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Ultrasound as Effective as CT Scans for Most Diagnoses

By MedImaging International staff writers
Posted on 02 Jun 2011

A new study by Israeli investigators exploring the effectiveness of costly and invasive computed tomography (CT) scans has shown that, in some cases, they do not offer a clinical advantage over a simpler, inexpensive ultrasound procedure.

For diagnosing head and neck ailments, tests that use radiation are always less desirable than those that do not. Otolaryngologists have a wide range of techniques available to them, including CT scans, magnetic resonance imaging (MRI), and ultrasound. CT uses a considerable amount of radiation and MRI a lower amount, but ultrasound is a noninvasive, nonradiating technique. It does not require injection of radioactive contrast material and has no side effects.

In his study, Dr. Michael Vaiman of Tel Aviv University's Sackler Faculty of Medicine (Israel) compared the efficacy of CT versus ultrasound scans for locating vertebral arteries in the throat, an important assessment that must be completed before a surgeon operates in the neck area of the body. After comparing the outcomes of 250 CT scans with 500 ultrasound images, he concluded that there is no advantage to using CT scans for most of these procedures, especially those that are used to locate anomalies in the neck to map major arteries before surgery can take place.

Dr. Vaiman's findings were published in the March 2011 issue of the journal European Archives of Oto-Rhino-Laryngology. Traditionally, clinicians have relied on CT scans to find neck arteries and assess neck tumors, enlarged lymphatic nodules, diseases of the salivary glands, different kinds of bronchial cysts, or the development of thyroid cancer.

Although ultrasound is not the investigation of choice for every neck pathology, it is adequate for diagnosis and assessment of treatment options for most of these conditions. Ultrasound not only locates a lesion, but also provides data about its size, consistency, and relation to other organs, as well as other features. "I would recommend the use of ultrasound scans, and not radiating CT scans, for most procedures," Dr. Vaiman stated. "I would especially recommend ultrasound when children are investigated. There are some tumors that do require CT or MRI investigation, but these cases are rare. When in doubt, and high-resolution imaging is necessary, I would suggest a low-radiating MRI."

This study follows warnings from international health organizations about the dangers of overexposure to CT-related radiation. Some medical experts caution that patients are exposed to too many CT scans, and the results could be harmful to their health. Excessive radiation can itself lead to cancerous growths, for example.

Although Dr. Vaiman's study focused on the relationship of arteries in the neck, he believes that most CT scans of other organs may also be unnecessary and would best be done using ultrasound. It is inexpensive, readily available, and over time, less harmful than CT scanning.

"Preoperative ultrasound investigation allows a very precise identification of abnormal vertebral arteries," he reported. "I believe that radiation-free ultrasound investigation of blood vessels is as precise as CT 3D [three-dimensional] imaging, and should be used as an alternative in most cases."

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Tel Aviv University's Sackler Faculty of Medicine

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61 (122.0703125): 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 (458.95576477051): SELECT fid FROM jos_deeppockets WHERE id=294735390 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294735390 AND published='1' LIMIT 1

63 (231.02760314941): 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=214 ORDER BY `ordering`

64 (56.982040405273): select jos_twitters.link from jos_twitters where cat=10

65 (31.948089599609): select jos_facebook.link from jos_facebook where cat=10

66 (33.140182495117): select jos_google_plus.link from jos_google_plus where cat=10

67 (31.948089599609): select jos_linkedin.link from jos_linkedin where cat=10

68 (34.093856811523): SELECT fid FROM jos_deeppockets WHERE id=294735390 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294735390 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=214 ORDER BY `ordering`

70 (802.99377441406): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294735390 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (280.85708618164): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294735390 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (423.90823364258): 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 (746.9654083252): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (211.00044250488): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (373.84033203125): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (106.0962677002): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (!!!!! 1778.8410186768): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (778.1982421875): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (44.107437133789): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (46.968460083008): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (33.140182495117): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (834.94186401367): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294735390 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (43.869018554688): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294735390 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (46.968460083008): 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 (90.122222900391): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (329.97131347656): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (38.862228393555): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (37.193298339844): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (83.208084106445): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (45.7763671875): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (47.922134399414): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (33.140182495117): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (32.186508178711): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (!!!!! 1960.0391387939): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735390 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735390 AND published='1' LIMIT 1

105 (103.95050048828): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735390 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735390 AND published='1' LIMIT 1

106 (110.86463928223): 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=294735390 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (102.99682617188): 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=294735390 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (!!!!! 2652.1682739258): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735390 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735390 AND published='1' LIMIT 1

109 (148.05793762207): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735390 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735390 AND published='1' LIMIT 1

110 (428.91502380371): 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=294735390 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (!!!!! 1193.0465698242): 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=294735390 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (!!!!! 1681.8046569824): 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 (898.12278747559): 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 (!!!!! 2199.1729736328): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735390 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735390 AND published='1' LIMIT 1

115 (381.9465637207): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735390 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735390 AND published='1' LIMIT 1

116 (712.87155151367): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735390 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735390 AND published='1' LIMIT 1

117 (86.069107055664): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735390 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735390 AND published='1' LIMIT 1

118 (905.03692626953): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735390 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735390 AND published='1' LIMIT 1

119 (974.89356994629): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735390 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735390 AND published='1' LIMIT 1

120 (912.90473937988): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735390 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735390 AND published='1' LIMIT 1

121 (!!!!! 2563.9533996582): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735390 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735390 AND published='1' LIMIT 1

122 (721.93145751953): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 78354.120254517): 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 (!!!!! 1422.1668243408): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294735390 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294735390 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 30480.146408081): ( 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 (79.870223999023): ( 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 (516.89147949219): 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 (72.002410888672): 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 (!!!!! 1373.0525970459): 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 (996.11282348633): 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 (613.92784118652): 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 (447.03483581543): 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 (62.942504882812): 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 (45.061111450195): 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 (!!!!! 10342.121124268): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735390 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (!!!!! 4462.0037078857): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735390 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (458.0020904541): SELECT name FROM jos_deeppockets WHERE id=214

138 (!!!!! 2175.0926971436): SELECT name FROM jos_deeppockets WHERE id=214

139 (!!!!! 4774.0936279297): 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 '((;)|(^))214((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

140 (!!!!! 4296.0643768311): 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 '((;)|(^))214((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

141 (!!!!! 4741.907119751): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735390 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735390 AND published='1' LIMIT 1

142 (134.94491577148): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735390 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735390 AND published='1' LIMIT 1

143 (!!!!! 35216.093063354): TRUNCATE TABLE jos_trademed_module

144 (!!!!! 9526.0143280029): 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=294735390 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (!!!!! 1500.129699707): 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=294735390 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (!!!!! 7647.9911804199): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735390 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (375.98609924316): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735390 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (!!!!! 9167.1943664551): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735390 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735390 AND published='1' LIMIT 1

149 (!!!!! 7304.9068450928): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735390 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735390 AND published='1' LIMIT 1

150 (!!!!! 2038.9556884766): 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 (268.93615722656): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735390 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735390 AND published='1' LIMIT 1

152 (84.161758422852): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735390 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735390 AND published='1' LIMIT 1

153 (777.00614929199): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294735390 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294735390 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (!!!!! 2091.1693572998): 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=214 or channel_id is null)

155 (103.95050048828): 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=214 or channel_id is null)

156 (82.015991210938): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (!!!!! 3105.8788299561): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735390 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735390 AND published='1' LIMIT 1

158 (190.97328186035): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735390 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735390 AND published='1' LIMIT 1

159 (!!!!! 3885.03074646): select jos_twitters.link from jos_twitters where cat=10

160 (166.89300537109): select jos_facebook.link from jos_facebook where cat=10

161 (!!!!! 3580.0933837891): select jos_google_plus.link from jos_google_plus where cat=10

162 (130.89179992676): select jos_linkedin.link from jos_linkedin where cat=10

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