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Higher Volume Cuts False Positives in Screening Mammography

By MedImaging International staff writers
Posted on 10 Mar 2011

Radiologists who interpret a high volume of mammograms may not identify more tumors but are better at determining which suspicious lesions are not malignant, according to new research. More...

The study's findings were published online and in the April 2011 print edition of the journal Radiology. "Contrary to our expectations, we observed no clear association between volume and sensitivity,” said the study's lead author, Diana S.M. Buist, PhD, MPH, senior investigator at the Group Health Research Institute (Seattle, WA, USA). "We did, however, find that radiologists with higher interpretive volume had significantly lower false-positive rates and recalled fewer women per cancer detected.”

An exam result is considered a false positive when additional testing is recommended for a suspicious lesion but no cancer is found. In addition to causing anxiety for patients, false-positives prompt additional testing that costs about US$1.6 billion per year, according to Dr. Buist.

The study included a review of data from six Breast Cancer Surveillance Consortium mammography registries in California, North Carolina, New Hampshire, Vermont, Washington, and New Mexico. The researchers studied various measures of interpretive volume in relation to screening performance for 120 radiologists who interpreted 783,965 screening mammograms between 2002 and 2006. Volume was measured in four ways: the number of screening and diagnostic mammograms read by a radiologist yearly--both separately and in combination--and the ratio of screening to total (diagnostic plus screening) mammograms. Screening performance was gauged by sensitivity (the ability to detect all cancers present) and false-positive and cancer detection rates.

The results showed that performance varied not only by the number of exams interpreted, but also by the ratio of screening to total (diagnostic plus screening) mammograms.

"Our analysis demonstrated that screening interpretive performance is unlikely to be affected by volume alone, but rather by a balance in the interpreted exam composition,” Dr. Buist said. "The data suggest that radiologists who interpret screening mammograms should spend at least a portion of their time interpreting diagnostic mammograms, because radiologists who interpreted very few diagnostic mammograms had worse performance, even if they read a high volume of screening mammograms.”

Because the study found that radiologists with higher annual interpretive volumes had lower false-positive rates--while maintaining sensitivity rates similar to their lower-volume colleagues--the researchers simulated the effect of increasing the minimum interpretive volume required of radiologists practicing in the United States, which is currently 960 mammograms every two years.

Based on 34 million women aged 40-79 receiving screening mammograms each year, the researchers estimated that increasing the annual minimum total volume requirement to 1,000 would result in 43,629 fewer women being recalled. The estimated cost associated with false-positive results would be reduced to $21.8 million.

"Recommending any increase in US volume requirements would entail crucial decisions about the relative importance of cancer detection versus false positive exams and workforce issues, since changes could curtail workforce supply and women's mammography access,” Dr. Buist said.

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60 (126.83868408203): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733801 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733801 AND published='1' LIMIT 1

61 (63.896179199219): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733801 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733801 AND published='1' LIMIT 1

62 (128.03077697754): select cover from jos_number where journalid in (5) and cover is not null order by left(issue,2)+right(issue,2)*12 desc limit 1

63 (519.0372467041): SELECT fid FROM jos_deeppockets WHERE id=294733801 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294733801 AND published='1' LIMIT 1

64 (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`

65 (54.836273193359): select jos_twitters.link from jos_twitters where cat=10

66 (41.961669921875): select jos_facebook.link from jos_facebook where cat=10

67 (37.908554077148): select jos_google_plus.link from jos_google_plus where cat=10

68 (36.954879760742): select jos_linkedin.link from jos_linkedin where cat=10

69 (43.153762817383): SELECT fid FROM jos_deeppockets WHERE id=294733801 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294733801 AND published='1' LIMIT 1

70 (41.961669921875): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=211 ORDER BY `ordering`

71 (302.07633972168): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294733801 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (234.84230041504): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294733801 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

73 (49.114227294922): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

74 (66.041946411133): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (38.862228393555): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (35.762786865234): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

88 (59.127807617188): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294733801 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (56.028366088867): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294733801 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

90 (50.067901611328): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

91 (61.03515625): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (35.762786865234): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (37.193298339844): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

105 (94.175338745117): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733801 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733801 AND published='1' LIMIT 1

106 (72.956085205078): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733801 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733801 AND published='1' LIMIT 1

107 (69.856643676758): 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=294733801 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (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_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=294733801 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

109 (97.990036010742): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733801 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733801 AND published='1' LIMIT 1

110 (61.03515625): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733801 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733801 AND published='1' LIMIT 1

111 (65.803527832031): 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=294733801 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (542.87910461426): 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=294733801 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

113 (774.86038208008): 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 (464.20097351074): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

115 (105.85784912109): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733801 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733801 AND published='1' LIMIT 1

116 (60.796737670898): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733801 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733801 AND published='1' LIMIT 1

117 (62.942504882812): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733801 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733801 AND published='1' LIMIT 1

118 (54.121017456055): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733801 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733801 AND published='1' LIMIT 1

119 (55.074691772461): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733801 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733801 AND published='1' LIMIT 1

120 (63.896179199219): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733801 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733801 AND published='1' LIMIT 1

121 (72.956085205078): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733801 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733801 AND published='1' LIMIT 1

122 (56.028366088867): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733801 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733801 AND published='1' LIMIT 1

123 (277.99606323242): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

124 (!!!!! 29716.968536377): SELECT * FROM jos_deeppockets WHERE jos_deeppockets.cat = 10 AND jos_deeppockets.type = 'deeppockets_item' AND jos_deeppockets.published = 1 AND jos_deeppockets.created + INTERVAL 14 DAY >= NOW() ORDER BY jos_deeppockets.hits DESC LIMIT 7

125 (547.17063903809): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294733801 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294733801 AND type='deeppockets_item' AND published='1' LIMIT 1

126 (!!!!! 10164.976119995): ( 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 (95.129013061523): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

128 (51.021575927734): 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 (39.100646972656): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

130 (49.829483032227): 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 (36.954879760742): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

132 (288.00964355469): 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 (73.909759521484): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

134 (48.160552978516): 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 (36.954879760742): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

136 (483.03604125977): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733801 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (299.93057250977): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733801 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

138 (50.067901611328): SELECT name FROM jos_deeppockets WHERE id=211

139 (39.100646972656): SELECT name FROM jos_deeppockets WHERE id=211

140 (741.00494384766): 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 (679.96978759766): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))211((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

142 (83.208084106445): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733801 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733801 AND published='1' LIMIT 1

143 (61.988830566406): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733801 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733801 AND published='1' LIMIT 1

144 (!!!!! 13082.027435303): TRUNCATE TABLE jos_trademed_module

145 (146.86584472656): 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=294733801 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (97.036361694336): 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=294733801 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

147 (617.98095703125): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733801 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=294733801 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

149 (110.86463928223): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733801 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733801 AND published='1' LIMIT 1

150 (72.956085205078): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733801 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733801 AND published='1' LIMIT 1

151 (!!!!! 1880.8841705322): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

152 (111.10305786133): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733801 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733801 AND published='1' LIMIT 1

153 (78.916549682617): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733801 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733801 AND published='1' LIMIT 1

154 (60.081481933594): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294733801 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294733801 AND type='deeppockets_item' AND published='1' LIMIT 1

155 (47.922134399414): 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 (43.153762817383): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=211 or channel_id is null)

157 (48.87580871582): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

158 (100.85105895996): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733801 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733801 AND published='1' LIMIT 1

159 (71.048736572266): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733801 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733801 AND published='1' LIMIT 1

160 (57.93571472168): select jos_twitters.link from jos_twitters where cat=10

161 (38.862228393555): select jos_facebook.link from jos_facebook where cat=10

162 (38.862228393555): select jos_google_plus.link from jos_google_plus where cat=10

163 (43.869018554688): select jos_linkedin.link from jos_linkedin where cat=10

164 (391.00646972656): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

165 (!!!!! 1591.9208526611): insert into jos_banners_delta values (14615,'2025-08-20 10:32:51','216.73.216.0','view'),(14202,'2025-08-20 10:32:51','216.73.216.0','view'),(14203,'2025-08-20 10:32:51','216.73.216.0','view')

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