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Adaptive Proton RT Democratizes Cancer Care

By MedImaging International staff writers
Posted on 20 Feb 2020

Image: The Varian Probeam proton therapy System (Photo courtesy of Varian)

An artificial intelligence (AI)-driven radiotherapy (RT) solution delivers a holistic adaptive treatment experience to improve patient care.

The Varian Medical Systems (Varian; Palo Alto, CA, USA) Ethos therapy, built on Varian's treatment delivery technology, is designed to provide a streamlined workflow enabled by AI-driven planning and contouring capabilities. The physician first defines clinical intent from pre-defined templates, and the preliminary treatment plan is generated based on the physician's initial clinical objectives. Treatment is then adapted in response to any changes in the patient's anatomy and the tumor's shape and position, on-couch and at the time of treatment.

By providing an up-to-date view of the patient's anatomy, Ethos therapy allows clinicians to make more informed adaptive treatment decisions. Ethos therapy offers the use of multimodality images, including magnetic resonance imaging (MRI), positron emission tomography (PET), computerized tomography (CT), and daily iterative cone beam computerized tomography (CBCT) images at the console itself. The entire process occupies a typical 15-minute timeslot, from initial patient setup on the couch and through treatment delivery.

“Ethos is the long-awaited solution that puts each patient truly at the center of care. This solution represents a new chapter in democratized cancer care," said Chris Toth, president of Varian Oncology Systems. “With Ethos, on-couch adaptive therapy is no longer an elusive aspiration that is too complex and time-consuming to be practical, and too exclusive for most clinics and patients. This is another important step in cancer care that moves us closer to achieving our vision of a world without fear of cancer.”

“Ethos therapy will enable our physicians to better visualize the changes in a patient's anatomy and quickly adapt the therapy accordingly to help provide better treatments to patients,” said Poul Geertsen, MD, PhD, head of radiotherapy at Herlev and Gentofte Hospital (Copenhagen, Denmark). “We have already delivered the first Ethos therapy treatment, and our clinical staff was impressed by the capabilities and the ability to deliver this advanced treatment in a typical timeslot.”

Varian specializes in proton therapy, a precise form of RT that uses charged particles instead of x-rays. It can be a more effective form of treatment than conventional RT as it is more precise, with minimal damage to surrounding tissue. Evidence is growing that protons can be effective in treating a number of cancers, in particular children and young people with brain tumors, for whom it appears to produce fewer side effects such as secondary cancers, growth deformity, hearing loss, and learning difficulties.

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61 (105.85784912109): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294780914 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294780914 AND published='1' LIMIT 1

62 (!!!!! 5117.1779632568): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294780914 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294780914 AND published='1' LIMIT 1

63 (710.96420288086): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294780914 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294780914 AND published='1' LIMIT 1

64 (96.08268737793): 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

65 (!!!!! 1266.9563293457): SELECT fid FROM jos_deeppockets WHERE id=294780914 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294780914 AND published='1' LIMIT 1

66 (78.916549682617): 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=213 ORDER BY `ordering`

67 (798.94065856934): select jos_twitters.link from jos_twitters where cat=10

68 (65.803527832031): select jos_facebook.link from jos_facebook where cat=10

69 (43.869018554688): select jos_google_plus.link from jos_google_plus where cat=10

70 (41.007995605469): select jos_linkedin.link from jos_linkedin where cat=10

71 (283.00285339355): SELECT fid FROM jos_deeppockets WHERE id=294780914 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294780914 AND published='1' LIMIT 1

72 (65.088272094727): 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=213 ORDER BY `ordering`

73 (!!!!! 5696.0582733154): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294780914 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

74 (!!!!! 1329.8988342285): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294780914 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

75 (108.95729064941): 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`

76 (!!!!! 5719.9001312256): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (!!!!! 8022.7851867676): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (!!!!! 7823.9440917969): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (!!!!! 5215.8832550049): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (890.97023010254): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (!!!!! 2124.0711212158): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (!!!!! 1136.0645294189): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (598.19221496582): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (921.01097106934): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (984.19189453125): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (257.96890258789): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (46.968460083008): SELECT show_live FROM jos_com_show_setting LIMIT 1

88 (649.92904663086): SELECT show_live FROM jos_com_show_setting LIMIT 1

89 (62.942504882812): SELECT show_live FROM jos_com_show_setting LIMIT 1

90 (!!!!! 1210.9279632568): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294780914 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

91 (530.95817565918): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294780914 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

92 (252.96211242676): 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`

93 (605.10635375977): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (61.03515625): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (48.160552978516): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (42.915344238281): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (42.915344238281): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (42.915344238281): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (!!!!! 2411.1270904541): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (401.02005004883): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (588.89389038086): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (57.93571472168): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (46.968460083008): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (42.915344238281): SELECT show_live FROM jos_com_show_setting LIMIT 1

105 (42.915344238281): SELECT show_live FROM jos_com_show_setting LIMIT 1

106 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

107 (118.97087097168): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294780914 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294780914 AND published='1' LIMIT 1

108 (234.12704467773): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294780914 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294780914 AND published='1' LIMIT 1

109 (223.87504577637): 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=294780914 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

110 (837.08763122559): 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=294780914 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (!!!!! 1719.9516296387): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294780914 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294780914 AND published='1' LIMIT 1

112 (943.89915466309): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294780914 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294780914 AND published='1' LIMIT 1

113 (119.92454528809): 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=294780914 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

114 (851.86958312988): 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=294780914 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

115 (!!!!! 6614.9234771729): 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

116 (!!!!! 8104.0859222412): 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

117 (!!!!! 7516.8609619141): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294780914 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294780914 AND published='1' LIMIT 1

118 (!!!!! 7994.8902130127): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294780914 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294780914 AND published='1' LIMIT 1

119 (!!!!! 7666.1109924316): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294780914 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294780914 AND published='1' LIMIT 1

120 (!!!!! 7933.8550567627): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294780914 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294780914 AND published='1' LIMIT 1

121 (!!!!! 7671.8330383301): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294780914 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294780914 AND published='1' LIMIT 1

122 (!!!!! 7953.1669616699): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294780914 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294780914 AND published='1' LIMIT 1

123 (!!!!! 7589.8170471191): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294780914 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294780914 AND published='1' LIMIT 1

124 (!!!!! 3988.9812469482): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294780914 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294780914 AND published='1' LIMIT 1

125 (!!!!! 9078.9794921875): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294780914 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294780914 AND type='deeppockets_item' AND published='1' LIMIT 1

126 (!!!!! 79901.933670044): ( 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 (448.94218444824): ( 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 (594.8543548584): 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 (198.1258392334): 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 (!!!!! 1043.0812835693): 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 (247.00164794922): 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 (324.01084899902): 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 (!!!!! 4742.8607940674): 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 (73.909759521484): 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 (46.014785766602): 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 (604.86793518066): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294780914 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (481.12869262695): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294780914 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

138 (66.041946411133): SELECT name FROM jos_deeppockets WHERE id=213

139 (42.200088500977): SELECT name FROM jos_deeppockets WHERE id=213

140 (779.86717224121): 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 '((;)|(^))213((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

141 (744.81964111328): 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 '((;)|(^))213((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

142 (105.14259338379): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294780914 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294780914 AND published='1' LIMIT 1

143 (75.101852416992): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294780914 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294780914 AND published='1' LIMIT 1

144 (518.0835723877): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294780914 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

145 (72.956085205078): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294780914 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

146 (98.943710327148): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294780914 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294780914 AND published='1' LIMIT 1

147 (57.93571472168): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294780914 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294780914 AND published='1' LIMIT 1

148 (!!!!! 1621.0079193115): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

149 (287.05596923828): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294780914 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294780914 AND published='1' LIMIT 1

150 (135.89859008789): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294780914 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294780914 AND published='1' LIMIT 1

151 (123.02398681641): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294780914 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294780914 AND type='deeppockets_item' AND published='1' LIMIT 1

152 (195.98007202148): 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=213 or channel_id is null)

153 (46.014785766602): 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=213 or channel_id is null)

154 (91.075897216797): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

155 (223.15979003906): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294780914 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294780914 AND published='1' LIMIT 1

156 (104.90417480469): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294780914 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294780914 AND published='1' LIMIT 1

157 (113.01040649414): select jos_twitters.link from jos_twitters where cat=10

158 (41.961669921875): select jos_facebook.link from jos_facebook where cat=10

159 (70.810317993164): select jos_google_plus.link from jos_google_plus where cat=10

160 (90.837478637695): select jos_linkedin.link from jos_linkedin where cat=10

161 (707.14950561523): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

162 (!!!!! 11125.087738037): insert into jos_banners_delta values (14615,'2025-08-03 23:00:35','216.73.216.210','view'),(14202,'2025-08-03 23:00:35','216.73.216.210','view'),(14203,'2025-08-03 23:00:35','216.73.216.210','view')

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