Practicing (Dis)connections

The paper addresses the reciprocal notions of mobility and mobilisation in medical imaging practice, in view of the contingent and multiple character of the knowledge-practices involving such images – and their interpretation – within and across situated settings. Based on an ethnographically informed study of a relatively routinized and film-based clinical Magnetic Resonance Imaging (MRI) practice of the brain and spine at a hospital neuroradiology department, the paper draws on Bowker and Star’s (1999) notion of infrastructural inversion, to explore the seemingly settled and relatively stable day-to-day character of the work practices entailed, tracing their at once embedded, yet, distributed and disparate – (dis)connected – configurations. 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, imaging 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 MRIs, CTs or X-rays of the patient. These elements may originate from far removed settings (in time or space) from the exam in question. Yet, they enter into the particular make-up and enactment of the imaging session in and through their relationality in the collective of practice at hand. The paper takes its point of departure in this inherent tension, problematizing the knowledge processes that enter into the composition 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 focuses particularly on the department’s development of in-house examination protocols as a consequence of its having replaced an older, pre-existing MRI scanner with a new model. This re-domestication of MRI as occasioned by the replacement scanner offers a range of sociomaterial and sociotechnical contingencies in the practice to come to light, in the constant interdisciplinary engagements among imaging practitioners (radiographers, radiology nurses and radiologists, etc.) as well as clinicians. The paper takes a de-centered approach to the characterization of technology and the knowledge-practices involved, to address how that which is being articulated through imaging is inextricably tied to the achievement of mobilization under the conditions afforded. The mobility of the images, it will be argued, is generally an effect, part and parcel of the mobilization of specific resources available and pertinent within the user-setting in question, rather than a precondition to it. The very coming-into-being of the images, not only in their imaging, but also their subsequent settings of interpretation and the distribution of knowledge-practices throughout the course of interdisciplinary interaction, are thus crucial to understanding of the epistemic underpinnings which render, and condition, how connections are mediated across extended settings of practice (in the MRI unit, at interdisciplinary case conferences, and at other hospitals, etc.). This relational view allows for the heterogeneity entailed in the domestication of the MRI scanner to come to the fore, and hence to draw upon particular tensions in the differentiation and displacements of the interdisciplinary knowledge and use practices to be addressed. With MRI as a case in point, the paper finally elaborates on issues of obduracy and uncertainties in the reordering and redistribution of knowledge-practices in and through sociotechnical change, particularly in the light of the advent of film-less radiology, and how MRI comes to be particularly implicated in the transition/development in radiology toward practices entailing picture archive and communication systems (PACS) and picture modules of electronic patient records (EPR).