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AI May Benefit Decision-Making in Less Experienced Clinicians Assessing Heart Ultrasounds

By MedImaging International staff writers
Posted on 09 Sep 2024

Coronary artery disease (CAD) is a leading cause of death globally, causing over 9 million deaths worldwide and 63,000 annually in the UK alone. More...

Stress echocardiography (SE), which is an ultrasound of the heart taken at rest and during stress, is crucial for assessing the risk of heart attacks and death in patients with known or suspected CAD. SE is not only among the most frequently used diagnostic tests for CAD but is also the primary imaging method available across the UK for this diagnosis. However, its accuracy ranges significantly, from 60% to 94%, influenced by the clinician's expertise and the quality of the images. The integration of artificial intelligence (AI) into healthcare presents significant potential to aid clinicians in diagnosing more swiftly and accurately, thus initiating treatments earlier. Now, a large randomized trial found no substantial evidence to suggest that AI assistance in clinical decision-making for heart ultrasound assessments improves detection rates compared to traditional practices for identifying patients with suspected heart disease who might benefit from invasive treatments. Nonetheless, the study highlighted that AI could enhance decision-making capabilities for less experienced clinicians and showed promise in particularly complex clinical sub-groups.

Developed by researchers at the University of Oxford (Oxford, UK) EchoGo Pro automates the interpretation of SE images by integrating novel image features with AI technology. This software's effectiveness was tested through the PROTEUS randomized controlled trial, which involved patients aged 18 and older referred for SE at 20 UK hospitals from November 2021 to June 2023 to investigate suspected CAD. The study involved 2,341 patients (average age 64 years; 45% female; 20% with pre-existing heart disease), who were randomly assigned to either standard clinical decision-making or AI-enhanced decision-making where clinicians used an AI-generated image analysis report (EchoGo Pro) during their image assessments to evaluate the likelihood of severe CAD. The main focus of the study was to compare the effectiveness of standard versus AI-augmented decision-making in directing patients towards invasive coronary angiograms and monitoring acute coronary events within a six-month period. By December 2023, 2,213 participants (94.5%) had completed the six-month follow-up.

Overall, 85 patients were referred for angiography post-SE. Among those not referred, 41 suffered acute coronary syndromes (nonfatal heart attacks) or cardiac deaths within six months, indicating potential misjudgments in referral decisions. The analysis revealed that AI-assisted decision-making did not show non-inferiority compared to traditional clinical decision-making in appropriately directing patients for coronary angiography. Among those referred, 27 out of 36 in the control group and 34 out of 49 in the AI group were deemed correct referrals. Regarding patients who suffered adverse events despite not being referred for angiography, there were 22 in the control group and 19 in the AI group, though the differences were not statistically significant. However, additional analyses indicated that AI could improve decision-making among less experienced clinicians and in complex cases where image interpretation is challenging.

“It is well reported that clinician performance in interpreting stress echocardiograms ranges widely according to the experience level of the operator,” said lead author Dr. Ross Upton from the University of Oxford. “The results of this trial suggest that AI has the potential to bring all operators, regardless of experience, up to the same level of accuracy. While the PROTEUS trial did not demonstrate meaningful differences in all-comers, the AI diagnostic may also benefit specific subgroups of patients in whom decision making is known to be more complex.”

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58 (!!!!! 1734.0183258057): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802382 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294802382 AND published='1' LIMIT 1

59 (91.075897216797): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802382 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294802382 AND published='1' LIMIT 1

60 (157.11784362793): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802382 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294802382 AND published='1' LIMIT 1

61 (87.976455688477): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802382 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294802382 AND published='1' LIMIT 1

62 (153.0647277832): 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 (793.9338684082): SELECT fid FROM jos_deeppockets WHERE id=294802382 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294802382 AND published='1' LIMIT 1

64 (127.07710266113): 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 (72.956085205078): select jos_twitters.link from jos_twitters where cat=10

66 (41.007995605469): select jos_facebook.link from jos_facebook where cat=10

67 (41.007995605469): select jos_google_plus.link from jos_google_plus where cat=10

68 (40.054321289062): select jos_linkedin.link from jos_linkedin where cat=10

69 (59.127807617188): SELECT fid FROM jos_deeppockets WHERE id=294802382 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294802382 AND published='1' LIMIT 1

70 (46.968460083008): 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 (432.01446533203): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294802382 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (365.9725189209): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294802382 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

73 (57.93571472168): 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 (82.015991210938): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (49.114227294922): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (47.206878662109): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (49.114227294922): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (38.862228393555): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (42.200088500977): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (38.862228393555): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (37.193298339844): SELECT show_live FROM jos_com_show_setting LIMIT 1

88 (79.870223999023): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294802382 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (45.061111450195): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294802382 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

90 (47.922134399414): 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 (83.208084106445): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (42.915344238281): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (44.107437133789): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (29.802322387695): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

105 (105.85784912109): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802382 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294802382 AND published='1' LIMIT 1

106 (66.995620727539): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802382 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294802382 AND published='1' LIMIT 1

107 (82.015991210938): 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=294802382 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (97.036361694336): 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=294802382 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

109 (128.98445129395): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802382 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294802382 AND published='1' LIMIT 1

110 (75.101852416992): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802382 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294802382 AND published='1' LIMIT 1

111 (77.009201049805): 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=294802382 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (700.95062255859): 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=294802382 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

113 (648.02169799805): 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 (435.11390686035): 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 (113.01040649414): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802382 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294802382 AND published='1' LIMIT 1

116 (66.041946411133): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802382 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294802382 AND published='1' LIMIT 1

117 (91.791152954102): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802382 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294802382 AND published='1' LIMIT 1

118 (113.01040649414): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802382 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294802382 AND published='1' LIMIT 1

119 (83.92333984375): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802382 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294802382 AND published='1' LIMIT 1

120 (57.93571472168): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802382 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294802382 AND published='1' LIMIT 1

121 (65.088272094727): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802382 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294802382 AND published='1' LIMIT 1

122 (51.021575927734): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802382 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294802382 AND published='1' LIMIT 1

123 (559.09156799316): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

124 (!!!!! 23761.034011841): 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 (641.1075592041): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294802382 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294802382 AND type='deeppockets_item' AND published='1' LIMIT 1

126 (!!!!! 8115.0531768799): ( 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 (113.96408081055): ( 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 (51.975250244141): 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 (33.140182495117): 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 (49.114227294922): 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 (75.817108154297): 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 (430.10711669922): 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 (66.041946411133): 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 (61.988830566406): 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 (41.007995605469): 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 (676.87034606934): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802382 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (512.83836364746): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294802382 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

138 (65.088272094727): SELECT name FROM jos_deeppockets WHERE id=214

139 (42.915344238281): SELECT name FROM jos_deeppockets WHERE id=214

140 (813.00735473633): 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 (737.90550231934): 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 (82.015991210938): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802382 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294802382 AND published='1' LIMIT 1

143 (55.074691772461): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802382 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294802382 AND published='1' LIMIT 1

144 (!!!!! 10385.990142822): TRUNCATE TABLE jos_trademed_module

145 (128.98445129395): 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=294802382 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (99.897384643555): 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=294802382 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

147 (659.94262695312): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802382 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (74.148178100586): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802382 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

149 (113.01040649414): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802382 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294802382 AND published='1' LIMIT 1

150 (51.975250244141): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802382 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294802382 AND published='1' LIMIT 1

151 (!!!!! 1449.8233795166): 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 (107.0499420166): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802382 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294802382 AND published='1' LIMIT 1

153 (252.00843811035): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802382 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294802382 AND published='1' LIMIT 1

154 (56.982040405273): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294802382 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294802382 AND type='deeppockets_item' AND published='1' LIMIT 1

155 (49.829483032227): 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 (43.869018554688): 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 (63.180923461914): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

158 (148.05793762207): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802382 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294802382 AND published='1' LIMIT 1

159 (53.882598876953): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802382 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294802382 AND published='1' LIMIT 1

160 (73.909759521484): select jos_twitters.link from jos_twitters where cat=10

161 (47.922134399414): select jos_facebook.link from jos_facebook where cat=10

162 (41.961669921875): select jos_google_plus.link from jos_google_plus where cat=10

163 (43.153762817383): select jos_linkedin.link from jos_linkedin where cat=10

164 (350.9521484375): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14202,14203)

165 (!!!!! 1022.8157043457): insert into jos_banners_delta values (14202,'2025-08-02 15:11:42','216.73.216.210','view'),(14203,'2025-08-02 15:11:42','216.73.216.210','view')

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