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

When Physicians Own or Lease MRIs, Back Scans and Surgery are More Likely

By MedImaging International staff writers
Posted on 09 May 2011

When physicians own or lease magnetic resonance imaging (MRI) equipment, their patients are more likely to receive scans for low back pain. Patients of orthopedists are more apt to undergo back surgery as well, according to new findings.

Financial incentives, inherent in self-referral, "seem to have an influence on physician behavior that we can't ignore, and an impact on patient care in the long run," said Jacqueline Baras Shreibati, MD, of Stanford University School of Medicine (Stanford, CA, USA), the lead study author. The study's findings were published online April 2011 on Health Services Research.

There is no definitive evidence that either MRI or surgery for low back pain improve outcomes, according to the investigators. The study compared scan rates for the Medicare patients of 1,033 primary care physicians and 1,271 orthopedists, before and after the physicians acquired MRI equipment, by purchase or by entering into lease arrangements, whereby they billed directly for scans they ordered.

As earlier studies had shown, when physicians begin self-referral for MRI scanning they become considerably more likely to order scans: in this study the rate increased by 13% for orthopedists' patients, and 32% for patients of primary care doctors. Moreover, patients who visited an orthopedist after he or she had acquired an MRI were 34% more likely to undergo back surgery within six months.

The study's aim was not to evaluate whether the additional surgeries were necessary, according to Dr. Shreibati. However, it did reveal "a direct relationship from imaging to surgery--in a group of patients where surgery is very controversial."

Jean M. Mitchell, PhD, professor of public policy at Georgetown University (Washington DC, USA), said, "the main contribution of this research is what it shows about ‘cascade effects' of self-referral--its impact not just on the procedure itself, but things that happen as a result. If the patient hadn't had the MRI, they never would have had the back surgery."

US Federal regulations prohibit physicians from referring US Medicaid or Medicare patients for health services in which they have a financial interest, but make an exception for in-office procedures, which has been interpreted to include MRI scans performed with offsite equipment leased on a per-scan basis. "Medicare spending alone would go down about 25% if self-referral were really policed or eliminated," Dr. Mitchell said.

While the findings do not indicate that patients should question their doctors' recommendations, Dr. Shreibati remarked, "I think it's important for them to keep in mind that financial incentives may influence the care they receive."

Related Links:
Stanford University School of Medicine
Georgetown University

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63 (52.928924560547): 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=212 ORDER BY `ordering`

64 (54.121017456055): select jos_twitters.link from jos_twitters where cat=10

65 (35.04753112793): select jos_facebook.link from jos_facebook where cat=10

66 (36.954879760742): select jos_google_plus.link from jos_google_plus where cat=10

67 (35.04753112793): select jos_linkedin.link from jos_linkedin where cat=10

68 (57.93571472168): SELECT fid FROM jos_deeppockets WHERE id=294734908 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294734908 AND published='1' LIMIT 1

69 (40.054321289062): 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=212 ORDER BY `ordering`

70 (383.13865661621): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294734908 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (409.84153747559): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294734908 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (51.021575927734): 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 (61.03515625): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (43.153762817383): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (33.855438232422): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (33.140182495117): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (33.855438232422): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (38.862228393555): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (58.174133300781): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294734908 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (36.001205444336): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294734908 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (40.054321289062): 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 (68.902969360352): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (37.193298339844): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (33.140182495117): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (33.140182495117): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (33.140182495117): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (33.855438232422): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (33.140182495117): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (55.074691772461): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (93.936920166016): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734908 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734908 AND published='1' LIMIT 1

105 (56.982040405273): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734908 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734908 AND published='1' LIMIT 1

106 (72.002410888672): 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=294734908 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (66.041946411133): 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=294734908 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (84.877014160156): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734908 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734908 AND published='1' LIMIT 1

109 (60.081481933594): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734908 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734908 AND published='1' LIMIT 1

110 (63.180923461914): 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=294734908 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (627.99453735352): 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=294734908 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (598.90747070312): 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 (557.89947509766): 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 (95.844268798828): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734908 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734908 AND published='1' LIMIT 1

115 (86.784362792969): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734908 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734908 AND published='1' LIMIT 1

116 (47.922134399414): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734908 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734908 AND published='1' LIMIT 1

117 (36.001205444336): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734908 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734908 AND published='1' LIMIT 1

118 (48.160552978516): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734908 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734908 AND published='1' LIMIT 1

119 (38.14697265625): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734908 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734908 AND published='1' LIMIT 1

120 (42.915344238281): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734908 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734908 AND published='1' LIMIT 1

121 (35.04753112793): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734908 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734908 AND published='1' LIMIT 1

122 (324.96452331543): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 56375.026702881): 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 (!!!!! 1241.92237854): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294734908 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294734908 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 23417.949676514): ( 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 (166.89300537109): ( 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 (230.07392883301): 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 (33.855438232422): 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 (46.968460083008): 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 (30.994415283203): 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 (318.05038452148): 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 (125.88500976562): 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 (31.948089599609): 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 (30.040740966797): 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 (439.88227844238): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734908 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (342.13066101074): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734908 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (87.02278137207): SELECT name FROM jos_deeppockets WHERE id=212

138 (52.928924560547): SELECT name FROM jos_deeppockets WHERE id=212

139 (794.1722869873): 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 '((;)|(^))212((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

140 (463.96255493164): 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 '((;)|(^))212((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

141 (65.803527832031): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734908 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734908 AND published='1' LIMIT 1

142 (47.206878662109): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734908 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734908 AND published='1' LIMIT 1

143 (!!!!! 12778.043746948): TRUNCATE TABLE jos_trademed_module

144 (76.055526733398): 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=294734908 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (51.021575927734): 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=294734908 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (693.08280944824): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734908 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (170.94612121582): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734908 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (313.99726867676): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734908 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734908 AND published='1' LIMIT 1

149 (179.05235290527): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734908 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734908 AND published='1' LIMIT 1

150 (!!!!! 2046.1082458496): 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 (575.06561279297): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734908 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734908 AND published='1' LIMIT 1

152 (53.167343139648): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734908 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734908 AND published='1' LIMIT 1

153 (46.014785766602): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294734908 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294734908 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (297.06954956055): 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=212 or channel_id is null)

155 (35.04753112793): 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=212 or channel_id is null)

156 (33.140182495117): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (237.94174194336): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734908 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734908 AND published='1' LIMIT 1

158 (134.94491577148): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734908 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734908 AND published='1' LIMIT 1

159 (73.909759521484): select jos_twitters.link from jos_twitters where cat=10

160 (30.994415283203): 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 (275.1350402832): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

164 (!!!!! 1085.0429534912): insert into jos_banners_delta values (14615,'2025-06-27 05:33:49','216.73.216.249','view'),(14202,'2025-06-27 05:33:49','216.73.216.249','view'),(14203,'2025-06-27 05:33:49','216.73.216.249','view')

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