Cs 2010

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  • Temporal, sequential, semiotic dimensions of TB deliberations
  • These are the references made where the deliberation seems to "rest" for a period of time—perhaps starting points in a stasis sense. Describe that the moving diamond is tracing an actual case presentation—one that I've observed and documented. This is a typical case presentation in that there were no anomalies here. Each red dot marks a spot on a kind of scatterplot here where at the 4 minute mark this kind of reference was made, at the 21 minute mark, this kind of reference was made, and so on. So let's follow how this particular deliberative process unfolded. Technical workplace documents and other published and unpublished studies are frequently invoked. Oral exchanges are frequently accompanied by gestures. But what's central to TB participants' ability to deliberate about future action, particularly actions related to options for treatment, are the images projected on the screen for everyone in the room—regardless of specialty—to see. But what I want to spend the rest of the time talking about is the central role of the pathological and radiological images that are projected onto the screen in the front of the room. Here are the points at which the images were actually projected (4 of them). The other red dots were when people made mention of the path/rad images, but they weren't actually up on the screen at the time. Now, here are the places when the moments of uncertainty were explicitly mentioned and attempts were made to resolve them: 1. Question of confirming the diagnosis. This particular patient happened to have two different cancers in two different anatomical locations. They wanted to confirm that the patient did, indeed, have two different cancers and not one cancer that had, over time, spread from one anatomical location to other (since, after all, it's possible for lung cancer to spread to the brain or to other places in the body—it's still lung cancer, even if it's in the brain). MDs can know this by extracting tissue then extracting cells and looking at them under a high powered microscope and observing the cells for their formal features that are characteristic of a particular "kind" of cancer.

Transcript

  • 1. :: Christa B. Teston, Rowan University | 19 March 2010 :: [ From Artifact to Action ] The Role of Medical Images in Cancer Care Deliberations
  • 2. [ Q’s ] How is risk communicated? How is evidence displayed? How are decisions made?
  • 3. [ Tufte (1992) :: Cholera ]
  • 4. [ Tufte (1992) :: Challenger ]
  • 5. [ Sauer (2003) :: Coal Mining ]
  • 6. [ Herndl, Fennel, Miller (1991) :: Nuclear Power ]
  • 7. [ site ] multidisciplinary medical workplace Tumor Board meeting
  • 8. [ methods ] Glaser & Strauss (1967) Grounded Theory Observational Heuristics
  • 9. [ Q ] How is medical decision-making shaped by visual renderings of disease?
  • 10. [ Fig. 1 ]
  • 11. [ example ] 1 tumor board deliberative trace
  • 12. Passage of Time (minutes) Kinds of References ? ? 5 10 15 20 25 30 Past Personal Experience Typical Practice Standard of Care Studies & Statistics Path. & Rad. Information Background Information
  • 13. “ Seeing those images will change minds .” :: Dr. Thomas | TB participant, oncologist ::
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  • 21. [ Fig. 2 ]
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  • 23. [ medical images ] materially rendered, argumentatively deployed, facilitate future action
  • 24. [ visual rhetoric ] more than mere illustration, epistemic in an ontological sense --- (Enos & Lauer, 1992; Scott, 1967; McNely & Teston, 2010)