intra-Abdominal Complications in Crohn's Disease: A Systematic Review and Meta-Analysis. J Crohns Colitis. 2024;18(6):958-972. doi:10.1093/ecco-jcc/jjad215
Key contact
Dr Takuma Konno
Medical Registrar
Townsville Hospital and Health Service