Over the course of 12 months, social scientist Rosana Horio Monteiro remained in the United States collecting data for her doctoral thesis Videographies of the heart. An ethnographic study of cardiac catheterization, defended at the Unicamp Geosciences Institute, in the Department of Scientific and Technological Policy. For five months, Rosana attended the cardiac catheterization laboratory at Albany Medical Center, an American teaching hospital considered a reference in the Troy region, northern New York State. Accompanying a group of seven young doctors, with three years of medical residency, and in the specialization phase in specific areas of cardiology through the fellowship program, Rosana investigated how medical knowledge is produced and reproduced through the use of images in the context of medical practice. Based on an ethnographic study, the researcher focused on this group of cardiologists who perform cardiac catheterization to diagnose coronary obstructions at Albany Medical Center.

Combining elements from the literature on social worlds and the sociology and anthropology of medicine, Rosana explains that the interpretation of images can be linked to the doctor's social position, status, gender, experience and academic training, their professional hierarchy and position. in the institution in which he works.

“In my thesis, I argue that the two-dimensional image of the heart that the doctor 'sees' produced by catheterization is not simply the objective and neutral representation of a process occurring in the heart. The doctor sees what he learned to see, what they told him that has to be seen”, says Rosana. This is where some differences of opinion occur. Doctors see the picture of how the heart works through filters that depend on your commitments, your beliefs and preferences of all kinds. “All these filters are mobilized and modify what is seen in the film”, deduces the researcher.

Diagnostics – What worried her, however, was how the images provided by catheterization were read by the professionals at that American hospital, how they interpreted the exams in order to develop their diagnoses. In other words: “I was interested in understanding how medical knowledge is constructed and produced from reading specific images of cardiac catheterization”. That's why Rosana chose a teaching hospital, because she was interested not only in monitoring the environment where the exams were carried out. That is, the cardiac catheterization laboratory, but also a place where it was possible to observe the work of young doctors who are in the process of learning how to read this type of image.

“I was able to understand how these young doctors interact with more experienced ones, with more experience reading the images produced by catheterization.” Rosana reveals that she sought to improve the study of laboratory ethnography, a methodology still little developed and explored in Brazil. Furthermore, she explains that she wanted to work with a group of research scientists accustomed to this type of field study and observation. Hospital doctors met once a week to discuss the images produced by the catheterization laboratory studied. Young doctors, surgeons, cardiologists, along with X-ray technicians, IT technicians and nurses, among other specialists, met to observe and discuss the images produced by catheterization. Such images had, in a certain way, some peculiarity – either because they were atypical cases or because they represented frequent cases or cases that could generate doubts regarding the diagnoses and prognoses indicated by the doctors responsible for the case under discussion.

What Rosana was looking for was exactly to identify what type of divergence occurred among doctors regarding the reading and interpretation of images. “I was able to observe that in cases where coronary obstructions were around 90%, and therefore even clearly visible, there was practically no disagreement among hospital professionals”, she explains. In the case of minimal obstructions reading, less than 40%, there was no need for surgical intervention. However, Rosana observed that it was the intermediate injuries that generated the main divergences, in which the speech of the doctors studied depended, among other factors, on their area of ​​specialization. For example, if it was a professional with extensive experience who performed catheterization as an intervention tool to unblock the artery (angioplasty), if it was carried out only for diagnosis (invasive cardiology), if it was a general practitioner.”

With this, Rosana concludes that the interpretation of images seems to be linked to the doctor's social position, experience and academic training. As if that were not enough, this interpretation is closely related to the doctor's position in the professional hierarchy and the reputation of the institution in which he works. What these doctors “see” is what they “learned to see” based on commitments, links with certain research traditions, acquired during academic training, in professional practice with the institution where they work, in their areas of specialization, and as members of certain social worlds”, assesses the researcher.

A journey inside the body
In medicine, especially since the 20th century, visual knowledge, images and the technology that produces them have become widely disseminated. Today, contemporary medical science is largely organized around the production and interpretation of images. Since the 60s, with the union between computers and X-ray technology — discovered by chance in 1895 by the German physicist Wilhelm Conrad Roentgen (1845-1923) and incorporated into medical practice — it has been possible to create images of internal structures and functions of the human body, which add to the doctor's ability to obtain diagnoses of certain diseases. According to Rosana, with these images doctors can avoid exploratory surgery and visualize vital organs in activity, in order to identify blockages and detect signs of possible future disorders. And one of these extraordinary medical resources is catheterization, although there are other more sophisticated means, such as computerized scintigraphy. Catheterization occurs with the introduction of a catheter into a channel or natural conduit of the body (urethra, esophagus, tube and vessels, etc.) with therapeutic objectives. In the case of cardiac catheterization, the catheter is introduced into the patient, guided to the coronary arteries, enabling visualization of the arteries through X-ray images, captured on 35 millimeter films.