10.54103/2036-461X/17775
Our paper is situated within the broader exploration of the epistemic and aesthetic potential of biomedical imaging technologies on the human lived experience. Intra-Active Sense-Making is guided by the grounding thesis that imaging technology ought to be understood as a set of material, rhetorical and performative processes, and as a way to challenge the ocularcentric presuppositions. By drawing on the new materialistic theses that phenomena are not pre-existent to intra-action, and that agency should be understood as distributed on human, animal, objectual, and ‘physical’ levels, we offer a performative understanding of biomedical imaging operations complementary to the reflective paradigm. Biomedical imaging may be understood through our idea of intra-active sense-making; while much literature states that medical imaging establishes a view of the self as quantified, atomized, and governable, we argue that the co-configuration of human senses and digital sensors is a source of new sense-making capabilities.
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Giulio Galimberti
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Cinéma & Cie. Film and Media Studies Journal
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Intra-Active Sense-Making. Towards a Performative Understanding of Biomedical Imaging
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Cinéma & Cie
Giulio Galimberti
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10.54103/2036-461X/17775
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39
Sense-making
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Intra-Active Sense-Making. Towards a Performative Understanding of Biomedical Imaging
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                                                                                       Intra-Active Sense-Making
                                                                                       Towards a Performative
                                                                                       Understanding of Biomedical Imaging
                                                                                       Nicole Miglio, Università degli Studi di Milano
                                                                                       Giulio Galimberti, Università degli Studi di Milano




                                                                                       Our paper is situated within the broader exploration of the epistemic and aesthetic po-               Keywords
                                                                                       tential of biomedical imaging technologies on the human lived experience. Intra-Acti-               Intra-action;
                                                                                       ve Sense-Making is guided by the grounding thesis that imaging technology ought
                                                                                                                                                                                        Performativity;
                                                                                       to be understood as a set of material, rhetorical and performative processes, and as
                                                                                       a way to challenge the ocularcentric presuppositions. By drawing on the new mate-            Biomedical Imaging;
                                                                                       rialistic theses that phenomena are not pre-existent to intra-action, and that agency              Visualization;
                                                                                       should be understood as distributed on human, animal, objectual, and ‘physical’ levels,           Sense-making
                                                                                       we offer a performative understanding of biomedical imaging operations complemen-                            DOI
                                                                                       tary to the reflective paradigm. Biomedical imaging may be understood through our                   https://doi.
This work is licensed under a Creative Commons Attribution 4.0 International License




                                                                                       idea of intra-active sense-making; while much literature states that medical imaging        org/10.54103/2036-
                                                                                       establishes a view of the self as quantified, atomized, and governable, we argue that the           461X/17775
                                                                                       co-configuration of human senses and digital sensors is a source of new sense-making
                                                                                       capabilities.



                                                                                       INTRODUCTION
                                                                                         In this paper, we explore biomedical imaging as a process that involves
                                                                                       human beings, bodies, images, data, and technological devices, as well as their
                                                                                       relative positions of power. Our goal in presenting this theoretical discussion is
                                                                                       to enrich the ongoing debates on biomedical imaging by offering a philosophical
                                                                                       understanding of this practice in terms of performativity, intra-action, and
                                                                                       sense-making. This analysis is organized into four sections.1
                                                                                         In the first two sections, we situate our position within contemporary
                                                                                       debates on biomedical imaging, by focusing specifically on the relationship
                                                                                       between visualization, biometrification, and images. Biomedical imaging is thus
                                                                                       discussed as a specific example of a broader biometrification trend, since it aims
                                                                                       to collect data, separate bodies, and classify subjects. This debate discusses the
                                                                                       transparency of the body, the objectivity of data, and the scientificity of images.
                                                                                       By reviewing key themes within the literature, we then present a preliminary
                                                                                       outline of our own research. In particular, we highlight that imaging can seem
                                                                                       to transparently reveal molecular dynamics, at the cost of carefully concealing
                                                                                       the initial act of interpretation that shapes mathematical data into visually
                                                                                       recognizable and satisfactory images. The fact that data must be processed in


                                                                                       Cinéma & Cie vol. 22 no. 39 2022 · ISSN 2036-461X                                                          69
     order to generate a visualizable form makes it impossible to assert any direct
     identification of code and image. Nevertheless, transformative processes — from
     phenomenon to data and then back to visualisation — are rarely documented
     or annotated. Biomedical imaging produces visual outputs that are prima facie
     distant from the original phenomenon from which they are extracted. Taking up
     this insight, we thus interrogate the very nature of biomedical images.
       In sections three and four, we explore new materialistic notions of agency,
     subject, and technology with the aim to reframe some key parameters of
     the analysis and focus on the very process of visualization. From there, we
     argue that biomedical imaging may be understood through our idea of intra-
     active sense-making: while Barad’s concept of ‘intra-action’ redefines what
     the individuals are and what does agency mean, the idea of sense-making is
     understood as the ‘process by which individual and collective experiences
     become meaningful’.2 When applied to biomedical imaging, intra-active sense-
     making helps us to rethink the intertwined relationships between technological
     production of images and lived experiences.
       All in all, the paper concludes that medical visual culture is grounded on
     specific theoretical choices of which the ‘ocularcentrism’ is a symptom of a
     wider understanding of the self as a subject who inter-acts with other subjects
     and objects; the primacy of the sight on the other senses is not teleological
     determined by the technological construction of biomedical imaging, but it is
     rather the result of philosophical conceptions of the subject and the data both
     in the scientific fields and in popular culture.



     BIOMEDICAL IMAGING AS A FORM
     OF BIOMETRIFICATION
        Our contemporary media environment is becoming increasingly enhanced by
     sensory devices and computer vision systems with the ability to process huge
     data sets for the recognition, identification, and monitoring of bodies. This has
     become more pervasive a fortiori with the upsurge of the COVID-19 pandemic,
     during which machine vision systems have become central to a broad spectrum
     of applications, from social surveillance to diagnostics.3 In the context of a
     health crisis that requires bodies to be distanced, machine vision systems
     facilitated the collection and analysis of remote data. It is not a specific feature
     of biomedical imaging devices that they are remote sensing technologies; in
     fact, various degrees of proximity between the body and the device pertain to
     its possible applications. From the distanced functioning of thermal imaging
     measurements to the tactile dimension of ultrasound, these technologies
     establish specific proximal relations in relation to lived bodies. Despite their
     respective differences, biomedical imaging devices work based on the same
     epistemic principle — namely that the concreteness and complexity of the living
     phenomenon can be more effectively and objectively understood through two-



70                                         Miglio, Galimberti, Intra-Active Sense-Making
dimensional image-data excerpted from the phenomenon than directly from the
phenomenon itself. This assumption involves two theoretical moves that we
will outline here. First, the human body is conceived as a source of information
that can be transmitted through an image or a digital code. The practice of
producing maps of codes that refer to our bodies as bounded and autonomous
entities is expressed through the primacy of biometrics, here understood as the
set of practices, from small-scale wearable trackers and Fitbits to large-scale
medical devices, such as MRI, with different levels of engagement and tension
between the subject and the apparatus. Here we focus on how biomedical
imaging exploits and converts the intricate materiality of the body into modular
systems by representing it as averages and discrete moments of a linear
journey.4 This tendency — which Haraway defines as ‘corporeal fetishism’5 — for
digital technologies to engage with human bodies in these ways reduces their
embodied lived experience to data.
   Second, the fact that information from our body is conveyed by an image
indicates a primacy of sight over other senses. By naïvely proposing an evidential
correspondence between the image and the psychophysiological processes,
biomedical imaging thus promotes a conception of the body subsumed under
the auspices of the visual, which Lupton calls ‘ocularcentric tendencies of
biomedicine’.6 These sets of practices transform the lived dynamics of the body
into something that can be seen and measured. As Lupton poignantly illustrates,
‘[m]edical visualizing technologies can work to draw attention away from the
fleshly body of the patient “in the rush to find visual proof”, thus dehumanising
the individual’.7
   Technologies that make visible parts and qualities of the body which are
not otherwise directly apparent to the naked eye have traditionally been
understood as a key practice in biomedicine. We follow Cartwright’s idea that,
‘[t]he dispersal of embodied sight triggered in science some often peculiar
attempts to maintain authority over subjects by maintaining authority over the
optical field’.8 Contemporary diagnostic imaging makes visible bodily activities
that have nothing to do with the visual realm, nor are they detected by lenses
or prostheses that intercept signals from the visible electromagnetic spectrum.
The epistemic primacy of the data made visible over accounts of lived experience
is symptomatic of the need to re-establish sight in the medical domain.
   Within these debates, biomedical technologies are conceived as means to
overcome first-person lived experiences and the limits of human perception with
mechanical objectivity and the machinic gaze.9 Along these lines, our conception
of what visualization can do is framed within our general understanding of the
human self’s relationship with the objectual world. Ultimately, visualization
processes are heuristically fruitful, in that they show what are considered to
be ‘subject’, ‘body’, ‘truth’. More specifically, visualization is often assumed as
part of our interactions with objects and data; despite contemporary efforts to
creatively rethink the activity/passivity divide in ways that do not naïvely align
with the subject/object dualism (i.e., in new materialism), the understanding
of biomedical imaging as a form of biometrification is still broadly popular and


Cinéma & Cie vol. 22 no. 39 2022 · ISSN 2036-461X                                     71
     grounded on the philosophical subject/object dualism.
        As Lupton notes, this also applies to digital data arising from visualization
     processes: ‘Because of their association with nonhuman entities such as digital
     devices and software, and because they are often viewed as non-material
     entities, digital data are often de-humanised and de-materialised in discourses’.10
     In dealing with these data, we tend to treat them as passive matter which ought
     to be decrypted, understood, and explained by the active cognitive gaze of the
     doctor, neglecting to acknowledge that what we visualize depends on our own
     vital processes. A further aspect of the issue relates to the design of images
     produced in visualization processes; any form of biomedical visualization is
     productive of images in which subjective bodily activity is obtained in contrast to
     the environment, not together with it. The iconic artifact obscures environmental
     considerations by focusing on a discrete part of what is, in fact, a co-constitutive
     process. Biomedical imaging shows a certain predilection for separating the
     phenomenon under study from a homogeneous and neutral background, e.g.,
     highlighting a single molecular dynamic among many complicated brain circuits
     in brain imaging, or contrasting human body temperature from environmental
     influences. The object of interest is separated to enable more manageable
     processing, perpetuating the idea that its occurrence is disengaged from other
     processes. Isolated as a discrete specimen, enlarged or flattened, pierced by
     non-light radiation, and perceived by a machinic gaze, bodily activity is quantified,
     extracted from a body, and abstracted from its materiality. By presenting
     image-data as functional mediation between a molecular phenomenon and
     human perception, diagnostic practice thus provides a specific epistemic key for
     accessing our bodies.11 The visual and biometric output of imaging procedures
     has certain design conditions and carries with it specific affordances, thus
     conditioning the kind of knowledge the human subject might gain from the
     phenomenon.



     WHAT KINDS OF IMAGES?
        Biomedical imaging arises through the need to produce an image that can be
     interrogated both by the practitioners and patients. The status of images issued
     from biomedical imaging is at the center of vivid debates within the literature,
     specifically when these images are surreptitiously conceived as testimonies
     of given realities. Within this context, current debates focus on the domain
     wherein biomedical imaging is nowadays situated by proposing a review of the
     presuppositions underlying ocularcentrism.12
        While the well-known concept of neuro-realistic fallacy 13 — namely the photo-
     like persuasive effect of the iconic output of non-visual bodily image-data —
     applies to the case of neuroimaging, it is our interest to explore how this fallacy
     may concern biomedical imaging per se. Given the photo-like effect of biomedical
     imaging and its inclusion in the phenomenon of biometrification, the dominant
     paradigm for analysing the image produced for diagnostic purposes is Farocki’s



72                                         Miglio, Galimberti, Intra-Active Sense-Making
concept of the operational image,14 which encompasses photogrammetry (i.e.,
the use of photography as a tool for scale measurement) as the archaeologically
founding technique of its scopic regime. With the shift from the representational
paradigm to the digital biometric one, the information carried by the photographic
image is quantified. The image thus becomes ‘operational’, i.e., it can be read by
a machine that extracts the information needed in order to perform or cause an
action to be performed. Operational images trigger decisions and do things in
the world rather than replacing or augmenting human vision. In the words of
Elsaesser,

         The operational image must be understood as an amassment of
         visual information that is meant to generate knowledge that has
         little to do with human perception or seeing, in the sense of ‘I
         see’ meaning ‘I know,’ and more to do with controlling territory,
         occupying space, monitoring a situation and mining it for useful
         information or active intervention.15

  Understanding biomedical imaging through the operational image paradigm
allows us to see that resulting images are in no sense forms of reflection (or
representation), even if viewed as distorted, manipulated, or implemented
by the medium; rather, they are more like diagrams that retain the relational
qualities of the material imprint.16 Within the operational paradigm, we thus
argue that biomedical images are not mirror-images, nor do they open direct
windows onto the invisible and non-visible world. This paradigm, however,
tends to pay little attention to the demonstrative — or, even better, persuasive —
goal of biomedical imaging. In fact, each image functions as a rhetorical device
that implements a more or less deliberate selection of parameters according to
which it reduces and models data that are not mere facts to be reported.17 The
biomedical image is not a one-to-one translation of a given reality, but instead
concerns a negotiation between the human operation and the phenomenon
under scrutiny.18 Insofar as biomedical imaging is not merely reflective, but also
constructive, it is crucial to investigate digital composition procedures as parts
of a whole process interrelated with images, bodies, and people.
  The objectivity sought from images produced by imaging devices perpetuates
the idea that data collection is pure, immaterial, and non-invasive recording, and
at the same time overlooks the complicated materiality of digital technology.
The myth of the objectivity and transparency of scientific images is bound up
with the cultural authority of the data; their presumptive scientificity is upheld
by virtue of the fact that the rawness and messiness of the matter is carefully
deleted from the picture.
  The materiality and functioning of technical operations therefore remains
black-boxed,19 and knowledge is produced concerning demonstrable effects
without understanding the process. The interpretive work of shaping data
(sample size choices, and other aspects of statistical and quantitative
manipulations) disappears in the final result. As Casini correctly points out,




Cinéma & Cie vol. 22 no. 39 2022 · ISSN 2036-461X                                    73
              Looking at how scientific knowledge is produced, rather than
              innocently discovered, is akin to looking under data visualization
              to consider its assumptions and conventions. What does ‘looking
              under’ data visualization mean? There is nothing natural or
              predetermined when it comes to data visualization.20

        While the cultural expectations regarding scientific visualization among
     non-expert audiences is such that the work of interpreting the image seems
     to be minimal, due to its transparent objectivity, deciphering work by experts
     is a crucial step. Images for medical use are perhaps especially subject to
     interpretive flexibility. Images resulting from visualization processes need
     thus to make explicit the epistemological frame of reference (e.g., captions and
     experimental conditions), since data do not speak for themselves; they must
     be instead accompanied by medical training and expertise in order to become
     vehicles for a communicable statement. The medical image has always been
     serving as an intermediary in the doctor-patient relationship: the body under
     analysis offers itself to the doctor’s gaze inter-mediated by the biomedical
     image. Nowadays, it might seem that the triangulation should be subverted: the
     patient’s body offers itself to the machinic perception, which is inter-mediated
     by the doctor’s analysis.21 What is being ‘observed’ is not the phenomenon
     itself but an encoded inscription of an activity that takes place beyond sensory
     thresholds. Data collected by the technical apparatuses of biomedical imaging
     come from electromagnetic or sound radiation outside our sensory capacities
     and are then translated into images of our bodies that are as familiar as possible
     to our eyes.22 This prosthetic feature of biomedical imaging defines specific
     power relationships between practitioners and patients, by radically modifying
     what counts as images to us, and how we conceive our own sensorial limits and
     potentials. As detection and imaging practices change, so does our access to
     what Hansen describes as the ‘expanded domain of sensibility’ — namely those
     aspects of the sensible that are detected by a variety of digital devices and to
     which the human sensorium cannot access.23
        We learn to think together with these images, not only through the logic of
     visual thinking but also by considering the retroactive-effects of using these
     sensorial prostheses. By interacting with these visualizations — since ‘they tune
     us into other registers of experience, and they attach us to perceptive practices
     that remake our sensory worlds’24 — we open up new ways of thinking about
     our lived bodies.



     INTRA-ACTIVE PRACTICES
     AND ENCOUNTERS
       Understanding biomedical imaging as a form of biometrification allows us
     to grasp the relationship between the subject and visualizing technologies in
     quantitative terms. It therefore helps to see how imaging serves to the aim of



74                                        Miglio, Galimberti, Intra-Active Sense-Making
detection. Nonetheless, biomedical imaging also has a qualitative dimension,
that concerns the sense-making undertaken by the subject during medical
scrutiny and in the encounter with resulting images.25
   Human experiences become meaningful to the self through complex
negotiation processes of one’s singular history, common and individual beliefs,
and shared norms. The significance of particular experiences arises from the
nonlinear intertwining of individual, social, and cultural values. Let’s consider
the case of biomedical imaging. The subject under scrutiny — for diagnostic
or experimental purposes — is a person who has a first-hand experience of a
part of the visualization process in non-neutral ways. They may have various
degrees of emotional investment during the procedure (e.g., the scan was
prescribed by the oncologist after surgery, or it is a routine test; a healthy
person is a part of a clinical trial). Again, they may be able to know exactly what
is ‘going on’ during the procedure or may be completely naïve to the point of
ignoring why the practitioner is moving their body in a given manner or making
that facial expression. All these qualitative variations fall under the sense-
making emerging through the visualization processes, in that the participants
bring into play singular and collective ways of making sense of the experience
they are having, either by being surprised, worried, or unconcerned during the
examination or by understanding or not understanding the visual outcomes.
   The theoretical core of our paper is precisely to show the intertwined
relationship between the technological side of biomedical imaging — including
its biometrification-driven purposes — and the lived experience that these
processes may entail for the self. Exploring this latter side thus involves
recognizing the performative dimension of biomedical imaging.26 According to
our theoretical proposal, the lack of reflection around the performative aspect
of biomedical imaging may lead to a misunderstanding of its lived relation with
the self, and epistemically risks remaining ‘locked into mechanistic models
of thought in which an image/text is “out there” and an eye brings it “into”
the mind’.27 By hiding the relational process underlying visualization, we are
forced to interact with these technologies as if they are straightforwardly
factual and objective statements. Gardner and Jenkins warn us against this, by
remembering that ‘there are few technological experiences with more potential
for creating a sense of disembodied alienation than seeing one’s physical self
portrayed two-dimensionally as data via algorithmic code’.28
   While it has been widely argued that we struggle to regain ownership of these
data because they erase the co-dependency between our body and the device,
it is part of our strategy to argue for a reappraisal of the lived experience of
diagnostic phenomenon. We are delving into the very nature of the self and its
complex relationship with technologies — specifically those ones that make it
possible to see the invisible and the non-visible; this is what is at stake in the
debate. The intertwined co-constitution of data, images, and lived experiences
necessitates a theoretical argument that sees the relationships between
human beings and technology not in terms of activity/passivity, but that may
instead grasp the mutual co-constitution of the phenomenon of visualization.


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     In other words, what is needed is a theoretical framework that can express
     the performative dimension of biomedical imaging. While much literature has
     focused on the results of imaging, our proposal is instead to take into account
     the very process of biomedical diagnostics by focusing on lived experience. This
     theoretical choice is motivated by the idea that considering only the result is a
     problematic move, since it overlooks the technical (and not only technological)
     processes that have led to the outputs. It is also grounded in a genuine
     misunderstanding of the interactive relationship between technologies and
     users — how technologies may affect the human being and how human beings
     impact the technologies themselves — and thus cannot grasp the retroactive
     dynamics of (imaging) technologies on the self.
       Our proposal is then to frame biomedical imaging within the theory of agential
     realism; the technology of biomedical imaging, the process itself, the involved
     subjects, and the final result ought not to be understood as individuals but as
     relata of a process of intra-action. Barad explains that understanding the relations
     between relata allows us to recognize ‘the mutual constitution of entangled
     agencies’.29 By refusing the notion of interaction — which is said to assume an
     encounter between individual agencies that occur after their own constitution
     —, Barad proposes that we might think of subjects in terms of intra-action,
     acknowledging that distinct agencies ‘do not precede, but rather emerge through,
     their intra-action’.30 This ontological framework insists on the relationality as the
     place of constitution of individual agencies, whose separation is possible in virtue
     of their mutual entanglement. As Barad puts it, ‘each “individual” always already
     includes all possible intra-actions with “itself” through all the virtual Others,
     including those that are non-contemporaneous with “itself”’.31
       According to her agential realist account, phenomena do not sign ‘the
     epistemological inseparability of observer and observed, or the results of
     measurements’, marking instead the ontologically inseparable relata of intra-
     active processes.32 This shift of paradigm impacts the epistemic understanding
     of several notions underlying Western philosophy — among others the ones of
     subject, object, process, agency, and causality — by having at the same time a radical
     effect ‘in understanding the nature of science and ontological, epistemological,
     and ethical issues more generally’.33 Instead of seeing relata qua individuals,
     agential realism acknowledges that every entity emerges through intra-active
     practices. That does not mean that it is impossible to grasp the specific individual
     moments of the whole process, but rather than the process should be primarily
     recognized in its wholeness; on this matter, Athanasiadou notes that,

               When the agential cut in the continuum of reality is enacted, that is
               the moment of a measurement could be described as clear but not
               distinct. This moment is clear insofar as relations can be drawn,
               space–time–matter is made specific, and an epistemological
               distinction between the object and the agency of the observation is
               established. However, the moment of the agential cut is not distinct
               insofar as it is ontologically inseparable from the continuity of the
               world. 34


76                                          Miglio, Galimberti, Intra-Active Sense-Making
  This approach is performative, in the sense that ‘subject and object do
not preexist as such but emerge through intra-actions’.35 By drawing on a
performative framework, some efforts have been made in recognizing the specific
agential dynamics underlying biotechnological processes and measurements;
for instance, de la Bellacasa takes into account touching technologies, which
she defines as ‘material and meaning-producing embodied practices entangled
with the very matter of relating-being’.36
  If we follow the idea that technologies of visualization are not exclusively
related to an ocularcentric paradigm, then we must recognize that they are not
straightforward neutral mirrors of reality, but rather they are fluid processes
of intra-action. As de la Bellacasa sums up, ‘[touching technologies] cannot
be about touch and get, or about immediate access to more reality. Reality is
a process of intra-active touch.’37 What we called ocularcentrism — following
Lupton — is philosophically dependent on a reflective framework which
conceives the subject and object as separate entities that pre-exist their mutual
relationship.38 The idea that sight has a primacy over other human senses is
acceptable only in a framework that sees the entities has separated and pre-
existent one to the other.



VISUALIZATION AS A
PERFORMATIVE PRACTICE
  Whereas from a reflective perspective biomedical visualization is forced to
distance the object of study from subjective experience, when considering
the performative aspect of imaging the agency of the apparatuses indistinctly
incorporates bodies and technologies. As Gabrys notes, ‘[i]nstruments,
observation, observer, and phenomena are entangled such that world-making
is a distributed and multiagential affair’.39
  We therefore argue that, in a theoretical exploration of biomedical imaging
processes, one should keep together the multiple and overlapping agencies of the
devices, the images produced, and the bodies involved at all stages, from scanning
to reading the results. By reframing imaging processes within the agential realistic
account, we argue that the focus shifts from an understanding of the visual output
as neutral, passive, objective, and reflective to the ‘vital and relational character
of data (that they are produced by and produce effects in the real world)’.40 Our
arguments then support Casini’s thesis that visualization ‘it is not only a practice
to make visible that which is not in sight, but a vital process capable of producing
cognitive and affective relationships between concepts, spaces, and people41’, and
that, as Lupton suggests, ‘the person engaging with their data is a performative
agent in an event with the data materialisations, just as they earlier were agential
in co-creating the data with the device they used to do this’.42
  The output of imaging technologies exerts a rather distinctive mode of sense-
making: people can recognize their molecular or imperceptible processes not at


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     the level of proprioceptive sensations, but thanks to the externalization facilitated
     by the device. Bypassing the subject’s actual sensory perception, this output —
     which very often consists of an image, as we have seen — raises questions
     about abstraction and arbitrariness with respect to the material phenomenon.
     Although it can in no way be validated on an intuitive or phenomenological level,
     it has a great capacity to impact our sense-making and our own sense of self.43
        The starting assumption is that digital and algorithmic mediation are
     increasingly important to our ability to define and understand ourselves.44
     What we have called biometric forms of body fetishism are productive, since
     they influence how we conceive of the human ‘self’ and their relations to the
     world. Codes impact and shape our bodily awareness. Biomedical imaging
     makes it possible to be informed about our bodies in ways that would otherwise
     be impossible to perceive. This awareness, far from leading to forms of self-
     alienation, may instead enhance self-reflective processes of recognition. By
     looking at images, people may apprehend information on their own bodily
     phenomena, which eventually can lead to creative ways of making sense of their
     lived experiences. If biomedical images are framed within this understanding of
     what these technologies offer to subjects, we see that they have the potential
     to provide forms of profound connections with subjective experiences. Lupton
     reports on cases where the use of self-tracking devices has enabled people to
     focus information on their own bodily processes. The activity of one’s body is
     transformed into digital data whose metrics and visualizations can enhance
     awareness of what one’s body is doing;45 Pantzar and Ruckenstein’s concept
     of situated objectivity goes in this direction, in that it grasps that people may
     positively enhance processes of sense-making of their digital data, which are
     not passively accepted as disembodied re-presentations of themselves.46 Along
     these lines, this situated objectivity is said to be hardly attainable in the field
     of biomedical imaging. On the one hand, there are imaging processes, such as
     MRI, that explicitly require patients to see their scans at a time after diagnosis.
     On the other hand, even when patients can observe their bodily images, they
     do not always have the ‘visual expertise’ (result of medical training) to fully
     understand what they are looking at. While it has been broadly recognized that
     data referring to our bodies may have agential capacities to influence the actions
     and behaviours of people to whom they are shown or described, there has been
     little attention on how people also have agential capacities to actively shape and
     rewrite these data instead of viewing them as inevitable and objective. Gardner
     and Jenkins grasp this crucial point by stating that,

               Although we found considerable evidence in support of the alienating
               impact of digitized bodily representations, we also discovered that,
               when allowed to play and ‘tarry’ with these technologies, users
               created dynamic, reflective relationships with the machines that
               can be characterized as productive, affective, and intra-active.47

       As discussed at length by other scholars like Lupton, data are not inscribed
     in passive bodies from which they are actively extracted by the device. Data



78                                         Miglio, Galimberti, Intra-Active Sense-Making
are rather agential entities because they relate to our life processes. We are
certainly not extrinsic spectators of these psychophysiological processes,
even if they may remain below the threshold of our awareness, as the pseudo-
representational mode of imaging might encourage us to think. Conceiving
imaging in terms of extraction of data to be detected does not open space for
the sense-making processes of the people whose visualized bodies are under
examination. Instead, data are not ‘extracted’ from the subject: on the contrary,
the visualized body and the visualizing image constantly shape each other,
being part of a process of mutual co-constitution that also includes the patient.
The boundary between the user’s subjective experience and the ‘objective’
representation of the data becomes porous by revealing thus their mutual co-
constitution.



CONCLUSIVE REMARKS OR TOWARDS
INTRA-ACTIVE SENSE-MAKING
OF BIOMEDICAL IMAGING
  In this paper, we put forth an understanding of biomedical imaging as
a complex phenomenon which is inextricably related to our philosophical
conceptions of self, body, device, image, and (scientific) knowledge. The core
aim of our theoretical proposal has been to explore what happens when we
take seriously the subject/object paradigm offered by new materialisms when
applied to biomedical imaging. By recasting the processes of visualization
within the framework of performativity, we then discussed how the images
produced through biomedical imaging ought to be understood in processual
terms. Conceiving of visualization processes as performative practices poses
a challenge to the allegedly oppositional dualism between the practitioner as
the entitled ‘reader’ of images and the patient as the ‘receiver’ of diagnosis,
by instead investigating the intra-action of relata as constitutive parts of an
extended process. Visualizations could thus gain the ability to transform data
sensed by our bodily processes into visual prostheses that extend our sense-
making processes. What we have argued is that images in themselves are
not sufficient for this explanatory process, but instead technical environment,
methodological choices, and agential cuts within each encounter between
patient, device, and practitioner must be taken into account. The theoretical
proposal we have sketched in this paper is intended to offer an alternative to
the understanding of biomedical imaging as pertaining to the representational
paradigm; by unveiling the intrinsic relationship between production of images,
technological devices, and human interactions, we let emerge the performative
dimension of biomedical imaging. The intra-active sense-making of biomedical
imaging defies the supposed ‘objectivity’ and ‘transparency’ of the data, when
understood as re-presentation of a given ‘external’ reality. Along these lines, as
Bleeker poignantly points out,


Cinéma & Cie vol. 22 no. 39 2022 · ISSN 2036-461X                                    79
              The design of data-based visualizations […] exemplif[ies] such
              relational understanding in how, rather than (providing the illusion
              of) presenting a transparent window to aspects of the world
              previously inaccessible to humans, they are apparatuses that set
              the stage for intra-actions that engage in and effectuate ways of
              knowing.48

       This process is intra-active because the relata do not pre-exist their own
     constitution, but are instead participating in mutual and continuous sense-
     making. This theoretical approach invites us to reconsider the intertwined and
     intermingled relationships between images, data, bodies, devices, and people
     as parts of a whole process of productive sense-making.
       All in all, by calling for further investigations and applications to several
     case studies — from MRI to ultrasound, from thermal imaging to X-rays —, this
     preliminary research may help us to productively re-imagine and re-think our
     participation in medical images’ production, and ultimately in the comprehension
     of what role we play in the making of ourselves.




80                                       Miglio, Galimberti, Intra-Active Sense-Making
Notes
 1
     Giulio Galimberti wrote § Biomedical Imaging as a Form of Biometrification, and § What Kinds of Images?,
while Nicole Miglio wrote § Intra-Active Practices and Encounters, and § Visualization as a Performative
Practice. Both authors together wrote the Introduction, and the § Conclusive Remarks or Towards Intra-
Active Sense-Making of Biomedical Imaging. All the authors listed have made a substantial, direct, and
intellectual contribution to the work and approved it for publication.
   2
      Nicole Miglio and Jessie Stanier, ‘Beyond Pain Scales: A Critical Phenomenology of Imagination in
the Expression of Pain’, Frontiers in Pain Research, 3 (2022). https://doi.org/10.3389/fpain.2022.895443
[accessed 25 May 2022].
   3
      Cf. Pandemic Media: Preliminary Notes Toward an Inventory, ed. by Philipp Dominik Keidl and others
(Lüneburg: Meson Press, 2020).
   4
      For some classical accounts, see e.g., Handbook of Biometrics, ed. by Anil K. Jain, Patrick Flynn, and
Arun A. Ross (Boston: Springer, 2007); Joseph Pugliese, Biometrics: Bodies, technologies, biopolitics (New
York: Routledge, 2012); Irma Van der Ploeg, The Machine-readable Body: Essays of Biometrics and the
Informatization of the Body (Herzogenrath: Shaker, 2005).
   5
     Donna Haraway, Modest Witness@ Second_Millenium. FemaleMan© _Meets_On coMouse™: Feminism
and Technoscience (New York: Routledge, 1997).
   6
     Deborah Lupton, ‘Towards sensory studies of digital health’, Digital health, 3 (2017), 1-6 (3).
   7
     Ibidem, 3.
   8
      Lisa Cartwright, Screening the Body: Tracing medicine’s visual culture (Minneapolis: University of
Minnesota Press 1995), 39.
   9
     Lorraine Daston and Peter Galison, ‘The image of objectivity’, Representations, 40 (1992), 81-128 (98).
   10
       Deborah Lupton, ‘How do data come to matter? Living and becoming with personal data’, Big Data &
Society, 5.2 (2018), 1-11 (2).
   11
       Cf. Maaike Bleeker, Nanna Verhoeff, Stefan Werning, ‘Sensing data: Encountering data sonifications,
materializations, and interactives as knowledge objects’, Convergence, 26.5-6 (2020), 1088-1107.
   12
      This applies specifically to brain and fetus visualizations, whose iconic status makes it very intricate to
separate from the technological functioning that underlies their own productions.
   13
      Cf. Silvia Casini, ‘Beyond the neuro-realism fallacy: from John R. Mallard’s hand-painted MRI image of a
mouse to BioArt scenarios’, Nuncius, 32.2 (2017), 440-471; Joseph Dumit, Picturing Personhood: Brain Scans
and Biomedical Identity (Princeton: Princeton University Press, 2004).
   14
      Harun Farocki, ‘Phantom Images’, Public, 29 (2004), 12–22.
   15
      Thomas Elsaesser, ‘The “return” of 3-D: On some of the logics and genealogies of the image in the twenty-
first century’, Critical Inquiry, 39.2 (2013), 217-246 (242).
   16
      Cf. Ksenia Fedorova, Tactics of Interfacing. Encoding Affect in Art and Technology (Cambridge, MA: The
MIT Press, 2020).
   17
      Cf. Tania Vladova, ‘De la distinction entre images scientifiques et images artistiques’, Images Re-vues.
Histoire, anthropologie et théorie de l’art, 19 (2021), <http://journals.openedition.org/imagesrevues/9818>
[accessed 10 February 2022], and Chiara Cappelletto, Embodying Art. How We See, Think, Feel, and Create
(New York: Columbia University Press, 2022).
   18
       Giuseppe Di Liberti and Andrea Pinotti, ‘Catégories caduques. Au-delà de la distinction entre images
artistiques et images scientifiques’, Images Re-vues. Histoire, anthropologie et théorie de l’art, 19 (2021),
<http://journals.openedition.org/imagesrevues/11868> [accessed 10 February 2022].
   19
       Bruno Latour, Pandora’s hope: essays on the reality of science studies (Cambridge, MA: Harvard
University Press, 1999).
   20
      Silvia Casini, Giving Bodies Back to Data Image Makers, Bricolage, and Reinvention in Magnetic Resonance
Technology (Cambridge, MA: The MIT Press, 2021), xx.
   21
       Cf. Kirsten Ostherr, Medical Visions. Producing the patient through film, television, and imaging
technologies (Oxford: Oxford University Press, 2013).
   22
      Along these lines, Parks defines the radiographic episteme as the practice of transducing ‘imperceptible
radiation into data that can be made productive within an information economy’. Lisa Parks, ‘Vertical
Mediation’, in Life in the Age of Drone Warfare, ed. by Lisa Parks and Caren Kaplan (Durham: Duke University


Cinéma & Cie vol. 22 no. 39 2022 · ISSN 2036-461X                                                          81
Press, 2017), 134–57, 143.
  23
     Mark Henry Hansen, Feed-forward. On the Future of Twenty-First-Century Media (Chicago: University of
Chicago Press, 2015).
  24
     Jennifer Gabrys, How to Do Things with Sensors (Minneapolis: University of Minnesota Press, 2019), 54.
  25
      We employ the notion of sense-making in a broader sense, that originates from enactivist discussion
on that matter (see e.g., Evan Thompson, ‘Living ways of sense making’, Philosophy Today, 55. Supplement
(2011), 114-123)
  26
      What we are referring to by the term ‘performative dimension’ is a particular way of understanding
scientific practice that considers how tools, subjects, matter and the knowledge obtained from them are
intertwined and co-constitute each other. STS, feminist theories and ANT have addressed the issue of how
transmitting information and deriving meaning from it is always the result of concomitant performances of
human beings, technologies and design or linguistic choices
  27
     Johanna Drucker, Visualization and Interpretation. Humanistic Approaches to Display (Cambridge, MA:
The MIT Press, 2020), 67.
  28
     Paula Gardner and Barbara Jenkins, ‘Bodily intra-actions with biometric devices’, Body & Society, 22.1
(2016), 3-30 (2).
  29
      Karen Barad, Meeting the Universe Halfway: Quantum Physics and the Entanglement of Matter and
Meaning (Durham: Duke University Press 2007), 33.
  30
     Ibidem.
  31
     Karen Barad, ‘On touching — The inhuman that therefore I am’, differences, 23.3 (2012), 206-22 (214).
  32
     Barad, Meeting the Universe Halfway, 33.
  33
     Ibidem. Later on, Barad explains that this shift may help us to rethink pillar concept within the history and
the practice of philosophy, such as ‘space, time, matter, dynamics, agency, structure, subjectivity, objectivity,
knowing, intentionality, discursivity, performativity, entanglement, and ethical engagement.’ Ibidem, 35.
  34
      Lila Athanasiadou, ‘Commutation Ontology’, in Posthuman Glossary, ed. by Rosi Braidotti and Maria
Hlavajova (New York: Bloomsbury Academic, 2018), 86-88, 87.
  35
     Barad, Meeting the Universe Halfway, 89.
  36
      Maria Puig De La Bellacasa, ‘Touching technologies, touching visions. The reclaiming of sensorial
experience and the politics of speculative thinking’, Subjectivity, 28.1 (2009), 297-315 (309).
  37
     Ibidem, 309.
  38
     We are aware that a critique of the hegemony of the visual in Western tradition has been made by a large
corpus of studies – from sensory studies to feminist studies. In this contribution, we refer to Lupton’s work
insofar as her analysis relates specifically to the diagnostic relationship between patient and practitioner.
  39
     Gabrys, How to Do Things with Sensors, 59.
  40
     Casini, Giving Bodies Back to Data, 207.
  41
     Ibidem, 31.
  42
     Lupton, ‘How do data come to matter?’, 8.
  43
     Cf. Ksenia Fedorova, ‘Neurointerfaces, Mental Imagery and Sensory Translation in Art and Science in the
Digital Age’, in Invisibility in Visual and Material Culture, ed. by Asbjørn Grønstad and Øyvind Vågnes (Cham:
Palgrave Macmillan, 2019), 91-109.
  44
     In fact, not only is the image digital, i.e., it has a numeric matrix that quantifies the incoming information,
but it is structured as a set of instructions entered during programming. The image thus contains an operating
code, that determines its visible output. On the question of images becoming algorithmic, thus turning into
software themselves, see Ingrid Hoelzl and Rémi Marie, Softimage. Towards a New Theory of the Digital
Image (Chicago: Intellect, 2015).
  45
     Cf. Lupton and Maslen, ‘The more-than-human sensorium’, 190-195.
  46
      Minna Ruckenstein and Mika Pantzar, ‘Beyond the quantified self: Thematic exploration of a dataistic
paradigm’, New Media & Society, 19.3 (2017), 401-418.
  47
     Gardner and Jenkins, ‘Bodily intra-actions with biometric devices’, 2.
  48
     Bleeker, Sensing data, 1090.




82                                                                   Miglio, Galimberti, Intra-Active Sense-Making
