Zdravko Kravanja, Miloš Bogataj (Editors), Proceedings of the 26th European Symposium on

Computer Aided Process Engineering – ESCAPE 26

June 12th -15th, 2016, Portorož, Slovenia © 2016 Elsevier B.V. All rights reserved.
http://dx.doi.org/10.1016/B978-0-444-63428-3.50310-6

Optimization of Preventive Maintenance Program

for Imaging Equipment in Hospitals
Danahe Marmolejo-Correa,a* Rosa G. Juarez-Valdivia,b Alejandra Rodriguez-
Navarrob
a
Department of Physics Engineering, University of Guanajuato, Loma del Bosque 103,
Colonia Lomas del Campestre, MX37150, León, Guanajuato, México.
b
Department of Chemical, Electronics and Biomedical Engineering, University of
Guanajuato, Loma del Bosque 103, Colonia Lomas del Campestre, MX37150, León,
Guanajuato, México.
d.marmlejocorrea@ugto.mx

Abstract
The goal of this work is to obtain the optimal schedule for the distribution of human
resources that provide Preventive Maintenance (PM) on Medical Equipment (ME) in
thirteen Hospitals and Medical Imaging Centers (H&MICs). Only Computed
Tomography and Magnetic Resonance Imaging Devices were selected for this study.
The abovementioned types of ME are commonly found and used in General Hospitals
in major cities. When the problem is stated as a Travelling Salesman Problem (TSP),
and additionally combining two optimization techniques: the Shortest Route Method
(SRM) and the Tabu Search (TS), the optimum schedule may be obtained. The thirteen
hospitals are located in four different cities in the Center of Mexico.
Keywords: Preventive Maintenance, Optimization, Shortest Route Method, Tabu
Search, Computed Tomography, Nuclear Magnetic Resonance.

1. Introduction
Mathematical Programming has shown important improvements to the total efficiency,
quality assurance, and reduction to the Total Annual Cost (TAC) of numerous industrial
processes, as well as solving numerous supply chain management problems. Gonzalez-
Silva and Hernández (1996) state that in the health sector Biomedical Engineers (BE)
are tasked with encouraging the financing and establishment of protocols for periodic
Preventive Maintenance (PM) and replacement of Medical Equipment. Optimization
techniques promote the correct and efficient management of Hospitals and Medical
Imaging Centers (H&MIC). Nowadays, an efficient PM plan and schedule for Medical
Equipment and Devices (MED) upkeep is very important. In Mexico, heuristic solutions
are still favored in many labor sectors. The lack of information and diffusion of
optimization techniques in small companies is due to their perception as large and
unnecessary expenses. PM services are usually offered and carried out by three different
actors in H&MICs:
1834 D. Marmolejo-Correa et al.

• The provider or manufacturer of the MEDs, when the device’s warrantee is still
valid.
• Independent companies (Outsourcing) hired for this specific service.
• The Department of Biomedical Engineering of the Hospital or Centre.
This paper is a case study of an outsourcing company, the second option in the list
above. The outsourcing company provides services for preventive and corrective
maintenance of MEDs in thirteen H&MICs. However, the company lacks protocols for
optimal scheduling that minimize the time and costs involved in performing PM. Before
the optimization study was performed, this company would establish its routes using
only heuristic considerations.
In general, the Total Annual Cost for providing PM is composed of three components:
• Transport (vehicle and fuel use)
• Salaries and meals (which depends on the number of engineers on the road)
• Parts (replacement of pieces of the devices)
The first two components are directly dependent on the distance between H&MICs.
This study aims to minimize the cost of raising orders for PM. The cost is a function of
the road-time of trip (distance/average velocity) and time for raising the order. The
optimal schedule for the actual MP will be presented in subsequent work.
1.1. Problem Statement:
A leader and pioneer company in the manufacture and maintenance of high-level
medical technology has Biomedical Engineers (BE) trained for providing preventive
and corrective maintenance to a variety of MEDs.
The BE of this pioneer company have been given the task of making the first PM for
Computed Tomography (CT) and Nuclear Magnetic Resonance (NMR) devices. These
MEDs were purchased by thirteen H&MICs located in the Bajío Region in the Center of
México. The first PM should be conducted two years after acquisition, within a
maximum window of 2 months. The first stage of the PM is conducting a diagnostic of
the equipment. The second stage is performing the actual maintenance.
It is estimated that the maximum time for raising the order on these two kinds of
equipment is close to 60 minutes providing it is done by two BEs, order time can be
almost double if only one BE is assigned to the task. However, spending on the salaries
of two skilled engineers means a significant increase in the labor cost, so many try and
seek only one BE. Presently, the company is not interested in minimizing the number of
days used for completing the tours. Thus, a problem statement that reflects the objective
of the work presented in this paper can be written as follows:
“Optimize the schedule of a team dedicated to raising orders for PM on N MEDs
located in N different H&MICs by minimizing travel, fuel use, and labor costs”.
The following section describes the methodology used to provide an optimal solution to
the abovementioned problem.
Optimization of Preventive Maintenance Program for Imaging Equipment in
Hospitals 1835

2. Methodology
2.1. Travelling Salesman Problem (TSP)
The case study can be put in the form of the well-known TSP. Comprehensive reviews
regarding TSP can be found in several papers such as, Laporte (1992) and Lenestra
(1975). The main characteristics of the TSP are listed as follows:
• The objective is to minimize the distance between cities visited.
• All cities should be visited only once.
• The tour is closed, i.e. the origin and destination are the same location.
The mathematical program is defined by the Equation (1).
n n
Min z =  dij xij
i =1 j =1

subject to
n

x
j =1
ij = 1, ∀i = 1, 2,..., n (1)
n

x
i =1
ij = 1, ∀j = 1, 2,..., n

xij = {0,1}

where dij is the distance from city i to city j, dij =¥ when i = j and dij = dji.

2.2. Tabu Search Algorithm (TS)

The TS is a Metaheuristic Algorithm designed to escape from a local optimum by
allowing flexible movements. The TS selects a new search movement in such a way that
temporally forbids the evaluation of previous solutions. The basic TS is composed by
the next elements.
• Tabu List: This is the instrument that lends a short-to-medium size memory to the
algorithm. The List “remembers” and disables movements from previous searches.
These disabled movements are referred to as Tabu Moves.
• Tenancy Period: This is the time (i.e. number of iterations) that the Tabu List
disables the Tabu Moves.
Taha (2012) gives a comprehensive and general procedure for the TS Algorithm.
• Step 0: Select an initial solution s0 ∈ S . Initialize the Tabu List L0 = ∅ and select a
list tabu size. Establish k = 0 .
• Step 1: Determine the neighborhood feasibility N ( sk ) that excludes inferior
members of the tabu list Lk .
• Step 2: Select the next movement sk +1 from N ( sk ) or Lk if there is a better solution
and update Lk +1 .
• Step 3: Stop if a condition of termination is reached, else, k = k + 1 and return to 1.
2.3. Location of the Hospitals and Imaging Medical Centers
The H&MICs are located in the Center of Mexico, in the so-called Bajío region. The
H&MICs selected for this case study are situated in four mid-sized cities: León,
Irapuato, Salamanca and Celaya, all in the State of Guanajuato. Table 1 shows the
actual distance between medical centers and Figure 1 shows the total network of the
1836 D. Marmolejo-Correa et
e al.

H&MICs in the abovemenntioned cities. S Seven H&MIC Cs are located in León, the other
o
three cities have
h two H&M MICs each. Thee central office (OFL) is loccated in León. The
label for eachh location is constructed by the letter H neext to the first letter of the k city
where the ithh H&MIC is located.

Figure 1. Co
omplete Networrk Superstructuree for the H&MIC
Cs
Table 1 Shorteest distances betw Centers (103 m).
ween Medical C

HL1 HL2 HL3 HL4

H HL5 HL
L6 HL7 HI1 HI2 HS1 H
HS2 HC1 HC2
OFL 7.7 8.6 9.3 1
12.0 9.9 12.0 18.0 75.0 73.0 93.0 92.0
9 137.0 1
132.0
HL1 ¥ 7.0 7.0 1
10.0 5.0 5.0 10.3 67.3 65.3 85.3 84.3 129.3 1
124.3
HL2 ¥ 1.0 2.0 2.0 4.0 9.4 66.4 64.4 84.4 83.4 128.4 1
123.4
HL3 ¥ 2.4 0.5 3.0 8.7 65.7 63.7 83.7 82.7 127.7 1
122.7
HL4 ¥ 2.9 5.0 6.0 63.0 61.0 81.0 80.0 125.0 1
120.0
HL5 ¥ 2.1 8.1 65.1 63.1 83.1 82.1 127.1 1
122.1
HL6 ¥ 6.0 63.0 61.0 81.0 80.0 125.0 1
120.0
HL7 ¥ 61.0 59.0 79.0 81.0 123.0 1
117.0
HI1 ¥ 2.0 27.0 28.0
2 72.0 66.0
HI2 ¥ 30.0 31.0
3 79.0 74.0
HS1 ¥ 2.0 46.0 41.0
HS2 ¥ 47.0 42.0
HC1 ¥ 6.0

The company y usually has two

t types of sservices: (a) Lo ocal and (b) R
Regional. The local
l
service focuss on the H&M MICs located inn León and reggional service attend
a the meddical
centres in thee other three smmaller cities. For
F both servicces, the followiing estimationss are
used:
1. Time for lifting
l the ordeer: 2 h if only oone BE is hiredd, 1 h with two BEs.
2. Salary forr the complete service (all 13 H&MICs): 133,000 Mexican Pesos (MXN).
3. Working hours
h per day: 8 h. Overtime is paid doublee.
4. Fuel pricee 14 MXN per liter.
5. Vehicle peerformance and average veloocities: (a) in ciities: 13.7 km/L L and 30 km/hh and
(b) in highhways: 19.2 km m/L and 80 km m/h.
 n of Preventive Maintenance Program
Optimization P for Im
maging Equipm
ment in
Hospitals 1
1837

6. Thee actual cost is close to the 344 MMXN (withh extra workingg hours) and it is
distributed ovver 3 days (seee Table 2).
The optimal sequence and scenario
s for liffting the PM orrder is sought. A soft restrictiion
regarding thee working hourrs must be addeed to the origin nal model (Eq. (2)). Eq. (3)
shows the rou ute time ti , j froom i and j as a function of the average veloocities v and thhe
time it takes to finish one activity
a (lifting of the order), ai = 1 h . The asssigned cost too
each distancee is calculated by Eq. (4). In tthe case of oveertime, Eq. (2) is not includedd in
the model, teex is the amounnt of extra workking hours in th hat tour while cex is the
associated coost to the extra hours.
n n

t
i =1 j =1
i, j xi , j ≤ 8 (22)

ti , j = vdi , j + ai (33)
di , j ⋅ F
ci , j = + ( tex ⋅ cex ) i≠ j (44)
p

If no extra working
w hours are allowed, then
t a weekly schedule shouuld be establisshed.
The completee algorithm waas implementedd in Wolfram Mathematica
M vv.10.2.

3. Results
For an initiaal approximatioon or solution,, one could co onsider that alll the H&MICss are
visited in onne tour. Thus, when there is no penalty co ost for extra working
w hours,, the
minimum disstance, cost, and
a time are 3003.9 km, 14,24 45.8 MXP, 300.7 h, respectivvely.
mplies that duriing 33 hours thhe BE is continnuously workinng, a condition that
This result im
is not recommmendable. Theere are 25 extrra hours that should be paid double (i.e. 2,000
MXN/h). Thhus, the total cost is 58,245.88 MXP. Figuree 2 shows the resulting pathh for
minimum tottal cost. Accorrding to the preevious result, iti can be estim
mated that at leaast 4
days of 8 wo orking hours arre needed for completing
c the tour. Table 4 shows some off the
Tabu Searchh iterations. Thhe minimum ccost is then 15,773.0 MXN N for the sequeence
when the H& &MICs are orddered by cities which is also the safest soluution, since driv ving
along highwaays is minimizzed as well. It should be meentioned that thhe TS was useed to
heuristically rearrange the H&MICs
H in thhe tours. The shhortest route method
m was useed to
minimize thee distance in each tour. Thhe savings of using a 5 dayy-tour sequencce is
17,654.8 MX XN, close to 533% of the actuaal cost.

F
Figure 2. Shortest tour: initial soolution.
1838 D. Marmolejo-Correa et al.

Table 2. Some results of the Tabu Search Algorithm

Dist. Time Total Cost

Sequence
(km) (h) (MXP)
OFL, HI2, HI1, HS2, HS1, HC1, HC2, HL7, 303.9 30.7 58,653.4
HL1, HL6, HL5, HL3, HL4, HL2, OFL
{OFL, HI2, HI1, HS2 OFL},{ OFL, HS1, 522.9 34.0 33,427.8
HC1, HC2, OFL},{ OLF,HL1, HL2, HL3,
HL4, HL5, HL6, HL7 OFL}
{OFL, HI2, HI1, HL7, OFL}{OFL, HS1, 673.7 36.6 22,759.6
HS2, HL1, OFL}{OLF, HC1, HC2, HL6,
OFL}{OLF, HL2, HL3, HL4, HL5, OFL}
{OFL, HI2, HI1, OFL}{OFL, HS1, HS2, 681.6 36.8 15,773.0*
OFL}{OLF, HC1, HC2, OFL}{OLF,HL7,
HL1, HL6, HL5, OFL}{OLF, HL3, HL4,
HL2,OFL}
{OFL, HC2, HC1, OFL}{OFL, HS1, 734.7 37.8 18,919.4
HI1,HL7, OFL}{OFL, HS2, HI2,HL1,
OFL}{OLF, HL3, HL4, HL2, OFL}{OLF,
HI5, HL6, OFL}

*Optimum solution

4. Conclusions
The optimum sequence of tours was found with a hybrid method of two methods: the
shortest route method, using the Traveler Salesman Problem as basis, and the Tabu
Search Algorithm for finding the best arrangement. According to the obtained results,
the best sequence of tours should be scheduled over five days. The savings found are
close 53% compared to the actual Preventive Maintenance Program. There is no need to
hire a second Biomedical Engineer, however, less qualified help at a lower pay scale
could be evaluated. The proposed methods can be used in various engineering fields, as
well as more application in the field of biomedical engineering, implemented for
optimizing hospital resources and the rotation and distribution of personnel and
activities within health institutions.

References
C.A. Gonzalez-Silva and Hernandez A., 1996, Maintanece Manual for Health Services:
Equipment and Buildings, HSP-UNI/Operating Manuals, PALTEX, Vol. 2, Issue. 6, (In
Spanish)
G. Laporte, 1992, The Traveling Salesman Problem: An Overview of Exact and Aproximate
Algorithms, The European Journal of Operational Research, Vol. 59, Issue. 2, pp 231-247.
J. Lenstra, 1975, Some Simple Applications of the Traveling Salesman Problem, Vol. 26, Issue 4,
pp 717-733.
H. Taha, 2011, Heuristic Programming, Operations Research: An Introduction, Nineth Edition,
Prentice Hall, Boston.