2014 7th Cairo International Biomedical Engineering Conference

Cairo, Egypt, December 11-13,2014

Application of Quality Function Deployment and Genetic Algorithm

for Replacement of Medical Equipment
Neven Saleh, Samanta Rosati, Amr Sharawi, Manal Abdel Wahed, and Gabriella Balestra

Abstract-The management of medical equipment raises a replacement decision for medical equipment. Therefore, it is
range of complex problems including those associated with necessary to propose methods for replacement planning able
replacement processes. One of the most significant challenges is to recognize what equipment should be considered for
to identify a proper list of medical equipment that requires
replacement and when replacement is economically feasible.
replacement and then to optimize this list. In this article, we
The literature is rich of different techniques for
present a new approach to solve this problem by integrating
Quality Function Deployment (QFD) and Genetic Algorithm
replacement of medical equipment, which were previously
(GA) in one framework. In a previous application, QFD has categorized into quantitative and qualitative [2]. One
proven its validity to solve the priority problem; meanwhile GA qualitative approach was conducted by Rajasekaran [3]. He
is an optimization method. Hence, the proposed model, QFD­ developed a replacement prioritization model according to a
GA, was developed to prioritize the medical equipment for
combination of technical, fmancial, and safety criteria
replacement process taking into account a set of criteria; in
utilizing a software program to produce a Relative
addition, the prioritized list is optimized according to the
available budget of the hospital to maximize the number of
Replacement Number (RRN) for each device. Hence, the
replaced devices. The validation of the proposed model was replacement decision is approved considering the resultant
carried out on sixty devices that include different types of RRN .
medical equipment in one public hospital. Results show that the In quantitative approaches, where a mathematical model
proposed model can efficiently classify the priority into four
is exploited to determine a replacement threshold; different
subcategories, and simultaneously maximize the number of
methods were proposed. One methodology [4] employed
medical equipment to be replaced considering the budget
constraint.
fuzzy AHP (Analytical Hierarchy Process) for solving the
problem of replacement in the fuzzy environment. Linguistic
Keywords-quaUty function deployment; genetic values are used to assess the ratings and weights for key
algorithms; medical equipment; replacement; priority components. Another example [5] proposed Artificial Neural
Network (ANN) models for the replacement problem.
I. INTRODUCTION According to this model; the equipment life status is
classified into three zones.

O
NE of the most common capital budgeting is the
replacement of a plant or equipment. Actually, all
capital budgeting decisions can be viewed as replacement
decisions. Expansion decisions are merely replacement
decisions in which all cash flows from the old asset are zero
[1]. Medical equipment replacement is often a complex issue
to model since it embraces a high number of problems.
Some of these problems are that most of decisions are made
based on subjective policies, inadequate information, and
poor analysis of costs and conditions of the devices [2].
This article presents a new approach to solve the problem
of replacement of medical equipment. The proposed model
is a framework that consists of Quality Function
Deployment (QFD) and Genetic Algorithm (GA). QFD is
considered as planning method; in addition, it proved its
consistency in the prioritization process [6]. GA is often
viewed as function optimizer for a range of problems. The
output of QFD is a prioritized list of medical equipment, and
then this list is optimized by the GA to maximize the number

In practice, few hospitals especially in developing of medical equipment taking into account the budget
constraint.
countries have formal plans for determining the appropriate

II. MATERIALS AND METHODS

Manuscript received in August 2014, accepted in October 2014.
Neven Saleh (corresponding author) is with the Biomedical Engineering
Quality Function Deployment
Department, Faculty of Engineering, Cairo University, Giza, Egypt. Also is
with Electronics and Telecommunication Department, Politecnico di Quality Function Deployment (QFD) is one of the Total
Torino, Torino, Italy. Quality Management (TQM) quantitative tools that could be
(phone: +201002854423; e-mail: nevensaleh@hotmail.com )
used to translate customer requirements into appropriate
Gabriella Balestra and Samanta Rosati are with Electronics and
Telecommunication Department, Politecnico di Torino, Torino, Italy. technical or service specifications. QFD uses visual matrices
(e-mail: gabriella.balestra@polito.it;samanta.rosati@polito.it ) that link customer requirements, design requirements, target
Amr Sharawi and Manal Abdel Wahed are with the Biomedical
values, and competitive performance into one chart called
Engineering Department, Faculty of Engineering, Cairo University, Giza,
Egypt the house of quality matrix [7].
(e-mail: amrarsha@link.net;manalaw2003@yahoo.com ) In our problem, the house of quality (HOQ) is employed
to build the base of the proposed model by selecting the
978-1-4799-4412-5/1411$31.00 c 2014 IEEE

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most important criteria. According to the basics of QFD, the In order to determine the fmal replacement score for every
customers in our case are the medical staff, including device, the technical criteria must be calculated. Based on
physicians and nurses who are responsible to ask literature and our experience, we decided to use the score
replacement; in addition, biomedical technicians who are indexes listed below in Table II
responsible for maintenance. Therefore, the voice of
customers (WHATs) is developed considering both the TABLE II
medical staff and the biomedical technicians. On the other DESCRlPTION OF TECHNICAL TERMS OF HOQ AND THEIR SCORES
hand, clinical engineers who are responsible for replacement Parameter Description Thresholds Score
decision are considered the voice of design (HOWs) . Table I Technology Technology Yes (obsolete) I
obsolescence. status No 0
shows customer requirements and technical requirements of
Downtime Ratio between Ratio 2: 20 % 3
the proposed HOQ. ratio [6]. downtime in 10%::; Ratio<20% 2
days to days a Ratio < 10 % 1
TABLE I year
CUSTOMER AND TECHNICAL REQUIREMENTS OF PROPOSED Failure rate Number of 2:2 for critical, 2:4 3
QFD [6]. failures a year for important, 2:5
based on device for necessary
Technical Requirements criticality level I for critical, 2-3 2
Customer
(critical, for important, 3-4
Requirements
Criteria Sub criteria important, and for necessary
necessary) o for critical, ::;1 for 1
Disposal of poor Technology important, ::;2 for
function devices. obsolescence necessary
(OS) Life ratio [6]. Ratio between Ratio>80 % 3
Disposal of obsolete the age and the 50% < Ratio::;80% 2
High downtime
devices. expected life Ratio::; 50 % 1
(DR)
Unavailable Checking spare Yes (unavailable) 1
Disposal of poor
High failure rate spare parts. parts availability No (available) 0
physical conditions. Technical
(FR) Recalls & Existence of Yes 1
alerts. recalls & alerts No 0
Disposal of high
Excessive life Costs ratio. Ratio between Ratio>45 % 3
service costs
ratio (LR) purchasing price 25% < Ratio<45% 2
to all service Ratio < 25 % 1
Disposal of high risk Unavailable
costs
devices spare parts
Backup ratio. Ratio between Ratio 2: 25 % 3
(USP)
low utilization
Disposal of poor Recall and alerts 10%::; Ratio<25% 2
devices to all
user's interface Safety (RA) devices in the
Ratio < 10 % 1
department
Disposal of old
devices
High costs rati0
Disposal of (CR) The proposed QFD model is illustrated in Fig.l, and the
unreliable devices
model components are described in detail in the text. Fig. I
Financial presents the relationships between WHATs and HaWs. The
Disposal of un
supported devices inputs to the HOQ are the customer requirements as
Backup ratio
described in Table I, meanwhile the output of the QFD is the
Disposal of low (BR)
utilization level of target matrix that is formulated as an equation describing the
devices technical terms based on their weights as follows

R = 17.30S + J3.5DR + 13.2FR + 15.5LR + 14.6USP +

5.1RA + 14.9CR + 5.BER (1)

'R' is the output replacement score that is the priority

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\.� i' •. • i !
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• corresponding technical criterion.
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A. Genetic Algorithms
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Genetic algorithms (GAs) are general purpose
J U 53}
optimization algorithms based on local search that mimic the
lO.5�
9 9 U 533 l(1.5�
1 1 4 4 l � 1.3 533 IO.5�
J 9 ] 1 J J J u 4.� B9!t principles inspired by biological reproduction to evaluate
;\1>\Ohlltlni;I!I 4"73 36S 3f2 42:1. 399 USJ !O�.8 l5S.17 27.16 su
r.:tL'tiH'i"dgbl � IfJ 13.5 112 15.5 14.6 5.099 1498 S.BS appropriate solutions to problems [8]. In general, GA starts
Rank 1 5 � 2 .. 8 .1 7
with a population of randomly created solutions [9]. New
Fig. 1 The proposed HOQ for medical equipment replacement populations are generated with the principle of survival of

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the fittest by applying genetic operators; crossover and Populations (number of solutions): 500, 600, 700, 800,
mutation, to produce new offspring. The process is repeated 900, 1000, 1200, 1500
until some criteria are met, acceptable solutions are found or Iterations: 400, 450, 500
the maximum number of iterations is reached. Crossover rate: 0.6, 0.7, 0.8, 0.9, 1
Because of the limited financial resources, hospitals must Mutation rate: 0.1, 0.2, 0.3, 0.4
allocate them carefully; hence the output prioritized list of
medical equipment for replacement should be optimized III. RESULTS
considering the budget constraint. Therefore, the second The proposed model for replacement of medical
stage of our model is to optimize the output of the QFD by equipment was tested using a list of 60 pieces of medical
the GA. In particular, GA construction includes an objective equipment belonging to one public hospital. This list
function formulation, an algorithm development, and contains 12 different types of devices. As the proposed
parameter tuning. model is divided in two stages, we consider the results stage
by stage as follows.
J) Objective Function Formulation: We assume the need
to maximize the number of medical equipment referred to A. Quality Function Deployment Results
the top priority list of devices, taking into account the The validity of proposed QFD model is verified by the
purchasing prices of these devices and the available budget. data set of medical equipment mentioned above.
The objective or fitness function of the model is Consequently, the output is a prioritized list of that medical
equipment for replacement purpose. Table III, shows sample
data of various types of investigated equipment along with
(2)
their priority scores.
TABLE 1Tl
SAMPLE DATA OF EQUIPMENT FOR REPLACEMENT PRIORITY
LY=lPiXi > B
K=
{� LY=lPiXi � B
(3) Device 0
S
D
R
F
R
L
R
US
P
R
A
C
R
B
R
R R
%
ventilator 0 3 3 3 1 0 2 3 192 83
Where Z is the objective function; w is the pnonty Incubator 0 3 2 1 0 0 3 2 141 61
weight; x is the device; p is the device purchasing price; B is Inf. pump 0 1 2 2 0 0 3 2 129 56
the available budget; i is the equipment index; n is the top Monitor 0 2 0 0 2 93 40

priority devices; and K is the replacement factor.

2) Algorithm Development: The major steps involved in By using the resultant replacement score percentages, the
the algorithm are the generation of a population of solutions, replacement priority is classified into four classes based
evaluation of the objective function, determination of the upon the authors' experience. The first class with very high
fittest solutions, and application of genetic operators [lO]. priority contains equipment with R% equal or greater than
The next algorithm provides the summary of the developed 70%. The second class, having R% in range 60 to 70%, is
algorithm. considered high priority. Class 3 is medium priority,
containing all equipment within range 50 to 60%. Finally all
1- Insert weights, prices, and budget; equipment with R% less than 50 is not considered for
2- Set the generation counter, t=O; replacement. Practically, our data set demonstrated that 8
3- Initialize the control parameters; devices are very high priority replacement, 15 devices are
4- Create the population, PO); high priority replacement, 17 devices should be included for
5- While the stopping criteria are not met do medium priority replacement, and 20 devices reveal no need
a. Evaluate the fitness of the solutions; for replacement.
b. Select parents via a Roulette Wheel;
B. Genetic Algorithm Results
c. Perform crossover to produce an offspring;
QFD results show that 23 pieces of investigated medical
d. Mutate the offspring;
equipment attained top priorities; i.e. 38% of devices came
e. Reconstruct a new population;
at top ranking. These devices in the worst case; should be
6- end
replaced by the end of current fiscal year. Therefore, we
consider only the list of top prioritized 23 pieces of medical
3) Parameter Tuning: The calculation of the GA is
equipment as the input of our proposed GA.
affected by its parameter settings (populations, crossover
Because the GA involves random calculations, the fmal
and mutation rates). Different combinations of populations
solution may come out differently with different trials. So,
and iterations were tested as well as crossover and mutation
the algorithm is calculated 20 times to optimize the
rates to find out the optimum set of parameters. The research
parameters and stop the program. The algorithm has been
sets up the following combinations of populations and
coded in MATLAB and run on a 2.1-GHZ CPU, Intel core 2
iterations followed by combinations of crossover and
Duo with 1.96 G-RAM taking a runtime of about 20 minutes
mutation rates
for every combination of parameters.

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 As we have twenty solutions, we compare the results by The optimum list of medical equipment is obtained by
means of a set of descriptive statistics in terms of mean and adopting those optimum set of parameters with the
standard deviation calculated on the resultant objective developed algorithm assuming that the available budget is
functions to fmd out the optimum solutions. The first 30% less than estimated prices of medical equipment. The
implementation was to run different initial populations with resultant optimum solutions suggest that 21 possible devices
different iterations to optimize both of them. Table IV could be replaced among 23 top priority devices. Also, by
presents a sample of this analysis; moreover, Fig. 2 altering the initial populations twice, we got out the same
illustrates the relationship between possible optimum results.
solutions and the initial population. The results for the
optimum populations that give the maximum number of best IV. CONCLUSIONS
solutions is 600 populations with 500 iterations. Due to the importance of the replacement decision in
medical equipment management, the authors developed a
TABLE IV new framework including QFD and GA. The developed
SAMPLE RESULTS OF FIRST COMBINAnON FOR DIFFERENT
model proved its robustness since it can efficiently prioritize
VALUES OF POPULAnONS AND ITERAnONS
and optimize a given list of medical equipment correctly,
Population Iterations
separating the equipment that needs replacement from that
500 400 0.8354 0.033 does not need it, and also avoiding the purchasing of
600 500 0.8466 0.038 equipment that consumes a large amount of budget.
700 450 0.8448 0.032 The research gives attention to some factors that could
impact the replacement decision. Moreover, it presents a
8 new definition for the backup concept by comparing the low
utilization devices to all devices in the department. In
� iteration 400 addition, it highlights the vital role of funding in the
replacement decision. Accordingly, the model argues an
_ iteration 450 objective policy that could guide the clinical engineering
department in the replacement management. In the future we
+----,-----r---r-�--, ----&- iteration 500
o could customize the model, modifying the criteria and the
400 600 800 1000 1200 1400 1600 objective function to better represent the equipment
Initial populations characteristics.

Fig. 2 Optimization of initial populations with iterations REFERENCES

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Fig.3 Optimization of crossover probabilities with mutation probabilities

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