Knowledge processes, distribution and alignment: Spatio-materialities and transformations in MRI praxis

This paper explores the mediation of sociomaterial practices and the spaces of their unfolding in diagnostic imaging as relates to Magnetic Resonance Imaging (MRI). In the course of an MRI exam, from the screening of the patient to the scanning itself, and onto the subsequent processing and analysis of the images, practitioners employ and juxtapose a variety of materials and means to frame and guide their inquiry. These may range from the initial clinical presentation of the patient’s referring department, to already available MRI’s, CT’s or X-rays of the patient. Even though these elements may have their origins (the particular sociotechnical contingencies as well as time of their initial materialization) far removed from the very scanning session in question, they enter into its particular make-up and enactment in and through their relationality in the collective of practice at hand. The individual elements are, in and of themselves, conditioned, in part, by the ontological basis of their production, and inclusion within the new collective. The study takes its outset in this inherent tension, problematizing the knowledge processes that enter into the construction and mediation of the images, in light of the distributed work and effects that characterize their materialization and articulation, both within—and subsequent to—the immediate confines of such production and use. The paper is based on an ethnographic study of a relatively routinized MRI practice at a neuroradiology department in Denmark. A characteristic element in the country’s radiological practice is the mutual elaboration of the patient’s case between the radiologist and the referring clinicians in an interdisciplinary ‘case conference’ setting. The paper will address the sociomaterial workings of such imaging practice first with respect to the traditional, film-based form of displaying ‘hard copy’ MRI’s, and then, with this as a backdrop, developments within filmless radiology, notably the incorporation of MR images in electronic patient record systems (EPR) and the more radiology-specific Picture Archive and Communication System (PACS). Paradoxically, in spite of MRI being a digital modality, the very sociomaterial contingencies of IT and electronic media come to have significant bearing on the spaces in which MRI’s can be articulated in practice through ‘filmless’ radiology.