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Cardiovascular Screening Recommended Every 5–10 Years for Chest Radiation Cancer Patients with Risk Factors

By MedImaging International staff writers
Posted on 13 Aug 2013

Cancer patients who receive chest radiotherapy should be screened for heart disease every 5–10 years, according to the two international cardiology societies.

The recommendations, established by the European Association of Cardiovascular Imaging (EACVI; Sophia Antipolis, France) of the European Society of Cardiology (ESC) and the American Society of Echocardiography (ASE; Morrisville, NC, USA), were defined in the first expert consensus statement on screening for radiation-induced heart disease (RIHD), published in the August 2013 issue of the European Heart Journal-Cardiovascular Imaging.

Prof. Patrizio Lancellotti, chair of the expert task force and president of the EACVI, said, “The prevalence of radiation-induced heart disease is increasing because the rate of cancer survival has improved. It’s a long term risk, and RIHD manifests 5-20 years after the radiation dose. Survivors of Hodgkin’s lymphoma and breast cancer received high doses of radiation on their chest under the old treatment regimes. Over time, these patients can develop RIHD in the heart valves, myocardium, vessels—including the aorta, the pericardium, and the coronary arteries. Their risk of death from coronary artery disease, myocardial ischemia, and myocardial infarction is increased. Radiotherapy is now given in lower doses but patients are still at increased risk of RIHD, especially when the heart is in the radiation field. This relates to patients treated for lymphoma, breast cancer, and esophageal cancer. Patients who receive radiotherapy for neck cancer are also at risk because lesions can develop on the carotid artery and increase the risk of stroke.”

RIHD is estimated to occur in 10%–30% of patients who receive chest radiotherapy within 5–10 years post-treatment. Cardiac structural and functional alterations after radiation can be identified early using echocardiography, cardiac computed tomography (CT), cardiac magnetic resonance (CMR), and nuclear cardiology. However, screening for RIHD is not routine practice.

In the report, the expert group recommended that (1) before initiating any chest radiotherapy course, patients should have screening for RIHD risk factors, a clinical examination, and a baseline echocardiographic evaluation. (2) Patients who receive chest radiation for tumors including breast cancer or lymphoma should receive cardiac screening five years post-treatment if they have any cardiac abnormality or are at high risk and 10 years post-treatment if not. (3) Cardiovascular screening should be repeated every 5–10 years depending on the presence of cardiac abnormalities and the level of risk. (4) All patients who had chest radiation for cancer in the past should receive a cardiac examination starting with echocardiography. (5) Lastly, patients are at high risk of RIHD if they have radiation for left-sided breast cancer, have a high dose of radiation (often used in young people), the irradiated area is not shielded, have a high dose of anthracyclines, or have cardiovascular risk factors including smoking, obesity, and inactivity.

“We wrote the expert consensus to raise the alarm that the risks of radiation-induced heart disease should not be ignored,” noted Prof. Lancellotti. Cardiovascular screening is needed before and after radiation therapy to detect RIHD early, follow-up patients at appropriate intervals, and define the optimal timing for any kind of intervention. Echocardiography is the first line of imaging assessment but in some patients we need other examinations including stress imaging, CT and CMR. For instance we can precisely assess the presence of myocardial fibrosis using CMR and more accurately assess cardiac calcification using CT.A registry of RIHD is needed in Europe to determine the true prevalence of the disease and collect outcome data. This together with screening should reduce the risk of patients developing RIHD and enable us to treat it early when it does occur.”

Related Links:
European Association of Cardiovascular Imaging
American Society of Echocardiography

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61 (!!!!! 9054.8992156982): 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 (722.16987609863): SELECT fid FROM jos_deeppockets WHERE id=294747700 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294747700 AND published='1' LIMIT 1

63 (373.12507629395): 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 (!!!!! 2326.0116577148): select jos_twitters.link from jos_twitters where cat=10

65 (101.80473327637): select jos_facebook.link from jos_facebook where cat=10

66 (47.922134399414): select jos_google_plus.link from jos_google_plus where cat=10

67 (44.822692871094): select jos_linkedin.link from jos_linkedin where cat=10

68 (56.028366088867): SELECT fid FROM jos_deeppockets WHERE id=294747700 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294747700 AND published='1' LIMIT 1

69 (52.928924560547): 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 (488.9965057373): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294747700 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (334.02442932129): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294747700 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (58.889389038086): 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 (72.002410888672): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (50.067901611328): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (51.021575927734): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (81.062316894531): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294747700 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (35.04753112793): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294747700 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (37.908554077148): 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 (!!!!! 1235.0082397461): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (!!!!! 3131.1511993408): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (!!!!! 3884.0770721436): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (264.88304138184): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (96.08268737793): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (!!!!! 3185.9874725342): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (133.03756713867): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (41.961669921875): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (159.97886657715): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747700 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747700 AND published='1' LIMIT 1

105 (108.95729064941): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747700 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747700 AND published='1' LIMIT 1

106 (60.081481933594): 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=294747700 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (803.94744873047): 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=294747700 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (!!!!! 7232.9044342041): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747700 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747700 AND published='1' LIMIT 1

109 (514.98413085938): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747700 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747700 AND published='1' LIMIT 1

110 (87.02278137207): 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=294747700 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (756.02531433105): 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=294747700 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (844.00177001953): 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 (624.8950958252): 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 (102.99682617188): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747700 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747700 AND published='1' LIMIT 1

115 (72.956085205078): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747700 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747700 AND published='1' LIMIT 1

116 (74.863433837891): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747700 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747700 AND published='1' LIMIT 1

117 (42.915344238281): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747700 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747700 AND published='1' LIMIT 1

118 (56.982040405273): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747700 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747700 AND published='1' LIMIT 1

119 (41.961669921875): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747700 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747700 AND published='1' LIMIT 1

120 (104.18891906738): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747700 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747700 AND published='1' LIMIT 1

121 (52.928924560547): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747700 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747700 AND published='1' LIMIT 1

122 (572.91984558105): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 66673.994064331): 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 (!!!!! 3877.1629333496): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294747700 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294747700 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 25050.87852478): ( 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 (144.95849609375): ( 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 (93.936920166016): 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 (61.988830566406): 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 (92.983245849609): 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 (64.849853515625): 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 (!!!!! 1044.9886322021): 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 (151.8726348877): 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 (63.896179199219): 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 (!!!!! 2494.0967559814): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747700 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (907.18269348145): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747700 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (!!!!! 2187.967300415): SELECT name FROM jos_deeppockets WHERE id=211

138 (707.86476135254): SELECT name FROM jos_deeppockets WHERE id=211

139 (!!!!! 1039.981842041): 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 (!!!!! 1631.0214996338): 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 (!!!!! 1940.9656524658): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747700 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747700 AND published='1' LIMIT 1

142 (!!!!! 1147.0317840576): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747700 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747700 AND published='1' LIMIT 1

143 (!!!!! 19531.011581421): TRUNCATE TABLE jos_trademed_module

144 (!!!!! 4766.9410705566): 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=294747700 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (774.86038208008): 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=294747700 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (!!!!! 1211.1663818359): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747700 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (113.01040649414): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747700 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (!!!!! 1379.0130615234): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747700 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747700 AND published='1' LIMIT 1

149 (!!!!! 1488.208770752): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747700 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747700 AND published='1' LIMIT 1

150 (!!!!! 3735.0654602051): 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 (!!!!! 1161.0984802246): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747700 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747700 AND published='1' LIMIT 1

152 (368.11828613281): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747700 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747700 AND published='1' LIMIT 1

153 (523.09036254883): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294747700 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294747700 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (!!!!! 5318.8800811768): 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 (!!!!! 2788.0668640137): 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 (!!!!! 4966.9742584229): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (509.97734069824): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747700 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747700 AND published='1' LIMIT 1

158 (!!!!! 1291.9902801514): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747700 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747700 AND published='1' LIMIT 1

159 (!!!!! 4448.8906860352): select jos_twitters.link from jos_twitters where cat=10

160 (587.22496032715): select jos_facebook.link from jos_facebook where cat=10

161 (244.140625): select jos_google_plus.link from jos_google_plus where cat=10

162 (293.01643371582): select jos_linkedin.link from jos_linkedin where cat=10

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