Abstract

The work of the radiographer is varied within clinical departments and involves organising and examining patients. Without the complex associations between the radiographer, X-ray machines, and X-ray request, none of this activity would take place. This thesis explores the role of the X-ray request in the practices that are used and develop within the radiography department. It utilises Actor-Network Theory as a framework through which to view the concept of noise in decision-making. This work highlights the role of the non-human and their agency in terms of the practices that are used to perform the X-ray examinations of patients.

This work took place within a district general hospital, and the data collection took the form of a focused ethnographic approach. Two weeks of observing radiographers took place within the viewing area of the X-ray department. Documents were also collected from the department; this included posters and the department’s technique guide. Semi-structured interviews took place with seven participants. This also led to documentary data collection from other publicly available documents (such as legislation and professional and statutory regulatory body publications) where these were mentioned/used by the participants. Data analysis was performed using reflexive thematic analysis across all data. Documentary data was also subject to appropriate analysis in line with Actor-Network Theory. Actor-Network Theory and the concept of noise in decision making were integrated into the analysis through sensitization to the associations formed and the role of the non-human.

The findings from the research initially focus on the identification of entities that cause noise within the network. Level noise was initially identified as the radiographer being either examine-focused or rule-focused. This led to the identification of stable-pattern noise within the Actor-Network, contributed by clinical information, space and time, radiographs, referral source, and protocols and documents. These were then analysed as to their impact on the practices that occur in the justification process. A key finding is that noisy actors in the system lead to a series of practices that help maintain the dynamic stability of the assemblage. These practices included bespoke workarounds (emergent practices and knowing-in-practice), the interaction of the radiographers with other staff and systems (historical and social practices), and interactions within the physical environment (embodied practices).

These findings have implications in terms of how the practices that take place around the X-ray request can be conceptualised. The X-ray request is a boundary object around which boundary

work takes place. The noisy actors within the Actor-Network lead to practices around this boundary object that are emergent, in that they emerge out of the specific conditions of the patient, the contents of the X-ray request, historical and social experiences. These emergent practices indicate that the radiographer acts as practitioner and operator (i.e., justifying and authorising the X-ray exposure) but also as a proxy-referrer depending on the specific conditions of the referral. This finding has implications for how this process is performed within departments and how it can feed into education. The final finding relates to the changes in working practices over time, especially in relation to the apparent isolation of the radiographer and the potential effects of this isolation on the practises employed in the department in relation to X-ray requests. The isolation has the potential to impact sharing knowledge and practices, not just about the authorisation/justification of X-ray request, but of wider radiographic practices. This may have implications for the design of the working environment in which radiographers work, to further allow sharing and moderation of practices.