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Considerable Increase in Pediatric CT Imaging Seen in the Emergency Departments

By MedImaging International staff writers
Posted on 21 Apr 2011

Computed tomography (CT) scans of children in hospital emergency departments increased substantially from 1995 to 2008. Researchers reported that these findings emphasize the need for collaboration among medical professionals to ensure that pediatric CT is appropriately ordered, performed, and interpreted.

The study's findings were published in the online edition of the journal Radiology. "We need to think creatively about how to partner with each other, with ordering clinicians and with CT manufacturers to ensure that all children are scanned only when it is appropriate and with appropriate techniques,” said the study's lead author, David B. Larson, MD, MBA, director of quality improvement in the department of radiology at Cincinnati Children's Hospital Medical Center (OH, USA).

Developments in CT technology such as helical scanning have made it a major tool for rapid diagnostic evaluation of children in the emergency department. Decreased scan times are particularly helpful in eliminating the need for sedation in many pediatric cases.
However, the relatively higher radiation doses associated with CT, compared to most other imaging exams, have raised concerns over an increase in risks tied to ionizing radiation. A child's organs are more sensitive to the effects of radiation than those of an adult, and they have a longer remaining life expectancy in which cancer may potentially form. Moreover, the current prevalence of CT makes it more likely that children will receive a higher cumulative lifetime dose of medically related radiation than those who are currently adults.

To evaluate CT utilization trends in children, Dr. Larson and colleagues analyzed US National Hospital Ambulatory Medical Care Survey data from 1995 to 2008.

The number of pediatric emergency department visits that included a CT examination increased five-fold over the study period, from roughly 330,000 to 1.65 million, with a compound annual growth rate of 14.3%. The leading complaints among those receiving CT included head injury, abdominal pain, and headache. The rate of imaging for abdominal pain increased the most, because of advancements in the technology.

"We found that abdominal CT imaging went from almost never being used in 1995 to being used in 15%-21% of visits in the last four years of the study,” Dr. Larson said. "In 1995, abdominal CT took much longer, the resolution was not as good, and the research hadn't been done to support it. By 2008, helical scanning had helped make CT very useful for abdominal imaging. It's widely available, it's fast, and there are a lot of great reasons to do it, but it does carry a higher radiation dose.”

Dr. Larson pointed out that abdominal CT's effective dose of radiation is up to seven times that of a head CT, suggesting that the radiation dose to children in emergency departments increased at an even higher rate from 1995 to 2008 than the rate of increase in the percentage of visits in which CT was performed.

Nonpediatric focused emergency departments made up 89.4% of emergency department visits associated with CT in children and increased from 316,133 examinations to 1,438,413 over the study period. Dr. Larson noted that most of the radiologists who oversaw and interpreted these studies likely were not subspecialty-trained in pediatric radiology. "The performance of CT in children requires special oversight, especially in regards to the selection of size-based CT scan parameters and sedation techniques. It is important to consistently tailor CT technique to the body size of the pediatric patient,” he said.

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62 (!!!!! 4050.0164031982): SELECT fid FROM jos_deeppockets WHERE id=294734611 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294734611 AND published='1' LIMIT 1

63 (461.10153198242): 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 (!!!!! 2882.0037841797): select jos_twitters.link from jos_twitters where cat=10

65 (71.048736572266): select jos_facebook.link from jos_facebook where cat=10

66 (40.054321289062): select jos_google_plus.link from jos_google_plus where cat=10

67 (35.762786865234): select jos_linkedin.link from jos_linkedin where cat=10

68 (53.882598876953): SELECT fid FROM jos_deeppockets WHERE id=294734611 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294734611 AND published='1' LIMIT 1

69 (37.908554077148): 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 (!!!!! 2122.163772583): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294734611 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (274.1813659668): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294734611 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (117.06352233887): 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 (!!!!! 2092.8382873535): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (58.174133300781): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (!!!!! 3652.0957946777): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294734611 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (97.036361694336): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294734611 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (70.095062255859): 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 (583.88710021973): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (377.89344787598): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (33.855438232422): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (33.140182495117): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (158.07151794434): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (350.9521484375): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (50.067901611328): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (!!!!! 1181.8408966064): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (48.87580871582): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (!!!!! 3468.9903259277): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734611 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734611 AND published='1' LIMIT 1

105 (85.115432739258): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734611 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734611 AND published='1' LIMIT 1

106 (67.949295043945): 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=294734611 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (730.03768920898): 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=294734611 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (!!!!! 1039.0281677246): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734611 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734611 AND published='1' LIMIT 1

109 (351.90582275391): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734611 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734611 AND published='1' LIMIT 1

110 (440.83595275879): 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=294734611 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (473.97613525391): 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=294734611 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (!!!!! 1069.0689086914): 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 (!!!!! 3679.9907684326): 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 (128.03077697754): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734611 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734611 AND published='1' LIMIT 1

115 (71.048736572266): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734611 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734611 AND published='1' LIMIT 1

116 (652.07481384277): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734611 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734611 AND published='1' LIMIT 1

117 (516.89147949219): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734611 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734611 AND published='1' LIMIT 1

118 (108.00361633301): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734611 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734611 AND published='1' LIMIT 1

119 (47.922134399414): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734611 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734611 AND published='1' LIMIT 1

120 (459.90943908691): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734611 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734611 AND published='1' LIMIT 1

121 (60.081481933594): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734611 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734611 AND published='1' LIMIT 1

122 (397.92060852051): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 55757.04574585): 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 (684.97657775879): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294734611 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294734611 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 17368.078231812): ( 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 (77.962875366211): ( 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 (46.014785766602): 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 (32.901763916016): 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 (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

130 (30.994415283203): 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 (535.96496582031): 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 (61.03515625): 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 (180.00602722168): 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 (234.12704467773): 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 (!!!!! 3768.9208984375): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734611 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (!!!!! 2528.9058685303): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734611 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (63.180923461914): SELECT name FROM jos_deeppockets WHERE id=211

138 (32.901763916016): SELECT name FROM jos_deeppockets WHERE id=211

139 (766.03889465332): 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 (634.90867614746): 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 (!!!!! 3515.0051116943): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734611 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734611 AND published='1' LIMIT 1

142 (116.10984802246): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734611 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734611 AND published='1' LIMIT 1

143 (!!!!! 17363.07144165): TRUNCATE TABLE jos_trademed_module

144 (!!!!! 4646.0628509521): 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=294734611 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (699.99694824219): 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=294734611 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (!!!!! 2794.0273284912): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734611 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (118.97087097168): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734611 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (!!!!! 3515.0051116943): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734611 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734611 AND published='1' LIMIT 1

149 (!!!!! 3941.0591125488): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734611 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734611 AND published='1' LIMIT 1

150 (!!!!! 1843.9292907715): 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 (221.96769714355): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734611 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734611 AND published='1' LIMIT 1

152 (!!!!! 2258.0623626709): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734611 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734611 AND published='1' LIMIT 1

153 (!!!!! 1266.0026550293): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294734611 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294734611 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (!!!!! 2403.9745330811): 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 (126.12342834473): 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 (89.883804321289): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (142.09747314453): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734611 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734611 AND published='1' LIMIT 1

158 (82.015991210938): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734611 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734611 AND published='1' LIMIT 1

159 (102.99682617188): select jos_twitters.link from jos_twitters where cat=10

160 (48.87580871582): select jos_facebook.link from jos_facebook where cat=10

161 (43.153762817383): select jos_google_plus.link from jos_google_plus where cat=10

162 (49.114227294922): select jos_linkedin.link from jos_linkedin where cat=10

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