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CT Scans Are No More Effective Than Ultrasound Detecting Kidney Stones

By MedImaging International staff writers
Posted on 02 Oct 2014

Image: An ultrasound of the bladder showing a ureter blocked by a kidney stone (Photo courtesy of UCSF).

To diagnose agonizing kidney stones in hospital emergency room environments, computed tomography (CT) scans have been found to be no better than less frequently-used ultrasound exams, according to a clinical study performed at 15 US medical centers.

The study’s findings were published September 18, 2014, in the New England Journal of Medicine (NEJM). CT, dissimilar to ultrasound, exposes patients to significant amounts of radiation. Even though CT scans are preferred by emergency-room physicians for kidney stone diagnosis, ultrasound should be used first, according to senior study author Rebecca Smith-Bindman, MD, a professor in the departments of radiology; epidemiology and biostatistics; and obstetrics, gynecology and reproductive medicine at the University of California San Francisco (UCSF; USA).

“Ultrasound is the right place to start,” Dr. Smith-Bindman said. “Radiation exposure is avoided, without any increase in any category of adverse events, and with no increase in cost." Patients in the study who were first examined with ultrasound sometimes received a follow-up CT exam at the physician’s discretion.

“Our results do not suggest that patients should undergo only ultrasound imaging, but rather that ultrasonography should be used as the initial diagnostic imaging test, with further imaging studies performed at the discretion of the physician on the basis of clinical judgment,” the study authors wrote.

Kidney stone rates are rising, and in a 2010 US National Health and Nutrition Examination Survey, one in 11 individuals reported having had at least one kidney stone. The use of CT to diagnose kidney stones has increased 10-fold in the last 15 years. CT exams typically are conducted by radiologists, while ultrasound exams may be conducted by emergency room physicians as well as radiologists.

Emergency room patients whose pain was suspected to be due to kidney stones were randomly assigned in the NEJM study to one of three imaging groups. In one group patients received an ultrasound exam performed by an emergency room physician on site. A second group received similar ultrasonography performed by a radiologist, a specialist in the procedure. The third group received an abdominal CT scan, also conducted by a radiologist.

With six months of patient follow-up, the study found that health outcomes for 2,759 patients were just as good with ultrasound as with CT, and that patients fared no worse when emergency physicians instead of radiologists performed the ultrasound exam. Serious adverse events, pain, return trips to the emergency department, or hospitalizations did not differ substantially among groups.

“New technology is developed all the time, and it’s hard to know when the new, sophisticated and expensive technology is better—in this case the simpler, cheaper, no-radiation technology is just as good,” Dr. Smith-Bindman said.

The study sites were emergency departments at academic medical centers throughout the United States, and included four “safety-net” hospitals serving low-income communities.

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University of California, San Francisco

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59 (79.870223999023): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754939 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754939 AND published='1' LIMIT 1

60 (!!!!! 5609.9891662598): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754939 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754939 AND published='1' LIMIT 1

61 (615.11993408203): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754939 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754939 AND published='1' LIMIT 1

62 (!!!!! 13935.804367065): 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

63 (425.81558227539): SELECT fid FROM jos_deeppockets WHERE id=294754939 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294754939 AND published='1' LIMIT 1

64 (159.02519226074): 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`

65 (!!!!! 1105.0701141357): select jos_twitters.link from jos_twitters where cat=10

66 (140.90538024902): select jos_facebook.link from jos_facebook where cat=10

67 (154.01840209961): select jos_google_plus.link from jos_google_plus where cat=10

68 (652.07481384277): select jos_linkedin.link from jos_linkedin where cat=10

69 (!!!!! 3367.9008483887): SELECT fid FROM jos_deeppockets WHERE id=294754939 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294754939 AND published='1' LIMIT 1

70 (83.92333984375): 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`

71 (!!!!! 1549.9591827393): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294754939 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (291.82434082031): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294754939 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

73 (52.213668823242): 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`

74 (!!!!! 7495.1648712158): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (!!!!! 7953.1669616699): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (!!!!! 7860.1837158203): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (!!!!! 8000.1354217529): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (!!!!! 7838.0107879639): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (!!!!! 7977.0088195801): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (!!!!! 7900.9532928467): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (!!!!! 8569.9558258057): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (!!!!! 7492.0654296875): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (!!!!! 8279.0851593018): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (!!!!! 7532.1197509766): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (!!!!! 5759.0007781982): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (!!!!! 1929.0447235107): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (!!!!! 5227.0889282227): SELECT show_live FROM jos_com_show_setting LIMIT 1

88 (844.00177001953): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294754939 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (924.82566833496): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294754939 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

90 (51.021575927734): 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`

91 (!!!!! 2200.8419036865): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (264.16778564453): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (324.96452331543): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (!!!!! 3463.9835357666): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (503.0632019043): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (232.93495178223): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (650.88272094727): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (!!!!! 6400.1083374023): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (!!!!! 7985.1150512695): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (!!!!! 11852.979660034): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (!!!!! 7971.0483551025): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (!!!!! 7848.9780426025): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (!!!!! 7965.087890625): SELECT show_live FROM jos_com_show_setting LIMIT 1

105 (!!!!! 7041.9311523438): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754939 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754939 AND published='1' LIMIT 1

106 (!!!!! 3029.1080474854): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754939 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754939 AND published='1' LIMIT 1

107 (190.01960754395): 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=294754939 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (!!!!! 1451.0154724121): 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=294754939 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

109 (!!!!! 2364.1586303711): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754939 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754939 AND published='1' LIMIT 1

110 (615.83518981934): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754939 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754939 AND published='1' LIMIT 1

111 (830.88874816895): 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=294754939 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (!!!!! 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=294754939 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

113 (!!!!! 1380.9204101562): 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 (!!!!! 1113.8916015625): 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

115 (636.10076904297): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754939 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754939 AND published='1' LIMIT 1

116 (612.97416687012): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754939 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754939 AND published='1' LIMIT 1

117 (157.83309936523): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754939 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754939 AND published='1' LIMIT 1

118 (68.902969360352): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754939 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754939 AND published='1' LIMIT 1

119 (91.791152954102): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754939 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754939 AND published='1' LIMIT 1

120 (69.141387939453): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754939 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754939 AND published='1' LIMIT 1

121 (63.180923461914): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754939 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754939 AND published='1' LIMIT 1

122 (227.92816162109): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754939 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754939 AND published='1' LIMIT 1

123 (545.97854614258): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

124 (!!!!! 131752.96783447): 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

125 (!!!!! 2254.9629211426): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294754939 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294754939 AND type='deeppockets_item' AND published='1' LIMIT 1

126 (!!!!! 4100.0843048096): ( 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 (175.95291137695): ( 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

128 (!!!!! 4354.9537658691): 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 (370.97930908203): 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

130 (199.0795135498): 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 (370.97930908203): 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

132 (33.140182495117): 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 (!!!!! 10810.136795044): 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

134 (!!!!! 7786.0355377197): 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 (!!!!! 7995.1286315918): 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

136 (622.03407287598): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754939 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (!!!!! 1448.8697052002): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754939 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

138 (!!!!! 1935.0051879883): SELECT name FROM jos_deeppockets WHERE id=214

139 (!!!!! 3712.8925323486): SELECT name FROM jos_deeppockets WHERE id=214

140 (!!!!! 10699.987411499): 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 (!!!!! 9150.9819030762): 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

142 (!!!!! 7723.8082885742): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754939 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754939 AND published='1' LIMIT 1

143 (!!!!! 7998.9433288574): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754939 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754939 AND published='1' LIMIT 1

144 (!!!!! 15328.884124756): TRUNCATE TABLE jos_trademed_module

145 (182.15179443359): 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=294754939 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (!!!!! 2671.0033416748): 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=294754939 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

147 (!!!!! 8942.1272277832): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754939 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (180.95970153809): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754939 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

149 (97.036361694336): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754939 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754939 AND published='1' LIMIT 1

150 (65.803527832031): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754939 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754939 AND published='1' LIMIT 1

151 (!!!!! 1523.9715576172): 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

152 (77.962875366211): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754939 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754939 AND published='1' LIMIT 1

153 (82.969665527344): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754939 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754939 AND published='1' LIMIT 1

154 (41.961669921875): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294754939 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294754939 AND type='deeppockets_item' AND published='1' LIMIT 1

155 (33.140182495117): 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 (29.087066650391): 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)

157 (101.08947753906): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

158 (139.95170593262): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754939 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754939 AND published='1' LIMIT 1

159 (51.021575927734): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754939 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754939 AND published='1' LIMIT 1

160 (82.969665527344): select jos_twitters.link from jos_twitters where cat=10

161 (!!!!! 1070.0225830078): select jos_facebook.link from jos_facebook where cat=10

162 (46.968460083008): select jos_google_plus.link from jos_google_plus where cat=10

163 (30.040740966797): select jos_linkedin.link from jos_linkedin where cat=10

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