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Wearable Ultrasound Navigation System Could Improve Lumbar Puncture Accuracy

By MedImaging International staff writers
Posted on 26 Sep 2024

A lumbar puncture, or spinal tap, is a common medical procedure in which a hollow needle is inserted into the spinal canal to access cerebrospinal fluid that surrounds the brain and spinal cord. More...

It is used to diagnose serious neurological conditions like meningitis or encephalitis and to administer anesthetics or chemotherapy. Physicians often refer to lumbar punctures as “blind bedside procedures” because they rely on feeling for the gap between two lumbar bones and then attempting to insert the needle in the correct location. This process can be particularly challenging in overweight or elderly patients. In some cases, the bony landmarks that guide the needle may not be easily felt, and in elderly patients, spinal degeneration adds to the difficulty. Multiple failed attempts can cause pain and increase the risk of blood contamination in the cerebrospinal fluid, potentially impacting the accuracy of diagnostic tests for conditions like meningitis, encephalitis, or subarachnoid hemorrhage. Now, researchers have developed an innovative ultrasound navigation system designed to provide accurate, real-time guidance for needle insertion during lumbar punctures.

The system, created by a team from Johns Hopkins University (Baltimore, MD, USA) and Clear Guide Medical (Baltimore, MD, USA), incorporates three key components to enhance needle accuracy: a cell phone-sized ultrasound scanner that can be attached to the patient’s skin along the lower spine, imaging algorithms that estimate bone surfaces, and an augmented reality display that superimposes a digital guide for needle insertion onto the view of the patient’s spine. This research builds on earlier findings, which demonstrated that the ultrasound scanner significantly improved visibility of the lumbar gap.

Published in IEEE Transactions on Medical Robotics and Bionics, the current study evaluated the overall accuracy of the navigation system, comparing two augmented reality methods: one using a tablet with camera-based tracking and the other using a head-mounted display similar to goggles, with optical-based tracking. Both approaches successfully guided needle placement, with an accuracy of 2.83 mm for the tablet and 2.76 mm for the head-mounted display, both within the 4 mm benchmark commonly used in spinal surgeries for needle placement precision.

The researchers also conducted a preliminary user study to gather feedback and compare the two augmented reality systems. Sixteen users completed eight sets of lumbar punctures using a realistic anatomical model (phantom) of the spine. The success rate for first-time needle insertions was 89%. On average, users required 1.14 attempts with the head-mounted display and 1.12 attempts with the tablet system to reach the target, defined as a rubber tube embedded in the phantom vertebrae canal. In comparison, other studies have shown that traditional methods using palpation often require multiple attempts. One study found that first-time needle insertion was successful in 71% of patients, while nearly 30% needed multiple attempts or failed entirely. Since completing this study, the researchers have replaced their needle tracking method using QR and other codes with artificial intelligence, simplifying the system for clinical use.

“This wearable ultrasound navigation system has several advantages over other imaging navigation methods,” said Peter Kazanzides, Ph.D., a research professor in computer science at Johns Hopkins University. “A pre-operative computed tomography scan would not be necessary, and clinicians would be able to use both hands to control the needle when using the navigation system. They currently use one hand to hold and guide the imaging probe and the other hand to insert the needle.”

“Our team at Hopkins is very excited about the direction we’re taking toward wearable ultrasound devices. Our device can capture the complex shape of lumbar bones without the shadows often seen in typical ultrasound scanners and it has the flexibility to adapt to motion,” added Emad Boctor, Ph.D., associate research professor at Johns Hopkins University and co-founder of Clear Guide Medical.

Related Links:
Johns Hopkins University
Clear Guide Medical

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57 (577.92663574219): 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=294802577 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

58 (!!!!! 2519.8459625244): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802577 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294802577 AND published='1' LIMIT 1

59 (480.89027404785): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802577 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294802577 AND published='1' LIMIT 1

60 (!!!!! 2733.9458465576): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802577 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294802577 AND published='1' LIMIT 1

61 (!!!!! 1092.9107666016): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802577 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294802577 AND published='1' LIMIT 1

62 (!!!!! 1293.8976287842): 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 (!!!!! 2262.1154785156): SELECT fid FROM jos_deeppockets WHERE id=294802577 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294802577 AND published='1' LIMIT 1

64 (811.10000610352): 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 (!!!!! 3017.9023742676): select jos_twitters.link from jos_twitters where cat=10

66 (!!!!! 1708.0307006836): select jos_facebook.link from jos_facebook where cat=10

67 (395.05958557129): select jos_google_plus.link from jos_google_plus where cat=10

68 (597.95379638672): select jos_linkedin.link from jos_linkedin where cat=10

69 (706.91108703613): SELECT fid FROM jos_deeppockets WHERE id=294802577 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294802577 AND published='1' LIMIT 1

70 (65.088272094727): 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 (623.94142150879): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294802577 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (411.9873046875): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294802577 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

73 (85.830688476562): 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 (67.949295043945): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (33.855438232422): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (34.809112548828): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (52.928924560547): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (33.140182495117): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (!!!!! 3283.0238342285): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (152.1110534668): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (167.1314239502): SELECT show_live FROM jos_com_show_setting LIMIT 1

88 (246.04797363281): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294802577 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (64.849853515625): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294802577 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

90 (!!!!! 1164.9131774902): 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 (81.062316894531): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (46.968460083008): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

105 (117.06352233887): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802577 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294802577 AND published='1' LIMIT 1

106 (66.995620727539): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802577 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294802577 AND published='1' LIMIT 1

107 (74.863433837891): 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=294802577 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (72.002410888672): 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=294802577 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

109 (127.07710266113): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802577 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294802577 AND published='1' LIMIT 1

110 (82.015991210938): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802577 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294802577 AND published='1' LIMIT 1

111 (72.002410888672): 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=294802577 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (605.10635375977): 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=294802577 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

113 (667.81044006348): 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 (492.09594726562): 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 (138.0443572998): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802577 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294802577 AND published='1' LIMIT 1

116 (70.095062255859): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802577 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294802577 AND published='1' LIMIT 1

117 (77.009201049805): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802577 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294802577 AND published='1' LIMIT 1

118 (56.028366088867): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802577 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294802577 AND published='1' LIMIT 1

119 (46.968460083008): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802577 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294802577 AND published='1' LIMIT 1

120 (41.007995605469): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802577 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294802577 AND published='1' LIMIT 1

121 (59.843063354492): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802577 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294802577 AND published='1' LIMIT 1

122 (40.054321289062): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802577 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294802577 AND published='1' LIMIT 1

123 (339.03121948242): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

124 (!!!!! 46166.181564331): 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 (657.08160400391): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294802577 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294802577 AND type='deeppockets_item' AND published='1' LIMIT 1

126 (!!!!! 17162.084579468): ( 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 (83.92333984375): ( 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 (82.015991210938): 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 (37.908554077148): 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 (41.961669921875): 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 (30.994415283203): 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 (413.17939758301): 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 (108.00361633301): 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 (108.95729064941): 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 (43.153762817383): 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 (448.94218444824): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802577 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (298.97689819336): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294802577 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

138 (149.01161193848): SELECT name FROM jos_deeppockets WHERE id=214

139 (81.062316894531): SELECT name FROM jos_deeppockets WHERE id=214

140 (670.19462585449): 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 (544.07119750977): 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 (64.13459777832): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802577 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294802577 AND published='1' LIMIT 1

143 (62.942504882812): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802577 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294802577 AND published='1' LIMIT 1

144 (!!!!! 8197.0691680908): TRUNCATE TABLE jos_trademed_module

145 (!!!!! 3630.1612854004): 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=294802577 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (118.01719665527): 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=294802577 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

147 (427.9613494873): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802577 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (213.8614654541): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802577 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=294802577 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294802577 AND published='1' LIMIT 1

150 (72.002410888672): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802577 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294802577 AND published='1' LIMIT 1

151 (!!!!! 1522.0642089844): 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 (92.029571533203): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802577 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294802577 AND published='1' LIMIT 1

153 (51.021575927734): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802577 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294802577 AND published='1' LIMIT 1

154 (36.001205444336): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294802577 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294802577 AND type='deeppockets_item' AND published='1' LIMIT 1

155 (30.994415283203): 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 (46.968460083008): 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 (82.969665527344): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

158 (!!!!! 1609.0869903564): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802577 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294802577 AND published='1' LIMIT 1

159 (58.889389038086): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802577 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294802577 AND published='1' LIMIT 1

160 (67.949295043945): select jos_twitters.link from jos_twitters where cat=10

161 (40.054321289062): select jos_facebook.link from jos_facebook where cat=10

162 (37.908554077148): select jos_google_plus.link from jos_google_plus where cat=10

163 (37.193298339844): select jos_linkedin.link from jos_linkedin where cat=10

164 (334.02442932129): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14202,14203)

165 (!!!!! 1260.9958648682): insert into jos_banners_delta values (14202,'2025-08-02 15:08:07','216.73.216.210','view'),(14203,'2025-08-02 15:08:07','216.73.216.210','view')

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