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Three-Pronged Initiative to Reduce Unnecessary Radiation Exposure from Medical Imaging

By MedImaging International staff writers
Posted on 08 Mar 2010

A U.S. initiative has been designed to reduce unnecessary radiation exposure from three types of medical imaging procedures: computed tomography (CT), nuclear medicine studies, and fluoroscopy. These procedures are the greatest contributors to total radiation exposure within the U.S. population and use much higher radiation doses than other radiographic procedures, such as conventional X-rays, dental X-rays, and mammography.

CT, nuclear medicine, and fluoroscopic imaging have led to early diagnosis of disease, improved treatment planning, and image-guided therapies that help save lives. The organizers of the initiative, the U.S. Food and Drug Administration (Silver Spring, MD, USA), announced it continues to support a strong dialogue between patients and physicians over the medical necessity and risk associated with these types of imaging studies.

However, like all medical procedures, CT, nuclear medicine, and fluoroscopy pose risks. These types of imaging exams expose patients to ionizing radiation, a type of radiation that can increase an individual's lifetime cancer risk. Accidental exposure to very high amounts of radiation also can cause injuries, such as skin burns, hair loss, and cataracts. Healthcare decisions made by patients and their physicians should include discussions of the medical need and associated risks for each procedure.

"The amount of radiation Americans are exposed to from medical imaging has dramatically increased over the past 20 years,” said Jeffrey Shuren, M.D., J.D., director of the FDA's Center for Devices and Radiological Health. "The goal of FDA's initiative is to support the benefits associated with medical imaging while minimizing the risks.”

While there is some disagreement over the extent of the cancer risk associated with exposure to radiation from medical imaging, there is broad agreement that steps can and should be taken to reduce unnecessary radiation exposure. For example, the radiation dose associated with a CT abdomen scan is the same as the dose from approximately 400 chest X-rays. In comparison, a dental X-ray calls for approximately one-half the radiation dose of a chest X-ray. Both diagnostics serve important, sometimes critical, public health needs.

Through the FDA's regulatory oversight of medical imaging devices, such as CT scanners, and through collaboration with other federal agencies and healthcare professional groups, the FDA is advocating the adoption of two principles of radiation protection: appropriate justification of the radiation procedure and optimization of the radiation dose used during each procedure. "Working together,” said Dr. Shuren, "the FDA and other organizations hope to help patients get the right imaging exam, at the right time, with the right radiation dose.”

The three-pronged initiative the FDA is announcing will promote the safe use of medical imaging devices, support informed clinical decision-making, and increase patient awareness of their own exposure. The FDA intends to issue targeted requirements for manufacturers of CT and fluoroscopic devices to integrate important safeguards into the design of their machines to develop safer technologies and to provide appropriate training to support safe use by practitioners. The agency intends to hold a public meeting on March 30-31, 2010, to solicit input on what requirements to establish.

Examples could include a requirement that these devices display, record, and report equipment settings and radiation dose, an alert for users when the dose exceeds a diagnostic reference level (the optimal dose for most patients), training for users, and a requirement that devices be able to capture and transmit radiation dose information to a patient's electronic medical record and to national dose registries. Moreover, the FDA and the Centers for Medicare and Medicaid Services are collaborating to incorporate key quality assurance practices into the mandatory accreditation and conditions of participation survey processes for imaging facilities and hospitals. These quality assurance practices will improve the quality of oversight and promote the safe use of advanced imaging technologies in those facilities.

The FDA recommends that healthcare professional organizations continue to develop, in collaboration with the agency, diagnostic radiation reference levels for medical imaging procedures, and increase efforts to develop one or more national registries for radiation doses. A dose registry would pool data from many imaging facilities nationwide, capturing dose information from a variety of imaging studies. This registry will help define diagnostic reference levels where they do not yet exist, validate levels that do exist, and provide benchmarks for health care facilities to use in individual imaging studies.

In a bid to empower patients and increase awareness, the FDA is collaborating with other organizations to develop and disseminate a patient medical imaging history card. This tool, which will be available on the FDA's Website, will allow patients to track their own medical imaging history and share it with their physicians, particularly when it may not be included in their medical records.

Related Links:
FDA Web site on Radiation Initiative
Food and Drug Administration

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58 (97.036361694336): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728363 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728363 AND published='1' LIMIT 1

59 (!!!!! 2058.9828491211): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728363 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728363 AND published='1' LIMIT 1

60 (323.05717468262): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728363 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728363 AND published='1' LIMIT 1

61 (!!!!! 3751.9931793213): 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 (682.11555480957): SELECT fid FROM jos_deeppockets WHERE id=294728363 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294728363 AND published='1' LIMIT 1

63 (415.80200195312): 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 (92.029571533203): select jos_twitters.link from jos_twitters where cat=10

65 (!!!!! 3411.0546112061): select jos_facebook.link from jos_facebook where cat=10

66 (118.97087097168): select jos_google_plus.link from jos_google_plus where cat=10

67 (44.107437133789): select jos_linkedin.link from jos_linkedin where cat=10

68 (69.856643676758): SELECT fid FROM jos_deeppockets WHERE id=294728363 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294728363 AND published='1' LIMIT 1

69 (58.174133300781): 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 (504.97055053711): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294728363 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (349.99847412109): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294728363 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (54.836273193359): 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 (118.01719665527): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (51.975250244141): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (61.03515625): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (52.928924560547): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (45.061111450195): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (41.961669921875): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (47.922134399414): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (41.961669921875): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (42.200088500977): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (92.983245849609): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294728363 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (45.061111450195): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294728363 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (52.928924560547): 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 (190.97328186035): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (44.822692871094): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (48.160552978516): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (118.97087097168): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (104.90417480469): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (39.815902709961): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (32.186508178711): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (38.862228393555): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (44.107437133789): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (50.067901611328): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (!!!!! 3830.9097290039): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728363 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728363 AND published='1' LIMIT 1

105 (139.95170593262): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728363 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728363 AND published='1' LIMIT 1

106 (92.983245849609): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294728363 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (832.79609680176): 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=294728363 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (118.97087097168): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728363 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728363 AND published='1' LIMIT 1

109 (72.002410888672): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728363 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728363 AND published='1' LIMIT 1

110 (78.916549682617): 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=294728363 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (735.99815368652): 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=294728363 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (713.10997009277): 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 (469.92301940918): 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 (82.969665527344): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728363 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728363 AND published='1' LIMIT 1

115 (51.021575927734): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728363 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728363 AND published='1' LIMIT 1

116 (81.062316894531): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728363 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728363 AND published='1' LIMIT 1

117 (58.889389038086): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728363 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728363 AND published='1' LIMIT 1

118 (53.882598876953): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728363 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728363 AND published='1' LIMIT 1

119 (40.054321289062): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728363 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728363 AND published='1' LIMIT 1

120 (49.114227294922): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728363 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728363 AND published='1' LIMIT 1

121 (57.93571472168): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728363 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728363 AND published='1' LIMIT 1

122 (444.88906860352): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 54671.049118042): 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 (609.15946960449): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294728363 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294728363 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 23201.942443848): ( 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 (80.82389831543): ( 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 (582.93342590332): 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 (52.928924560547): 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 (281.09550476074): 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 (51.021575927734): 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 (190.01960754395): 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 (107.0499420166): 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 (194.07272338867): 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 (53.167343139648): 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 (472.06878662109): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728363 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (!!!!! 3078.9375305176): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728363 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (350.9521484375): SELECT name FROM jos_deeppockets WHERE id=211

138 (66.995620727539): SELECT name FROM jos_deeppockets WHERE id=211

139 (777.00614929199): 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 (674.96299743652): 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 (88.930130004883): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728363 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728363 AND published='1' LIMIT 1

142 (66.041946411133): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728363 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728363 AND published='1' LIMIT 1

143 (!!!!! 15038.013458252): TRUNCATE TABLE jos_trademed_module

144 (!!!!! 1605.9875488281): 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=294728363 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (117.06352233887): 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=294728363 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (529.05082702637): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728363 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (!!!!! 2043.0088043213): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728363 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (109.91096496582): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728363 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728363 AND published='1' LIMIT 1

149 (50.067901611328): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728363 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728363 AND published='1' LIMIT 1

150 (!!!!! 1540.8992767334): 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 (113.96408081055): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728363 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728363 AND published='1' LIMIT 1

152 (77.009201049805): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728363 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728363 AND published='1' LIMIT 1

153 (43.869018554688): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294728363 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294728363 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (34.093856811523): 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 (360.01205444336): 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 (61.03515625): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (258.9225769043): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728363 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728363 AND published='1' LIMIT 1

158 (122.0703125): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728363 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728363 AND published='1' LIMIT 1

159 (63.896179199219): select jos_twitters.link from jos_twitters where cat=10

160 (33.855438232422): select jos_facebook.link from jos_facebook where cat=10

161 (32.901763916016): select jos_google_plus.link from jos_google_plus where cat=10

162 (32.901763916016): select jos_linkedin.link from jos_linkedin where cat=10

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