Summary and reflection on 'Technology as an Occasion for Structuring: Evidence from Observations of CT Scanners and the Social Order of Radiology Departments'

Past research has explored the relationship between technology and structure, proposing two main conceptualizations of structure. Some scholars argue that technology is typically viewed as a material cause, with a fixed relationship between technology and structure that is unaffected by the environment. This perspective leads researchers to analyze the impact of technology on structure at the organizational level, commonly reflected in the concept of "technological determinism." On the other hand, some scholars contend that structure is a pattern of action, interaction, and cognition, emphasizing that structure is the result of human activity rather than an entity independent of these activities. Finally, a portion of scholars attempt to integrate these two perspectives, suggesting that structure is a dual concept of both process and form. This means that structure both reflects and constrains action, while simultaneously being continuously reshaped by that action, thereby revealing the dynamic relationship between institutions and actions.

Due to the multiple perspectives on the relationship between technology and structure, as well as the existing evidence being somewhat chaotic, this study aims to explore the relationship between technology and structuring by focusing on the introduction of CT scanners as a new technology into the radiology departments of two different hospitals.

METHODOLOGY

The study involved a field trial of the changes in personnel structure and relationships following the introduction of CT scanners into the radiology departments. Specifically, it detailed the introduction of identical CT scanners into two hospitals, where both departments had the same personnel structure.

TRADITIONAL RADIOLOGIST-TECHNOLOGIST RELATIONSHIP

Radiologists hold a dominant position in their relationship with technologists, with authority highly centralized. In the medical field, radiologists have gained the exclusive right to interpret medical images, a power achieved by excluding other professionals (such as physicists and engineers) and prohibiting other physicians from interpreting images. Radiology technologists are typically responsible for managing patient examinations and producing images for radiologists. While technologists are trained to operate equipment and recognize anatomical structures, they have not received training in image interpretation. Consequently, even experienced technologists have relatively limited abilities in identifying pathologies on X-ray images. In contrast, radiologists receive dual training in both

equipment operation and image interpretation. In practice, radiologists issue commands that technologists carry out, usually without hesitation.

DIVISION OF LABOR AND COOPERATION IN CT DEPARTMENTS TODAY

Before presenting the research findings, I will first provide a brief overview of the workflows and division of responsibilities between radiologists and technicians in a mature CT department. This context will facilitate a clearer understanding of the subsequent discussion—namely, the interactions between radiologists and technicians and the structuring process following the introduction of CT technology in Hospitals A and B.

In modern CT departments, radiologists and technicians have clearly defined roles and collaborate closely. First, radiologists establish scanning protocols based on examination requirements, setting parameters such as the area, thickness, and use of contrast agents to ensure the images meet diagnostic standards. Next, CT technicians are responsible for executing the specific operations, including positioning the patient, setting device parameters, and monitoring the scanning process, all while ensuring patient safety and comfort. After image acquisition, technicians perform an initial assessment of image quality; if the images are unclear, they adjust the parameters and rescan. Subsequently, radiologists conduct a detailed interpretation of the acquired images, identifying lesions and writing diagnostic reports for the referring physicians.

THE STRUCTURING OF A’S CT OPERATION

The collaborative structure that emerged at Hospital A differs from the traditional hierarchical relationship between radiologists and technologists, where, in this case, technologists gained greater autonomy.

Phase 1: Negotiation of Discretion

The staff at Hospital A lacked experience with CT scanning. To address this, the hospital reassigned two internal X-ray technicians to the CT department and hired an additional radiologist, who had completed specialized CT training, along with two experienced technicians, forming a new CT examination team.

Since the department was newly established and lacked standard procedures or defined roles, the initial weeks of CT operation focused on clarifying responsibilities among staff. During these early scans, CT technologists typically acted independently without seeking the experienced radiologist’s approval, such as deciding on set parameters for a scan area. In certain instances, however, the radiologist would question a technologist’s decision, often by asking for information or an explanation of their actions. The technologists would then justify their approach, and the radiologist would usually endorse their choice. Additionally, their dialogue process typically consists of the following steps: (1) the technician poses questions and potential solutions; (2) the radiologist provides direct answers; (3) the technician outlines the next steps in their action plan; (4) the radiologist confirms whether the technician’s plan is appropriate. Since the questions assume answers, they are often posed by experienced technicians who are better able to demonstrate their knowledge of the scanning process.

Such interactions reaffirm the radiologists’ greater authority and expertise in traditional contexts, while also validating the technicians’ claims to professional knowledge. As technological strategies become more responsive and capable, radiologists begin to grant them greater discretion. This creates an environment that is closer to the ideal, where all professional roles are coordinated effectively. Consequently, radiologists are increasingly less involved in routine decision-making.

Phase 2: Maintaining autonomy

In the first three weeks of the scanner’s operation, the inexperienced radiologists occasionally participated in scans, while the newly hired radiologist was always present and took charge. Their interactions with the technologists were limited, often posing questions through their more experienced colleagues, which created a covert teaching dynamic. As the radiologists decided to rotate CT duties, the role relationships changed, breaking the previous interaction patterns. Technologists responded to the radiologists’ incorrect questions or preferences using covert teaching methods to avoid causing offense. Although the radiologists generally refrained from discussing interpretive matters with the technologists, they occasionally had to consult them in urgent situations. This led to a reversal of roles, with radiologists beginning to directly ask technologists about pathologies, thus disrupting the traditional flow of knowledge.

When machine malfunctions occur, inexperienced radiologists mistakenly attribute the issue to the incompetence or insufficient technical skills of the technologists, leading to a shift in the interaction order. Radiologists often state or inquire about problems while insinuating that the technologists are at fault, ultimately rejecting the technologists’ explanations that the issue lies with the technology. This trend undermines the moral authority of radiologists, resulting in technologists developing disdain for the inexperienced radiologists. Technologists perceive the radiologists as lacking knowledge, which increases unnecessary work and disrupts the smooth operation of the CT process. Concurrently, radiologists feel anxious due to this perception of inadequacy and begin to exhibit hostility toward the technologists. To mitigate these feelings, technologists gradually take on more decision-making responsibilities, while radiologists reduce their involvement in day-to-day operations to save face. Ultimately, the CT technologists at Hospital A gain considerable autonomy in their routine work.

THE STRUCTURING OF B’S CT OPERATION

Phase 1: Negotiating Dependence

Two months before the scanner arrived, Hospital B hired a radiologist specialized in CT scanning. Meanwhile, a long-standing radiologist in the department was responsible for organizing the operation of the scanner. The team of technicians consisted of four members from the head scanning team and four from other areas.

At Hospital B, the arrival of the scanner marked the first phase of structuring in personnel decisions, but the interaction pattern was vastly different from that of Hospital A. Since all the technologists were novices in body scanning, the radiologists trained them by giving directions. The daily interaction between radiologists and technologists is typically based on a command-action sequence. Radiologists often do not clearly communicate their preferences before technologists take action, which makes it difficult for the technologists to understand and learn during practical operations. Radiologists frequently adjust their instructions while reviewing patient images, and this one-way communication fails to effectively train the technologists, instead continuously reinforcing the authority of the radiologists. In this environment, giving directions becomes the only form of communication between radiologists and technologists, lacking detailed reasoning and explanations, which hinders the development of the technologists’ skills.

In the early phases of structuring at the urban hospital, the interaction between radiologists and technologists primarily manifested as a request for guidance. Technologists would ask radiologists for appropriate courses of action when unsure about what to do, and the radiologists would provide instructions. This interaction not only helped technologists learn but also reinforced the authority of the radiologists, leading to a perception of arbitrariness in the work environment. Over time, technologists gradually stopped proactively asking what to do and instead began to focus on the

radiologists’ personal preferences, further deepening their reliance on the radiologists’ authority. Ultimately, this interaction pattern solidified the radiologists’ control and the technologists’ dependent roles.

Phase 2 and 3:Constructing and Ensuring Ineptitude

At the end of the fourth week of operation, the radiologists implemented a new duty system, assigning technologists to staggered two-week shifts and deciding to spend more time in the office to reduce the technologists’ dependency. However, the radiologists’ absence did not boost the technologists’ confidence; instead, it forced them to choose between acting independently and risking mistakes or seeking guidance and appearing ignorant. Due to this physical separation, technologists had to walk to the radiologists’ office to ask questions, which made the radiologists feel irritated and respond sarcastically to their inquiries. This led to a new interaction pattern characterized by accusatory questioning, where radiologists began to doubt the technologists’ abilities. This dynamic deepened the technologists’ reliance, prompting the radiologists to ultimately return to the control room to reestablish traditional interaction roles.

Phase 4: Toward Independence

In the sixteenth week, Hospital B implemented a new duty system, reassigning several new technologists and allowing experienced radiologists to return to work in other areas. This change marked the emergence of a fourth phase of structuring, during which inexperienced radiologists began actively seeking technical assistance from technologists, thereby reversing the previous interaction pattern. Radiologists were no longer just issuing commands; instead, they consulted with technologists, who gradually became the guides. As a result, both parties started to participate jointly in decision-making, enhancing their mutual professionalism, and this new interaction pattern was termed “mutual execution.” As these interactions became more frequent, the control exerted by radiologists gradually relaxed, leading to a more flexible role relationship characterized by a complementary skill set. However, due to the earlier dependence of technologists on radiologists, they had psychologically accustomed themselves to this submissive relationship. Even in the new interaction mode of mutual execution, they continued to maintain a deep-seated respect for the radiologists’ profession.

Conclusion

Viewing technology as a catalyst for structuring reveals a paradox: identical technologies can lead to similar dynamics but yield different outcomes. Despite similar role changes within departments at two hospitals, differing formal properties in their interaction orders produced entirely distinct structures. This analysis shows that the structuring process is shaped by the interactions among social roles rather than the technology itself.

Overall, structuring theory posits that uncertainty and complexity associated with technology are socially constructed and vary by context. While technology does influence organizational dynamics, its impact depends on specific historical processes. Predicting the influence of technology on organizational structure requires considering contextual factors and creating a taxonomy of scripts to explain how expertise is distributed and adapted in daily interactions. Structuring theory uses historical timelines to understand social processes, emphasizing that structure is an outcome of ongoing interactions.

Reflection

This article gave me a deeper understanding of technology’s role in organizational structures—not as a simple tool or static external factor, but as a dynamic social catalyst. Through its analysis of two radiology departments, the article shows how identical CT scanning technology can drive diverse structural outcomes depending on differing social contexts. The departments experienced distinct structural evolutions due to variations in role interactions, expertise distribution, and historical context. Structuring theory’s concept that “technological uncertainty and complexity are socially constructed” challenges traditional linear causal thinking and emphasizes the context-dependent nature of technological impact. This perspective encourages me to look beyond the features of the technology itself and to grasp its role and significance within specific social systems when considering its organizational effects. Reflecting on this, I realize that introducing new technology requires attention not only to its technical deployment but also to how it integrates with team roles and interactions, ultimately enabling a more effective fusion of technology and organizational structure.