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Campaign Established to Lower Radiation Dose in Pediatric Fluoroscopic Procedures

By MedImaging International staff writers
Posted on 01 Mar 2011

A new imaging campaign has developed easily accessible online teaching materials and checklists to help providers use the lowest dose necessary to perform fluoroscopic procedures on children.

Physicians, medical physicists, and radiologic technologists are encouraged to visit the Image Gently Website to review these important materials and factor the information into their clinical decision-making. The campaign is conducted by the Alliance for Radiation Safety in Pediatric Imaging, founded by the Society for Pediatric Radiology (SPR; Reston, VA, USA), American College of Radiology (ACR; Reston, VA, USA), American Society of Radiologic Technologists (ASRT; Albuquerque, NM, USA), and the American Association of Physicists in Medicine (AAPM; College Park, MD, USA), and now comprises more than 50 medical organizations serving more than 500,000 healthcare providers worldwide.

There is no doubt that fluoroscopic procedures help improve and save lives. However, children are more sensitive to radiation than adults are, and cumulative radiation exposure to their smaller, developing bodies over time could have adverse effects. When fluoroscopic procedures are indicated, providers where appropriate are urged to pause and child-size the technique (match kVp and mAs to size of child); use lowest pulse rate possible; limit fluoroscopic time and limit use of magnification mode; and carefully collimate area of interest and utilize appropriate shielding.

Utilize pulsed digital fluoroscopic equipment with adjustable frame speeds and last image hold and capture capability. "The diagnostic results that these procedures provide, as with all medical techniques, also come with their own potential questions and concerns. This extension of the Image Gently initiative gives providers real world, practical guidance to help ensure that the radiation dose administered to children via these procedures is as low as possible given the particular circumstances of each case,” said Marta Hernanz-Schulman MD, FAAP, FACR, chair, ACR Pediatric Guidelines and Standards Committee, past president of the SPR and member of the Alliance Steering Committee, who is leading the diagnostic fluoroscopy component of the Image Gently campaign.

"Healthcare providers want to ensure that these lifesaving procedures are performed with the utmost care and safety in children. Pediatric patient care is greatly improved during fluoroscopy by collaboration of professionals across multiple disciplines. The information provided on the Image Gently Website provides a basis for interaction among the radiologists, the radiologic technologists, qualified medical physicists and other team members to improve image quality at reduced radiation doses to the patient,” said Maryellen L. Giger, PhD, FAAPM, FAIMBE, president of the American Association of Physicists in Medicine.

Referring physicians are encouraged to ask the following of any imaging provider to whom they refer their pediatric patients: if the facility is accredited by the ACR; if the technologists are certified or licensed, and whether they have experience with children; how frequently the facility performs the requested fluoroscopic study in children; and lastly, of a board certified radiologist with pediatric experience, or a pediatric radiologist will be performing and interpreting the study.

"Image Gently has developed the Pause and Pulse campaign in part as follow-up to the public meeting held by the US Food and Drug Administration (FDA). Like the FDA, we believe that there is an opportunity to promote radiation protection in fluoroscopy in children. Fluoroscopy in children is a commonly performed study and there is a significant opportunity to decrease radiation dose for children, while still performing a diagnostic exam. These materials raise awareness and provide evidence based educational materials to work toward this goal,” said Marilyn Goske, MD, chair of the Alliance, past president of the SPR, and Silverman Chair for Radiology Education at Cincinnati Children's Medical Center.

"Our goal is to ensure that every facility uses appropriate dose reduction techniques when performing imaging and interventional procedures in children,” said James Temme, M.P.A., R.T.(R)(QM), FASRT, president of the American Society of Radiologic Technologists. "The technique must always be matched to the size and needs of the child.”

The Image Gently site also contains the latest research and educational materials to aid radiologists, radiologic technologists, medical physicists, and other imaging stakeholders in determining the appropriate techniques to be used in the imaging of children, and how the radiation received from these exams may affect pediatric patients over time.

Related Links:
Image Gently Campaign
Society for Pediatric Radiology
American College of Radiology
American Society of Radiologic Technologists
American Association of Physicists in Medicine

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59 (!!!!! 2712.0113372803): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733658 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733658 AND published='1' LIMIT 1

60 (158.07151794434): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733658 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733658 AND published='1' LIMIT 1

61 (!!!!! 9947.0615386963): 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 (!!!!! 3705.9783935547): SELECT fid FROM jos_deeppockets WHERE id=294733658 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294733658 AND published='1' LIMIT 1

63 (417.94776916504): 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 (67.949295043945): select jos_twitters.link from jos_twitters where cat=10

65 (46.968460083008): select jos_facebook.link from jos_facebook where cat=10

66 (322.81875610352): select jos_google_plus.link from jos_google_plus where cat=10

67 (45.061111450195): select jos_linkedin.link from jos_linkedin where cat=10

68 (256.06155395508): SELECT fid FROM jos_deeppockets WHERE id=294733658 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294733658 AND published='1' LIMIT 1

69 (44.822692871094): 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 (593.90068054199): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294733658 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (279.90341186523): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294733658 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (105.14259338379): 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 (!!!!! 2159.8339080811): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (252.00843811035): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (!!!!! 2281.9042205811): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (339.03121948242): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (52.928924560547): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (237.94174194336): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (!!!!! 1482.0098876953): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (!!!!! 4172.0867156982): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (!!!!! 2115.9648895264): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (150.91896057129): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (557.18421936035): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (!!!!! 2182.9605102539): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (363.82675170898): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (132.08389282227): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294733658 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (87.02278137207): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294733658 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (303.98368835449): 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 (70.095062255859): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (41.961669921875): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (38.862228393555): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (33.140182495117): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (41.961669921875): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (33.855438232422): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (33.140182495117): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (33.855438232422): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (406.02684020996): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (509.02366638184): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733658 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733658 AND published='1' LIMIT 1

105 (67.949295043945): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733658 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733658 AND published='1' LIMIT 1

106 (82.969665527344): 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=294733658 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (!!!!! 1994.8482513428): 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=294733658 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (!!!!! 7108.9267730713): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733658 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733658 AND published='1' LIMIT 1

109 (!!!!! 7918.119430542): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733658 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733658 AND published='1' LIMIT 1

110 (!!!!! 7848.9780426025): 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=294733658 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (!!!!! 4007.10105896): 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=294733658 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (676.15509033203): 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 (!!!!! 1624.8226165771): 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 (120.16296386719): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733658 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733658 AND published='1' LIMIT 1

115 (117.77877807617): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733658 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733658 AND published='1' LIMIT 1

116 (84.161758422852): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733658 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733658 AND published='1' LIMIT 1

117 (56.028366088867): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733658 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733658 AND published='1' LIMIT 1

118 (124.93133544922): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733658 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733658 AND published='1' LIMIT 1

119 (41.961669921875): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733658 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733658 AND published='1' LIMIT 1

120 (44.107437133789): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733658 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733658 AND published='1' LIMIT 1

121 (38.862228393555): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733658 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733658 AND published='1' LIMIT 1

122 (288.00964355469): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 127398.96774292): 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 (!!!!! 7293.9395904541): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294733658 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294733658 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 21715.879440308): ( 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 (61.988830566406): ( 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 (537.87231445312): 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 (509.02366638184): 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 (492.09594726562): 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 (436.06758117676): 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 (646.11434936523): 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 (43.153762817383): 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 (!!!!! 1536.1309051514): 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 (38.14697265625): 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 (!!!!! 1169.9199676514): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733658 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (727.17666625977): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733658 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (!!!!! 3135.2043151855): SELECT name FROM jos_deeppockets WHERE id=211

138 (!!!!! 4477.9777526855): SELECT name FROM jos_deeppockets WHERE id=211

139 (665.90309143066): 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 (591.99333190918): 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 (!!!!! 1679.8973083496): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733658 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733658 AND published='1' LIMIT 1

142 (55.074691772461): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733658 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733658 AND published='1' LIMIT 1

143 (!!!!! 17905.950546265): TRUNCATE TABLE jos_trademed_module

144 (!!!!! 1230.001449585): 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=294733658 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (!!!!! 1239.0613555908): 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=294733658 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (!!!!! 1421.2131500244): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733658 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (353.09791564941): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733658 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (122.0703125): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733658 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733658 AND published='1' LIMIT 1

149 (179.05235290527): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733658 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733658 AND published='1' LIMIT 1

150 (!!!!! 2343.1777954102): 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 (128.98445129395): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733658 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733658 AND published='1' LIMIT 1

152 (174.99923706055): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733658 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733658 AND published='1' LIMIT 1

153 (!!!!! 2423.0480194092): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294733658 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294733658 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (77.009201049805): 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 (183.10546875): 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 (30.994415283203): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (847.81646728516): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733658 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733658 AND published='1' LIMIT 1

158 (!!!!! 3370.0466156006): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733658 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733658 AND published='1' LIMIT 1

159 (144.00482177734): select jos_twitters.link from jos_twitters where cat=10

160 (78.916549682617): select jos_facebook.link from jos_facebook where cat=10

161 (301.12266540527): 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

163 (691.89071655273): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

164 (!!!!! 1343.9655303955): insert into jos_banners_delta values (14615,'2025-08-23 02:01:22','216.73.216.171','view'),(14202,'2025-08-23 02:01:22','216.73.216.171','view'),(14203,'2025-08-23 02:01:22','216.73.216.171','view')

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