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Radiologists Spearhead Strategy to Address Medical Imaging Overuse

By MedImaging International staff writers
Posted on 23 Sep 2010

Overutilization of medical imaging services exposes patients to unnecessary radiation and adds to healthcare costs, according to a report that calls on radiologists to organize a collaborative effort to limit imaging overutilization.

"In most cases, an imaging procedure enhances the accuracy of a diagnosis or guides a medical treatment and is fully justified, because it benefits the patient,” said the article's lead author, William R. Hendee, Ph.D., professor of radiology, radiation oncology, biophysics and bioethics at the Medical College of Wisconsin (Milwaukee, USA; Medical College of Wisconsin (Milwaukee, USA). "But some imaging procedures are not justified, because they are unnecessary for the patient's care. These are the uses of imaging that we, as medical physicists, radiologists, radiation oncologists, and educators, are trying to identify and eliminate.”

The growth in medical imaging over the past 20 years has provided significant and life-saving benefits to patients. Medical imaging has allowed millions of patients to avoid more invasive diagnostic and treatment procedures. However, overutilization of medical imaging services can be detrimental to patients by exposing them to unnecessary radiation. Between 1980 and 2006, the annual U.S. population radiation dose from medical procedures increased seven-fold, according to the U.S. National Council on Radiation Protection and Measurements.

In August 2009, the American Board of Radiology Foundation (Tucson, AZ, USA) hosted a two-day summit with more than 60 participating organizations to examine the causes and effects of imaging over-utilization. The summit identified several key forces influencing overutilization, including payment mechanisms and financial incentives in the U.S. healthcare system, the practice behavior of referring physicians, self-referral, defensive medicine, patient expectations, and duplicate imaging exams.

"There are many causes of overutilization of imaging in medicine,” Dr. Hendee said. "Some of these causes, such as self-referral to physician-owned imaging facilities and defensive medicine to shield against potential lawsuits, are beyond radiology's influence to correct and must be dealt with more globally within medicine. However, some of the causes do occur within radiology, and the profession is hard at work to address them.”

Summit participants offered several suggestions to reduce overutilization, such as a national collaborative effort to develop evidence-based appropriateness criteria for imaging, greater use of practice guidelines in requesting and conducting imaging exams, decision support at the point-of-care, education of referring physicians and the public, accreditation of imaging facilities, management of self-referral and defensive medicine, and payment reform. The report outlined several of these suggestions and stated that these efforts will require the cooperation and active collaboration of many groups, including radiologists, physicists, oncologists, referring physicians, payers of healthcare services, patient, and public interest groups, and vendors of medical imaging equipment.

A second summit called "Improving Patient Care through Effective Communicating in Imaging” was held in Washington, DC, USA, August 5-6, 2010.

In June 2009, the Radiological Society of North America (RSNA; Oak Brook, IL, USA) and the American College of Radiology (Reston, VA, USA) established the Joint Task Force on Adult Radiation Protection to address concerns about patient radiation exposure from medical imaging procedures. The task force subsequently widened the participating primary member institutions to include the American Association of Physicists in Medicine (College Park, MD, USA) and the American Society of Radiologic Technologists (Albuquerque, NM, USA), and it is in the process of developing the "Image Wisely” campaign for adult radiation protection.

The article appeared online in August 2010 and in the October 2010 issue of the journal Radiology.

Related Links:
Medical College of Wisconsin
American Board of Radiology Foundation

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61 (!!!!! 4764.0800476074): 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 (!!!!! 2038.9556884766): SELECT fid FROM jos_deeppockets WHERE id=294731271 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294731271 AND published='1' LIMIT 1

63 (82.015991210938): 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 (402.92739868164): select jos_twitters.link from jos_twitters where cat=10

65 (43.869018554688): select jos_facebook.link from jos_facebook where cat=10

66 (34.093856811523): select jos_google_plus.link from jos_google_plus where cat=10

67 (265.12145996094): select jos_linkedin.link from jos_linkedin where cat=10

68 (148.05793762207): SELECT fid FROM jos_deeppockets WHERE id=294731271 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294731271 AND published='1' LIMIT 1

69 (139.95170593262): 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 (829.93507385254): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294731271 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (344.99168395996): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294731271 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (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`

73 (66.995620727539): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (41.961669921875): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (33.855438232422): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (111.10305786133): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294731271 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=294731271 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (54.121017456055): 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 (83.92333984375): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (45.7763671875): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (48.160552978516): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (38.862228393555): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (105.85784912109): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294731271 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294731271 AND published='1' LIMIT 1

105 (69.141387939453): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294731271 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294731271 AND published='1' LIMIT 1

106 (87.976455688477): 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=294731271 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (75.817108154297): 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=294731271 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (140.90538024902): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294731271 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294731271 AND published='1' LIMIT 1

109 (74.148178100586): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294731271 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294731271 AND published='1' LIMIT 1

110 (61.988830566406): 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=294731271 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (604.86793518066): 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=294731271 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (935.07766723633): 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 (818.01414489746): 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 (!!!!! 5210.8764648438): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294731271 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294731271 AND published='1' LIMIT 1

115 (123.02398681641): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294731271 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294731271 AND published='1' LIMIT 1

116 (120.87821960449): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294731271 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294731271 AND published='1' LIMIT 1

117 (73.909759521484): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294731271 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294731271 AND published='1' LIMIT 1

118 (71.048736572266): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294731271 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294731271 AND published='1' LIMIT 1

119 (56.028366088867): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294731271 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294731271 AND published='1' LIMIT 1

120 (66.041946411133): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294731271 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294731271 AND published='1' LIMIT 1

121 (57.93571472168): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294731271 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294731271 AND published='1' LIMIT 1

122 (507.83157348633): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 56122.064590454): 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 (792.02651977539): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294731271 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294731271 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 23416.996002197): ( 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 (127.07710266113): ( 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 (91.075897216797): 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 (55.074691772461): 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 (72.956085205078): 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 (37.908554077148): 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 (413.89465332031): 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 (42.915344238281): 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 (44.107437133789): 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 (46.014785766602): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

135 (526.90505981445): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294731271 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (513.07678222656): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294731271 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (46.968460083008): SELECT name FROM jos_deeppockets WHERE id=211

138 (34.093856811523): SELECT name FROM jos_deeppockets WHERE id=211

139 (678.06243896484): 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 (589.84756469727): 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 (74.863433837891): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294731271 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294731271 AND published='1' LIMIT 1

142 (50.067901611328): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294731271 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294731271 AND published='1' LIMIT 1

143 (!!!!! 16663.074493408): TRUNCATE TABLE jos_trademed_module

144 (!!!!! 4451.0364532471): 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=294731271 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (832.08084106445): 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=294731271 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (567.91305541992): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294731271 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (70.095062255859): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294731271 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (82.969665527344): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294731271 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294731271 AND published='1' LIMIT 1

149 (78.916549682617): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294731271 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294731271 AND published='1' LIMIT 1

150 (!!!!! 1590.9671783447): 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 (102.99682617188): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294731271 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294731271 AND published='1' LIMIT 1

152 (51.975250244141): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294731271 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294731271 AND published='1' LIMIT 1

153 (46.014785766602): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294731271 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294731271 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (35.04753112793): 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 (31.948089599609): 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 (33.855438232422): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (92.983245849609): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294731271 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294731271 AND published='1' LIMIT 1

158 (649.92904663086): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294731271 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294731271 AND published='1' LIMIT 1

159 (56.028366088867): select jos_twitters.link from jos_twitters where cat=10

160 (30.994415283203): select jos_facebook.link from jos_facebook where cat=10

161 (30.994415283203): select jos_google_plus.link from jos_google_plus where cat=10

162 (31.948089599609): select jos_linkedin.link from jos_linkedin where cat=10

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