- Assistant Professor, Medical Imaging - (Clinical Scholar Track)
Following my 5 year residency program in NW London and at the Queen's Medical Centre, University of Nottingham in the UK, I spend 2 years doing a diagnostic and interventional Neuroradiology Fellowship at the University of Nottingham. The diagnostic component of the fellowship included pediatric neuroradiolgy and head and neck radiology. The diagnositic component angiography, head and neck and spinal procedures, including vertebroplasty.During my fellowship I was elected by my peers to be the fellow representative on the British Society of Neuroradiology committee for 2 years. Following my fellowship I secured a postition as a Consultant neuroradiologist at Imperial College NHS Trust, London UK from November 2007 leaving to come to the USA in January 2013. Whilst at Imperial College NHS Trust I established an acute stroke MRI service at St Mary's hospital and was lead Pediatric Neuroradiologist. My role was primarily as a diagnostic neuroradiologist reporting neurovascular, pediatric, tumor, tertiary referral neurology, neurosurgical, spinal surgical, and head and neck radiology. My teaching commitment was to medical students, registrars in radiology, fellows and physiotherapists. I was an invited speaker on several national courses, including the prestigous Imperial College Spine Course.
- Nottingham University Medical School, England, UK
- BM BS: Nottingham University Medical School, England, 1996
- University of Arizona, Tucson, Arizona (2013 - Ongoing)
- Imperial College NHS Trust (2007 - 2013)
- Saguaro Teaching Award
- University of Arizona Medical Student Teaching Award for faculty in the department of radiology., Summer 2016
Licensure & Certification
- Arizona Medical Board License (2017)
- General Medical Council, GMC, London, UK (1996)
- Arizona Teaching Licence, Arizona Board of Medicine (2013)
I lecture and give regular formal teaching sessions to medical students, as well as fellows and residents in radiology and neurology. I have been awarded the Medical Student teaching prize twice in the Department of Medical Imaging at the University of Arizona. At University Hospital Nottingham and Imperial College I also taught Orthopaedic and Neurosurgery residents for their final FRCS examination. I have taught on nationally recognized British courses, including several Imperial College radiology courses such as the “On call” and Trauma Courses and the Imperial College Spine Course. I also teach on several University of Arizona undergraduate and post graduate courses. I also teach neuroanatomy in the dissection room at the University of Arizona and have previously taught neuroanatomy to Imperial College and University of Arizona medical students.
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- Appleton, J. P., Woodhouse, L. J., Adami, A., Becker, J. L., Berge, E., Cala, L. A., Casado, A. M., Caso, V., Christensen, H. K., Dineen, R. A., Gommans, J., Koumellis, P., Szatmari, S., Sprigg, N., Bath, P. M., Wardlaw, J. M., & , E. I. (2019). Imaging markers of small vessel disease and brain frailty, and outcomes in acute stroke. Neurology.More infoTo assess the association of baseline imaging markers of cerebral small vessel disease (SVD) and brain frailty with clinical outcome after acute stroke in the Efficacy of Nitric Oxide in Stroke (ENOS) trial.
- Zaninovich, O. A., Avila, M. J., Kay, M., Becker, J. L., Hurlbert, R. J., & Martirosyan, N. L. (2019). The role of diffusion tensor imaging in the diagnosis, prognosis, and assessment of recovery and treatment of spinal cord injury: a systematic review. Neurosurgical focus, 46(3), E7.More infoOBJECTIVEDiffusion tensor imaging (DTI) is an MRI tool that provides an objective, noninvasive, in vivo assessment of spinal cord injury (SCI). DTI is significantly better at visualizing microstructures than standard MRI sequences. In this imaging modality, the direction and amplitude of the diffusion of water molecules inside tissues is measured, and this diffusion can be measured using a variety of parameters. As a result, the potential clinical application of DTI has been studied in several spinal cord pathologies, including SCI. The aim of this study was to describe the current state of the potential clinical utility of DTI in patients with SCI and the challenges to its use as a tool in clinical practice.METHODSA search in the PubMed database was conducted for articles relating to the use of DTI in SCI. The citations of relevant articles were also searched for additional articles.RESULTSAmong the most common DTI metrics are fractional anisotropy, mean diffusivity, axial diffusivity, and radial diffusivity. Changes in these metrics reflect changes in tissue integrity. Several DTI metrics and combinations thereof have demonstrated significant correlations with clinical function both in model species and in humans. Its applications encompass the full spectrum of the clinical assessment of SCI including diagnosis, prognosis, recovery, and efficacy of treatments in both the spinal cord and potentially the brain.CONCLUSIONSDTI and its metrics have great potential to become a powerful clinical tool in SCI. However, the current limitations of DTI preclude its use beyond research and into clinical practice. Further studies are needed to significantly improve and resolve these limitations as well as to determine reliable time-specific changes in multiple DTI metrics for this tool to be used accurately and reliably in the clinical setting.
- Keerthivasan, M. B., Winegar, B., Becker, J. L., Bilgin, A., Altbach, M. I., & Saranathan, M. (2018). Clinical Utility of a Novel Ultrafast T2-Weighted Sequence for Spine Imaging. AJNR. American journal of neuroradiology, 39(8), 1568-1575.More infoTSE-based T2-weighted imaging of the spine has long scan times. This work proposes a fast imaging protocol using variable refocusing flip angles, optimized for blurring and specific absorption rate.
- Saranathan, M., Worters, P. W., Rettmann, D. W., Winegar, B., & Becker, J. (2017). Physics for clinicians: Fluid-attenuated inversion recovery (FLAIR) and double inversion recovery (DIR) Imaging. Journal of magnetic resonance imaging : JMRI, 46(6), 1590-1600.More infoA pedagogical review of fluid-attenuated inversion recovery (FLAIR) and double inversion recovery (DIR) imaging is conducted in this article. The basics of the two pulse sequences are first described, including the details of the inversion preparation and imaging sequences with accompanying mathematical formulae for choosing the inversion time in a variety of scenarios for use on clinical MRI scanners. Magnetization preparation (or T2prep), a strategy for improving image signal-to-noise ratio and contrast and reducing T weighting at high field strengths, is also described. Lastly, image artifacts commonly associated with FLAIR and DIR are described with clinical examples, to help avoid misdiagnosis.
- Erly, W. K., Becker, J. L., Inampudi, R., Hur, S. J., Nael, K., & Kubal, W. S. (2016). Fractures of the posterolateral maxillary sinus: a masticator space blowout injury?. Emergency radiology, 23(5), 439-42.More infoSegmental, depressed fractures of the posterolateral maxillary sinus may occur as a result of trauma to the masticator space, previously described in association with mandibular fractures. The authors hypothesize that the fracture is due to a transient increase in pressure in the masticator space (blow out) and therefore should be seen in association with other regional fractures.
- Grams, R. W., Kidwell, C. S., Doshi, A. H., Drake, K., Becker, J., Coull, B. M., & Nael, K. (2016). Tissue-Negative Transient Ischemic Attack: Is There a Role for Perfusion MRI?. AJR. American journal of roentgenology, 207(1), 157-62.More infoApproximately 60% of patients with a clinical transient ischemic attack (TIA) do not have DWI evidence of cerebral ischemia. The purpose of this study was to assess the added diagnostic value of perfusion MRI in the evaluation of patients with TIA who have normal DWI findings.
- Grams, R., Kidwell, S. M., Drake, K. W., Becker, J., Coull, B. M., & Nael, K. (2016). Tissue Negative-Transient Ischemic Attack: Is There a Role for MRI Perfusion?. American Journal of Roentgenology.
- Krishnan, K., Scutt, P., Woodhouse, L., Adami, A., Becker, J. L., Cala, L. A., Casado, A. M., Chen, C., Dineen, R. A., Gommans, J., Koumellis, P., Christensen, H., Collins, R., Czlonkowska, A., Lees, K. R., Ntaios, G., Ozturk, S., Phillips, S. J., Sprigg, N., , Szatmari, S., et al. (2016). Continuing versus Stopping Prestroke Antihypertensive Therapy in Acute Intracerebral Hemorrhage: A Subgroup Analysis of the Efficacy of Nitric Oxide in Stroke Trial. Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association, 25(5), 1017-26.More infoMore than 50% of patients with acute intracerebral hemorrhage (ICH) are taking antihypertensive drugs before ictus. Although antihypertensive therapy should be given long term for secondary prevention, whether to continue or stop such treatment during the acute phase of ICH remains unclear, a question that was addressed in the Efficacy of Nitric Oxide in Stroke (ENOS) trial.
- Becker, J. (2015). Neuroradiology: The Essentials with MR and CT. Journal of Magnetic Resonance Imaging, 42, 1203--1204.
- Krishnan, K., Mukhtar, S. F., Lingard, J., Houlton, A., Walker, E., Jones, T., Sprigg, N., Cala, L. A., Becker, J. L., Dineen, R. A., Koumellis, P., Adami, A., Casado, A. M., Bath, P. M., & Wardlaw, J. M. (2015). Performance characteristics of methods for quantifying spontaneous intracerebral haemorrhage: data from the Efficacy of Nitric Oxide in Stroke (ENOS) trial. Journal of neurology, neurosurgery, and psychiatry, 86(11), 1258-66.More infoPoor prognosis after intracerebral haemorrhage (ICH) is related to haemorrhage characteristics. Along with developing therapeutic interventions, we sought to understand the performance of haemorrhage descriptors in large clinical trials.
- Krishnan, K., Scutt, P., Woodhouse, L., Adami, A., Becker, J. L., Berge, E., Cala, L. A., Casado, A. M., Caso, V., Chen, C., Christensen, H., Collins, R., Czlonkowska, A., Dineen, R. A., Gommans, J., Koumellis, P., Lees, K. R., Ntaios, G., Ozturk, S., , Phillips, S. J., et al. (2016). Glyceryl Trinitrate for Acute Intracerebral Hemorrhage: Results From the Efficacy of Nitric Oxide in Stroke (ENOS) Trial, a Subgroup Analysis. Stroke; a journal of cerebral circulation, 47(1), 44-52.More infoThe Efficacy of Nitric Oxide in Stroke (ENOS) trial found that transdermal glyceryl trinitrate (GTN, a nitric oxide donor) lowered blood pressure but did not improve functional outcome in patients with acute stroke. However, GTN was associated with improved outcome if patients were randomized within 6 hours of stroke onset.
- Salameh, A., Bello, N., Becker, J., & Zangeneh, T. (2015). Fatal Granulomatous Amoebic Encephalitis Caused by Acanthamoeba in a Patient With Kidney Transplant: A Case Report. Open forum infectious diseases, 2(3), ofv104.More infoGranulomatous amoebic encephalitis (GAE) due to Acanthamoeba is almost a uniformly fatal infection in immune-compromised hosts despite multidrug combination therapy. We report a case of GAE in a female who received a deceased donor kidney graft. She was treated with a combination of miltefosine, pentamidine, sulfadiazine, fluconazole, flucytosine, and azithromycin.
- Vedelago, J., Dick, E., Thomas, R., Jones, B., Kirmi, O., Becker, J., Alavi, A., & Gedroyc, W. (2014). Look away: arterial and venous intravascular embolisation following shotgun injury. Journal of trauma management & outcomes, 8, 19.More infoWe describe two cases of intravascular embolization of shotgun pellets found distant to the entry site of penetrating firearm injury. The cases demonstrate antegrade embolization of a shotgun pellet from neck to right middle cerebral artery, and antegrade followed by retrograde venous embolization through the left lower limb to pelvis. Radiologists and Trauma Physicians should be aware that post shotgun injury, the likelihood of an embolised shot pellet is increased compared to other types of firearm missile injury, and should therefore search away from the site of injury to find such missiles. Shotgun pellets may travel in an antegrade or a retrograde intravascular direction - both were seen in these cases - and may not be clinically obvious. This underscores the importance of a meticuluous search through all images, including CT scout images, for evidence of their presence.
- Rajeswaran, G., Becker, J. L., Michailidis, C., Pozniak, A. L., & Padley, S. P. (2006). The radiology of IRIS (immune reconstitution inflammatory syndrome) in patients with mycobacterial tuberculosis and HIV co-infection: Appearances in 11 patients. Clinical radiology, 61(10), 833-43.More infoTo determine the radiological manifestations of IRIS (immune reconstitution inflammatory syndrome) in patients with HIV and mycobacterium tuberculosis co-infection, in the context of their demographic and clinical data.
- Altbach, M. I., Mandava, S., Johnson, K., Li, Z., Keerthivasan, M. B., Becker, J., Bilgin, A., Weinkauf, C. C., Altbach, M. I., Mandava, S., Johnson, K., Li, Z., Keerthivasan, M. B., Becker, J., Bilgin, A., & Weinkauf, C. C. (2018, June). Rapid Carotid Artery T2 and T1 Mapping Using a Radial TSE and IR-FLASH Approach. In 2018 Meeting of the International Society for Magnetic Resonance in Medicine.
- Saranathan, M., Altbach, M. I., Becker, J., Martin, D. R., Bilgin, A., & Keerthivasan, M. B. (2017, May). Clinical utility of a novel ultrafast T2 Weighted sequence for Spine Imaging.. In 25th Annual meeting of ISMRM, 538.
- Becker, J., Kubal, W. S., Hur, S., Khan, R., Inampudi, R., Carmody, R. F., Gilbertson-Dahdal, D., Buckner, R., & Nael, K. (2015, April 2015). The Utility of a Rapid 13-Minute MRI Protocol for Evaluation of the Pediatric Brain Following Intracranial Trauma. American Society of Neuroradiology Meeting. Chicago, IL: American Society of Neuroradiology.
- Becker, J., Martirosyan, N. L., Choudhary, G., Krupinski, E. A., Erly, W. K., & Kubal, W. S. (2015, April 2015). Feasibility Study to Assess Diffusion Tensor Imaging for Evaluation of Acute Traumatic Cervical Cord Injury. American Society of Neuroradiology Meeting. Chicago, IL: American Society of Neuroradiology.
- Erly, W. K., Becker, J., Chokr, J., Choudhary, G., Winegar, B. A., & Erly, S. (2017, October). Analysis of diagnostic yield of MR sequence combinations in patients from the ER. WNRS annual meeting. Kauai, HI: Western neuroradiological society.
- Udayasankar, U., Becker, J., Khan, R., Winegar, B., L, F., Hinkel, T., & Patel, V. (2017, November). Pain in the Neck: Tales from the ED. Radiological Society of North America. Chicago, IL: RSNA.
- Kubal, W. S., Becker, J., Erly, W. K., Nael, K., & Inampudi, R. (2015, April). Masticator Blow-out Fracture, a Previously Unappreciated Fracture of the Lateral Maxillary Sinus.. American Society of Neuroradiology. Chicago, IL: American Society of Neuroradiology.