A dynamic sequential decision-making model on MRI real-time scheduling with simulation-based optimization.

Magnetic resonance imaging (MRI) is widely used in diagnostic medicine and contributes significantly to US health care spending. Scheduling MRI jobs involves uncertainties (e.g., patient arrival time, scanning time, and preparation time) that can lead to excessive delays and high costs in MRI operations. This study addresses real-time decision making in use of MRI scanners based on job assignment and sequencing decisions that override the appointment schedule. The decisions are made using real-time information of the waiting patients, the utilization status of the MRI scanners, and the partially revealed uncertainties of scanning times of current patients. A sequential decision-making framework and a simulation-based solution method are proposed to utilize massive real-time information and match the use of MRI rescheduling in practice. The results are then compared with a real case in a large midwestern academic medical center in the US. This study illustrates that the proposed method reduces patient waiting time by 21.7% and improves utilization of MRI scanners by 23.0%. An optimality gap of 13.6% is provided when compared to off line scheduling methods based on a mixed integer programming (MIP) model. The number of simulation replications in this approach uses the ranking and selection method, which not only reduces solution time, but also provides solution quality guarantees wherein the probability of errors in the proposed method for one day is less than 0.1%. In 100 randomly generated workday experiments, all of the scheduling decisions given by the proposed method perform better than current policy, with an average reduction of 17.93 minutes in each patient's waiting time and an improvement of scanner utilization by 7.20%.