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AI-Based Risk Model Leverages Mammograms for Personalized Breast Cancer Screening

By MedImaging International staff writers
Posted on 21 Jan 2022

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A new technology for creating risk-based screening guidelines use machine learning to provide personalized breast cancer screening.

Tempo, developed by scientists from MIT’s Computer Science and Artificial Intelligence Laboratory (CSAIL) and Jameel Clinic for Machine Learning and Health (Cambridge MA, USA), uses an AI-based risk model that looks at who was screened and when they got diagnosed to recommend a patient return for a mammogram at a specific time point in the future, like six months or three years. The same Tempo policy can be easily adapted to a wide range of possible screening preferences, which would let clinicians pick their desired early detection to screening cost trade-off, without training new policies.

While mammograms are currently the gold standard in breast cancer screening, swirls of controversy exist: advocates argue for the ability to save lives, (women 60-69 had a 33% lower risk of dying compared to those who didn’t get mammograms), and another camp argues about costly and potentially traumatic false positives (a meta-analysis of three randomized trials found a 19% over-diagnosis rate from mammography). Even with some saved lives, and some overtreatment and overscreening, current guidelines are still a catch all: women aged 45 to 54 should get mammograms every year. While personalized screening has long been thought of as the answer, tools that can leverage the troves of data to do this lag behind.

Early uses of AI in medicine stem back to the 1960’s, where many refer to the Dendral experiments as kicking off the field. Researchers created a software system that was considered the first expert kind that automated the decision-making and problem-solving behavior of organic chemists. Sixty years later, deep medicine has greatly evolved drug diagnostics, predictive medicine, and patient care.

Tempo uses reinforcement learning, a machine learning method widely known for success in games like Chess and Go, to develop a “policy” that predicts a follow-up recommendation for each patient. The training data here only had information about a patient’s risk at the time points when their mammogram was taken (when they were 50, or 55, for example). The team needed the risk assessment at intermediate points, so they designed their algorithm to learn a patient’s risk at unobserved time points from their observed screenings, which evolved as new mammograms of the patient became available.

The team first trained a neural network to predict future risk assessments given previous ones. This model then estimates patient risk at unobserved time points, and it enables simulation of the risk-based screening policies. Next, they trained that policy, (also a neural network), to maximize the reward (for example, the combination of early detection and screening cost) to the retrospective training set. Eventually, you’d get a recommendation for when to return for the next screen, ranging from six months to three years in the future, in multiples of six months – the standard is only one or two years.

Let’s say patient A comes in for their first mammogram, and eventually gets diagnosed at year four. In year two, there’s nothing, so they don’t come back for another two years, but then at year four they get a diagnosis. Now there's been two years of gap between the last screen, where a tumor could have grown. Using Tempo, at that first mammogram, year zero, the recommendation might have been to come back in two years. And then at year two, it might have seen that risk is high, and recommended that the patient come back in six months, and in the best case, it would be detectable. The model is dynamically changing the patient’s screening frequency, based on how the risk profile is changing.

Tempo uses a simple metric for early detection, which assumes that cancer can be caught up to 18 months in advance. While Tempo outperformed current guidelines across different settings of this assumption (six months, twelve months), none of these assumptions are perfect as the early detection potential of a tumor depends on that tumor's characteristics. The team suggested that follow up work using tumor growth models could address this issue. Also, the screening cost metric, which counts the total screening volume recommended by Tempo, doesn't provide a full analysis of the entire future cost because it does not explicitly quantify false positive risks or additional screening harms.

There are many future directions that can further improve personalized screening algorithms. The team says one avenue would be to build on the metrics used to estimate early detection and screening costs from retrospective data, which would result in more refined guidelines. Tempo could also be adapted to include different types of screening recommendations, such as leveraging MRI or mammograms, and future work could separately model the costs and benefits of each. With better screening policies, recalculating the earliest and latest age that screening is still cost-effective for a patient might be feasible.

“By tailoring the screening to the patient's individual risk, we can improve patient outcomes, reduce over treatment and eliminate health disparities,” said Adam Yala, MIT CSAIL PhD student and lead researcher. Given the massive scale of breast cancer screening, with tens of millions of women getting mammograms every year, improvements to our guidelines are immensely important.”

“Current guidelines divide the population into a few large groups, like younger or older than 55, and recommend the same screening frequency to all the members of a cohort. The development of AI based risk models that operate over raw patient data give us an opportunity to transform screening, giving more frequent screens to those who need it and sparing the rest,” added Yala. “A key aspect of these models is that their predictions can evolve over time as a patient’s raw data changes, suggesting that screening policies need to be attuned to changes in risk and be optimized over long periods of patient data.”

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57 (!!!!! 6723.8807678223): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791302 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294791302 AND published='1' LIMIT 1

58 (337.83912658691): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791302 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294791302 AND published='1' LIMIT 1

59 (!!!!! 6441.8315887451): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791302 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294791302 AND published='1' LIMIT 1

60 (!!!!! 3074.1691589355): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791302 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294791302 AND published='1' LIMIT 1

61 (!!!!! 3973.9608764648): select cover from jos_number where journalid in (5) and cover is not null order by left(issue,2)+right(issue,2)*12 desc limit 1

62 (!!!!! 8043.0507659912): SELECT fid FROM jos_deeppockets WHERE id=294791302 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294791302 AND published='1' LIMIT 1

63 (771.99935913086): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=215 ORDER BY `ordering`

64 (844.00177001953): select jos_twitters.link from jos_twitters where cat=10

65 (323.05717468262): select jos_facebook.link from jos_facebook where cat=10

66 (!!!!! 1157.9990386963): select jos_google_plus.link from jos_google_plus where cat=10

67 (591.03965759277): select jos_linkedin.link from jos_linkedin where cat=10

68 (72.956085205078): SELECT fid FROM jos_deeppockets WHERE id=294791302 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294791302 AND published='1' LIMIT 1

69 (183.10546875): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=215 ORDER BY `ordering`

70 (346.89903259277): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294791302 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (216.00723266602): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294791302 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (!!!!! 8682.0125579834): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

73 (74.148178100586): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (46.968460083008): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (69.856643676758): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294791302 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (56.028366088867): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294791302 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (!!!!! 3466.1293029785): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

90 (96.08268737793): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (69.141387939453): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (33.140182495117): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (45.061111450195): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (82.015991210938): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791302 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294791302 AND published='1' LIMIT 1

105 (47.922134399414): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791302 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294791302 AND published='1' LIMIT 1

106 (86.069107055664): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294791302 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (67.949295043945): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294791302 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (!!!!! 1766.9200897217): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791302 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294791302 AND published='1' LIMIT 1

109 (67.949295043945): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791302 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294791302 AND published='1' LIMIT 1

110 (56.028366088867): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294791302 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (376.93977355957): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294791302 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (550.98533630371): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

113 (386.95335388184): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

114 (149.96528625488): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791302 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294791302 AND published='1' LIMIT 1

115 (56.028366088867): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791302 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294791302 AND published='1' LIMIT 1

116 (62.942504882812): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791302 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294791302 AND published='1' LIMIT 1

117 (45.7763671875): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791302 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294791302 AND published='1' LIMIT 1

118 (113.96408081055): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791302 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294791302 AND published='1' LIMIT 1

119 (48.87580871582): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791302 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294791302 AND published='1' LIMIT 1

120 (365.01884460449): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

121 (!!!!! 52865.028381348): SELECT * FROM jos_deeppockets WHERE jos_deeppockets.cat = 10 AND jos_deeppockets.type = 'deeppockets_item' AND jos_deeppockets.published = 1 AND jos_deeppockets.created + INTERVAL 14 DAY >= NOW() ORDER BY jos_deeppockets.hits DESC LIMIT 7

122 (242.94853210449): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791302 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294791302 AND published='1' LIMIT 1

123 (251.05476379395): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791302 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294791302 AND published='1' LIMIT 1

124 (!!!!! 2896.0704803467): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294791302 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294791302 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 1092494.9645996): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

126 (97.990036010742): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

127 (61.03515625): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

128 (39.100646972656): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

129 (78.916549682617): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

130 (49.114227294922): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

131 (46.968460083008): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

132 (39.100646972656): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

133 (467.06199645996): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791302 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

134 (372.17140197754): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294791302 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

135 (225.06713867188): SELECT name FROM jos_deeppockets WHERE id=215

136 (37.908554077148): SELECT name FROM jos_deeppockets WHERE id=215

137 (493.04962158203): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))215((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

138 (413.89465332031): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))215((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

139 (70.095062255859): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791302 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294791302 AND published='1' LIMIT 1

140 (44.822692871094): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791302 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294791302 AND published='1' LIMIT 1

141 (!!!!! 8392.0955657959): TRUNCATE TABLE jos_trademed_module

142 (112.05673217773): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294791302 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

143 (64.13459777832): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294791302 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

144 (838.04130554199): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791302 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

145 (54.836273193359): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791302 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

146 (64.849853515625): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791302 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294791302 AND published='1' LIMIT 1

147 (48.160552978516): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791302 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294791302 AND published='1' LIMIT 1

148 (!!!!! 1167.0589447021): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

149 (66.041946411133): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791302 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294791302 AND published='1' LIMIT 1

150 (44.107437133789): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791302 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294791302 AND published='1' LIMIT 1

151 (41.007995605469): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294791302 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294791302 AND type='deeppockets_item' AND published='1' LIMIT 1

152 (29.802322387695): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=215 or channel_id is null)

153 (28.133392333984): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=215 or channel_id is null)

154 (29.087066650391): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

155 (184.05914306641): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791302 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294791302 AND published='1' LIMIT 1

156 (77.962875366211): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791302 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294791302 AND published='1' LIMIT 1

157 (68.187713623047): select jos_twitters.link from jos_twitters where cat=10

158 (41.007995605469): select jos_facebook.link from jos_facebook where cat=10

159 (39.100646972656): select jos_google_plus.link from jos_google_plus where cat=10

160 (39.100646972656): select jos_linkedin.link from jos_linkedin where cat=10

161 (351.90582275391): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

162 (!!!!! 1417.1600341797): insert into jos_banners_delta values (14615,'2025-06-18 02:53:15','216.73.216.120','view'),(14202,'2025-06-18 02:53:15','216.73.216.120','view'),(14203,'2025-06-18 02:53:15','216.73.216.120','view')

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