Bringing the Body's Deepest Secrets to Light

Raymond Sze is head of imaging and radiology at Children's National Medical Center.
Raymond Sze is head of imaging and radiology at Children's National Medical Center. (By John Kelly -- The Washington Post)
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By John Kelly
Wednesday, December 3, 2008

There's no use trying to hide something from Raymond Sze. He has a way of looking right inside you. True, this sometimes requires the use of a magnetic resonance imaging machine or the injection of a radioactive isotope, but he'll leave no cell unturned as he plumbs your body's innermost secrets.

Dr. Sze (pronounced "Zee") is head of imaging and radiology at Children's National Medical Center. You know how creative artists at Disney are called Imagineers? It's a title that might fit Dr. Sze and his colleagues as well. Call them Image-ineers. If you can imagine imaging it, they will image it.

"It's sort of like Disneyland here," says Dr. Sze during a recent whirlwind tour of his domain. Instead of Frontierland, there's Fluoroscopyland. Instead of Tomorrowland, there's Nuclear Medicineland. Each tool and technology is designed to reveal a different thing, from basic anatomy (Is this bone broken?) to function (Is blood going where it's supposed to?). The department does 100,000 scans a year.

"Normal anatomy is kind of beautiful: smooth, elegant," says Dr. Sze, 46, as we pause near a CT scanner. "Disease is kind of ugly."

The things we value -- smoothness, symmetry, a pleasing proportion -- are threatened when disease takes hold. When he looks at the CT image on a screen, Dr. Sze can see that the seemingly healthy girl who's just been examined has scarring on her lungs and old surgical staples in her chest. The scan is a history of her battles with disease and reconnaissance for battles to come.

Not only does accurate imaging allow surgeons to see what they'll encounter once they get in, it can keep them from going in needlessly in the first place. Take appendicitis, which often fools doctors. "In the old days, 25 percent of the time the surgeon would go in and find nothing," Dr. Sze says. With accurate imaging, "the rate of false positives has plummeted."

In a half-lit room where radiologists are scrutinizing images on computer screens, Dr. Sze pulls up a spine. "I can move it up and down, pan it, flip it, reverse it," he says. "There's a huge host of digital things I can do."

Gone, for the most part, are big floppy X-rays in manila envelopes. Now, digital sensors record the information as ones and zeros and make the pictures available on computer screens all over the hospital. (And gone, too, is that staple of old doctor TV shows: the satisfying shunk you'd hear when an X-ray was planted on a wall-mounted lightbox. Dr. Sze says he used to be able to flip a sheet of film from six feet away.)

When the patients run from newborns to teenagers, certain adjustments have to be made. The CT tube in which patients lie is tilted at the head to protect the eyes during brain scans. That's because repeated exposure to CT radiation can cause cataracts.

"If you're 80, that's one thing; but if you're 10, it's a big deal," Dr. Sze says.

Because moving during a CT scan can blur the image, and because kids have a hard time sitting still for an hour, Children's has a sedation unit where young patients can be anaesthetized before being scanned.

And unlike most regular hospital imaging departments, Dr. Sze says, his staff looks at every image before releasing it to the patient's doctor, making sure a view hasn't been missed.

"We don't want them to have to come back," he says.

Finally, we enter MRIland, where incredibly powerful magnets help paint a picture of what's inside us.

"The magnet creates a super magnetic field that aligns the water molecules in our body," Dr. Sze explains. "It's funny, but an MRI is really singing water molecules, singing protons."

And when the body sings, Dr. Sze is listening.

I Can See Clearly Now

"I travel all over the world, and I show X-rays to other doctors," Martin Eichelberger, a Children's surgeon, told me not long ago. "The first thing they say is, 'Where'd you get the quality of those X-rays?' People just don't have this. It's artistry."

As with everyone who works at Children's, this artistry is performed regardless of a patient's ability to pay. Every year at this time, we raise money for the hospital's uncompensated care fund, which pays the medical bills of poor kids. Our goal is $500,000. So far we've raised $35,932.

To donate, write a check or money order payable to "Children's Hospital," and mail it to Washington Post Campaign, P.O. Box 17390, Baltimore, Md. 21297-1390.

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