AI in Fracture Detection: A Cross-Disciplinary Analysis of Physician Acceptance Using the UTAUT Model

Abstract

Background/Objectives: Artificial intelligence (AI) tools for fracture detection in radiographs are increasingly approved for clinical use but remain underutilized. Understanding physician attitudes before implementation is essential for successful integration into emergency care workflows. This study investigates the acceptance of an AI-based fracture detection tool among physicians in emergency care settings, using the Unified Theory of Acceptance and Use of Technology (UTAUT) model. Methods: A cross-sectional, pre-implementation survey was conducted among 92 physicians across three hospitals participating in the SMART Fracture Trial (ClinicalTrials.gov: NCT06754137). The questionnaire assessed the four core UTAUT constructs-performance expectancy (PE), effort expectancy (EE), social influence (SI), facilitating conditions (FC)-and additional constructs such as attitude toward technology (AT), diagnostic confidence (DC), and workflow efficiency (WE). Responses were collected on a five-point Likert scale. Structural equation modeling (SEM) and confirmatory factor analysis (CFA) were performed to assess predictors of behavioral intention (BI). Results: PE was the strongest predictor of BI (β = 0.5882, p < 0.001), followed by SI (β = 0.391, p < 0.001), FC (β = 0.263, p < 0.001), and EE (β = 0.202, p = 0.001). These constructs explained a substantial proportion of variance in BI. WE received the lowest ratings, while internal consistency for SI and BI was weak. Moderator analyses showed prior AI experience improved EE, whereas more experienced physicians were more skeptical regarding WE and DC. However, none of the moderators significantly influenced BI. Conclusions: Physicians' intention to use AI fracture detection is primarily influenced by perceived usefulness and ease of use. Implementation strategies should focus on intuitive design, targeted training, and clear communication of clinical benefits. Further research should evaluate post-implementation usage and user satisfaction.

Keywords: AI; CDSS; UTAUT; acceptance; artificial intelligence; clinical decision support system; diagnostic tools; emergency care; fracture detection; physicians; survey.

Figure 1

Unified Theory of Acceptance and Use of Technology (UTAUT) framework adapted from Venkatesh et al., 2003 [15].

Figure 2

Adapted UTAUT framework used in this study.

Figure 3

Frequency distribution of participant ratings across UTAUT and extension items on a 5-point Likert scale.