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Increasing Use of CT Scanning on Pregnant Women Tracked by Study

By MedImaging International staff writers
Posted on 16 Apr 2009

Researchers have found that over a 10-year period, radiologic exams on pregnant women have more than doubled, according to a new study.

"Imaging utilization has not been previously studied in the pregnant population," said Elizabeth Lazarus, M.D., assistant professor of diagnostic imaging at the Warren Alpert School of Medicine at Brown University (Providence, RI, USA) and a radiologist at Rhode Island Hospital (Providence, RI, USA). "This population may be vulnerable to the adverse effects of radiation."

Dr. Lazarus and colleagues conducted a retrospective review of nuclear medicine, computed tomography (CT), fluoroscopy, and plain-film X-ray imaging examinations performed at Rhode Island Hospital and Women and Infants' Hospital from 1997 through 2006 to determine how often these imaging exams were performed on pregnant women and the estimated radiation dose to the fetus. Data were then compared to the number of infant deliveries per year for that same time period.

The researchers found that from 1997 to 2006, the total number of imaging studies performed on pregnant women at their institution increased by 10.1% per year, but the number of CT exams increased by 25.3% per year. CT delivers a higher amount of radiation than many other radiologic procedures.

CT exams are not routinely ordered for pregnant women, but may be necessary to detect suspected life-threatening conditions such as bleeding in the brain, blood clots in the lungs, or appendicitis. Since CT exposes the developing fetus to radiation, concerns are often raised regarding overuse. The majority of CT examinations (approximately 75%) analyzed in the study were performed in areas of the mother's body separate from the uterus, so the fetus was not exposed to any direct radiation. Still, low levels of radiation have been shown to carry a small risk of harm to a developing fetus.

"Women should know that imaging is generally safe during pregnancy and is often used to detect potentially life-threatening problems," Dr. Lazarus said. "However, this study should raise awareness about imaging trends in pregnant patients and help us continue in our efforts to minimize radiation exposure," Dr. Lazarus said.

The researchers evaluated 5,270 examinations on 3,285 patients. During the 10 years of the study, the number of patients imaged per year increased from 237 to 449, and the number of exams per year increased from 331 to 732. This represented an 89% increase in patients and a 121% increase in examinations over the course of the study. During the same 10 years, the number of deliveries only increased 7% from 8,661 to 9,264. Imaging utilization rates (exams per 1,000 deliveries) increased 107%.

Use of plain-film X-rays increased an average of 6.8% per year, and the number of nuclear medicine examinations rose by approximately 11.6% annually. Fluoroscopy utilization increased by 10.6% per year, and CT examinations increased by 25.3% per year.

A milliGray (mGy) is a unit of measure of absorbed radiation. The average estimated fetal radiation exposure per exam for CT was 4.3 mGy, compared to 2.91 mGy for fluoroscopy, 0.40 mGy for nuclear medicine, and 0.43 mGy for X-rays.

Dr. Lazarus hopes that increased use of electronic medical records will help physicians and patients keep track of the number and types of imaging tests performed on pregnant women and give appropriate consideration to alternative imaging tests--such as magnetic resonance imaging (MRI) and ultrasound--that do not expose the patient or fetus to ionizing radiation.

The study was published in March 2009 the online edition of the journal Radiology.

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Warren Alpert School of Medicine at Brown University

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62 (681.87713623047): SELECT fid FROM jos_deeppockets WHERE id=294722837 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294722837 AND published='1' LIMIT 1

63 (!!!!! 5485.0578308105): 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=211 ORDER BY `ordering`

64 (145.91217041016): select jos_twitters.link from jos_twitters where cat=10

65 (41.007995605469): select jos_facebook.link from jos_facebook where cat=10

66 (51.021575927734): select jos_google_plus.link from jos_google_plus where cat=10

67 (41.007995605469): select jos_linkedin.link from jos_linkedin where cat=10

68 (97.990036010742): SELECT fid FROM jos_deeppockets WHERE id=294722837 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294722837 AND published='1' LIMIT 1

69 (53.167343139648): 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=211 ORDER BY `ordering`

70 (485.89706420898): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294722837 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (332.11708068848): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294722837 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (44.107437133789): 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 (66.041946411133): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (104.18891906738): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (47.922134399414): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (38.862228393555): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (45.061111450195): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (38.862228393555): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (116.10984802246): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294722837 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (60.081481933594): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294722837 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (51.975250244141): 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 (50.067901611328): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (33.855438232422): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (82.969665527344): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722837 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722837 AND published='1' LIMIT 1

105 (62.942504882812): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722837 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722837 AND published='1' LIMIT 1

106 (113.01040649414): 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=294722837 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (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_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=294722837 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (94.175338745117): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722837 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722837 AND published='1' LIMIT 1

109 (49.114227294922): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722837 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722837 AND published='1' LIMIT 1

110 (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.id=294722837 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (600.09956359863): 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=294722837 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (617.98095703125): 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 (348.09112548828): 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 (!!!!! 2280.9505462646): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722837 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722837 AND published='1' LIMIT 1

115 (56.982040405273): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722837 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722837 AND published='1' LIMIT 1

116 (96.08268737793): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722837 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722837 AND published='1' LIMIT 1

117 (46.968460083008): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722837 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722837 AND published='1' LIMIT 1

118 (65.088272094727): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722837 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722837 AND published='1' LIMIT 1

119 (63.896179199219): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722837 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722837 AND published='1' LIMIT 1

120 (66.041946411133): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722837 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722837 AND published='1' LIMIT 1

121 (59.127807617188): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722837 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722837 AND published='1' LIMIT 1

122 (408.88786315918): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 55943.965911865): 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 (!!!!! 1534.9388122559): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294722837 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294722837 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 33186.912536621): ( 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 (92.029571533203): ( 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 (123.02398681641): 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 (40.054321289062): 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 (!!!!! 3605.842590332): 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 (132.08389282227): 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 (463.96255493164): 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 (65.803527832031): 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 (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

134 (42.200088500977): 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 (399.11270141602): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722837 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (396.9669342041): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722837 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (434.87548828125): SELECT name FROM jos_deeppockets WHERE id=211

138 (43.153762817383): SELECT name FROM jos_deeppockets WHERE id=211

139 (790.11917114258): 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 '((;)|(^))211((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

140 (!!!!! 3821.1345672607): 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 '((;)|(^))211((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

141 (!!!!! 1873.9700317383): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722837 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722837 AND published='1' LIMIT 1

142 (78.916549682617): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722837 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722837 AND published='1' LIMIT 1

143 (!!!!! 10550.975799561): TRUNCATE TABLE jos_trademed_module

144 (!!!!! 6668.8060760498): 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=294722837 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (870.94306945801): 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=294722837 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (!!!!! 1438.8561248779): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722837 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (89.168548583984): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722837 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (108.00361633301): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722837 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722837 AND published='1' LIMIT 1

149 (77.962875366211): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722837 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722837 AND published='1' LIMIT 1

150 (!!!!! 2132.8926086426): 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 (!!!!! 3715.0382995605): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722837 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722837 AND published='1' LIMIT 1

152 (133.03756713867): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722837 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722837 AND published='1' LIMIT 1

153 (951.05171203613): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294722837 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294722837 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (129.93812561035): 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=211 or channel_id is null)

155 (57.93571472168): 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=211 or channel_id is null)

156 (118.01719665527): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (133.03756713867): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722837 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722837 AND published='1' LIMIT 1

158 (80.108642578125): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722837 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722837 AND published='1' LIMIT 1

159 (!!!!! 6585.8364105225): select jos_twitters.link from jos_twitters where cat=10

160 (!!!!! 5012.9890441895): select jos_facebook.link from jos_facebook where cat=10

161 (!!!!! 2856.969833374): select jos_google_plus.link from jos_google_plus where cat=10

162 (!!!!! 2749.2046356201): select jos_linkedin.link from jos_linkedin where cat=10

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