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Adding Breast Tomosynthesis to Digital Mammography Increases Diagnostic Effectiveness

By MedImaging International staff writers
Posted on 04 Dec 2012

Adding a new technology called tomosynthesis--a three-dimensional (3D) breast imaging technique--to conventional digital mammography has been shown to considerably increase radiologists’ diagnostic accuracy while reducing false-positive recall rates.

The multicenter study’s findings were published November 2012 in the journal Radiology. “This is the first major advance in breast imaging and breast cancer screening since the development of breast MRI magnetic resonance imaging],” said lead researcher Elizabeth A. Rafferty, MD, director of breast imaging at the Avon Comprehensive Breast Center at Massachusetts General Hospital (Boston, MA, USA). “The beauty of tomosynthesis is that it addresses two major concerns with screening mammography: missed cancers and false-positive rates.”

There is substantial evidence, according to the US National Cancer Institute, that screening mammography can slash breast cancer mortality in women between the ages of 40 and 74. However, as many as 30% of breast cancers are not identified by mammography and an additional 8% to 10% of women who undergo a screening mammogram are recalled for additional testing when no cancer is present (a false-positive result).

In contrast to a screening digital mammogram, which involves two X-ray images of each breast, breast tomosynthesis captures multiple, low-dose images from different angles around the breast. The images are then utilized to generate a 3D reconstruction of the breast. Both digital mammography and breast tomosynthesis, which was approved by the US Food and Drug Administration (FDA) in February of 2011, can be performed on the same mammography equipment, in rapid succession.

Dr. Rafferty’s study was comprised of 1,192 women recruited from five sites, of whom 997, including 780 screening cases and 217 women who required prebiopsy breast imaging, had complete data sets. Each of the women underwent a standard digital mammogram followed by breast tomosynthesis. The total radiation dose for the combined procedure was less than 3 milligray, which is the FDA threshold for one mammogram.

Drawing from the eligible cases, the researchers then conducted two reader studies
involving 312 and 310 cases, respectively. Twelve radiologists participated in the first reader study and 15 radiologists in the second. A total of 48 tumors were included in the first reader study and 51 tumors in the second. Compared to digital mammography alone, the use of both standard mammogram and tomosynthesis resulted in increased diagnostic accuracy for all 27 radiologists. Moreover, the diagnostic sensitivity of the combined exam--or the rate at which cancer present in the breast was correctly identified--increased by 10.7% for radiologists in reader study 1 and 16% for radiologists in reader study 2.

“Almost all of the gains in diagnostic sensitivity with the combined modality were attributable to the improved detection and characterization of invasive cancers, which are the cancers we are most concerned about because of their potential to metastasize,” Dr. Rafferty said.

By adding of breast tomosynthesis to traditional digital mammography, false-positive recall rates also substantially decreased for all 27 of the radiologists. Absolute recall rate reductions of 38.6% and 17.1% were seen in Reader Studies 1 and 2, respectively.

“In the clinical setting, we would expect that type of reduction in recall rate to translate into a substantial number of unnecessary diagnostic tests being avoided,” Dr. Rafferty said.

Related Links:
Comprehensive Breast Center at Massachusetts General Hospital

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61 (!!!!! 9881.9732666016): 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 (!!!!! 7658.9584350586): SELECT fid FROM jos_deeppockets WHERE id=294743666 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294743666 AND published='1' LIMIT 1

63 (!!!!! 8068.0847167969): 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 (!!!!! 7489.9196624756): select jos_twitters.link from jos_twitters where cat=10

65 (!!!!! 7997.989654541): select jos_facebook.link from jos_facebook where cat=10

66 (!!!!! 7913.1126403809): select jos_google_plus.link from jos_google_plus where cat=10

67 (!!!!! 8057.1174621582): select jos_linkedin.link from jos_linkedin where cat=10

68 (!!!!! 6021.0227966309): SELECT fid FROM jos_deeppockets WHERE id=294743666 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294743666 AND published='1' LIMIT 1

69 (!!!!! 14038.0859375): 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 (!!!!! 11849.164962769): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294743666 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (!!!!! 4347.0859527588): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294743666 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (200.03318786621): 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 (693.79806518555): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (!!!!! 3803.014755249): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (401.97372436523): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (46.968460083008): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (243.18695068359): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (252.00843811035): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (318.05038452148): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (183.10546875): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (166.89300537109): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (768.18466186523): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294743666 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (108.00361633301): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294743666 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (87.02278137207): 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 (!!!!! 2957.1056365967): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (43.153762817383): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (152.8263092041): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (32.186508178711): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (174.99923706055): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (115.15617370605): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (296.83113098145): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (33.140182495117): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (195.02639770508): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (112.05673217773): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (102.99682617188): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (68.902969360352): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (218.86825561523): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (51.021575927734): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (!!!!! 1473.9036560059): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743666 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743666 AND published='1' LIMIT 1

105 (164.98565673828): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743666 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743666 AND published='1' LIMIT 1

106 (296.83113098145): 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=294743666 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (619.17304992676): 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=294743666 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (!!!!! 2203.9413452148): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743666 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743666 AND published='1' LIMIT 1

109 (63.896179199219): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743666 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743666 AND published='1' LIMIT 1

110 (459.90943908691): 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=294743666 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (716.9246673584): 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=294743666 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (552.17742919922): 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 (406.98051452637): 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 (83.208084106445): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743666 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743666 AND published='1' LIMIT 1

115 (46.968460083008): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743666 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743666 AND published='1' LIMIT 1

116 (77.009201049805): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743666 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743666 AND published='1' LIMIT 1

117 (57.93571472168): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743666 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743666 AND published='1' LIMIT 1

118 (72.002410888672): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743666 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743666 AND published='1' LIMIT 1

119 (53.167343139648): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743666 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743666 AND published='1' LIMIT 1

120 (95.844268798828): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743666 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743666 AND published='1' LIMIT 1

121 (50.783157348633): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743666 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743666 AND published='1' LIMIT 1

122 (310.18257141113): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 64739.942550659): 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 (544.07119750977): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294743666 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294743666 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (53.882598876953): ( 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 (36.954879760742): ( 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 (34.093856811523): 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 (29.087066650391): 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 (41.007995605469): 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 (29.087066650391): 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 (29.087066650391): 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 (32.186508178711): 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 (30.040740966797): 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 (56.028366088867): 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 (584.84077453613): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743666 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (320.9114074707): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743666 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (47.922134399414): SELECT name FROM jos_deeppockets WHERE id=211

138 (35.04753112793): SELECT name FROM jos_deeppockets WHERE id=211

139 (700.95062255859): 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 (499.01008605957): 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 (60.081481933594): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743666 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743666 AND published='1' LIMIT 1

142 (46.014785766602): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743666 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743666 AND published='1' LIMIT 1

143 (!!!!! 7889.0323638916): TRUNCATE TABLE jos_trademed_module

144 (757.93266296387): 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=294743666 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (!!!!! 8185.863494873): 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=294743666 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (!!!!! 1259.0885162354): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743666 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (296.11587524414): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743666 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (665.90309143066): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743666 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743666 AND published='1' LIMIT 1

149 (51.975250244141): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743666 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743666 AND published='1' LIMIT 1

150 (!!!!! 2026.0810852051): 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 (849.96223449707): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743666 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743666 AND published='1' LIMIT 1

152 (174.04556274414): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743666 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743666 AND published='1' LIMIT 1

153 (450.13427734375): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294743666 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294743666 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (34.093856811523): 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 (153.0647277832): 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 (370.97930908203): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (550.0316619873): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743666 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743666 AND published='1' LIMIT 1

158 (195.98007202148): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743666 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743666 AND published='1' LIMIT 1

159 (583.88710021973): select jos_twitters.link from jos_twitters where cat=10

160 (81.062316894531): select jos_facebook.link from jos_facebook where cat=10

161 (232.93495178223): select jos_google_plus.link from jos_google_plus where cat=10

162 (30.994415283203): select jos_linkedin.link from jos_linkedin where cat=10

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