‘Sehkollektiv’: Sight Styles in Diagnostic Computed Tomography

Friedrich, Kathrin

doi:10.1007/s12376-010-0050-4

Cited by 7 publications

(8 citation statements)

References 45 publications

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“…In this article we have emphasised the social nature of knowledge in the process of coming to a shared way of seeing, or what Friedrich labelled “sight style.” This differentiates our account of socio‐technological epistemology from the tradition of distributed cognition, as we do not invoke internal or external representations. Of course, the word “representation” is frequently used in the clinic as elsewhere in scientific contexts, but our emphasis has been on how something comes to be agreed upon as a representation, and we do not take for granted in advance that anything actually is a representation because this assumes that it is already or a priori clear how to interpret it as a representation.…”

Section: Discussionmentioning

confidence: 99%

“…This is what we focus on in this paper. In her article on computed tomography (CT) images as diagnostic tools, Friedrich proposes that the interpretation of these images depends upon the development of shared “sight styles” across radiologists in a clinic. Her account draws upon Ludwik Fleck's notion of “thought styles” and “thought collectives,” stressing the social processes and the role of technologies such as software, through which people come to see in the same way .…”

Section: Introductionmentioning

confidence: 99%

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A social‐technological epistemology of clinical decision‐making as mediated by imaging

Baalen

Carusi

Sabroe

et al. 2016

Evaluation Clinical Practice

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In recent years there has been growing attention to the epistemology of clinical decision‐making, but most studies have taken the individual physicians as the central object of analysis. In this paper we argue that knowing in current medical practice has an inherently social character and that imaging plays a mediating role in these practices. We have analyzed clinical decision‐making within a medical expert team involved in diagnosis and treatment of patients with pulmonary hypertension (PH), a rare disease requiring multidisciplinary team involvement in diagnosis and management. Within our field study, we conducted observations, interviews, video tasks, and a panel discussion. Decision‐making in the PH clinic involves combining evidence from heterogeneous sources into a cohesive framing of a patient, in which interpretations of the different sources can be made consistent with each other. Because pieces of evidence are generated by people with different expertise and interpretation and adjustments take place in interaction between different experts, we argue that this process is socially distributed. Multidisciplinary team meetings are an important place where information is shared, discussed, interpreted, and adjusted, allowing for a collective way of seeing and a shared language to be developed. We demonstrate this with an example of image processing in the PH service, an instance in which knowledge is distributed over multiple people who play a crucial role in generating an evaluation of right heart function. Finally, we argue that images fulfill a mediating role in distributed knowing in 3 ways: first, as enablers or tools in acquiring information; second, as communication facilitators; and third, as pervasively framing the epistemic domain. With this study of clinical decision‐making in diagnosis and treatment of PH, we have shown that clinical decision‐making is highly social and mediated by technologies. The epistemology of clinical decision‐making needs to take social and technological mediation into account.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A social‐technological epistemology of clinical decision‐making as mediated by imaging

Baalen

Carusi

Sabroe

et al. 2016

Evaluation Clinical Practice

View full text Add to dashboard Cite

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“…Taking the use of imaging technologies for diagnosis and treatment of a complex disease as our central example, we argue that establishing a common way of seeing or mode of perception is essential to establishing what can count as a reason in the inter-subjective framework, as argued by (Carusi 2008), developing the notion of the sensus communis from Kantian aesthetics. Carusi's suggestion that the visualisation software plays an important role in forming this common way of seeing is borne out by Kathrin Friedrich's analysis of computed tomography images (Friedrich 2010). Friedrich shows that software plays an important mediating role in setting up shared 'sight styles' across a team (Friedrich 2010), drawing upon Ludwig Flecks' notion of 'thought collectives' and 'thought styles' (Fleck 1979(Fleck , 1986e [1947).…”

Section: Introductionmentioning

confidence: 99%

“…Carusi's suggestion that the visualisation software plays an important role in forming this common way of seeing is borne out by Kathrin Friedrich's analysis of computed tomography images (Friedrich 2010). Friedrich shows that software plays an important mediating role in setting up shared 'sight styles' across a team (Friedrich 2010), drawing upon Ludwig Flecks' notion of 'thought collectives' and 'thought styles' (Fleck 1979(Fleck , 1986e [1947). While Friedrich focuses on the software interface of images (the Graphical User Interface or GUI), we focus on the interactions around image processing that lead to images that have the features required for clinicians.…”

Section: Introductionmentioning

confidence: 99%

Implicit trust in clinical decision-making by multidisciplinary teams

Baalen

Carusi

2017

Synthese

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In clinical practice, decision-making is not performed by individual knowers but by an assemblage of people and instruments in which no one member has full access to every piece of evidence. This is due to decision making teams consisting of members with different kinds of expertise, as well as to organisational and time constraints. This raises important questions for the epistemology of medicine, which is inherently social in this kind of setting, and implies epistemic dependence on others. Trust in these contexts is a highly complex social practice, involving different forms of relationships between trust and reasons for trust: based on reasons, and not based on reasons; based on reasons that are easily accessible to reflection and others that are not. In this paper, we focus on what it means to have reasons to trust colleagues in an established clinical team, collectively supporting or carrying out every day clinical decision-making. We show two important points about these reasons, firstly, they are not sought or given in advance of a situation of epistemic dependence, but are established within these situations; secondly they are implicit in the sense of being contained or nested within other actions that are not directly about trusting another person. The processes of establishing these reasons are directly about accomplishing a task, and indirectly about trusting someone else's expertise or competence. These processes establish a space of reasons within which what it means to have reasons for trust, or not, gains a meaning and traction in these team-work settings. Based on a qualitative study of decision-making in image assisted diagnosis and treatment of a 123Synthese complex disease called pulmonary hypertension (PH), we show how an intersubjective framework, or 'space of reasons' is established through team members forging together a common way of identifying and dealing with evidence. In dealing with images as a central diagnostic tool, this also involves a common way of looking at the images, a common mode or style of perception. These frameworks are developed through many iterations of adjusting and calibrating interpretations in relation to those of others, establishing what counts as evidence, and ranking different kinds of evidence. Implicit trust is at work throughout this process. Trusting the expertise of others in clinical decision-making teams occurs while the members of the team are busy on other tasks, most importantly, building up a framework of common modes of seeing, and common ways of identifying and assessing evidence emerge. It is only in this way that trusting or mistrusting becomes meaningful in these contexts, and that a framework for epistemic dependence is established.

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“…For the collective and perceptual dispositions activated when reading CT scans, seeFriedrich (2010).6 For more on the visual culture and visual history of medicine, see HoltzmannKevles (1997) andCartwright (1995).…”

mentioning

confidence: 99%

Digital Matters: Processes of Normalization in Medical Imaging

Fitsch

Friedrich

2018

Catalyst

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With the introduction of advanced computing technologies, medical imaging increasingly entails normalization – through procedures that create, shape, and adjust comparable variables deduced from processes in the living body. The computational rationalities of imaging technologies such as functional magnetic resonance imaging (fMRI) and computed tomography (CT) not only determine how human bodies are envisioned and visualized, but also how they need to be aligned with apparatuses to answer experimental and diagnostic inquiries. By drawing on the theoretical concepts of computational rationality and intra-action and on ethnographic observations, we aim to disentangle processes of normalization and intra-actions of bodies and technologies in medical imaging on three levels. First, we show how, in the history of theoretical mathematics, dynamic processes were conceptualized as discrete and hence calculable. In particular, the ideas of Joseph Fourier informed the development of fMRI imaging algorithms, which are currently applied in experimental contexts. Second, we analyze how the application of these algorithms enables and determines practices in fMRI-based research. Third, we explore how bodies and technologies are aligned with tomography scanners on a very material level and thereby demonstrate the convergence of digitalization and materialization on both conceptual and physical levels, which opens up possibilities for visualizing and understanding human bodies. On a theoretical and analytical level, we argue that a critical analysis of digital imaging processes calls for scrutiny of the epistemic and operational preconditions that are actualized but concealed in the application of imaging technologies.

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‘Sehkollektiv’: Sight Styles in Diagnostic Computed Tomography

Cited by 7 publications

References 45 publications

A social‐technological epistemology of clinical decision‐making as mediated by imaging

A social‐technological epistemology of clinical decision‐making as mediated by imaging

Implicit trust in clinical decision-making by multidisciplinary teams

Digital Matters: Processes of Normalization in Medical Imaging

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