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Styles of Objectivity: Agency, Alignment, and Automation in Image-Guided Surgery

Periodic Reporting for period 1 - IMAGUS (Styles of Objectivity: Agency, Alignment, and Automation in Image-Guided Surgery)

Reporting period: 2015-09-01 to 2017-08-31

Medical decisions are increasingly based on image data that are used in all stages of medical treatment. In these contexts, images are not mere conduits of information. They guide, navigate, govern, and control. The new imaging methods promise to increase precision and improve health outcomes. However, as medical diagnosis and therapy grow more dependent on images, the status and role of these images become increasingly controversial. Image-guided applications reshape clinical practices, impact medical decisions, and transform the relationship between physician and patient. This is also the case in surgery where advanced imaging technologies are currently transforming operating rooms into sophisticated augmented reality studios, exploring recent developments in computer visualization, navigation applications and robotic systems. The main scientific objective of the IMAGUS project is to develop a new framework that accounts for the active role of images in surgical contexts, providing a systematic basis for handling the impact of these images and assessing their controversial aspects. To attain this goal a new theory of images has been developed, which conceives images as operative. The theory also includes a new notion of objectivity, which accounts for the key features of image-guided applications such as agency, alignment and automation. In addition, a new method has been developed, which provides a strategy for analyzing images as part of an operation. A second objective of the IMAGUS project is to contribute to conceptual and methodological innovation through a two-way transfer of visual knowledge and visual literacies across the medicine and humanities/social science domains. To attain this goal, the researcher has co-organized and/or participated in several explorative workshops where researchers with backgrounds in medicine and humanities/social science have come together to develop strategies for sharing the visual knowledge of their respective domains and for exploring the potential for medical and technological optimization. A further aim connected to the second objective is to raise critical awareness of the mediating roles of images in both domains. This aim has been obtained through co-authored articles where humanities/social science visual literacies are brought to bear on medical questions, and vice versa. In terms of career advancement, the objective of the IMAGUS project is to attain and consolidate a leading independent position for the researcher. The undertaking of the project on the premises of the Cluster of Excellence Image Knowledge Gestaltung: An Interdisciplinary Laboratory at the Humboldt University Berlin, has contributed to significantly widen the researcher’s knowledge and competences and to increase the international visibility of her research. The collaboration with members of the Image Guidance base project, especially, has fostered an innovative leap in research. In addition, in the process of conducting the IMAGUS project, the researcher has acquired a range of scientific, technical and complementary skills of relevance to the establishment of an independent research career.
The project has pursued its goal through a collaborative and interdisciplinary effort that involved researchers with backgrounds in humanities/social science and medicine, many of whom are affiliated with the Image Guidance base project at the Cluster. The main research, focusing on the development of a framework for assessing the mediating role of images in image-guided interventions, has been conducted through a combination of observation and interviews, supplemented by literature reviews focusing on image-guided applications of relevance. The research also included a series of analyses of concrete image-guided applications in practical use, such as navigated transcranial magnetic stimulation (nTMS) and other applications used for neurosurgical planning and navigation. Analyses of a robotic radiosurgery system (CyberKnife) has also been undertaken to allow comparison between image-guided systems that involve different levels of automation. The observations and interviews have been conducted at the Charité University Hospital, in close collaboration with members of the Image Guidance base project. The main scientific achievement of the IMAGUS project is the new framework that account for the active role of images in surgical contexts. The framework includes a theory of operative images and a method that supplies a strategy for undertaking operational analyses of image-guided applications. The framework, including its conceptual and methodological aspects, is outlined in four scientific articles. The second achievement of the project is its contribution to a two-way transfer of visual knowledge and visual literacies across the medical and humanities/social science domains. This part of the research has resulted in two further scientific articles that address a medical and a humanities/social science audience, respectively. Other results of the IMAGUS project include three popularized publications, six presentations at conferences, workshops and seminars, three explorative workshops, and co-organization of a PhD course on operative images.
The framework developed by the IMAGUS project, which accounts for the active role of images in surgical contexts, has the potential of making an impact on the visual/media/science studies research field. The framework developed, including its methodological as well as conceptual aspects, has validity far beyond surgical situations – throwing light on the role of operative images in other use contexts (military, scientific, artistic, everyday). It also has the potential of making an impact on the medical field, providing a systematic basis for evaluating the controversial aspects of images used in image-guided applications. By providing a framework that is the result of a two-way transfer of knowledge across the medical and humanities/social science domains, it contributes to conceptual and methodological innovation in both domains. Beyond that, it contributes to raising critical awareness about the mediating roles of images among medical researchers and practitioners, as well as among general academic and lay audiences.
Image-guided surgical intervention. Credit: Moritz Queisner, Malte Euler, CC-BY-NC-ND 4.0