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CT Screening Reduces Lung Cancer Deaths

By MedImaging International staff writers
Posted on 27 Jul 2011

Findings of a US lung cancer-screening trial reported a 20% reduction in lung cancer deaths among study participants who were screened with low-dose helical computed tomography (CT) versus those screened with chest X-ray.

Conducted by the American College of Radiology Imaging Network (ACRIN; Philadelphia, PA, USA) and the US National Cancer Institute’s Lung Screening Study Group, the National Lung Screening Trial (NLST) enrolled 53,000 current and former heavy smokers aged 55 to 74 at 33 sites across the United States. The NLST published online in the June 30, 2011, in the New England Journal of Medicine.

Most lung cancers are detected when they cause symptoms, by which time the disease is more likely to be advanced and less curable. “The trial results provide hard evidence of the mortality benefit from low-dose helical CT screening for lung cancer in an older and heavy smoker population. These findings, and the vast amount of additional data generated by the NLST that are still being studied, offer a rich resource of information that will inform the development of clinical guidelines and policy recommendations,” stated Denise R. Aberle, MD, the national principal investigator for NLST ACRIN, a deputy co-chair of ACRIN, professor of radiology and bioengineering and vice chair for research in Radiological Sciences at the University of California, Los Angeles (UCLA).

The nearly decade old trial, sponsored by the US National Cancer Institute (Bethesda, MD, USA), a part of the National Institutes of Health, enrolled participants, over a 20-month period, who were randomly assigned to receive three yearly screening examinations with either low-dose helical CT or standard chest X-ray.

The article provides important details about the number of screens that identified abnormalities potentially related to lung cancer and how many abnormalities were ultimately found to be cancer. The authors reported, “During the screening phase of the trial, 39.1% of participants in the low-dose helical CT arm and 16.0% of those in the chest X-ray arm had a positive screening result. Across all three screening examination rounds, when a positive result was found, 96.4% of the low-dose helical CT and 94.5% of the chest X-ray examinations were false-positive.”

William C. Black, MD, chair of the ACRIN Outcomes and Economics Committee and NLST site principal investigator at Dartmouth-Hitchcock Medical Center (Hanover, NH, USA) commented, “The follow-up for positive screening examinations most frequently involved further imaging tests and the data show that follow-up with invasive procedures was uncommon. We also found that lower rates of follow-up resulting from a positive scan occurred at later screening rounds.”

The vast majority of false-positive results was probably due to the detection of normal lymph nodes or inflamed tissues. Adverse events (damages resulting from the actual screening examinations) were few and relatively minor in the NLST. The rate of complications among participants who underwent a diagnostic evaluation prompted by a positive screening was under 2% for either type of screening.

“Although the NLST provides definitive evidence about the effectiveness of low-dose helical CT screening for lung cancer, significant further work is required to answer questions critical for the development of public policy recommendations,” stated Constantine Gatsonis, PhD, the director of the ACRIN Biostatistics and Data Management Center, and chair of biostatistics in the public health program of the Warren Alpert Medical School of Brown University (Providence, RI).

Additional studies based on NLST data--to include the use of statistical modeling--will determine significant data about which patient risk profiles, screening regimens and positive screen criteria result in the greatest screening benefit. As Dr. Gatsonis emphasized, “Given the considerable costs associated with low-dose helical CT screening, a cost-effectiveness analysis using the NLST data are underway that will guide decisions about the best use of finite health care resources.”

The NLST also provided a unique opportunity to further investigation of molecular biomarkers for the early detection of lung cancer. Specimens of blood, sputum, and urine collected at ACRIN sites are banked in the NLST-ACRIN Biorepository, as are specimens of early-stage lung cancer, all obtained with consent from NLST participants. This resource is available to the larger research community. “These specimens provide a rich resource to validate molecular markers that may complement imaging to detect early lung cancer,” noted Dr. Aberle. “By coupling biospecimen collection with imaging-based screening, the NLST-ACRIN Biorepository is relatively enriched for early clinical-stage lung cancers and associated biospecimens, and provides a unique resource of extremely well-characterized biospecimens with longitudinal data.”

“The knowledge that low-dose CT is a viable screening tool for detecting lung cancers at a curable stage is a tremendous first step for better understanding its implications for clinical care. Working with the Eastern Cooperative Oncology Group through the recently announced alliance, will allow us to extend these significant results to answer future questions critical for translating [these] findings into clinical practice,” said Mitchell D. Schnall, MD, PhD, ACRIN’s network chair and the Matthew J. Wilson professor of research radiology at the University of Pennsylvania (Philadelphia, USA). “Furthermore, ACRIN is engaged in a research project with Boston University [MA, USA] funded by the United States Department of Defense to investigate the role of blood and sputum-based laboratory tests to better define patient populations who would most benefit from lung cancer screening and, thereby, reducing false-positive screenings.”

Related Links:
American College of Radiology Imaging Network
US National Cancer Institute

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56 (999.92752075195): 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=294736307 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

57 (!!!!! 2315.9980773926): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736307 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736307 AND published='1' LIMIT 1

58 (!!!!! 12514.114379883): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736307 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736307 AND published='1' LIMIT 1

59 (203.84788513184): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736307 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736307 AND published='1' LIMIT 1

60 (!!!!! 4729.9861907959): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736307 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736307 AND published='1' LIMIT 1

61 (857.83004760742): 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 (585.07919311523): SELECT fid FROM jos_deeppockets WHERE id=294736307 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294736307 AND published='1' LIMIT 1

63 (!!!!! 5347.0134735107): 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 (!!!!! 7056.9515228271): select jos_twitters.link from jos_twitters where cat=10

65 (969.88677978516): select jos_facebook.link from jos_facebook where cat=10

66 (62.942504882812): select jos_google_plus.link from jos_google_plus where cat=10

67 (220.06034851074): select jos_linkedin.link from jos_linkedin where cat=10

68 (68.902969360352): SELECT fid FROM jos_deeppockets WHERE id=294736307 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294736307 AND published='1' LIMIT 1

69 (656.8431854248): 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 (661.13471984863): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294736307 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (!!!!! 2266.8838500977): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294736307 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (!!!!! 13714.075088501): 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 (!!!!! 3736.9728088379): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (645.16067504883): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (335.9317779541): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (427.0076751709): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (924.11041259766): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (284.91020202637): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (85.115432739258): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (!!!!! 1845.121383667): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (!!!!! 2758.9797973633): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (598.19221496582): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (!!!!! 3260.8509063721): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (597.95379638672): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (!!!!! 1331.8061828613): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (348.09112548828): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (!!!!! 5748.987197876): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294736307 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (564.0983581543): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294736307 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (901.22222900391): 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 (183.10546875): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (61.988830566406): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (47.922134399414): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (38.862228393555): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (43.153762817383): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (38.862228393555): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (42.915344238281): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (43.153762817383): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (38.862228393555): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (60.081481933594): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (39.815902709961): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (150.91896057129): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736307 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736307 AND published='1' LIMIT 1

105 (86.069107055664): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736307 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736307 AND published='1' LIMIT 1

106 (165.93933105469): 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=294736307 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (97.990036010742): 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=294736307 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (!!!!! 1387.1192932129): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736307 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736307 AND published='1' LIMIT 1

109 (303.03001403809): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736307 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736307 AND published='1' LIMIT 1

110 (129.93812561035): 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=294736307 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (671.8635559082): 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=294736307 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (689.02969360352): 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 (679.01611328125): 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 (167.1314239502): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736307 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736307 AND published='1' LIMIT 1

115 (76.055526733398): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736307 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736307 AND published='1' LIMIT 1

116 (96.797943115234): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736307 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736307 AND published='1' LIMIT 1

117 (66.041946411133): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736307 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736307 AND published='1' LIMIT 1

118 (81.062316894531): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736307 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736307 AND published='1' LIMIT 1

119 (60.081481933594): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736307 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736307 AND published='1' LIMIT 1

120 (81.062316894531): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736307 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736307 AND published='1' LIMIT 1

121 (50.067901611328): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736307 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736307 AND published='1' LIMIT 1

122 (499.96376037598): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 231072.18742371): 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 (!!!!! 16193.866729736): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294736307 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294736307 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 7777.9293060303): ( 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 (!!!!! 7687.0918273926): ( 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 (!!!!! 3773.9276885986): 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 (530.00450134277): 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 (670.19462585449): 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 (470.87669372559): 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 (699.99694824219): 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 (62.942504882812): 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 (658.03527832031): 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 (!!!!! 4179.9545288086): 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 (581.02607727051): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736307 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (508.06999206543): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736307 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (904.79850769043): SELECT name FROM jos_deeppockets WHERE id=211

138 (354.05158996582): SELECT name FROM jos_deeppockets WHERE id=211

139 (!!!!! 6241.0831451416): 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 (!!!!! 3615.8561706543): 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 (!!!!! 4431.0092926025): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736307 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736307 AND published='1' LIMIT 1

142 (151.8726348877): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736307 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736307 AND published='1' LIMIT 1

143 (!!!!! 24442.911148071): TRUNCATE TABLE jos_trademed_module

144 (!!!!! 4338.9797210693): 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=294736307 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (82.015991210938): 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=294736307 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (!!!!! 7314.2051696777): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736307 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (383.85391235352): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736307 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (!!!!! 3124.9523162842): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736307 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736307 AND published='1' LIMIT 1

149 (329.01763916016): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736307 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736307 AND published='1' LIMIT 1

150 (!!!!! 1684.9040985107): 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 (!!!!! 7494.9264526367): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736307 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736307 AND published='1' LIMIT 1

152 (!!!!! 8309.8411560059): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736307 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736307 AND published='1' LIMIT 1

153 (!!!!! 4315.8531188965): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294736307 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294736307 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (874.99618530273): 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 (290.87066650391): 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 (!!!!! 2344.8467254639): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (!!!!! 6518.8407897949): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736307 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736307 AND published='1' LIMIT 1

158 (!!!!! 2892.017364502): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736307 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736307 AND published='1' LIMIT 1

159 (838.9949798584): select jos_twitters.link from jos_twitters where cat=10

160 (230.07392883301): select jos_facebook.link from jos_facebook where cat=10

161 (501.15585327148): select jos_google_plus.link from jos_google_plus where cat=10

162 (458.95576477051): select jos_linkedin.link from jos_linkedin where cat=10

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