Paper long abstract:

A novel imaging technology, tomosynthesis, was adopted for use at a university hospital in Sweden in 2006. The superiority of tomosynthesis over x-ray in depicting pathologies associated with cystic fibrosis, a degenerative genetic disease, was soon discovered, while the existing "gold standard" for this work remains CT scanning. The advantage of tomosynthesis over CT has to do with patient safety (less radiation) and cost-effectiveness. This longitudinal, ethographic case-study follows the emergence of a prospective standard for monitoring the progress of cystic fibrosis using tomosynthesis through the work of an interdisciplinary team of radiologists, medical physicists and educational researchers.

Daily hospital work is permeated with medical standards, which align a plethora of heterogeneous actors into standardised practices. When a new technology is adopted, the alignments will shift. How do the divergent actors draw upon the standardised practices and reorganise themselves around the new technology? How does a widely accepted scoring system used with CT- "Brody's score"- become converted for use with tomosynthesis? This entails translating criteria and visualisations of pathologies from the axial plane of CT to coronal orientation of tomosynthesis images. To study this, we have conceptualised Brody's score as a "token" in order to follow its path through and as part of the team's interdisciplinary working, and to identify critical moments where a shift in the development process has occurred. The paper reports two such shifts focussing on how division of lungs into analytic units was repeatedly re-negotiated in order to transpose the scoring system between the different technologies.