CT Suite: The Work of Diagnosis in the Age of Noninvasive Cutting (review)

Barry F. Saunders's CT Suite is about professional cultural workings of the medical-imaging device called computed tomography (CT). It is a book about the cultural logic at work in radiological diagnosis, about the cultic dimension of the social rites of medical imaging. It is also about the continued historical presence of the cadaver, dissection, and the detective work of diagnosis in contemporary medicine.

CT Suite builds on ethnographic participant observation in a clinic in 1996-97. Across six chapters, the book denaturalizes the visual power of CT by scrutinizing the many social practices involved in the interpretation of images. In particular, it addresses how CT practitioners set scans (anatomical pictures) in relation to various texts, data, other images, and notions of normality. Saunders also highlights the making of social relations around and through CT, especially the professional hierarchies, norms, and interests vested in the codified routines of CT work. Two chapters inquire how the truth value of CT scans is further grounded outside the CT reading room, exploring the hierarchical divides made spectacular by the staging of teaching situations, the importance of mastering an archive of pathological cases ("the materia of dead, fixed tissue" [p. 297]), and the significance of demonstrations of collective professional self-confidence at annual exhibitions of radiological equipment.

Thus, CT Suite does the work one has come to expect from an STS study of medical imaging. The social practices of visual representations and interpretations in anatomical/functional medical imaging have been addressed in productive ways by scholars such as Anne Beaulieu, Amit Prasad, Kelly Joyce, and Andreas Roepstorff, to take examples from the past decade only. However, CT Suite does something more unusual in STS, analyzing the tension between the social organization of practices of looking and the cultural underpinnings of (late) modernity's medical-visual enterprise. In this, it is closer to the works of Lisa Cartwright, José van Dijck, Eva Åhrén, Michael Sappol, and even Joseph Dumit's seminal Picturing Personhood (2004).

Saunders makes a strong, original contribution to that field by providing a cultural historical reading of the medical gaze performed through CT. It keeps bringing the reader back to a few key themes: the cadaver, the intrigue, the suspicious observer, the case, and photography's "posthumous shock" (a phrase used by Walter Benjamin). The cadaver—dead body of pathological anatomy and modern medicine—makes its first major appearance in CT Suite when Saunders exhumes the historical visual conventions of the bodily "slice" depicted by a CT scan. It returns in the author's analysis of the endeavor to achieve diagnostic closures through correlation with pathological analysis, of the entwinement of practices of CT imaging and biopsy (the taking of tissue samples), and of the "posthumous shock" delivered to the body by the imaging of the lesion.

Saunders reads diagnostic work with CT through the historical angle of the "intrigue," a mystery to be solved at the center of (among others) Edgar Allan Poe's short novels, which he sets in parallel to the nineteenth- and early-twentieth-century developments of comparative anatomy, pathological anatomy, and forensic photography. The diagnostic intrigue stages a detective story, in which a suspicious reader/observer (the reader of CT scans) attempts to identify a disease by comparisons, intuition, and photographic dissection of the corpse of the victim. CT thus constantly links the corpse and the living patient, making it a problematic, if not fundamentally dehumanizing, technology, Saunders argues.

This book is not only elegant, but necessary and timely. Saunders illustrates brilliantly that understanding the cultural logic at work in medical imaging requires the examination of inscriptions and re-inscriptions of the medical gaze. It demands a historical reading of which understandings of the body and which desires to know are at work in our contemporary technomedical vision. CT Suite is an inspiring and important work for scholars of medical technology and of visualization and imagery in...