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Technology Lowers Radiation Exposure from Cardiac Scans Without Impairing Image Quality

By MedImaging International staff writers
Posted on 06 Jul 2009

An approach that includes techniques to reduce the amount of radiation from cardiac computed tomography angiography (CCTA) scanning (used to diagnose coronary artery disease) was associated with decreasing patient exposure to radiation without significantly changing the quality of the images, according to a new study.

Coronary artery disease remains the most frequent cause of death and disability in the developed world, and rates are increasing among developing nations. More...

"As the population at risk has increased, national healthcare systems are under financial pressure to deliver cost-effective diagnosis and risk stratification of symptomatic patients suspected of having coronary ischemia. Noninvasive multislice CCTA has emerged since 2000 as a new diagnostic test with the potential to efficiently address this challenge,” the investigators reported in their study, which was published in the Journal of the American Medical Association (JAMA) on June 10, 2009. Findings from multiple studies suggest that CCTA may definitively exclude the diagnosis of coronary artery disease in a considerable proportion of appropriately selected patients, however radiation dose from this procedure is of concern.

Gilbert L. Raff, M.D., from William Beaumont Hospital (Royal Oak, MI, USA) and colleagues conducted a study to determine whether implementation of an intervention to improve the technique for scan acquisition would be associated with a reduction in the estimated radiation dose from CCTA and what would be the associated effects on image quality. The study included 4,995 patients undergoing CCTA for suspected coronary artery disease at 15 hospital imaging centers, which included small community hospitals and large academic centers; 4,862 patients (97.3%) had complete radiation data for analysis. The techniques to reduce radiation dose included minimized scan range, heart rate reduction, electrocardiographic-gated tube current modulation, and reduced tube voltage in suitable patients.

The researchers found that compared with the control period, patients' median (midpoint) estimated radiation dose in the follow-up period was reduced by 53.3%. An increase in the number of patients receiving the target dose below a certain level (compared with the control period) was achieved at all sites. The increase in the proportion of those reaching the target dose was greatest at low-volume sites (less than 30 scans per month).

"Importantly, despite the reduction in the radiation doses, there were no significant changes during the control period compared with follow-up period in median image quality rating or the proportion of diagnostic-quality scans (554/620 patients [89%] in the control period vs. 769/835 patients [92%] in the follow-up period),” the authors wrote in their article.

The most powerful factors associated with achievement of the target radiation dose were the use of lower tube voltage, which increased from 13-43% of cases, and a site study volume of more than 30 scans per month. Among patient-related variables, reduction in heart rate demonstrated a strong positive association with a decreased radiation dose.

"Baseline data obtained in this study support the concern that CCTA testing may result in relatively high radiation doses, but the rapid improvement in radiation dose in the first three intervention months demonstrates how use of existing technology and technical methods is associated with dramatically reduced dosages. The dose-reduction program involved an educational aspect at every level in the imaging process. Without a feedback loop of regular dose measurements and reports, similar monitoring of patient preparation, and appropriate imaging protocols and resultant image quality, there would neither be the opportunity to detect dose elevations nor the ability to improve practice,” the researchers noted. "The importance of radiation-reduction techniques must be emphasized during physician and technologist training and physicians should demonstrate technical mastery of these methods before certification to oversee CCTA scanning.”

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59 (62.942504882812): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294724360 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294724360 AND published='1' LIMIT 1

60 (109.91096496582): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294724360 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294724360 AND published='1' LIMIT 1

61 (46.968460083008): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294724360 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294724360 AND published='1' LIMIT 1

62 (88.930130004883): 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 (612.02049255371): SELECT fid FROM jos_deeppockets WHERE id=294724360 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294724360 AND published='1' LIMIT 1

64 (47.922134399414): 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`

65 (50.067901611328): select jos_twitters.link from jos_twitters where cat=10

66 (31.948089599609): select jos_facebook.link from jos_facebook where cat=10

67 (36.954879760742): select jos_google_plus.link from jos_google_plus where cat=10

68 (39.100646972656): select jos_linkedin.link from jos_linkedin where cat=10

69 (51.021575927734): SELECT fid FROM jos_deeppockets WHERE id=294724360 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294724360 AND published='1' LIMIT 1

70 (34.809112548828): 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`

71 (420.09353637695): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294724360 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (286.10229492188): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294724360 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

73 (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`

74 (61.03515625): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (33.855438232422): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (29.087066650391): 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 (33.140182495117): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (29.802322387695): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

88 (103.95050048828): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294724360 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (39.100646972656): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294724360 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

90 (45.061111450195): 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 (50.067901611328): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (33.140182495117): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (33.855438232422): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (31.948089599609): 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 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

105 (155.92575073242): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294724360 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294724360 AND published='1' LIMIT 1

106 (88.930130004883): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294724360 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294724360 AND published='1' LIMIT 1

107 (53.167343139648): 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=294724360 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (45.061111450195): 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=294724360 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

109 (154.97207641602): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294724360 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294724360 AND published='1' LIMIT 1

110 (52.928924560547): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294724360 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294724360 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=294724360 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (514.03045654297): 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=294724360 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

113 (592.94700622559): 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 (380.03921508789): 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 (82.015991210938): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294724360 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294724360 AND published='1' LIMIT 1

116 (46.014785766602): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294724360 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294724360 AND published='1' LIMIT 1

117 (47.922134399414): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294724360 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294724360 AND published='1' LIMIT 1

118 (37.908554077148): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294724360 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294724360 AND published='1' LIMIT 1

119 (41.007995605469): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294724360 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294724360 AND published='1' LIMIT 1

120 (38.14697265625): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294724360 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294724360 AND published='1' LIMIT 1

121 (41.961669921875): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294724360 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294724360 AND published='1' LIMIT 1

122 (77.009201049805): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294724360 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294724360 AND published='1' LIMIT 1

123 (291.10908508301): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

124 (!!!!! 19928.932189941): 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 (555.03845214844): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294724360 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294724360 AND type='deeppockets_item' AND published='1' LIMIT 1

126 (!!!!! 8097.1717834473): ( 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 (147.10426330566): ( 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 (79.154968261719): 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 (38.14697265625): 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 (39.100646972656): 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 (27.894973754883): 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 (307.08312988281): 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 (37.193298339844): 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 (36.954879760742): 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 (504.0168762207): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294724360 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (328.06396484375): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294724360 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

138 (47.922134399414): SELECT name FROM jos_deeppockets WHERE id=211

139 (75.101852416992): SELECT name FROM jos_deeppockets WHERE id=211

140 (576.01928710938): 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 (563.14468383789): 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

142 (63.896179199219): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294724360 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294724360 AND published='1' LIMIT 1

143 (59.127807617188): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294724360 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294724360 AND published='1' LIMIT 1

144 (!!!!! 8642.9119110107): TRUNCATE TABLE jos_trademed_module

145 (92.029571533203): 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=294724360 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (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_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=294724360 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

147 (839.9486541748): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294724360 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (50.067901611328): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294724360 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

149 (52.928924560547): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294724360 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294724360 AND published='1' LIMIT 1

150 (38.14697265625): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294724360 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294724360 AND published='1' LIMIT 1

151 (!!!!! 1106.0237884521): 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 (51.021575927734): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294724360 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294724360 AND published='1' LIMIT 1

153 (41.007995605469): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294724360 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294724360 AND published='1' LIMIT 1

154 (31.948089599609): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294724360 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294724360 AND type='deeppockets_item' AND published='1' LIMIT 1

155 (28.848648071289): 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 (27.894973754883): 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)

157 (28.848648071289): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

158 (63.896179199219): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294724360 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294724360 AND published='1' LIMIT 1

159 (44.107437133789): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294724360 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294724360 AND published='1' LIMIT 1

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

161 (31.948089599609): select jos_facebook.link from jos_facebook where cat=10

162 (30.040740966797): select jos_google_plus.link from jos_google_plus where cat=10

163 (30.994415283203): select jos_linkedin.link from jos_linkedin where cat=10

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