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

MRI Safe for Patients with Implanted Cardiac Devices When Specific Guidelines Followed

By MedImaging International staff writers
Posted on 16 Oct 2011

Magnetic resonance imaging (MRI), an important diagnostic modality, has conventionally been off limits to more than 2 million people in the United States alone who have an implanted pacemaker to regulate heart rhythms or an implanted defibrillator to prevent sudden cardiac death. Now, cardiologists recently reported that a protocol they developed has shown to be effective in enabling patients with implanted cardiac devices to safely undergo an MRI scan.

The study’s findings were published in the October 4, 2011, issue of the journal Annals of Internal Medicine. “We believe this is the largest prospective study of MRI in patients with implanted devices,” said lead author Dr. Saman Nazarian, a cardiac electrophysiologist and an assistant professor of medicine at the Johns Hopkins University School of Medicine (Baltimore, MD, USA). “The guidelines we have published can be used to make MRI more available to people who could benefit from early detection of cancer and other diseases and for guiding surgeons during procedures. MRI is considered superior to CT scans in many clinical scenarios, especially for brain and spinal cord imaging.” To date, more than 700 patients with implanted cardiac devices have safely undergone MRI exams at Johns Hopkins.

Their prospective study followed 438 people with implanted cardiac devices who had 555 MRI scans. Almost all of the exams, 94%, were conducted at The Johns Hopkins Hospital. The rest were performed at Rambam Medical Center (Haifa, Israel). The researchers discovered that with appropriate precautions, patients with pacemakers and defibrillators can have an MRI scan with very low risk of the device malfunctioning, moving, heating, or causing abnormal heart rhythms due to the magnetic and radiofrequency energy generated by the imaging.

The devices implanted in three of the patients in the study (1.5%) had a power-on reset event during an MRI scan, meaning that the energy emitted from the scanner caused the devices to return to default settings. This is a rare occurrence that necessitates close expert monitoring during the test, but is easily remedied after the test is completed. None of the three had device dysfunction during the long-term follow-up of between 15 and 66 weeks. One of those patients completed four repeated MRI examinations during the study without any problems.

Johns Hopkins cardiac electrophysiologist and biomedical engineer Dr. Henry Halperin began researching the issue of MRI safety with implanted devices about 15 years ago, testing a range of devices. The safety protocol he developed is now being adopted by institutions worldwide.

“The newer pacemakers made after 1998 and defibrillators manufactured since 2000 come with electromagnetic interference protection,” said Dr. Halperin, who is a professor of medicine at the Johns Hopkins University School of Medicine and the senior author of the study. In addition to the age of the device, the Hopkins team checks the type and configuration of the leads attached to the device. For example, if a lead is disconnected and is not part of the device’s function, an MRI would not be recommended because the tip of the wire could get very hot.

“We reprogram the device to a safe mode while the patient is having the MRI scan,” said Rozann Hansford, RN, MPH, a study author who monitors patients at Johns Hopkins during the scans. “We carefully monitor the patient’s blood pressure, electrical activity of the heart and oxygen saturation, and look for any unusual symptoms. After the test, we reprogram the device and carefully check its function.” The patients’ devices are examined again in three to six months.

The researchers concluded that with a protocol based on device selection, programming, and careful patient monitoring, MRI can be performed safely in many patients who have a pacemaker or a defibrillator. “With the advancing age of the population and the expanding indications for pacemakers and defibrillators, this has become an increasingly important issue, and a lifesaving one for some patients,” noted Dr. Nazarian. He added that many of the patients with cardiac devices who have come to Hopkins for an MRI scan had tumors and other serious problems diagnosed and treated, whereas those problems had been missed by an earlier imaging test, such as a CT or ultrasound exam.

Related Links:
Johns Hopkins University School of Medicine
Rambam Medical Center

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58 (56.982040405273): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737593 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737593 AND published='1' LIMIT 1

59 (92.029571533203): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737593 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737593 AND published='1' LIMIT 1

60 (92.029571533203): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737593 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737593 AND published='1' LIMIT 1

61 (127.07710266113): 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 (473.97613525391): SELECT fid FROM jos_deeppockets WHERE id=294737593 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294737593 AND published='1' LIMIT 1

63 (302.07633972168): 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 (45.061111450195): select jos_twitters.link from jos_twitters where cat=10

65 (29.087066650391): select jos_facebook.link from jos_facebook where cat=10

66 (30.040740966797): select jos_google_plus.link from jos_google_plus where cat=10

67 (28.133392333984): select jos_linkedin.link from jos_linkedin where cat=10

68 (63.180923461914): SELECT fid FROM jos_deeppockets WHERE id=294737593 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294737593 AND published='1' LIMIT 1

69 (35.04753112793): 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 (291.82434082031): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294737593 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (255.10787963867): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294737593 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (47.922134399414): 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 (55.074691772461): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (61.988830566406): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (29.802322387695): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (77.962875366211): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294737593 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (33.140182495117): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294737593 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (36.001205444336): 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 (74.148178100586): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (46.014785766602): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (33.140182495117): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (70.095062255859): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (93.936920166016): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737593 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737593 AND published='1' LIMIT 1

105 (63.896179199219): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737593 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737593 AND published='1' LIMIT 1

106 (48.87580871582): 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=294737593 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (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_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=294737593 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (93.936920166016): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737593 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737593 AND published='1' LIMIT 1

109 (43.153762817383): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737593 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737593 AND published='1' LIMIT 1

110 (74.148178100586): 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=294737593 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (381.9465637207): 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=294737593 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (530.00450134277): 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 (318.05038452148): 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 (75.101852416992): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737593 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737593 AND published='1' LIMIT 1

115 (46.968460083008): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737593 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737593 AND published='1' LIMIT 1

116 (52.928924560547): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737593 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737593 AND published='1' LIMIT 1

117 (41.961669921875): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737593 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737593 AND published='1' LIMIT 1

118 (43.869018554688): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737593 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737593 AND published='1' LIMIT 1

119 (36.954879760742): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737593 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737593 AND published='1' LIMIT 1

120 (45.061111450195): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737593 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737593 AND published='1' LIMIT 1

121 (41.007995605469): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737593 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737593 AND published='1' LIMIT 1

122 (164.98565673828): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 19496.917724609): 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 (391.96014404297): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294737593 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294737593 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 7009.0293884277): ( 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 (66.995620727539): ( 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 (467.77725219727): 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 (82.015991210938): 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 (200.03318786621): 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 (36.001205444336): 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 (166.89300537109): 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 (37.908554077148): 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 (116.82510375977): 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 (32.186508178711): 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 (328.06396484375): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737593 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (268.93615722656): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737593 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (127.79235839844): SELECT name FROM jos_deeppockets WHERE id=212

138 (30.994415283203): SELECT name FROM jos_deeppockets WHERE id=212

139 (605.10635375977): 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 (452.04162597656): 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 (66.995620727539): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737593 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737593 AND published='1' LIMIT 1

142 (49.114227294922): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737593 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737593 AND published='1' LIMIT 1

143 (!!!!! 7695.9133148193): TRUNCATE TABLE jos_trademed_module

144 (92.983245849609): 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=294737593 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (55.789947509766): 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=294737593 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (821.11358642578): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737593 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (50.067901611328): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737593 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (91.075897216797): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737593 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737593 AND published='1' LIMIT 1

149 (69.141387939453): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737593 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737593 AND published='1' LIMIT 1

150 (!!!!! 1147.0317840576): 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 (51.021575927734): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737593 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737593 AND published='1' LIMIT 1

152 (41.007995605469): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737593 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737593 AND published='1' LIMIT 1

153 (44.107437133789): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294737593 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294737593 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (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)

155 (31.948089599609): 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 (39.100646972656): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (368.11828613281): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737593 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737593 AND published='1' LIMIT 1

158 (66.995620727539): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737593 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737593 AND published='1' LIMIT 1

159 (104.90417480469): select jos_twitters.link from jos_twitters where cat=10

160 (27.894973754883): select jos_facebook.link from jos_facebook where cat=10

161 (27.894973754883): 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 (244.140625): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

164 (896.93069458008): insert into jos_banners_delta values (14615,'2025-06-26 18:37:17','216.73.216.249','view'),(14202,'2025-06-26 18:37:17','216.73.216.249','view'),(14203,'2025-06-26 18:37:17','216.73.216.249','view')

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