DEPARTMENT OF DIAGNOSTIC RADIOLOGY


Dr. med. habil. Dávid László Tárnoki, MD, PhD

Centre head

Dr. med. habil. Ádám Domonkos Tárnoki, MD, PhD

Head of radiology department



Centre head: Dr. med. habil. Dávid László Tárnoki, MD, PhD

Head of radiology department: Dr. med. habil. Ádám Domonkos Tárnoki, MD, PhD

Deputy head of radiology department: Mátyás Ujlaki, MD

Head of X-ray lab: Sándor Manninger, MD, PhD

Head of ultrasound lab: Zsófia Barta, MD

Head of mammography lab: Rita Fülöp, MD

Head of CT lab: Katalin Horváth, MD

Head of MRI lab: Katalin Horváth, MD

Head of interventional lab: Péter Szavcsur, MD

Radiology secretary: Viktória Joó, Annamária Joó. Email: rtg.titkarsag@oncol.hu   


Head of nuclear medicine department: István Sinkovics, MD 

PET/CT lab: Prof. Dr. Katalin Borbély, PhD

In 2016 a new, cutting-edge fluoroscopy machine and three X-rays have been installed suitable for digital storage.
The integrated Department of X-ray Diagnostics was established in 1977, where the staff swapped between the inpatient and outpatient ward on a weekly basis.
Since January 1, 1997 Mária Gődény MD is in charge of the department as Chief Physician, Head of Department. Over the years, significant developments and changes have occurred at the department. Ultrasound devices have been replaced. In autumn 1999, the CT site building (No 18) has been reconstructed to make plenty of room for the new spiral CT and MRI equipment. In 2012, our department has obtained a new angiography machine (ARTIS, DSA) by an application, which plays a key role in the treatment of oncological diseases. In 2012, breast diagnostics (mammography, breast ultrasound) and breast cancer screening have been relocated to the 1st floor of Building No 14, where patients are welcome in waiting rooms and examination rooms with modern design. In 2013, a new 3-tesla MRI scanner (Discovery MR750W 3.0T) has been deployed, which provides advanced diagnostic options for cancer patients. In 2016 a new, cutting-edge fluoroscopy machine and three X-rays have been installed suitable for digital storage. In 2017, the old CT was replaced by a 128-slice GE CT scanner and a second 64-slice Siemens CT scanner was also installed. As the part of a large-scale project with many financial sacrifices, we managed to install the picture archiving and communication system (PACS) in 2004, which was further expanded and updated in 2011
Our work involves the detection of oncological and other pathological lesions. We play a major role in diagnosing and staging oncologic diseases, as well as in the evaluation of treatment response.

General information to the patients

The objective of imaging techniques is to identify or exclude neoplastic lesions, thereby determine the stage of the disease. These methods help us decide on treatment options as they provide precise information on size, location, and stage of lesions. These techniques are also used in the assessment of treatment effectiveness and post-treatment patient follow-up for the early detection of recurrent tumors. If radiotherapy is the treatment of choice, imaging methods help in targeting and distribution of the planned amount of radiation dose.

Imaging procedures utilize radiations with different wave characteristics enabling the visualization of the human body and the detection of the tumor. These are electromagnetic radiations with different wavelength and frequency.

Computer-assisted techniques (ultrasonography, computed tomography, and magnetic resonance imaging) have taken over the place of conventional radiography in tumor assessment. Angiography provides data on the vasculature of tumors, and in some cases, targeted therapy (cytostatic drugs) of the lesions is possible through blood vessels. No imaging method can surpass the accuracy of histologic findings, though in some cases the benign or malignant nature of the lesion may be inferred. In some cases image-guided cell or tissue sampling is possible.

Imaging studies are indicated by the treating physician. Definitive diagnosis can be established only with the cooperation of the treating physician and the diagnostician (radiologist). Therefore, if you have any complaints or suspicions related to the disease, please, consult your treating physician first. If you do not have a treating physician, schedule an appointment at the competent clinic as instructed by your GP to choose the adequate imaging modality. Careful consideration is particularly important in the case of scans with radiation exposure in order to avoid causeless and unreasonable examinations and to establish the accurate diagnosis with the highest efficiency - as soon as possible.

With the exception of conventional X-rays, each examination is performed on a scheduled appointment. Emergency examinations, of course, are given priority over other scans. Examinations start at 8 AM with the exception of CT and MRI, where scans begin at 7 AM.

We expect patients with a scheduled appointment to arrive on time to ensure continuous workflow. We are committed to keep the scheduled appointments, but partly due to unforeseen urgent examinations, and partly due to difficulties encountered during normal scans delays are not uncommon. We appreciate your patience and understanding.

The results of studies are presented in findings, which are available immediately after the examination in the case of X-rays, fluoroscopy, ultrasonography and mammography; whereas CT, MRI, and angiography findings are available three workdays following the examination.

Some scans require your written consent. You will be informed on the potential risks that may arise during the examinations. If anything is not clear for you, feel free to discuss it with our colleagues.

• If you are pregnant, please, notify us of this information in advance. • Always bring your previous medical records, findings, and discharge summaries. If you received an image of a previous examination, please, bring it as well.

Departments

Conventional X-ray Imaging

The simplest imaging technique is the system of conventional X-ray images:
To distinguish tissues from each other in a conventional X-ray image, their ray absorption (proportional to density) should differ by at least 10%. The density of soft tissues and bone tissues differ by 80-90%, whereas the disparity between adipose tissues and other soft tissues is only 10%. It is easier to separate soft tissue organs or muscle groups if they are surrounded by adipose tissue. High density white shadow is produced by calcifications and calcareous structures, thus by calcified tumors. In the esophagus X-ray, swallow examination you are asked to drink contrast agent. During the upper gastrointestinal series, the inner surface of the esophagus, stomach, duodenum and small bowels can be visualized by this method enabling the examination of pathological lesions.

Ultrasonography

Conventional ultrasonography shows the human body in very thin "slices". Recent techniques enable the spatial visualization of the scanned area, which is known as the so-called 3D technology. 4D technology represents the spatial image in motion (the latter stands for the fourth dimension). Doppler ultrasound can be performed separately or as part of conventional ultrasonography. Doppler ultrasound is a special method which is suitable for the analysis of blood in motion. Status of the blood vessels and certain circulation parameters can be examined with the use of Doppler US. Doppler ultrasound may help in the detection of blood clots in blood vessels (deep vein thrombosis), in the examination of vascular stenosis (carotid and limb arteries), as well as in the observation of blood vessels in inflammatory lesions and tumors.

Some US scans are carried out by a specially designed small transducer inserted into the cavity situated closer to the target organ for more accurate imaging and higher resolution.

These include:
• Transvaginal US for more accurate assessment of female genitalia
• Transrectal US for more accurate assessment of the prostate through the rectum
• Intrarectal US for more accurate assessment of the rectum (note that rectal tumors away from the anus by more than 10 cm, and large tumors causing significant narrowing of the rectum cannot be observed by this method)
In addition, US can be used for:
• Guiding interventions, targeted tissue (biopsy) or cytological (FNAB = fine needle aspiration biopsy) sampling of lesions.

Mammography

Mammography is a scanning method developed for the examination of breasts during which plain X-ray images of the female mammae are acquired. The major role of mammography is the detection of breast cancer. Clinical mammography stands for the examination of patients with complaints and symptoms (referral and appointment are required). We are engaged in screening programs of asymptomatic patients, primarily in the organized breast cancer screening campaign of the population. Radiologists are looking for asymptomatic, early-stage tumors with screening. The screening mammography is performed bianually among women in the age group of 45-65 years. In case a lesion is detected in a mammogram, additional examinations will be necessary. Multi-directional enlarged images are obtained, an ultrasound is performed, and if necessary, a biopsy will be carried out with the consent of the patient. Cell sampling is a type of biopsy with results available within an hour. Another method is called core biopsy, which provides histology results. However, the assessment of this sample takes several days. In some cases it may be necessary to perform a breast MRI (magnetic resonance imaging), which is carried out in prone position with the use of intravenous contrast medium.

Computer Tomography (CT)

CT is an imaging technique during which - in most cases - transverse slices of the human body are acquired. This method brought a whole new perspective in the field of radiology. Even subtle differences of ray absorption can be recognized in a CT image enabling excellent soft tissue diagnostics. Soft tissue diagnostics can be further enhanced by using intravenous contrast agents. It is easier to determine the nature of a lesion with a CT scan. Thanks to radiodensity the structure and tissue composition of a lesion can be more accurately assessed in comparison with conventional X-ray technology. CT has become the first-line diagnostic method for the examination of central nervous system, as well as the human body as a whole. One of its disadvantages is that the patient is exposed to radiation during the scan.
Multiple contrast agents can be used during a CT examination. To visualize the gastrointestinal tract, the patient is asked to drink a liquid containing contrast material. if you are aware of iodine sensitivity, hyperthyroidism or you experienced sickness and rash during previous scans with contrast material (angiography, pyelography, and cholangiography), please, let us now in advance. You are expected to notify our staff of any other allergic complications.
Allergy symptoms can be alleviated by administering intravenous injection and infusion. Please, tell us immediately if you have any complaints during the administration of the contrast material, during or after the scan throughout the mandatory waiting period.
Duration of the scan is approximately 10-20 minutes.
Since the data obtained during the scan require further computer-assisted processing and evaluation, the finding won’t be available immediately after the procedure. If you wish to receive more information, feel free to ask the interpreting physician or the assistant.
After the scan, you will be informed on when and how will you or your treating/referring physician receive the findings.

Magnetic Resonance Imaging (MRI)

The scan is performed in a magnetic field applying radio frequency waves. MR images reflect primarily water content. Several tissue components can be analyzed by changing the measurement mode (sequence). MRI is the best method at soft tissue imaging. Since flow can be visualized by MRI, accurate data may be obtained on the lesion’s vasculature and its location related to blood vessels. It is a technique without ionizing radiation, thus, it does not have harmful biological effects according to our present knowledge.
According to current scientific knowledge MRI is not harmful to living organisms, however, if you are pregnant, please, notify our staff of this information in advance. Do not eat 3 hours before an abdominal or pelvic MRI, but you can drink and take your medications.
You will be called by our assistant, who will maintain direct contact with you throughout the scan. Please, confide in the assistant and answer his/her questions specifically. Please, give him/her your medical records, X-ray films, and previous discharge summaries to provide the interpreting physician with as much information as possible. Your permission is required to copy your findings and discharge summaries.
Please, carefully read the patient information sheet, then, fill out and sign the informed consent form.
The study lasts 30 minutes on average. Periodic sound effects are caused by measurements during the scan. Measurement noise is often disturbing, thus it is attenuated by earmuffs, earphones or earplugs.
Some patients receive intravenous contrast material during the scan, as some lesions can be accurately assessed using this method. Tell us, if contrast agent allergy occurred during a previous MRI scan, if any drug made you sick or you are aware of sensitivity to whatever active agent. Please, tell us immediately if you have any complaints during the administration of the contrast material, during or after the scan.
Since the data obtained during the scan require further computer-assisted processing and evaluation, the finding won’t be available immediately after the procedure. After the scan, you will be informed on when and how will you or your treating/referring physician receive the findings.

Interventional processes

Specific intervention procedures are also included among the tasks of the Department of Diagnostic Radiology.
The following image-guided interventions are performed at our department:
Guided interventions:
- Diagnostic sampling for cytology, histology, bacteriology (less common) or other lab testst.
Mostly involved regions and organs for using diagnostic sampling:
Peripheral lymph nodes, superficial soft tissues, thyroid gland, salivary glands, breast, thoracic wall, and extremity soft tissues.
Parenchymal organs in body cavities: liver, retroperitoneum, kidneys, abdominal space-occupying lesions, lungs in the chest, mediastinum.
Modalities: used for image-guided procedures: US, CT, rtg mammograph
- Therapeutic interventions: fluid tap, abscess drainage, liver RFTA (radio frekvention tumor ablation)
The patient is asked to sign the informed consent form after providing him/her with sufficient information. It should be taken into consideration that the procedures cannot be applied in all cases, especially with a therapeutic indication. Therefore, prior consultations with the treating physician are required, and if necessary, a multidisciplinary discussion is advised.
Interventions involving superficial soft tissues may be performed on an outpatient basis.
If the intervention involves a parenchymal organ, body cavity or a serous membrane, hospital monitoring is required for a day after the intervention. Blood work and coagulation tests are also necessary prior to the procedure (serum prothrombin, coagulogram) In such cases, a preliminary assessment is indicated to determine the most adequate technique for targeting

Angiography

Angiography is an X-ray technique acquiring series of images after filling the blood vessels with contrast agent. During angiography a catheter must be inserted in the proper blood vessel, which in most cases is the femoral artery. Less frequently, the intervention is conducted on the axillary artery.
Angiography plays a partly diagnostic, partly therapeutic role. Since the advent of ultrasound, computer tomography and magnetic resonance imaging, the use of angiography in diagnostics has decreased, however, it is becoming more common as a therapeutic intervention. By the means of angiography cytostatic agents can be administered in the blood vessels supplying the tumour, pathological vessels can be occluded, and vital blood vessels – which are infiltrated by the tumor – can be dilated.

Physicians, fellow workers

Dr. Gődény Mária – Chief Physician, Head of Department
Dr. Petri Klára – Chief Physician, Vice Head of Department
Fábiánné Kiss Szilvia – Head Assistant

Secretary
• Paizs Márta

Engineers
• Bíró Erzsébet Gyöngyvirág
• Zömbik Viktor

Physicians
• Dr. Andi Judit
• Dr. Bahéry Mária
• Dr. Barta Zsófia
• Dr. Bata Orsolya
• Dr. Bidlek Mária
• Dr. Bőcs Katalin
• Dr. Csemez Imre
• Dr. Fehér Terézia
• Dr. Horváth Katalin
• Dr. Jederán Éva
• Dr. Kovács Eszter
• Dr. Léránt Gergely
• Dr. Lóránd Ágnes
• Dr. Manninger Sándor
• Dr. Palócz Edina
• Dr. Simon Péter
• Dr. Szavcsur Péter
• Dr. Tamás Krisztina
• Dr. Tóth Eszter
• Dr. Ujlaki Mátyás

Residents
• Dr. Bitai Zsuzsanna
• Dr. Csernus Réka
• Dr. Fehér György
• Dr. Heintz Ádám
• Dr. Horváth Barnabás
• Dr. Kissik Imre
• Dr. Kun Sarolt
• Dr. Laszip Luca
• Dr. Nyemecz Dorottya
• Dr. Perjési Eszter
• Dr. Róna Ágnes
• Dr. Somorácz-Kiss Dóra
• Dr. Szalontai László

Radiographers and assistans
X-ray Dept.

• Révész Csilla – Head of Assistant
• Bakos Judit
• Bollókné Homonnay Erzsébet
• Buchinger Rita
• Bruckner Éva
• Dobi Krisztina
• Dr. Dolgosné Farkas Edina
• Gerendai Tamásné
• Kovács Szabina
• Mészáros Judit
• Nagyné Tóth Judit
• Patacsi Vivien
• Sebestyén Ildikó
• Sutyák Helga
• Szabóné Varga Márta
• Tóth Anett
• Tóth Dominika
• Utassy Regina
• Villányi Edit

Mammography Dept.
• Károly Beatrix – Head Assistant
• Boros Lászlóné
• Deák Gabriella
• Gulyás Zoltánné
• Kis Zita
• Molnár Anikó
• Novák Melinda
• Reitmann Katalin
• Simonné Muhari Ágnes
• Vatai Ildikó
• Vári Józsefné

CT-MRI Dept.
• Bauer Andrea – Head Assistant
• Antal Anita
• Cseri Zsolt
• Falta Emese
• Garai Gabriella
• Janiga Ildikó
• Laczik Krisztina
• Reitmann Judit
• Szabados Eszter
• Kótiné Fléger Viktória
• Nagy Nikolett
• Pataki Attila
• Toplák Tímea
• Kőrösi Eszter
• Fleckenstein Sándorné
• Lévai Anna
• Polgárné Mayer Ildikó
• Madarász Tiborné
• Dinnyés Veronika
• Farkas Flóra
• Korb Annamária
• Völgyesi Tilda
• Tóth Erika

Dr Gődény Mária
From 1990, she was given the opportunity to learn about magnetic resonance (MR) diagnostics and compare CT and MR imaging at the Central Radiology Department of Semmelweis University led by Professor László Szlávy. She was the first one in Hungary to develop the CT and MR protocols for head and neck imaging. Results obtained during the research enabled her to defend her thesis in 1993 on the "role of CT and MR scans in the evaluation of nasal and sinus inflammations.
In 1996, she received the Fulbright Fellowship with the application titled "State-of-the-art Imaging in Head and Neck Cancer" enabling her to spend four months at the UCSF (University California San Francisco) Department of Neuroradiology led by Prof. W.P. Dillon.
From January 1, 1997 she is the Head of the Department of Diagnostic Radiology at the National Institute of Oncology, Budapest.
Since 2006 she takes part regularly in graduate, postgraduate and PhD education at the University of Medicine and Pharmacy of Târgu Mureş, Romania. Since 2009 she has been associate professor of the Department of Medical Training and Research and supervisor of the Doctoral School at the same university. Her PhD students, Dr. Katalin Horváth and Dr. Éva Jederán successfully defended the results of their research in 2013.
Since 2009 she has also been the supervisor of the Doctoral School of University of Pécs.
From 1986 she has been a regular lecturer at congresses, postgraduate and graduate courses in head and neck and other topics of oncoradiology.
Since 1997, she is regularly organizing national and international conferences, multidisciplinary courses and congresses on various topics of oncoradiology (including 4 international conferences and 58 domestic courses).
She is member and board member of several Hungarian and international medical societies.
She was the chairman of the Hungarian Society of Oncologists between 2011 and 2013.
She has received several honors, among others the commemorative medal of Béla Alexander, the commemorative medal of Pál Kisfaludi, the commemorative ring of OOI Pro Patiente, the Lajos Markusovszky award for publishing an article in the Orvosok Hetilapja in 2012, MOT Krompecher award.
In 2017 she acquired the title Doctor of the Hungarian Academy of Sciences. Title of her dissertation: The role of multiparametric MR imaging in determining prognostic and predictive factors in head and neck tumors, as well as in the major tumor groups of the pelvis.

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