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Radiation Doses from CT Scans Found to Vary Greatly

By MedImaging International staff writers
Posted on 12 Jan 2010

Doses of radiation from commonly performed computed tomography (CT) scans vary widely, appear higher than typically believed, and may contribute to an estimated tens of thousands of future cancer cases, according to two new reports.

The studies were published in the December 14/28, 2009, issue of Archives of Internal Medicine, one of the JAMA&Archives journals. CT scans have become increasingly common in the United States-about 70 million were performed in 2007, up from 3 million in 1980, according to background information in one of the articles. "While CT scans can provide great medical benefits, there is concern about potential future cancer risks because they involve much higher radiation doses than conventional diagnostic X-rays,” the authors of one report write. For example, a chest CT scan exposes the patient to more than 100 times the radiation dose of a standard chest X-ray. "The risks to individuals are likely to be small, but because of the large number of persons exposed annually, even small risks could translate into a considerable number of future cancers.”

It is important to understand how much radiation medical imaging delivers to help balance benefits and risks, the investigators noted. In one article, Rebecca Smith-Bindman, M.D., of the University of California, San Francisco (UCSF; USA), and colleagues studied 1,119 patients undergoing the 11 most common types of diagnostic CT scans at four area institutions in 2008. Using hospital records, they calculated the radiation dosage involved with each scan and then estimated lifetime risks of cancer that could be attributed to those scans.

Radiation dosage varied widely between different types of CT studies; median (midpoint) doses ranged from 2 mSv for a routine head CT scan to 31 mSv for a multiphase abdomen and pelvis scan. "Within each type of CT study, effective dose varied significantly within and across institutions, with a mean [average] 13-fold variation between the highest and lowest dose for each study type,” the UCSF investigators wrote.

The estimated number of CT scans that would lead to the development of one cancer case also varied by type of CT scan and also by each patient's age and sex. For instance, an estimated one in 270 women and one in 600 men who undergo CT coronary angiography (a heart scan) at age 40 will develop cancer as a result. One cancer case will likely occur among every 8,100 women and 11,080 men who had a routine head CT scan at the same age. "For 20-year-old patients, the risks were approximately doubled, and for 60-year-old patients, they were approximately 50 percent lower,” the investigators noted.

"The radiation exposure associated with CT has increased substantially over the past two decades, and efforts need to be undertaken to minimize radiation exposure from CT, including reducing unnecessary studies, reducing the dose per study and reducing the variation in dose across patients and facilities,” the researchers concluded. "Patient outcomes studies are needed to help define when CT leads to the greatest benefit and when these studies may have no impact, where that the radiation risk may be greater than the benefit expected from the examinations. Understanding exposures to medical radiation delivered through actual clinical studies is a crucial first step toward developing reasonable strategies to minimize unnecessary exposures.”

In another paper, Amy Berrington de González, D. Phil., of the U.S. National Cancer Institute (Bethesda, MD, USA), and colleagues constructed a risk model to estimate age-specific cancer risks for each scan type. Data were derived from previous reports of radiation-associated cancer risks, national surveys, and insurance claims. "Overall, we estimated that approximately 29,000 future cancers could be related to CT scans performed in the U.S. in 2007,” the researchers reported. This includes an estimated 14,000 cases resulting from scans of the abdomen and pelvis; 4,100 from chest scans; 4,000 from head scans; and 2,700 from CT angiography. One-third of these projected cancer cases would occur following scans performed on individuals age 35 to 54 years, compared with 15% due to scans performed in children and teens. Two-thirds of the cancers would be in women.

"Changes made to practice now could help to avoid the possibility of reaching the level of attributable risk suggested above (2%). Our detailed estimates highlight several areas of use in which the public health impact may be largest, specifically abdomen and pelvis and chest CT scans in adults aged 35 to 54 years,” the authors concluded. "Further work is needed to investigate the balance of the risks and benefits from CT scan use and to assess the potential for dose or exposure reduction.”

"The articles in this issue make clear that there is far more radiation from medical CT scans than has been recognized previously, in amounts projected to cause tens of thousands of excess cancers annually,” noted Rita F. Redberg, M.D., M.Sc., of the University of California, San Francisco, and editor of Archives of Internal Medicine, in an accompanying editorial. "Also, as these scans have become more sensitive, incidental findings lead to additional testing [and often more radiation], biopsies, and anxiety.”

"Although a guiding principle in medicine is to ensure that the benefit of a procedure or therapy outweighs the risk, the explosion of CT scans in the past decade has outpaced evidence of their benefit. Although there are clear instances when CT scans help determine the treatment course for patients, more and more often patients go directly from the emergency department to the CT scanner even before they are seen by a physician or brought to their hospital room. To avoid unnecessarily increasing cancer incidence in future years, every clinician must carefully assess the expected benefits of each CT scan and fully inform his or her patients of the known risks of radiation,” Dr. Redberg concluded.

Related Links:
University of California, San Francisco
U.S. National Cancer Institute

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56 (819.92149353027): 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=294727350 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

57 (!!!!! 1308.9179992676): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294727350 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294727350 AND published='1' LIMIT 1

58 (57.93571472168): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294727350 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294727350 AND published='1' LIMIT 1

59 (!!!!! 1352.071762085): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294727350 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294727350 AND published='1' LIMIT 1

60 (61.03515625): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294727350 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294727350 AND published='1' LIMIT 1

61 (!!!!! 5349.87449646): 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 (!!!!! 1107.931137085): SELECT fid FROM jos_deeppockets WHERE id=294727350 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294727350 AND published='1' LIMIT 1

63 (350.9521484375): 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 (41.961669921875): select jos_twitters.link from jos_twitters where cat=10

65 (30.040740966797): select jos_facebook.link from jos_facebook where cat=10

66 (83.92333984375): select jos_google_plus.link from jos_google_plus where cat=10

67 (88.930130004883): select jos_linkedin.link from jos_linkedin where cat=10

68 (189.06593322754): SELECT fid FROM jos_deeppockets WHERE id=294727350 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294727350 AND published='1' LIMIT 1

69 (86.069107055664): 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 (639.20021057129): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294727350 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (550.0316619873): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294727350 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (104.90417480469): 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 (100.13580322266): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (106.0962677002): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (29.802322387695): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (67.949295043945): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (93.936920166016): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (67.949295043945): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (93.936920166016): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (67.949295043945): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (92.029571533203): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (70.095062255859): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (164.98565673828): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (77.009201049805): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (97.036361694336): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (69.141387939453): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (370.97930908203): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294727350 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (88.930130004883): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294727350 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (168.0850982666): 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 (144.00482177734): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (322.10350036621): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (126.12342834473): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (72.002410888672): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (182.8670501709): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (133.03756713867): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (317.09671020508): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (33.855438232422): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (127.07710266113): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (301.83792114258): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (100.85105895996): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (106.0962677002): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (149.01161193848): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (!!!!! 3118.9918518066): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294727350 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294727350 AND published='1' LIMIT 1

105 (148.05793762207): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294727350 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294727350 AND published='1' LIMIT 1

106 (325.91819763184): 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=294727350 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (894.78492736816): 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=294727350 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (!!!!! 7140.1596069336): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294727350 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294727350 AND published='1' LIMIT 1

109 (570.77407836914): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294727350 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294727350 AND published='1' LIMIT 1

110 (474.92980957031): 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=294727350 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (571.96617126465): 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=294727350 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (!!!!! 1111.0305786133): 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 (931.97822570801): 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 (359.05838012695): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294727350 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294727350 AND published='1' LIMIT 1

115 (218.86825561523): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294727350 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294727350 AND published='1' LIMIT 1

116 (693.08280944824): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294727350 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294727350 AND published='1' LIMIT 1

117 (118.01719665527): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294727350 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294727350 AND published='1' LIMIT 1

118 (311.13624572754): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294727350 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294727350 AND published='1' LIMIT 1

119 (258.9225769043): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294727350 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294727350 AND published='1' LIMIT 1

120 (252.96211242676): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294727350 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294727350 AND published='1' LIMIT 1

121 (50.067901611328): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294727350 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294727350 AND published='1' LIMIT 1

122 (!!!!! 7873.0583190918): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 92121.124267578): 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 (!!!!! 5223.9894866943): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294727350 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294727350 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (406.98051452637): ( 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 (65.088272094727): ( 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 (502.10952758789): 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 (54.121017456055): 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 (158.07151794434): 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 (688.07601928711): 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 (340.93856811523): 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 (240.08750915527): 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 (318.05038452148): 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 (390.05279541016): 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 (988.00659179688): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294727350 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (880.95664978027): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294727350 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (288.96331787109): SELECT name FROM jos_deeppockets WHERE id=211

138 (!!!!! 4688.024520874): SELECT name FROM jos_deeppockets WHERE id=211

139 (714.06364440918): 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 (!!!!! 1040.9355163574): 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 (!!!!! 1176.118850708): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294727350 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294727350 AND published='1' LIMIT 1

142 (247.00164794922): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294727350 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294727350 AND published='1' LIMIT 1

143 (!!!!! 4855.8712005615): TRUNCATE TABLE jos_trademed_module

144 (!!!!! 3304.0046691895): 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=294727350 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (566.00570678711): 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=294727350 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (!!!!! 1125.0972747803): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294727350 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (272.03559875488): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294727350 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (!!!!! 2288.1031036377): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294727350 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294727350 AND published='1' LIMIT 1

149 (464.91622924805): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294727350 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294727350 AND published='1' LIMIT 1

150 (!!!!! 3680.944442749): 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 (823.974609375): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294727350 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294727350 AND published='1' LIMIT 1

152 (339.98489379883): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294727350 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294727350 AND published='1' LIMIT 1

153 (473.97613525391): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294727350 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294727350 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (295.16220092773): 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 (117.06352233887): 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 (532.86552429199): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (!!!!! 1084.0892791748): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294727350 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294727350 AND published='1' LIMIT 1

158 (446.08116149902): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294727350 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294727350 AND published='1' LIMIT 1

159 (756.02531433105): select jos_twitters.link from jos_twitters where cat=10

160 (437.97492980957): select jos_facebook.link from jos_facebook where cat=10

161 (33.140182495117): select jos_google_plus.link from jos_google_plus where cat=10

162 (143.05114746094): select jos_linkedin.link from jos_linkedin where cat=10

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