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AI System Boosts Radiologist Detection of Intracranial Hemorrhage on CT Scans

By MedImaging International staff writers
Posted on 17 Oct 2022

Image: Caire ICH immediately detects or rules out ICH (Photo courtesy of Caire Health)

Intracranial hemorrhage (ICH) is one of many conditions that can be readily diagnosed from a head computed tomography (CT) scan and has a poor prognosis with only 20% of survivors fully recovering at six-months post-incidence. Its short acquisition time, widespread availability, and ever-decreasing radiation burden, have made the head CT a staple of care worldwide, particularly in the emergency setting. However, the number of acquired CT examinations requiring radiologist interpretation is growing at a rate that outpaces the growth of the radiologist population, which introduces concerns surrounding the presence of errors in imaging-based diagnoses, particularly for pathologies where misdiagnoses may lead to delays in time-sensitive treatment. An erroneous diagnosis is always damaging, but principally for acute pathologies where time plays a critical role in patient outcomes.

Artificial intelligence (AI) technologies, specifically computer vision (CV) algorithms, have continued to expand their applications to the interpretation of various medical imaging modalities, given their ability to rapidly interpret these scans in coordination with their demonstrated strong performance. Despite evidence suggesting that a concerted effort by AI and clinicians can yield higher diagnostic accuracy than either party alone, particularly for inexperienced practitioners, the role of an AI tool as an adjunct to radiologists to reduce human diagnostic error with respect to ICH is not yet widely adopted. Additionally, though algorithms have been constructed to evaluate scans for the presence of an ICH, they treat ICH as a homogenous pathology, when in fact various subtypes of ICH are observed and often managed in differing ways. A new study to evaluate the utility of a novel deep learning algorithm designed to aid radiologist diagnostic performance by identifying the presence of ICH and its respective subtype(s) on a non-contrast head CT scan (NCCT) has found that the tool has potential to improve patient outcomes and reduce misdiagnosis.

In the retrospective, multi-reader, and multi-case study, researchers at the Texas Tech University Health Sciences Center (Lubbock, TX, USA) evaluated the diagnostic accuracy of three board-certified radiologists with and without the aid of the Caire ICH deep-learning system from Caire Health Inc. (Tallahassee, FL, USA). For the study, the researchers specifically obtained 100 ICH-negative NCCTs and 100 individual studies for each ICH subtype: epidural (EDH), subdural (SDH), subarachnoid (SAH), intraparenchymal (IPH), and intraventricular hemorrhage (IVH). Each radiologist interpreted each imaging case independently. After a washout period of 48 hours, the radiologists interpreted the same cases with the support of the deep learning system. The Caire ICH software is a deep-learning tool with a single convolutional neural network and a long short-term memory mechanism that provides information regarding the presence or absence of an intracranial hemorrhage, the subtype(s) of the hemorrhage detected, the full range of slices where the hemorrhage exists, and the four slices on which the hemorrhage can be best viewed.

The researchers found that the system improved inter-reader agreement by an average of 5.76% in a dataset with an ICH prevalence of 74.3%. Accuracy, sensitivity and specificity all increased by 6.15, 4.6 and 10.62%, respectively. Compared to interpretations completed without the use of the system, radiologists detected an additional 18 ICHs on average, while also improving their identification of different ICH subtypes when the tool was utilized.

“This work adds to the evidence that deep-learning strategies may increase the performance of trained radiologists in diagnosing critical findings on head NCCT scans,” the authors wrote. “As we have shown, this strategy may be seamlessly integrated into the radiologists' clinical workflow and potentially expedite the diagnosis and treatment of patients with ICH in resource-rich or resource-limited areas.”

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63 (300.88424682617): 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 (!!!!! 1228.0941009521): select jos_twitters.link from jos_twitters where cat=10

65 (757.93266296387): select jos_facebook.link from jos_facebook where cat=10

66 (617.02728271484): select jos_google_plus.link from jos_google_plus where cat=10

67 (514.03045654297): select jos_linkedin.link from jos_linkedin where cat=10

68 (877.14195251465): SELECT fid FROM jos_deeppockets WHERE id=294794984 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294794984 AND published='1' LIMIT 1

69 (!!!!! 3046.0357666016): 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 (763.1778717041): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294794984 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (!!!!! 1610.0406646729): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294794984 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (!!!!! 1445.0550079346): 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 (!!!!! 2447.1282958984): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (297.06954956055): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (344.99168395996): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (141.85905456543): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (57.93571472168): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294794984 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (133.03756713867): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294794984 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (35.04753112793): 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 (355.00526428223): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (410.07995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (527.14347839355): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (!!!!! 3098.9646911621): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (60.796737670898): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (324.01084899902): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (178.09867858887): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (185.96649169922): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (129.93812561035): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (170.94612121582): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (114.91775512695): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (161.88621520996): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (174.99923706055): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794984 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794984 AND published='1' LIMIT 1

105 (45.061111450195): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794984 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794984 AND published='1' LIMIT 1

106 (154.01840209961): 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=294794984 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (353.09791564941): 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=294794984 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (270.84350585938): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794984 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794984 AND published='1' LIMIT 1

109 (52.928924560547): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794984 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794984 AND published='1' LIMIT 1

110 (105.14259338379): 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=294794984 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (483.98971557617): 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=294794984 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (669.95620727539): 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 (427.0076751709): 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 (104.18891906738): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794984 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794984 AND published='1' LIMIT 1

115 (83.208084106445): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794984 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794984 AND published='1' LIMIT 1

116 (57.93571472168): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794984 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794984 AND published='1' LIMIT 1

117 (96.08268737793): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794984 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794984 AND published='1' LIMIT 1

118 (46.014785766602): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794984 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794984 AND published='1' LIMIT 1

119 (36.001205444336): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794984 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794984 AND published='1' LIMIT 1

120 (279.90341186523): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

121 (!!!!! 100745.91636658): 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 (!!!!! 7517.8146362305): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794984 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794984 AND published='1' LIMIT 1

123 (!!!!! 8104.0859222412): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794984 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794984 AND published='1' LIMIT 1

124 (!!!!! 7706.880569458): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294794984 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294794984 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 1938993.9308167): ( 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 (!!!!! 1032743.9308167): ( 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 (707.86476135254): 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 (488.9965057373): 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 (997.06649780273): 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 (!!!!! 1276.969909668): 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 (959.87319946289): 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 (540.97175598145): 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 (303.98368835449): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794984 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

134 (601.05323791504): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794984 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

135 (!!!!! 1103.8780212402): SELECT name FROM jos_deeppockets WHERE id=215

136 (!!!!! 2558.9466094971): SELECT name FROM jos_deeppockets WHERE id=215

137 (!!!!! 1129.8656463623): 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 (!!!!! 3535.0322723389): 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 (!!!!! 6145.0004577637): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794984 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794984 AND published='1' LIMIT 1

140 (!!!!! 1504.8980712891): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794984 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794984 AND published='1' LIMIT 1

141 (!!!!! 13669.967651367): TRUNCATE TABLE jos_trademed_module

142 (721.93145751953): 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=294794984 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

143 (!!!!! 3009.0808868408): 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=294794984 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

144 (!!!!! 9703.8745880127): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794984 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

145 (!!!!! 2885.8184814453): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794984 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

146 (!!!!! 6299.9725341797): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794984 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794984 AND published='1' LIMIT 1

147 (!!!!! 7632.9708099365): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794984 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794984 AND published='1' LIMIT 1

148 (!!!!! 5063.0569458008): 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 (!!!!! 6075.1438140869): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794984 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794984 AND published='1' LIMIT 1

150 (687.83760070801): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794984 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794984 AND published='1' LIMIT 1

151 (576.01928710938): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294794984 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294794984 AND type='deeppockets_item' AND published='1' LIMIT 1

152 (!!!!! 5522.0127105713): 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 (337.12387084961): 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 (!!!!! 1317.024230957): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

155 (!!!!! 1883.9836120605): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794984 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794984 AND published='1' LIMIT 1

156 (97.036361694336): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794984 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794984 AND published='1' LIMIT 1

157 (!!!!! 1260.0421905518): select jos_twitters.link from jos_twitters where cat=10

158 (42.915344238281): select jos_facebook.link from jos_facebook where cat=10

159 (36.001205444336): select jos_google_plus.link from jos_google_plus where cat=10

160 (36.001205444336): select jos_linkedin.link from jos_linkedin where cat=10

161 (!!!!! 9099.9603271484): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

162 (!!!!! 14275.074005127): insert into jos_banners_delta values (14615,'2025-04-30 18:35:00','18.188.90.83','view'),(14202,'2025-04-30 18:35:00','18.188.90.83','view'),(14203,'2025-04-30 18:35:00','18.188.90.83','view')

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