The ray of hope:hidden work and the pursuit of accuracy

Informed by the study of humans and machines in heterogeneous networks, this thesis examines how relations are made and how the discursive ordering within networks of associations can shape technologies and their worlds. In a critical exploration of the introduction and use of X-ray Volumetric Imaging (XVI) into radiotherapy practice in two locations, I show how processes of embedding this system and its uncertainties were managed. X-ray Volumetric Imaging, the focus of a number of fundraising campaigns in the mid 2000s, was introduced accompanied by a fanfare of newness and discourses of ‘hope’, ‘inspiring clinical confidence’ and ‘accuracy’. The XVI, and the possibilities it affords, were incorporated into strategic planning priorities across the UK based on a rationale of self-evidence and despite the absence of health technology assessment (the customary way of analysing the use and establishment of technologies into the UK’s National Health Service). Using an ethnographic approach, the hidden work during the introduction of the XVI (e.g. demands made on patients, practices and practitioners) becomes visible and the ‘price’ of accuracy (e.g. issues of additional radiation dose) is revealed. Through exploring these areas, the contingencies, contradictions and complexities involved as attempts were made to make the XVI durable or ‘work’ in practice, are discussed. My exploration of the contemporary introduction of XVI draws on history of science and technology, science studies, organisation studies and feminist studies of technoscience. I explore the introduction of XVI and the ‘experimental’ nature of its introduction, set against uncertainties regarding the system’s effectiveness and consequences. The thesis contributes to STS scholarship on the importance of human/non-human collectives in showing how heterogeneous arrangements contribute to ordering and organising technologies in practice. I provide a case study which critically reflects upon the way in which a machine’s capabilities are presented in isolation of the demands made on humans and the consequences of these introductions. In doing so I demonstrate different ways of seeing XVI technologies, the disparity between people’s hopes, alongside technological promises which are yet to be realised, and the work that is done in order for such systems to fit into practice