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Technique Reduces Exposure in Children Requiring Repeat CT Brain Scans

By MedImaging International staff writers
Posted on 21 Oct 2013

A team of US pediatric neuroradiologists and neurosurgeons has developed a way to minimize harmful radiation exposure in children with a condition that requires repeat computed tomography (CT) scans of the brain. The clinicians reported that they decreased radiation exposure without losing the diagnostic accuracy of the images or compromising treatment decision-making.

The approach, described online September 20, 2013 in a report in the Journal of Neurosurgery, calls for using fewer X-ray images slices of the brain captured by CT scanners—seven instead of the traditional 32 to 40 slices. This approach, the study revealed, reduced radiation exposure by an average of almost 92% per patient compared with standard head CT scans, while still rendering the images diagnostically accurate. “The traditional thinking has been that fewer slices would, by definition, mean less clarity and less accuracy, rendering a CT scan suboptimal, but our findings show otherwise,” said lead investigator Jonathan Pindrik, MD, chief neurosurgery resident at Johns Hopkins Children’s Center (Baltimore, MD, USA).

The research involved analysis of CT scans of patients with excessive fluid in the brain, a disorder called hydrocephalus that requires periodic fluid-draining surgeries and a head CT before each procedure. The investigators compared two standard CT scans with two limited-slice, low-dose CT scans for each one of 50 children, ages 17 and younger, treated for hydrocephalus over five years at Johns Hopkins Children’s Center. The standard CT scan images were performed prior to the launch of the new radiation-minimizing protocol.

The radiation-minimizing technique in all 50 patients produced clear and 100% accurate images of the brain ventricles. When capturing alterations in ventricle size, however, the low-dose application resulted in a 4% error rate: Two of the 50 images were visually unclear, generating confusion among the clinicians who reviewed them. There were no false negatives in the low-dose images, but three false positives, the study revealed. Therefore, there were no instances of clinicians falsely identifying normal ventricular size, but three instances of clinicians perceiving a change in ventricular size when there was none. Taken as a whole, the radiation-minimizing approach was obviously sufficient, according to the researchers, and would have not compromised treatment outcomes.

The Hopkins team noted that the radiation-minimizing technique could be particularly important in pediatric emergency rooms, where the need for fast diagnosis disqualifies the use of more cumbersome, radiation-free imaging alternatives such as MRI scanning. It also can be used for routine evaluation in smaller community hospitals that may lack MRI equipment, according to the researchers.

CT scans are important imaging tools that have transformed the diagnosis and treatment of many disorders by providing rapid, effective, and accurate images, but they have pushed up levels of radiation exposure in both children and adults, according to the investigators. Ionizing radiation, used in X-rays and CT scans, has been long implicated in the development of specific tumors because of its ability to damage DNA. Children are particularly susceptible to the effects of radiation because of their smaller size, growing tissues and rapidly dividing cells, and because of their longer lifespans that allow slow-growing cancers to emerge years after exposure, the researchers noted.

“We have been searching for ways to minimize radiation exposure in kids without sacrificing the diagnostic accuracy of the images—and that is no easy feat—but we believe our limited-slice CT scans achieved that balance,” stated senior study investigator Edward Ahn, MD, a pediatric neurosurgeon at the Johns Hopkins Children’s Center.

Hydrocephalus is frequently treated by placing a catheter that drains excess fluid from the brain into the abdomen, a procedure known as ventriculoperitoneal shunting. Children with brain shunts require periodic imaging to assess catheter position and function. Shunt failure that occurs when a catheter dislodges or infection occurs is a common and dangerous complication and considered an emergency. However because shunt failure often causes nonspecific symptoms such as headache, vomiting and fever, a definitive diagnosis requires a brain scan.

There are more than 62 million CT scans performed yearly in the United States alone, four million of them in children. Experts estimate that radiation from medical imaging is the single largest source of radiation exposure in the population, and that up to 2% of all cancers stem from exposure to medical radiation.

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60 (!!!!! 1306.0569763184): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748721 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748721 AND published='1' LIMIT 1

61 (65.088272094727): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748721 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748721 AND published='1' LIMIT 1

62 (!!!!! 2065.1817321777): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748721 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748721 AND published='1' LIMIT 1

63 (108.95729064941): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748721 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748721 AND published='1' LIMIT 1

64 (118.97087097168): 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

65 (!!!!! 1219.0341949463): SELECT fid FROM jos_deeppockets WHERE id=294748721 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294748721 AND published='1' LIMIT 1

66 (69.141387939453): 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`

67 (51.021575927734): select jos_twitters.link from jos_twitters where cat=10

68 (29.087066650391): select jos_facebook.link from jos_facebook where cat=10

69 (30.994415283203): select jos_google_plus.link from jos_google_plus where cat=10

70 (30.040740966797): select jos_linkedin.link from jos_linkedin where cat=10

71 (41.007995605469): SELECT fid FROM jos_deeppockets WHERE id=294748721 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294748721 AND published='1' LIMIT 1

72 (37.908554077148): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=211 ORDER BY `ordering`

73 (607.01370239258): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294748721 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

74 (384.09233093262): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294748721 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

75 (!!!!! 1006.1264038086): 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`

76 (75.101852416992): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (33.855438232422): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (29.802322387695): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (348.80638122559): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (41.961669921875): SELECT show_live FROM jos_com_show_setting LIMIT 1

88 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

89 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

90 (322.10350036621): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294748721 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

91 (33.855438232422): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294748721 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

92 (158.78677368164): 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`

93 (491.85752868652): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (46.968460083008): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (519.99092102051): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (70.810317993164): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (51.021575927734): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (42.915344238281): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (44.107437133789): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (116.82510375977): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (488.0428314209): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

105 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

106 (49.114227294922): SELECT show_live FROM jos_com_show_setting LIMIT 1

107 (545.02487182617): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748721 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748721 AND published='1' LIMIT 1

108 (347.85270690918): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748721 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748721 AND published='1' LIMIT 1

109 (59.127807617188): 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=294748721 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

110 (187.87384033203): 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=294748721 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (!!!!! 1138.9255523682): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748721 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748721 AND published='1' LIMIT 1

112 (157.83309936523): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748721 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748721 AND published='1' LIMIT 1

113 (57.93571472168): 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=294748721 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

114 (575.06561279297): 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=294748721 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

115 (835.89553833008): 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

116 (589.13230895996): 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

117 (183.10546875): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748721 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748721 AND published='1' LIMIT 1

118 (66.995620727539): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748721 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748721 AND published='1' LIMIT 1

119 (139.95170593262): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748721 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748721 AND published='1' LIMIT 1

120 (71.048736572266): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748721 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748721 AND published='1' LIMIT 1

121 (73.19450378418): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748721 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748721 AND published='1' LIMIT 1

122 (56.982040405273): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748721 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748721 AND published='1' LIMIT 1

123 (70.095062255859): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748721 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748721 AND published='1' LIMIT 1

124 (58.889389038086): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748721 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748721 AND published='1' LIMIT 1

125 (252.00843811035): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

126 (!!!!! 53371.906280518): 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

127 (!!!!! 6035.0894927979): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294748721 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294748721 AND type='deeppockets_item' AND published='1' LIMIT 1

128 (!!!!! 20024.061203003): ( 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

129 (106.0962677002): ( 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

130 (86.069107055664): 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

131 (61.03515625): 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

132 (!!!!! 6932.9738616943): 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

133 (71.048736572266): 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

134 (575.06561279297): 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

135 (60.081481933594): 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

136 (93.936920166016): 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

137 (56.982040405273): 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

138 (941.99180603027): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748721 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

139 (756.97898864746): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748721 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

140 (231.02760314941): SELECT name FROM jos_deeppockets WHERE id=211

141 (51.021575927734): SELECT name FROM jos_deeppockets WHERE id=211

142 (!!!!! 1003.0269622803): 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

143 (594.8543548584): 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

144 (461.81678771973): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748721 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748721 AND published='1' LIMIT 1

145 (263.92936706543): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748721 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748721 AND published='1' LIMIT 1

146 (!!!!! 10550.022125244): TRUNCATE TABLE jos_trademed_module

147 (172.85346984863): 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=294748721 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

148 (86.069107055664): 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=294748721 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

149 (!!!!! 1914.9780273438): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748721 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

150 (82.015991210938): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748721 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

151 (194.07272338867): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748721 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748721 AND published='1' LIMIT 1

152 (204.08630371094): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748721 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748721 AND published='1' LIMIT 1

153 (!!!!! 1637.2203826904): 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

154 (265.12145996094): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748721 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748721 AND published='1' LIMIT 1

155 (102.04315185547): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748721 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748721 AND published='1' LIMIT 1

156 (!!!!! 4513.0252838135): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294748721 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294748721 AND type='deeppockets_item' AND published='1' LIMIT 1

157 (!!!!! 2764.9402618408): 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)

158 (87.02278137207): 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)

159 (162.12463378906): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

160 (!!!!! 1299.8580932617): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748721 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748721 AND published='1' LIMIT 1

161 (97.036361694336): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748721 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748721 AND published='1' LIMIT 1

162 (446.79641723633): select jos_twitters.link from jos_twitters where cat=10

163 (31.948089599609): select jos_facebook.link from jos_facebook where cat=10

164 (28.848648071289): select jos_google_plus.link from jos_google_plus where cat=10

165 (54.836273193359): select jos_linkedin.link from jos_linkedin where cat=10

166 (305.17578125): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

167 (931.0245513916): insert into jos_banners_delta values (14615,'2025-08-19 06:22:39','216.73.216.0','view'),(14202,'2025-08-19 06:22:39','216.73.216.0','view'),(14203,'2025-08-19 06:22:39','216.73.216.0','view')

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