STUDY OF THE EFFECTIVENESS OF DIGITAL RADIOGRAPHY IN FRACTURE DIAGNOSIS AT SIMALUNGUN DISTRICT HOSPITAL

Abstract

Fracture diagnosis is a crucial element in the management of musculoskeletal injuries, significantly impacting patient quality of life and healthcare system efficiency. Digital radiography (DR) has emerged as a revolutionary medical imaging technology offering the potential for improved diagnostic accuracy, radiation dose reduction, and workflow efficiency compared to conventional radiography (CR). However, the implementation and comprehensive evaluation of DR effectiveness in the context of regional hospitals in Indonesia, particularly in Simalungun Regency, which has limited access to advanced medical technology, remains largely unexplored. Recent data indicate an increasing prevalence of musculoskeletal injuries due to physical activity and accidents, necessitating faster and more accurate diagnostic solutions. This research gap lies in the lack of empirical studies specifically measuring the comparative diagnostic performance of DR and CR in detecting fractures in a regional hospital patient population, as well as their impact on service efficiency. Therefore, this study aims to quantitatively and qualitatively evaluate the effectiveness of digital radiography (DR) compared to conventional radiography (CR) in diagnosing fractures at Simalungun Regency Hospital. This study is based on the theoretical framework of the Technology Acceptance Model (TAM) that integrates perceived ease of use and usefulness, and Signal Detection Theory (SDT) to measure diagnostic accuracy. The primary hypothesis of this study is that digital radiography will demonstrate higher sensitivity and specificity, as well as shorter diagnostic time compared to conventional radiography. This study used a retrospective comparative study design with quantitative and qualitative approaches (mixed design), chosen because of its ability to directly compare two imaging modalities and explore clinicians' perceptions of the new technology. The study sample consisted of 200 patients undergoing radiographic examination for suspected fractures, with 100 patients using DR and 100 patients using CR, selected through convenience sampling. Data collection instruments included medical records, radiographic images, and a structured questionnaire to assess the perceptions of radiologists and radiology technicians, with validity through expert judgment and questionnaire reliability measured using Cronbach's Alpha. Data were analyzed using parametric and non-parametric statistical tests, as well as thematic analysis for qualitative data. The quantitative analysis showed that digital radiography had significantly higher sensitivity (96.5% vs. 89.2%, p < 0.01) and specificity (98.1% vs. 94.7%, p < 0.05) in detecting fractures compared to conventional radiography, with a substantial effect size (Cohen's d = 0.78 for sensitivity, Cohen's d = 0.62 for specificity). Secondary analysis found that image processing and diagnosis reporting times were on average 15% shorter when using DR. A significant unexpected finding was radiologists' perception of the superior quality of DR images in visualizing fine bone details and complex anatomical areas, as well as increased confidence in making diagnostic decisions when using digital images. This study concluded that digital radiography was significantly more effective than conventional radiography in the diagnosis of fractures at Simalungun District Hospital, as evidenced by increased diagnostic accuracy and time efficiency. The theoretical contribution of this study is the validation of the TAM and SDT models in the context of implementing medical imaging technology in a district hospital. Practically, these findings provide a strong basis for hospitals to adopt DR technology to improve the quality of musculoskeletal injury diagnostic services. Recommendations include ongoing training for medical personnel and regular evaluation of the technology's performance.