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Personalized Intraoperative Radiation Therapy During Cancer Surgery

By MedImaging International staff writers
Posted on 09 Sep 2014

A New York City Medical Center is finding new ways to employ personalized, internal radiation delivered in the operating room right after a cancer tumor is removed. Intraoperative radiotherapy (IORT) represents an effort to reduce the risk of a recurrence, lessen the duration of standard postoperative external radiation, and reduce the risk to healthy tissue associated with external radiation.

NewYork-Presbyterian Hospital Medical Center (New York, NY, USA), in 2012, became the first hospital in New York City to offer IORT to women with certain breast cancers. In this therapy, a spherical applicator is used to deliver a single, even dose of radiation to the inside surface of a rounded cavity after a lumpectomy.

Now, physicians at NewYork-Presbyterian/Columbia are expanding these innovating efforts by offering IORT for other types of cancer in the abdomen and pelvis. Unlike that in the breast, the tumor bed in the abdomen and pelvis may not be as precisely defined after surgery, and several sites at risk for recurrence may need to be treated.

Earlier in 2014, in the hospital’s first case of using IORT for a cancer other than breast cancer, a woman with recurrent colon cancer in the pelvic cavity needed to have treatment to separate areas of her body. The surgeon, Ravi Kiran, MD, a professor of surgery (in epidemiology) and chief of colorectal surgery at NewYork-Presbyterian/Columbia, removed the tumor, but could not cut too close to major blood vessels and other organs. Because of the fundamental limitations of surgery, and because the patient had already received a high lifetime cumulative dose of radiation therapy in earlier treatments, Dr. Kiran and Clifford Chao, MD, a professor of radiation oncology and chair of radiation oncology at NewYork-Presbyterian/Columbia, decided to use IORT to “mop up” any reamining tumor cells. Dr. Chao used a flat radiotherapy applicator to deliver radiation to areas close to blood vessels along the pelvic wall and a spherical applicator to treat a region lower in the pelvic cavity. “We also used a protective wrap, or draping, made of material that shields organs like the bowel or blood vessels from scatter radiation,” Dr. Chao said.

In a second procedure, which involved a 23-year-old woman with a bile duct tumor, two differently shaped applicators were used to deliver IORT to the retroperitoneal tissue after removal of the tumor and nearby lymph nodes. The surgery, performed by Tomoaki Kato, MD, a professor of surgical oncology and chief of abdominal organ transplantation at NewYork-Presbyterian/Columbia, was the first case in the United States to use Zeiss Intrabeam flat applicators after removal of a bile duct tumor. The flat applicator was used to deliver radiation to the surface where the retroperitoneal aortic lymph node had been. A sphere-shaped applicator was inserted into the right lobe of the liver near the hepatic artery, where the soft organ could completely surround the tiny globe and absorb a 20–30 minute, low-dose IORT session.

“Because of the way the tumor needs to be removed, or because the spaces between a tumor and large vessels and nerves are too small, microscopic lesions are more likely to be attached to the surface of blood vessels and nerves. IORT allows us to treat those areas and lower the risk of recurrence,” said Dr. Chao, who performed the radiation therapy procedure and is leading the hospital’s IORT efforts.

In a third patient, Jason Wright, MD, a professor of Women’s Health (in obstetrics and gynecology) and chief of gynecologic oncology at NewYork-Presbyterian/Columbia, used a similar approach to treat a gynecologic cancer, working with Dr. Chao. In specific breast cancer patients, IORT has eliminated an additional six to seven weeks of radiotherapy, and according to a 10-year randomized trial published in 2010, provided the same results as traditional full-breast radiation. Dr. Chao is hopeful that similar benefits will be seen in other types of cancer cases, and he sees this as another step toward customized cancer care.

“The possibilities are encouraging,” said Dr. Chao. “We could see patients ahead of time and then work with the surgeon to develop a personalized radiation treatment for the specific tumor. When you open up the abdomen to remove a tumor from the liver, bowel, or pancreas, the terrain of the surgical bed is a more open, uneven surface. So we need radiotherapy applicators that suit the specific anatomical terrain. In some areas of the body, the applicator could be a half sphere, an irregular shape for uneven surfaces, or a tiny device that fits into a small space where we have anatomic challenges. We can devise personalized therapy based on a patient’s specific anatomy.”

Dr. Chao is currently working with engineers and physicists from NewYork Presbyterian/Columbia and NewYork-Presbyterian/Weill Cornell Medical Center to design and develop applicators for colorectal, head and neck, lung, and gynecologic cancers.

Zeiss Intrabeam, developed by Carl Zeiss (Oberkochen, Germany), is a mobile radiation oncology platform that offers additional treatment options for a wide range of cancer types, through use of its US Food and Drug Administration (FDA)-cleared spherical, needle, flat, and surface applicators. Because of the low X-ray energy, Intrabeam does not require any complicated radiation shielding measures and is suitable even for mobile use.

Related Links:
NewYork-Presbyterian Hospital Medical Center
Carl Zeiss

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57 (46.014785766602): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754470 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754470 AND published='1' LIMIT 1

58 (55.074691772461): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754470 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754470 AND published='1' LIMIT 1

59 (42.915344238281): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754470 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754470 AND published='1' LIMIT 1

60 (83.92333984375): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754470 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754470 AND published='1' LIMIT 1

61 (46.968460083008): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754470 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754470 AND published='1' LIMIT 1

62 (351.90582275391): SELECT name FROM jos_deeppockets WHERE id=294754470 LIMIT 1

63 (206.94732666016): SELECT name FROM jos_deeppockets_archive WHERE id=294754470 LIMIT 1

64 (51.975250244141): SELECT a.* FROM jos_components AS a WHERE ( a.admin_menu_link = 'option=com_syndicate' OR a.admin_menu_link = 'option=com_syndicate&hidemainmenu=1' ) AND a.option = 'com_syndicate'

65 (73.909759521484): 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=294754470 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

66 (488.9965057373): 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=294754470 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

67 (!!!!! 1397.1328735352): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754470 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754470 AND published='1' LIMIT 1

68 (72.956085205078): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754470 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754470 AND published='1' LIMIT 1

69 (101.80473327637): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754470 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754470 AND published='1' LIMIT 1

70 (48.87580871582): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754470 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754470 AND published='1' LIMIT 1

71 (87.02278137207): 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

72 (510.93101501465): SELECT fid FROM jos_deeppockets WHERE id=294754470 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294754470 AND published='1' LIMIT 1

73 (333.78601074219): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=211 ORDER BY `ordering`

74 (42.915344238281): select jos_twitters.link from jos_twitters where cat=10

75 (39.815902709961): select jos_facebook.link from jos_facebook where cat=10

76 (106.0962677002): select jos_google_plus.link from jos_google_plus where cat=10

77 (60.081481933594): select jos_linkedin.link from jos_linkedin where cat=10

78 (99.897384643555): SELECT fid FROM jos_deeppockets WHERE id=294754470 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294754470 AND published='1' LIMIT 1

79 (72.002410888672): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=211 ORDER BY `ordering`

80 (273.9429473877): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294754470 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

81 (240.80276489258): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294754470 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

82 (41.007995605469): 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`

83 (49.114227294922): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (33.855438232422): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (33.140182495117): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

88 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

89 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

90 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (59.843063354492): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (60.081481933594): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294754470 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

98 (36.954879760742): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294754470 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

99 (35.04753112793): 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`

100 (52.928924560547): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

105 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

106 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

107 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

108 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

109 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

110 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

111 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

112 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

113 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

114 (90.122222900391): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754470 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754470 AND published='1' LIMIT 1

115 (54.836273193359): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754470 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754470 AND published='1' LIMIT 1

116 (54.121017456055): 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=294754470 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

117 (49.114227294922): 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=294754470 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

118 (78.201293945312): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754470 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754470 AND published='1' LIMIT 1

119 (44.107437133789): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754470 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754470 AND published='1' LIMIT 1

120 (58.889389038086): 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=294754470 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

121 (573.87351989746): 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=294754470 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

122 (516.17622375488): 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

123 (310.89782714844): 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

124 (77.009201049805): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754470 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754470 AND published='1' LIMIT 1

125 (56.982040405273): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754470 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754470 AND published='1' LIMIT 1

126 (58.889389038086): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754470 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754470 AND published='1' LIMIT 1

127 (40.054321289062): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754470 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754470 AND published='1' LIMIT 1

128 (95.129013061523): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754470 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754470 AND published='1' LIMIT 1

129 (40.054321289062): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754470 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754470 AND published='1' LIMIT 1

130 (230.07392883301): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

131 (!!!!! 19052.982330322): 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

132 (120.87821960449): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754470 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754470 AND published='1' LIMIT 1

133 (52.928924560547): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754470 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754470 AND published='1' LIMIT 1

134 (452.99530029297): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294754470 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294754470 AND type='deeppockets_item' AND published='1' LIMIT 1

135 (!!!!! 458898.06747437): ( 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

136 (150.91896057129): ( 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

137 (46.968460083008): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

138 (27.894973754883): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

139 (30.040740966797): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

140 (28.133392333984): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

141 (28.848648071289): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

142 (26.941299438477): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

143 (469.92301940918): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754470 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

144 (364.06517028809): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754470 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

145 (238.89541625977): SELECT name FROM jos_deeppockets WHERE id=211

146 (31.948089599609): SELECT name FROM jos_deeppockets WHERE id=211

147 (425.10032653809): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))211((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

148 (364.06517028809): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))211((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

149 (63.896179199219): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754470 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754470 AND published='1' LIMIT 1

150 (46.014785766602): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754470 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754470 AND published='1' LIMIT 1

151 (!!!!! 8610.0101470947): TRUNCATE TABLE jos_trademed_module

152 (108.95729064941): 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=294754470 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

153 (64.13459777832): 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=294754470 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

154 (977.0393371582): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754470 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

155 (64.849853515625): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754470 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

156 (72.002410888672): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754470 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754470 AND published='1' LIMIT 1

157 (48.87580871582): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754470 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754470 AND published='1' LIMIT 1

158 (!!!!! 1203.0601501465): 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

159 (59.127807617188): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754470 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754470 AND published='1' LIMIT 1

160 (41.961669921875): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754470 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754470 AND published='1' LIMIT 1

161 (40.054321289062): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294754470 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294754470 AND type='deeppockets_item' AND published='1' LIMIT 1

162 (30.040740966797): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=211 or channel_id is null)

163 (27.894973754883): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=211 or channel_id is null)

164 (30.040740966797): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

165 (125.16975402832): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754470 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754470 AND published='1' LIMIT 1

166 (51.021575927734): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754470 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754470 AND published='1' LIMIT 1

167 (36.954879760742): select jos_twitters.link from jos_twitters where cat=10

168 (32.186508178711): select jos_facebook.link from jos_facebook where cat=10

169 (35.04753112793): select jos_google_plus.link from jos_google_plus where cat=10

170 (30.994415283203): select jos_linkedin.link from jos_linkedin where cat=10

171 (291.10908508301): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

172 (!!!!! 1127.9582977295): insert into jos_banners_delta values (14615,'2025-04-29 22:09:31','13.59.134.12','view'),(14202,'2025-04-29 22:09:31','13.59.134.12','view'),(14203,'2025-04-29 22:09:31','13.59.134.12','view')

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General/Advanced Imaging

New AI Method Captures Uncertainty in Medical Images

CT Coronary Angiography Reduces Need for Invasive Tests to Diagnose Coronary Artery Disease

Novel Blood Test Could Reduce Need for PET Imaging of Patients with Alzheimer’s

CT-Based Deep Learning Algorithm Accurately Differentiates Benign From Malignant Vertebral Fractures

Imaging IT

New Google Cloud Medical Imaging Suite Makes Imaging Healthcare Data More Accessible

Global AI in Medical Diagnostics Market to Be Driven by Demand for Image Recognition in Radiology

AI-Based Mammography Triage Software Helps Dramatically Improve Interpretation Process

Artificial Intelligence (AI) Program Accurately Predicts Lung Cancer Risk from CT Images

Industry News

Bayer and Google Partner on New AI Product for Radiologists

Samsung and Bracco Enter Into New Diagnostic Ultrasound Technology Agreement

IBA Acquires Radcal to Expand Medical Imaging Quality Assurance Offering

International Societies Suggest Key Considerations for AI Radiology Tools

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Personalized Intraoperative Radiation Therapy During Cancer Surgery

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