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AAPM 2025 - 67th Annual Meeting & Exhibition of the American Association of Physicists in Medicine

Smartphones Assist Remote Diagnosis of Acute Appendicitis

By MedImaging International staff writers
Posted on 11 Dec 2009

Image: The appendix as viewed on an iPhone 3G (Photo courtesy of Dr. A Choudhri - RSNA org.).

Special software allows viewing of raw clinical image data in full resolution, allowing acute appendicitis to be accurately diagnosed from a remote location by a radiologist using an iPhone.

Researchers at Johns Hopkins University (JHU, Baltimore, MD, USA) and the University of Virginia (Charlottesville, CT, USA) performed abdomen and pelvis computerized tomography (CT) studies on 25 patients with pain in the right lower abdomen. All patients had either surgical confirmation of the diagnosis of acute appendicitis, or follow-up clinical evaluation confirming no acute appendicitis. Each study was viewed by five blinded radiologists on a handheld device (iPhone 3G), equipped with OsiriX open source mobile medical image viewing software. The studies were evaluated for the ability to find the appendix, the maximum appendiceal diameter, presence of an appendicolith, periappendicial stranding and fluid, abscess formation, and a binary assessment of the diagnosis of acute appendicitis. The studies were also compared to a faculty-read of the study as performed on a dedicated picture archiving and communication system (PACS) workstation.

The results showed that 15 of the 25 patients were correctly identified as having acute appendicitis on 74 (99%) of 75 interpretations, with one false negative; there were no false positive readings. In eight of the 15 patients who had appendicitis, calcified deposits within the appendix were correctly identified in 88% of the interpretations. All 15 patients had signs of inflammation near the appendix that were correctly identified in 96% of interpretations, and 10 of the 15 had fluid near the appendix, which was correctly identified in 94% of the interpretations. Three abscesses were correctly identified by all five readers. However, handheld device measurements of the appendix averaged almost one millimeter larger than measurements on the PACS workstation, suggesting that appedendical diameter should not be used as the sole basis for diagnosis. The study results were presented at the annual meeting of the Radiological Society of North America (RSNA), held during November-December 2009 in Chicago (IL, USA).

"The iPhone interpretations of the CT scans were as accurate as the interpretations viewed on dedicated PACS workstations,” said lead author Asim Choudhri, M.D., of the division of neuroradiology at JHU. "The scans can be read in full resolution with very little panning, and the software allows the reader to zoom and adjust the contrast and brightness of the image. The radiologist is evaluating actual raw image data, not snapshots.”

The researchers concluded that remote viewing of studies may be feasible for emergent consultation to expedite emergency room care when consultation with a specialist is needed, which could be of particular benefit for subspecialist consultation for on-call residents.

Related Links:
Johns Hopkins University
University of Virginia

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61 (!!!!! 1801.0139465332): 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 (!!!!! 4728.0788421631): SELECT fid FROM jos_deeppockets WHERE id=294726849 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294726849 AND published='1' LIMIT 1

63 (850.91590881348): 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=216 ORDER BY `ordering`

64 (252.96211242676): select jos_twitters.link from jos_twitters where cat=10

65 (46.968460083008): select jos_facebook.link from jos_facebook where cat=10

66 (524.99771118164): select jos_google_plus.link from jos_google_plus where cat=10

67 (36.001205444336): select jos_linkedin.link from jos_linkedin where cat=10

68 (39.815902709961): SELECT fid FROM jos_deeppockets WHERE id=294726849 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294726849 AND published='1' LIMIT 1

69 (355.95893859863): 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=216 ORDER BY `ordering`

70 (370.97930908203): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294726849 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (263.21411132812): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294726849 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (43.869018554688): 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 (206.94732666016): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (!!!!! 3868.8182830811): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (87.02278137207): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (38.862228393555): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (57.93571472168): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294726849 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (45.061111450195): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294726849 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (48.87580871582): 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 (!!!!! 3378.15284729): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (97.990036010742): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (46.014785766602): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (41.961669921875): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (46.014785766602): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (114.20249938965): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726849 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726849 AND published='1' LIMIT 1

105 (64.13459777832): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726849 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726849 AND published='1' LIMIT 1

106 (75.101852416992): 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=294726849 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (653.02848815918): 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=294726849 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (102.04315185547): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726849 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726849 AND published='1' LIMIT 1

109 (46.014785766602): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726849 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726849 AND published='1' LIMIT 1

110 (52.928924560547): 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=294726849 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (635.14709472656): 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=294726849 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (824.92828369141): 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 (808.0005645752): 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 (!!!!! 1679.8973083496): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726849 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726849 AND published='1' LIMIT 1

115 (300.88424682617): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726849 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726849 AND published='1' LIMIT 1

116 (462.05520629883): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726849 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726849 AND published='1' LIMIT 1

117 (571.96617126465): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726849 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726849 AND published='1' LIMIT 1

118 (906.94427490234): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726849 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726849 AND published='1' LIMIT 1

119 (65.803527832031): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726849 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726849 AND published='1' LIMIT 1

120 (50.067901611328): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726849 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726849 AND published='1' LIMIT 1

121 (38.862228393555): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726849 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726849 AND published='1' LIMIT 1

122 (364.06517028809): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 76138.973236084): 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

124 (!!!!! 1613.8553619385): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294726849 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294726849 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 22042.036056519): ( 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 (!!!!! 2321.0048675537): ( 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 (122.0703125): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

128 (92.983245849609): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

129 (294.92378234863): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

130 (177.14500427246): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

131 (380.03921508789): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

132 (149.01161193848): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

133 (215.05355834961): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

134 (142.09747314453): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

135 (346.89903259277): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726849 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (234.84230041504): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726849 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (113.01040649414): SELECT name FROM jos_deeppockets WHERE id=216

138 (31.232833862305): SELECT name FROM jos_deeppockets WHERE id=216

139 (535.96496582031): 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 '((;)|(^))216((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

140 (507.11631774902): 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 '((;)|(^))216((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

141 (109.91096496582): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726849 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726849 AND published='1' LIMIT 1

142 (46.014785766602): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726849 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726849 AND published='1' LIMIT 1

143 (!!!!! 13653.993606567): TRUNCATE TABLE jos_trademed_module

144 (494.95697021484): 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=294726849 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (81.062316894531): 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=294726849 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (404.11949157715): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726849 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (!!!!! 1245.0218200684): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726849 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (78.916549682617): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726849 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726849 AND published='1' LIMIT 1

149 (41.007995605469): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726849 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726849 AND published='1' LIMIT 1

150 (!!!!! 1204.0138244629): 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

151 (63.896179199219): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726849 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726849 AND published='1' LIMIT 1

152 (44.107437133789): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726849 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726849 AND published='1' LIMIT 1

153 (34.093856811523): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294726849 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294726849 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (29.087066650391): 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=216 or channel_id is null)

155 (30.994415283203): 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=216 or channel_id is null)

156 (60.081481933594): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (113.01040649414): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726849 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726849 AND published='1' LIMIT 1

158 (43.869018554688): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726849 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726849 AND published='1' LIMIT 1

159 (41.007995605469): select jos_twitters.link from jos_twitters where cat=10

160 (25.98762512207): select jos_facebook.link from jos_facebook where cat=10

161 (26.941299438477): select jos_google_plus.link from jos_google_plus where cat=10

162 (25.98762512207): select jos_linkedin.link from jos_linkedin where cat=10

163 (!!!!! 5327.9399871826): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14202,14203)

164 (!!!!! 1461.0290527344): insert into jos_banners_delta values (14202,'2025-06-21 12:18:36','216.73.216.120','view'),(14203,'2025-06-21 12:18:36','216.73.216.120','view')

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