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Triggered Imaging Technology Continually Monitors Tumor Location During Radiosurgical Procedures

By MedImaging International staff writers
Posted on 07 Dec 2011

A US university health system has become the first medical center in the world to utilize intrafraction motion review (IMR), or “triggered imaging,” to continually monitor tumor location during radiosurgery for lung cancer.

IMR, which is a unique capability of the TrueBeam linear accelerator from Varian Medical Systems (Palo Alto, CA, USA) enables visual verification that a tumor is being properly targeted. “With triggered imaging, clinicians use the imager on the TrueBeam system to observe the targeted tumor repeatedly, at a predetermined portion of the respiratory cycle, in order to check on the tumor’s location and trajectory,” said Chris Toth, senior director of marketing at Varian. “If the tumor is not where it is supposed to be, they can halt treatment and intervene to enhance the accuracy of the targeting.”

Physicians from the University of Alabama at Birmingham (UAB) Health System (USA) used the IMR tool for the first time earlier in November 2011 when delivering a gated RapidArc radiosurgery treatment for inoperable early-stage lung cancer. RapidArc enables fast, precise image-guided intensity-modulated radiotherapy (IMRT) by delivering dose continuously as the treatment machine rotates around the patient. Gated RapidArc makes it possible to monitor patient breathing and compensate for tumor motion during a RapidArc treatment. The gating system turns the treatment beam on and off in synchrony with the patient’s breathing to increase treatment precision. With IMR, or triggered imaging, the gating system also triggers the imager to generate a low-dose X-ray of the targeted tumor at a specific point in the patient’s respiratory cycle.

“With IMR, we can now monitor the gating accuracy and ensure that the beam hits the tumor,” said Richard Popple, PhD, associate professor of medical physics at UAB. “It will allow us to monitor tumor position in real time and intervene if a change in patient respiratory pattern causes a shift. The increased precision could potentially increase tumor control and decrease the amount of surrounding healthy lung tissues exposed to the beam.”

“The IMR tool offers us a way of verifying that our gating strategy remains valid throughout an entire treatment,” added Chris Dobelbower, MD, PhD, radiation oncologist at UAB. “It also gives us the ability to hold the beam should the target wander from isocenter if the patient’s breathing pattern were to change due to a cough or a sneeze, or other interference. Those events did not happen with our first patient, so no treatment interruptions were necessary.”

To utilize IMR during the treatment for lung cancer, Dr. Dobelbower collaborated with thoracic surgeon Douglas J. Minnich, MD, assistant professor at UAB Healthcare, who positioned a set of radio-opaque fiducial markers into the lung tumor using electromagnetic navigational bronchoscopy--an approach that employs three-dimensional CT imaging to guide the procedure. These markers made it possible to see the tumor’s location within the surrounding healthy tissues using X-ray images generated during treatment.

“IMR makes it possible to complete lung cancer treatments with a high level of precision and confidence that you’re treating the area you want to treat,” Dr. Minnich said. “Rather than imaging at the beginning of treatment and then doing your best to account for respiratory motion, IMR allows you to actually watch the tumor and monitor your targeting as the treatment proceeds.”

According to Dr. Dobelbower, the ability to capture an image with every breath, identify when a targeted tumor has shifted, halt a treatment, and reposition the patient makes a new level of precision feasible. “This was previously only possible by a time-consuming and cumbersome process of interrupting treatment for additional imaging,” he said.

Related Links:
Varian Medical Systems
University of Alabama at Birmingham Health System

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62 (602.96058654785): SELECT fid FROM jos_deeppockets WHERE id=294738364 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294738364 AND published='1' LIMIT 1

63 (56.028366088867): 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 (65.088272094727): select jos_twitters.link from jos_twitters where cat=10

65 (30.040740966797): select jos_facebook.link from jos_facebook where cat=10

66 (30.994415283203): select jos_google_plus.link from jos_google_plus where cat=10

67 (27.894973754883): select jos_linkedin.link from jos_linkedin where cat=10

68 (30.994415283203): SELECT fid FROM jos_deeppockets WHERE id=294738364 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294738364 AND published='1' LIMIT 1

69 (36.001205444336): 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 (352.14424133301): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294738364 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (294.20852661133): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294738364 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (61.988830566406): 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 (49.829483032227): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (29.087066650391): 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 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (110.14938354492): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294738364 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (30.994415283203): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294738364 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (34.093856811523): 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 (49.829483032227): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (77.962875366211): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738364 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738364 AND published='1' LIMIT 1

105 (43.869018554688): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738364 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738364 AND published='1' LIMIT 1

106 (52.928924560547): 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=294738364 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (46.968460083008): 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=294738364 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (73.909759521484): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738364 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738364 AND published='1' LIMIT 1

109 (46.014785766602): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738364 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738364 AND published='1' LIMIT 1

110 (46.014785766602): 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=294738364 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (533.10394287109): 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=294738364 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (635.14709472656): 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 (376.93977355957): 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 (76.055526733398): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738364 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738364 AND published='1' LIMIT 1

115 (46.968460083008): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738364 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738364 AND published='1' LIMIT 1

116 (44.107437133789): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738364 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738364 AND published='1' LIMIT 1

117 (37.908554077148): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738364 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738364 AND published='1' LIMIT 1

118 (40.054321289062): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738364 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738364 AND published='1' LIMIT 1

119 (77.962875366211): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738364 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738364 AND published='1' LIMIT 1

120 (50.067901611328): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738364 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738364 AND published='1' LIMIT 1

121 (36.001205444336): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738364 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738364 AND published='1' LIMIT 1

122 (302.07633972168): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 26265.144348145): 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 (627.04086303711): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294738364 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294738364 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 9183.1684112549): ( 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 (102.04315185547): ( 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 (163.07830810547): 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 (45.061111450195): 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 (59.127807617188): 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 (85.115432739258): 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 (452.99530029297): 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 (51.975250244141): 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 (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

134 (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

135 (494.00329589844): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738364 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (345.94535827637): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738364 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (39.100646972656): SELECT name FROM jos_deeppockets WHERE id=211

138 (28.848648071289): SELECT name FROM jos_deeppockets WHERE id=211

139 (535.01129150391): 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 (493.04962158203): 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 (68.902969360352): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738364 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738364 AND published='1' LIMIT 1

142 (42.915344238281): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738364 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738364 AND published='1' LIMIT 1

143 (!!!!! 8825.0637054443): TRUNCATE TABLE jos_trademed_module

144 (109.91096496582): 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=294738364 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (58.174133300781): 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=294738364 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (551.93901062012): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738364 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (87.976455688477): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738364 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (72.956085205078): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738364 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738364 AND published='1' LIMIT 1

149 (45.061111450195): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738364 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738364 AND published='1' LIMIT 1

150 (!!!!! 1313.9247894287): 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 (60.081481933594): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738364 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738364 AND published='1' LIMIT 1

152 (49.114227294922): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738364 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738364 AND published='1' LIMIT 1

153 (51.975250244141): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294738364 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294738364 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (51.975250244141): 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 (46.014785766602): 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 (69.141387939453): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (107.0499420166): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738364 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738364 AND published='1' LIMIT 1

158 (82.015991210938): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738364 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738364 AND published='1' LIMIT 1

159 (54.836273193359): select jos_twitters.link from jos_twitters where cat=10

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

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

162 (28.133392333984): select jos_linkedin.link from jos_linkedin where cat=10

163 (278.94973754883): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

164 (!!!!! 1116.0373687744): insert into jos_banners_delta values (14615,'2025-08-19 23:28:34','216.73.216.0','view'),(14202,'2025-08-19 23:28:34','216.73.216.0','view'),(14203,'2025-08-19 23:28:34','216.73.216.0','view')

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