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Bone Suppression and CAD Software Improves Lung Nodule Detection on Chest X-Ray

By MedImaging International staff writers
Posted on 19 Dec 2012

Three studies reported that using bone suppression and computer-aided detection (CAD) software can significantly improve the detection of lung nodules on chest X-ray images. More...

CAD performed well on images captured by both portable and upright X-ray machines in the studies, and that most false-positive marks—the marking of portions on the chest X-ray that are not lung nodules—call radiologists’ attention to other significant abnormalities, including serious lung disorders, and to medical devices in or on the chest that radiologists would be able to swiftly disregard. The studies’ findings were presented Radiological Society of North America (RSNA) annual meeting held November 2012 in Chicago (IL, USA). Riverain Technologies’ ClearRead software was used in each of the studies.

Riverain’s ClearRead software suppresses the ribs and clavicles on traditional chest X-ray images, providing radiologists with a clear, unobstructed image of the lungs and exposing abnormalities that may be a sign of disease. The software is easy to install and adopt, requiring no additional imaging equipment or staffing, and no additional radiation exposure to patients. It can be used to immediately enhance images generated by all X-ray machines throughout a hospital or health system.

In a study at Radbound University Nijmegen Medical Center (RUNMC; The Netherlands), five attending radiologists and three radiology residents who were not skilled with the Riverain Technologies (Dayton, OH, USA) software detected more confirmed lung nodules utilizing ClearRead bone suppression 2.4 software than when they evaluated the X-ray images on their own.

The radiologists read 300 chest X-ray images with and without bone suppression (111 X-rays with solitary lung nodules and 189 control cases with no nodules). They identified 79% of the lung nodules with bone suppression, with about 0.3 false positive per image compared to 71% detection of lung nodules and 0.21 false positive per image when they reviewed the X-rays on their own.

“The detection of hard-to-find nodules classified as ‘moderately subtle’ and ‘subtle’ was especially improved,” said Steven Schalekamp, MD, a PhD student in the department of radiology of RUNMC. “The radiologists using the bone-suppression software found 26% of the lung nodules that were missed entirely on conventional X-ray images.”

In a separate RUNMC study involving 300 radiographs and eight readers, the radiologists’ performance also improved when they read the images using Riverain’s CAD software, ClearRead +Detect 5.2, which circles suspected lung nodules on bone-suppressed X-ray images. The radiologists accurately detected 79% of 111 lung nodules with CAD, versus 73% when reviewing the bone-suppressed image without CAD.

The radiologists’ false-positive rate per image was 0.28 when they used CAD and bone suppression combined, and 0.23 when they used bone suppression without CAD. ClearRead +Detect found more than half of the nodules that were missed by the radiologists.
In a University of Chicago Medical Center (IL, USA) study of 608 unselected, consecutive chest X-ray images, (479 X-rays with abnormalities, such as lung nodules, other lung diseases and scars; and 129 X-rays without significant abnormalities), Riverain’s ClearRead +Detect 5.2 CAD software on its own, without radiologist interpretation, detected 72% of lung nodules present, or 82 of 114 nodules. The software detected a majority of the nodules regardless of whether the image had been captured using a portable or upright X-ray machine, and even when other abnormalities, including underlying lung disease, were present.

“CAD found the majority of lung nodules in this large study, which simulates a real-world, clinical setting where the use of portable X-ray images and the presence of other abnormalities in patients’ chests make lung nodule detection challenging,” said Steve Worrell, Riverain’s chief technology officer.

The CAD software had 1.3 false-positives per image (0.7 on X-rays without significant abnormalities and 1.5 on images with abnormalities). Forty-one percent of the false-positives across all radiographs indicated other notable pathologic changes, including fluid in the lungs (edema), pneumonia, a partial or full collapse of a lung (atelectasis), other lung diseases, calcifications, and scars.

Nineteen percent of the false-positive marks were attributed to medical devices in or on the chest, including electrocardiogram leads and catheter ports. As Dr. Schalekamp’s study suggests, the number of false positives actually reported in a clinical environment would be lower because radiologists use their judgment to rapidly reject automatically generated marks that are caused by grossly abnormal tissue or medical devices.

“We expect that after a learning period, radiologists would be able to dismiss false-positive CAD marks very quickly,” Dr. MacMahon said. “We know that small cancers are often visible in retrospect but were not detected on earlier X-rays,” Dr. MacMahon added. “Routine use of bone suppression and CAD on chest X-rays will reduce the chances of a cancer being missed, thus improving the likelihood of diagnosing unsuspected early-stage disease.”

Related Links:
Radbound University Nijmegen Medical Center
Riverain Technologies
University of Chicago Medical Center

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52 (44.107437133789): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743887 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743887 AND published='1' LIMIT 1

53 (314.95094299316): SELECT name FROM jos_deeppockets WHERE id=294743887 LIMIT 1

54 (211.00044250488): SELECT name FROM jos_deeppockets_archive WHERE id=294743887 LIMIT 1

55 (43.869018554688): SELECT a.* FROM jos_components AS a WHERE ( a.admin_menu_link = 'option=com_syndicate' OR a.admin_menu_link = 'option=com_syndicate&hidemainmenu=1' ) AND a.option = 'com_syndicate'

56 (57.93571472168): 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=294743887 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

57 (396.0132598877): 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=294743887 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

58 (!!!!! 1160.1448059082): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743887 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743887 AND published='1' LIMIT 1

59 (61.03515625): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743887 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743887 AND published='1' LIMIT 1

60 (109.91096496582): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743887 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743887 AND published='1' LIMIT 1

61 (53.882598876953): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743887 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743887 AND published='1' LIMIT 1

62 (73.909759521484): 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

63 (569.82040405273): SELECT fid FROM jos_deeppockets WHERE id=294743887 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294743887 AND published='1' LIMIT 1

64 (311.85150146484): 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`

65 (42.915344238281): select jos_twitters.link from jos_twitters where cat=10

66 (29.087066650391): select jos_facebook.link from jos_facebook where cat=10

67 (30.994415283203): select jos_google_plus.link from jos_google_plus where cat=10

68 (27.894973754883): select jos_linkedin.link from jos_linkedin where cat=10

69 (31.948089599609): SELECT fid FROM jos_deeppockets WHERE id=294743887 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294743887 AND published='1' LIMIT 1

70 (33.140182495117): 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`

71 (252.96211242676): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294743887 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (211.95411682129): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294743887 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

73 (37.908554077148): 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`

74 (54.121017456055): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

88 (43.153762817383): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294743887 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (30.040740966797): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294743887 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

90 (33.855438232422): 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`

91 (51.021575927734): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

105 (68.902969360352): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743887 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743887 AND published='1' LIMIT 1

106 (60.081481933594): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743887 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743887 AND published='1' LIMIT 1

107 (49.829483032227): 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=294743887 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (48.160552978516): 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=294743887 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

109 (80.108642578125): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743887 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743887 AND published='1' LIMIT 1

110 (46.968460083008): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743887 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743887 AND published='1' LIMIT 1

111 (46.968460083008): 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=294743887 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (793.9338684082): 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=294743887 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

113 (538.11073303223): 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 (394.10591125488): 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

115 (77.009201049805): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743887 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743887 AND published='1' LIMIT 1

116 (48.87580871582): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743887 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743887 AND published='1' LIMIT 1

117 (47.922134399414): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743887 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743887 AND published='1' LIMIT 1

118 (36.954879760742): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743887 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743887 AND published='1' LIMIT 1

119 (76.055526733398): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743887 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743887 AND published='1' LIMIT 1

120 (54.121017456055): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743887 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743887 AND published='1' LIMIT 1

121 (71.048736572266): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743887 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743887 AND published='1' LIMIT 1

122 (51.021575927734): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743887 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743887 AND published='1' LIMIT 1

123 (256.06155395508): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

124 (!!!!! 19357.919692993): 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

125 (543.11752319336): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294743887 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294743887 AND type='deeppockets_item' AND published='1' LIMIT 1

126 (!!!!! 7275.1045227051): ( 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 (137.0906829834): ( 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

128 (56.028366088867): 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 (41.007995605469): 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

130 (63.180923461914): 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 (28.848648071289): 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

132 (289.9169921875): 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 (99.897384643555): 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

134 (30.994415283203): 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 (28.133392333984): 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

136 (451.08795166016): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743887 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (313.04359436035): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743887 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

138 (219.10667419434): SELECT name FROM jos_deeppockets WHERE id=216

139 (33.140182495117): SELECT name FROM jos_deeppockets WHERE id=216

140 (505.92422485352): 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 (504.97055053711): 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

142 (99.18212890625): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743887 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743887 AND published='1' LIMIT 1

143 (72.002410888672): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743887 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743887 AND published='1' LIMIT 1

144 (!!!!! 7874.0119934082): TRUNCATE TABLE jos_trademed_module

145 (97.990036010742): 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=294743887 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (56.982040405273): 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=294743887 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

147 (!!!!! 6653.0704498291): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743887 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (87.02278137207): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743887 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

149 (100.13580322266): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743887 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743887 AND published='1' LIMIT 1

150 (46.968460083008): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743887 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743887 AND published='1' LIMIT 1

151 (!!!!! 1247.8828430176): 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

152 (60.081481933594): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743887 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743887 AND published='1' LIMIT 1

153 (46.968460083008): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743887 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743887 AND published='1' LIMIT 1

154 (35.04753112793): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294743887 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294743887 AND type='deeppockets_item' AND published='1' LIMIT 1

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 (30.040740966797): 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)

157 (32.901763916016): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

158 (77.962875366211): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743887 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743887 AND published='1' LIMIT 1

159 (43.153762817383): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743887 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743887 AND published='1' LIMIT 1

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

161 (28.133392333984): select jos_facebook.link from jos_facebook where cat=10

162 (34.093856811523): select jos_google_plus.link from jos_google_plus where cat=10

163 (37.908554077148): select jos_linkedin.link from jos_linkedin where cat=10

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Bone Suppression and CAD Software Improves Lung Nodule Detection on Chest X-Ray

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