Petrillo 2016

International Journal of Information Technology & Decision Making
Vol. 15 (2016)
°c World Scienti¯c Publishing Company
DOI: 10.1142/S021962201640006X
An AHP-Topsis Integrated Model for Selecting the Most

Appropriate Tomography Equipment
by NANYANG TECHNOLOGICAL UNIVERSITY on 07/17/16. For personal use only.
Miguel Angel Ortiz Barrio

Universidad de la Costa, Department of Industrial Engineering
58th Street # 55 - 66 Barranquilla, Colombia
Int. J. Info. Tech. Dec. Mak. Downloaded from www.worldscientific.com
mortiz1@cuc.edu.co
Fabio de Felice
University of Cassino and Southern Lazio
Department of Civil and Mechanical Engineering
G. Di Biasio 43 Cassino, 03043, Italy
defelice@unicas.it
Kevin Parra Negrete*, Brandon Aleman Romero†

and Adriana Yaruro Arenas‡
Universidad de la Costa, Department of Industrial Engineering
58th Street # 55 - 66 Barranquilla, Colombia
*kparra7@cuc.edu.co
†baleman1@cuc.edu.co
‡
ayaruro1@cuc.edu.co
Antonella Petrillo§
University of Naples Parthenope, Department of Engineering
Isola C4 Centro Direzionale Napoli Napoli, 80143, Italy
antonella.petrillo@uniparthenope.it
Published 13 July 2016
Selecting a suitable Multi Criteria Decision-Making (MCDM) method is a crucial step in

selecting appropriate medical equipment. The aim of the research is to de¯ne the most ap-
propriate tomography equipment through the integration of the Analytic Hierarchy Process
(AHP) and Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS)
method. A hybrid model is presented. The AHP is used to de¯ne the weights of each criterion
and sub-criterion through qualitative comparisons. Then, TOPSIS is used to evaluate the
purchase options. This research provides decision makers with a scienti¯c and rigorous decision
support system useful in strategic and complex decision. A numerical example is also presented.
Keywords: Analytic hierarchy process (AHP); technique for order of preference by similarity to
ideal solution (TOPSIS); multi-criteria decision making (MCDM); tomography; medical
applications.
§ Corresponding author.
1
2 M. A. O. Barrios et al.
1. Introduction
Multi Criteria Decision-Making (MCDM) methods are a set of methods designed to
ensure that a synthesis of multiple sources of information is documented and directed
toward a stated goal which can help with the comparison of alternatives based on
decision matrices.1,2
MCDM has seen an incredible amount of use over the last several decades.
MCDM is frequently used to solve real-world problems with multiple, con°icting,
and incommensurate attributes.3,4 In particular, MCDM is successfully used in
many di®erent selection processes.5 The aim of the present paper is not to analyze in
detail the several common MCDM methods, but only to highlight the most wide-
spread methods. In order to identify those methods, a search was conducted for
common MCDM methods by title, abstract, and keywords, while utilizing the fol-
lowing databases: Elsevier, Springer, ScienceDirect, and IEEExplore.6 The following
MCDM methods were identi¯ed: Analytic Hierarchy Process (AHP),7 Analytic
Network Process (ANP),8 Technique for Order of Preference by Similarity to Ideal
Solution (TOPSIS),9 Elimination Et Choix Traduisant la REalite (ELECTRE),10
Vlse Kriterijumska Optimizacija Kompromisno Resenje, means Multicriteria Opti-
mization and Compromise Solution (VIKOR),11 and Preference Ranking Organi-
zation Method for Enrichment Evaluation (PROMETHEE).12 According to the
literature search conducted, it became apparent that the selection process can be
modeled as a MCDM problem. Selection problems can have various di®erent and
con°icting criteria for making a selection among predetermined decision alter-
natives.13 Some relevant applications about the selection problem in medical sector
are: the use of AHP to select medical equipment such as pacemakers and im-
plantable de¯brillators proposed by Balestra et al.14 or the selection of an intensive
care ventilators analyzed by Chatburn and Primiano15 or the selection of medical
products and materials in Korea as developed by Cho and Kim.16 Although di®erent
MCDM exist, all of them follow a number of common steps: problem de¯nition,
identi¯cation of alternatives, criteria selection, preparation of the decision matrix,
and assigning weights to the criteria. The newest trend with respect to MCDM
method use is to combine two or more methods to make up for shortcomings in a
single method.17 For instance Arikan and Kucukce18 applied AHP and PRO-
METHEE II to minimize economic losses from the inadequate assessment of sup-
pliers in medical ¯eld. While, Santos and Garcia19 used AHP and ELECTRE to
acquire hospital medical equipment. In the present paper our aim is to present an
integrated MCDM approach based on the AHP and TOPSIS method applied within
the medical ¯eld. In fact, in the literature several applications exist in which AHP
and TOPSIS are frequently used to solve real-world problems.20 But literature does
not provide studies that directly focus on tomography equipment selection. Thus,
the novelty of this research is to develop a methodological tool, based on AHP-
TOPSIS methods, to the ¯eld of medicine which represents a strategic ¯eld for the
development of the human community. Through the proposed tool is possible to
An AHP-Topsis Integrated Model 3
provide a theoretical justi¯cation for decision support in selecting tomography

equipment under conditions of uncertainty.
AHP and TOPSIS are chosen because AHP is one of the most popular methods of
MCDM and has many advantages.21 AHP is scalable, and it can easily adjust in size
to accommodate decision-making problems due to its hierarchical structure. While
TOPSIS is \an approach to identify an alternative which is closest to the ideal so-
lution and farthest from the negative ideal solution in a multi-dimensional computing
space",22 it has numerous advantages. It is a simple process. It is easy to use and
program. TOPSIS and AHP have become a widely accepted integrated multi-criteria
decision analysis method for the following reasons: the ability to provide complete
ranking results; the suitability to be combined with stochastic analysis; the use of
weights and objective data to calculate the relative distances; the smoothing of
tradeo®s by dealing with nonlinear relationships and the ease at which it can be
converted into a programmable procedure. The primary goal of our research is to
provide a useful decision-making tool to develop a model to consider the decision
makers' (DMs') preferential system and judgments. As stated by Tavana and
Hatami-Marbini23 the selection of an MCDM framework or method should be done
carefully according to the nature of the problem, types of choices, measurement
scales, dependency among the attributes, type of uncertainty, expectations of the
DMs, and quantity and quality of the available data and judgments. For the above
reasons in the present paper an AHP/TOPSIS integrated model is presented. Ad-
ditionally, the AHP is able to reduce the complexity of decision making in a reliable
way, support both a single person or a group decision and usually does not require
the presence of a specialist.24 While, the main objective of TOPSIS is to provide
ranking of alternatives that ¯nd the optimal alternative which should be nearest to
the positive ideal solution and furthest from the negative ideal solution.25 As
highlighted above, in addition to the single MCDM approach, there are some inte-
grated approaches studied in alternative selection problems in the literature. How-
ever, there is no evidence of any applications in the medical ¯eld. An example of an
application in the literature is given by Zaidan et al.,26 they evaluated and selected a
health informatics open-source EMR software package-based MCDM using inte-
grated AHP–TOPSIS in group context of the available options of open-source EMR
software. Other applications in di®erent and various ¯elds include: Misra and Ray27
proposed an integrated AHP–TOPSIS model for software selection and a multi-
criteria decision-making evaluation was de¯ned. The model used AHP and TOPSIS.
Nwokoagbara et al.28 identi¯ed the best micro algae strain for viable biodiesel pro-
duction by using an AHP and TOPIS method. Furthermore, some authors propose a
Fuzzy AHP-TOPSIS method such as Ref. 29. They proposed a Fuzzy Analytic
Hierarchy Process (Fuzzy AHP) and fuzzy technique in order of preference by
similarity to the ideal solution (fuzzy TOPSIS) to successfully determine the priority
weights of multiple criteria and selects the ¯ttest suppliers by taking the vagueness
and imprecision of human assessments into consideration. Beikkhakhian et al.,30
propose the application of a model in evaluating agile supplier selection criteria and
ranking suppliers using fuzzy TOPSIS–AHP methods. Taylan et al.31 applied Fuzzy
AHP to create appropriate weights for ¯ve main criteria, i.e., time, cost, quality,
safety, and environmental sustainability and then use Fuzzy Technique for Order of
Preference by Similarity to Ideal Solution (Fuzzy TOPSIS) to rank the 30 con-
struction projects on the basis of the opinions of seven DM in various sectors in Saudi
Arabia. Ren and Sovacool32 propose an integrated method based on AHP–TOPSIS
has been developed to rank the low-carbon energy systems from most to least im-
portant, with major implications for Chinese DMs and stakeholders. De¯nitively,
there are applications in several sub¯elds and activities, but healthcare applications
are not addressed. Thus, the methodological approach presented in this paper also
tries to cover this gap. In detail, in the proposed methodological approach to select
the most appropriate tomography equipment is identi¯ed through a hybrid model

based on the integration of AHP and TOPSIS method. AHP is used to de¯ne the
weights of each criterion and sub-criterion through qualitative information that was
collected from di®erent responders through pairwise comparisons. Then, TOPSIS
was used to evaluate the purchase options. As an outcome, this paper provides DMs
with a scienti¯c and rigorous decision support system useful in making strategic and
complex decisions. A numerical example is also presented.
The remainder of this paper is organized as follows: in Sec. 2 methods are pre-
sented; Sec. 3 analyzes the mathematical model; in Sec. 4 survey design is presented;
Sec. 5 analyzes the result, in Sec. 6, discussion on results is developed. Finally, Sec. 7
presents concluding remarks.
2. Hierarchy De¯nition
The project was discussed with the maintenance boss and the ethics committee of a
clinic. This research was carried out through interviews with all the departments
involved with tomography equipment. In Fig. 1 is shown the tomography equipment,
understudy.
Fig. 1. A typical tomography equipment.

The research did not involve patient participation. The participating depart-
ments, as a decision-making team, identi¯ed a total of three purchase options that
satisfy the requirements of the clinic considering patient pro¯les and internal process
analysis. For the hierarchy design, ¯ve criteria, 17 sub-criteria, and a goal were
identi¯ed in order to take into account the needs of this organization and health care
sector.33–35
The AHP model was checked and discussed during multiple meetings in order
to verify that it was understandable and clear. The AHP model is presented in
Fig. 2.
The aim of the AHP model is to ensure both an appropriate investment and the
protection of patients. In detail, ¯ve criteria were identi¯ed: PERFORMANCE (C1),
PATIENT SAFETY (C2), TECHNOLOGY LEVEL (C3), FINANCIAL ASPECTS

(C4), and TECHNICAL ASPECTS (C5). First, PERFORMANCE is described as
the relation between the actual standard of the tomography equipment and its
theoretical or ideal standard. Second, PATIENT SAFETY is considered as the
prevention of harm to patients and how the tomography equipment could cause
harm36; TECHNOLOGY LEVEL is de¯ned as a measure of technology capacities
of the tomography equipment. FINANCIAL ASPECTS involve the investment
related to the purchase and maintenance of the equipment. Finally, TECHNICAL
Fig. 2. Hierarchy for selection of the best purchase option at the moment of acquiring tomography
equipment in clinics.
ASPECTS cover all the aspects in reference to the physical structure of the medical
equipment.
Below is a description for each sub-criteria. In particular, the PERFORMANCE
criterion (C1) is made up of ¯ve sub-criteria: SPATIAL RESOLUTION (S1), RUN
SPEED (S2), PROCESSING SOFTWARE (S3), IMAGE RESOLUTION (S4), and
NUMBER OF CUTS (S5). First, SPATIAL RESOLUTION is described as the
ability of the tomography equipment to discriminate between two adjacent high-
contrast objects. RUN SPEED is de¯ned as the velocity of the equipment at the
moment of scanning; while PROCESSING SOFTWARE deals with the software
that is used to manipulate images to perform operations. IMAGE RESOLUTION is

considered as the sharpness of the image generated by the tomography equipment.
Finally, NUMBER OF CUTS criterion is related to the amount of body/head sec-

tions obtained from the equipment at the time of scanning.
The PATIENT SAFETY criterion (C2) is composed of three sub-criteria: RA-
DIATION DOSE (S6), EASE OF PATIENT MONITORING (S7), and CON-
TRAST CONTROL (S8). RADIATION DOSE is related to the tissue-weighted sum
of the equivalent doses generated during scanning in all speci¯ed tissues and organs
of the body which represents a probability of cancer induction and genetic e®ects on
a patient's health. EASE OF PATIENT MONITORING is described as the possi-
bility of assessing the patient's health continuously while scanning. CONTRAST
CONTROL is de¯ned as a control on dose contrast medium given to a patient.
The next criterion (TECHNOLOGY LEVEL (C3)) is broken down as three sub-
criteria: APPLICATION SOFTWARE (S9), INTEROPERATIVITY (S10), and
AUTOMATIC HANDLING (S11). The ¯rst sub-criterion is related to the presence
of software that facilitates the analysis and visualization of tomography data by
radiologists. INTEROPERATIVITY is described as the extent to which medical
information systems and tomography equipment can exchange data and then in-
terpret the shared data. While the AUTOMATIC HANDLING sub-criterion refers
to the tomography equipment that has task automation in its operation.
The FINANCIAL ASPECTS (C4) criterion is also broken down into three sub-
criteria: PRICE (S12), MAINTENANCE COST (S13), and EASE OF PAYMENT
(S14). PRICE is the amount of money (US) that is paid to purchase the tomography
equipment. MAINTENANCE COST is described as the costs associated with
keeping the tomography equipment in good condition by regularly checking it and
repairing it when necessary. EASE OF PAYMENT is about the advance payment
percentage that the manufacturer requires in order to deliver the tomography
equipment to the clinic.
The TECHNICAL ASPECTS (C5) are evaluated against three sub-criteria:
INFORMATION STORING (S15), ENERGY CONSUMPTION (S16), and EASE
OF MAINTENANCE (S17). First, INFORMATION STORING involves the
amount of data that the tomography equipment is capable of storing. ENERGY
CONSUMPTION is de¯ned as the amount of energy that the equipment uses
in order to guarantee an optimal performance during operation. Finally, EASE OF
MAINTENANCE refers to how feasible is to keep the tomography equipment in

good condition, according to the maintenance requirements and the availability of
technical support and supplies.
3. Description of Proposed Methodology

The proposed methodology requires one to calculate criteria and sub-criteria weights
with respect to the goal in order to determine how each of them contributes to this
particular decision. As a complementary outcome, di®erences between the responses
of the user departments are explored through a correlation analysis. Then, the
TOPSIS technique is used to evaluate the purchase options with basis of quantitative
information through which criteria and sub-criteria are measured. As a ¯nal point,
the purchase option with the highest closeness coe±cient is chosen as the best al-
ternative for the clinical needs. Figure 3 shows the framework of the proposed
methodology.
After forming the decision hierarchy, criteria and sub-criteria weights are calcu-
lated using the AHP. Technically, by using the AHP one determines the relative
Fig. 3. Proposed methodology for the selection of the most appropriate purchase for tomography
equipment in a clinic.
priority (w i Þ of the ith criterion by exploiting a multilevel hierarchical structure of

decision-making problems.
The steps of AHP algorithm are described as follows:
. Make pairwise comparison matrices for both the criteria and sub-criteria. In this
study, a three point scale has been used as previous studies37–39 because it has been
demonstrated that most responders do not use more than three judgments (equal,
more much more) and lay users reported puzzled at the moment of using a more
complex scale.40–43
. Determine the relative normalized weight ðW j Þ of each criterion/sub-criterion by
normalizing the geometric mean of the rows in the comparison matrix:

hY N i1=N
GM j ¼ a
j¼1 ij
; ð3:1Þ
,
X
N
W j ¼ GM j GM j : ð3:2Þ
j¼1
. Calculate matrix A3 and A4 as follows:
A3 ¼ A1 A2; ð3:3Þ
A3
A4 ¼ : ð3:4Þ
A2
where

A2 ¼ W 1 ; W 2 ; . . . ; W j T ð3:5Þ
. Determine the maximum eigenvalue which is the mean of matrix A4.
. Calculate the consistency index (CI).
. Calculate the consistency ratio (CR).
4. Survey Design
The survey was carried out to allow each participant to determine the relative
importance of each criterion with respect to the rest of the criteria; and for each sub-
criterion with respect to all other sub-criteria. The survey design is illustrated in
Fig. 4.
For each pairwise comparison it was asked: In the selection of tomography
equipment, according to your expertise, how relevant is RADIATION DOSE with
respect to EASE OF PATIENT MONITORING ? Participants responded using the
three-level scale previously mentioned. This process was then repeated, creating
similar surveys to determine the relative importance of each criterion and sub-cri-
terion. This design was taken to reduce confusion while ¯lling it out and to eliminate
intransitive judgments.
Fig. 4. Survey design (taken from Ref. 41).

4.1. Decision-making team

The expert team was formed by:
. One Electronic engineer, the head of the Maintenance Department, with more
than seven years of experience in the clinic.
. Three Radiologists, with more than 10 years of experience in contact with
tomography equipment.
. One Administrative and Financial Management personnel with signi¯cant expe-
rience in leading these types of companies.
. One Industrial engineer from the University with a master in integrated logistics
and with extensive knowledge and experience in the design of decision-making
models in healthcare systems.
The Radiology Department was included in the decision-making team because it

is in charge of using tomography equipment to perform Computer Tomography (CT)
scans that can help a physician diagnose disease, trauma, or abnormality; plan and
guide interventional procedures and monitor the e®ectiveness of therapies applied on
patients. The radiologists who work in this department have valuable experience
that can lead to the identi¯cation of important operational aspects to take into
account at the moment of purchasing this type of equipment.
The Maintenance Department has been also added as a participant of this team.
This department keeps records about the most frequent failures that could appear in
tomography equipment. Furthermore, speci¯c conditions of this equipment could limit
the e®ectiveness of this department in terms of time and cost. The knowledge and
experience acquired by this department is meaningful in this decision-making process.
Finally, The Administrative and Financial Direction as a member of this group, has
been attached as well, because it contacts providers to purchase necessary medical
equipment for the correct functioning of the clinic. For this, the department explores
the most convenient payment, delivery, and warranty conditions before purchasing;
reason by which, its considerations must be taken into account to complement the
decision-making model. It should be noted that these departments have meetings to
discuss these decisions with basis on the investment plan of the clinic.
These participants made the comparisons with the support of the designed sur-
vey. Each respondent was required to answer for the department in which they were
working. It is also worth noting that none of the participants from the clinic an
author of this paper.
4.2. Feedback of decision-making team

In the ¯nal step, to understand di®erent reasons supporting the ranking of purchase
options and the relative importance of each criterion and sub-criterion, the hierarchy
was presented and discussed with the decision-making team and managers of the clinic.
During the pairwise comparisons process, some loss of interest or distractions may
appear, which will generate inconsistencies in the decision-making process.44 If this
occurs, the comparisons must be made again by the participants because incon-
sistencies reduce the level of reliability in the decision making. Although, some in-
consistency could be present, it is necessary to calculate it in order not to overpass
the limit value. For this, respondent's consistency is determined by consistency index
(CI). This indicator is divided by random index (RI) whose values depend on the
matrix size. The resulting division is named as a consistency ratio (CR) which should
not overpass 0.1 to consider judgments as appropriate.45–49
4.3. Criterion importance

Through the use of the AHP it was possible to establish the contribution of each
criterion with respect to the goal of the decision-making model. These contributions
are the result of participants' agreement in the aim of obtaining a decision that
satis¯es the di®erent departments that use tomography equipment. Under the AHP
each criterion was assessed taking into account how relevant it is with respect to
others at the moment of acquiring tomography equipment in a clinic. Finally, these
criteria are ranked according to the scores that were obtained.
4.4. Correlation coe±cient between departments of the clinic

Another purpose of this study is to identify possible di®erences between the
departments that are linked through the use of tomography equipment. This is an
important input at the time of designing tomography equipment. Although some
methods have been studied to measure unanimously,41,50 one of the most used
methods is correlation analysis. In this analysis, a linear correlation coe±cient is
calculated proportioning how well matched the department preferences are. This is
done by Eq (4.1):
xy
r¼ ; ð4:1Þ
x y
where:
xy ¼ Covariance between responses of user department \x" and user department
\y",
x ¼ Standard deviation of responses from the user department \x",

y ¼ Standard deviation of responses from the user department \y".
The linear correlation coe±cient re°ects if two sets of preferences are ranked in
the same order. \r" values are between 1 and þ1. Large positive values (close to 1)
of this coe±cient, re°ect a high similarity between the preferences of the two
departments in the study. If r ¼ 1, the preferences are identical. However, r values
that are far 1 (including negative) show dissimilarities between the preferences.
If r ¼ 1, perceptions of the two departments in the study are completely opposite.
5. TOPSIS Approach
This technique is based upon the concept that the chosen candidate (alternative)
should be the shortest distance from the positive ideal solution and the farthest from
the negative ideal solution.51
The steps of TOPSIS are given as below:
. Create an assessment matrix by considering \y" purchase options and \z" sub-
criteria with the intersection of each purchase option and sub-criteria given as X ij ;
then the resulting matrix is ðX ij Þ yxz .
2 3
S S S
P1 6 x 1 x 2 x z 7
P2 6
11 12 1z 7
6 x 21 x 22 x 2z 7
6 7
6 7
D ¼ P3 6 7 ð5:1Þ
.. 66 x 31 x 32 x 3z 7
. 6. 7
.. .. 7
4 .. . . 5
Py
x y1 x y2 x yz
. Normalize the judgment matrix (X ij Þ yxz to transform it into R ¼ ðn ij Þ yxz using the
following formula:
x ij
n ij ¼ qffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffi
Py ffi: ð5:2Þ
x 2
i¼1 ij
. Calculate the weighted normalized decision matrix:

D ¼ ðd ij Þ yxz ¼ ðw j n ij Þ; i ¼ 1; 2; . . . ; y
2 3
d 11 d 12 . . . d 1j . . . d 1z
6 . .. .. .. .. .. 7
6 .. 7
6 . . . . . 7
6 d ij . . . d iz 7
D ¼ 6 d i1 d i2 7 ð5:3Þ
6 7
6 .. .. . .. 7
4 . . . . . .. . . . . 5
d y1 d y2 . . . d yj . . . d yz
. Determine the positive and negative ideal solutions

Aþ ¼ fð maxd ij jj 2 J Þð mind ij jj 2 J 0 Þ for i ¼ 1; 2; . . . ; yg
i i
¼ fd 1 ; d 2 ; . . . ; d j ; . . . ; d zþ g;
þ þ þ
ð5:4Þ
0
A ¼ fð mind ij jj 2 J Þð maxd ij jj 2 J Þ for i ¼ 1; 2; . . . ; yg
i i
¼ fd 1 ; d 2 ; . . . ; d j ; . . . ; d z g;

ð5:5Þ
where:
J ¼ fj ¼ 1; 2; . . . ; zjj associated with the benefit sub criteriag;
J 0 ¼ fj ¼ 1; 2; . . . ; zjj associated with the cost sub criteriag:

. Calculate the positive and negative ideal separation

Positive ideal separation
vffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffi
uX
u z
Si ¼ t
þ
ðd ij d jþ Þ2 ; i ¼ 1; 2; . . . ; y: ð5:6Þ
j¼1
Negative ideal separation

vffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffi
uX
u z
Si ¼ t

ðd ij d j Þ2 ; i ¼ 1; 2; . . . ; y: ð5:7Þ
j¼1
Determine the relative closeness coe±cient to the Ideal Solution:

S iþ
CC i ¼ ; 0 < CC i < 1; i ¼ 1; 2; . . . ; y; ð5:8Þ
ðS iþ þ S i Þ
CC i ¼ 1 if A i ¼ Aþ ;
CC i ¼ 0 if A i ¼ A :
Finally, the rank of purchase options is decided according to a descending order

of CC i .
5.1. Description of TOPSIS matrix

In this study, TOPSIS is used to evaluate the di®erent purchase options when
selecting tomography equipment. Initially, a decision matrix for three purchase
options with respect to 17 sub-criteria is developed. A variable has been de¯ned for
each sub-criterion. First, SPATIAL RESOLUTION (S1) is measured according to a
3-level scale where (0) represents low resolution (1) medium resolution, and (2) high
resolution. RUN VELOCITY (S2) is de¯ned in ips (inches per second); NUMBER
OF CUTS (S3) is measured according to the number of slices that tomography
equipment can realize. On the other hand, IMAGE QUALITY (S4) is dimensioned in
a 3-level scale where (0) represents low quality (1) medium quality, and (2) high
quality. PROCESSING SOFTWARE (S5) is de¯ned according to the existence of
software that permits data management. Thus, it is quali¯ed with (0) if it does not
have processing software and (1) if it has it. RADIATION DOSE (S6) is measured in
MHU (Mega heat units). EASE OF PATIENT MONITORING (S7) is dimensioned
in s/rotation. CONTRAST CONTROL (S8) is de¯ned in mm. APPLICATION
SOFTWARE (S9) is measured taking into account the presence of this software.
Therefore, it is judged with (0) if tomography equipment does not have application
software and (1) if it has it. INTEROPERATIVITY (S10) is evaluated according to
the capability that tomography equipment has to be connected and exchange data
with an information system. In this way, if the equipment does not have connections
with \IS" is quali¯ed with (0); otherwise with (1). AUTOMATIC HANDLING (S11)
is assessed with (0) if the equipment cannot be managed automatically; otherwise
with (1). By the other side PRICE (S12) and MAINTENANCE COST (S13) are
measured in USD. EASE OF PAYMENT (S14) is de¯ned in terms of advance
payment percentage (%). INFORMATION STORING (S15) is measured in GB
(Gigabytes); ENERGY CONSUMPTION (S16) is de¯ned in KW (kilowatts) and
¯nally, EASE OF MAINTENANCE (S17) is measured in terms of year guarantee. It
is good to remark that all this information was collected from the speci¯cations
established in the webpage of the manufacturers.
In the next step, by using Eq. (5.2), the normalized decision matrix is calculated.
After this, a weighted normalized matrix is determined using Eq. (5.3). Then, by
using Eqs. (5.4) and (5.5), respectively, positive and negative ideal solutions are set.
Next, it is necessary to determine the distance of the purchase options from the
positive ideal solution and the negative ideal solution. These distances are calculated
by employing Eqs. (5.6) and (5.7) correspondingly. Finally, the closeness coe±cients
of the purchase options are de¯ned using Eq. (5.8).
6. Results and Discussion

In this way, researchers, practitioners, and healthcare DMs can select more precise
methodologies at the moment of selecting the best purchase option for tomography
equipment in a clinic. In addition to this, di®erences between tomography users have
been explored in order to determine trends, consensus, and perceptions. The pairwise
comparisons are computed using Superdecisions ° c software and a limit matrix is
calculated. The limit matrix re°ects the contributions of decision criteria with re-
spect to the goal, including the sub-criteria weights in their corresponding criterion
and decision-making goal. These scores have been enlisted in Table 1 and graphed in
Figs. 5 and 6 as it is shown below.
According to the AHP results, IMAGE RESOLUTION with a 0.31012 priority
got the highest score and is the most relevant sub-criterion in PERFORMANCE
cluster. The second most important sub-criterion in this cluster was NUMBER OF
CUTS with 0.21145. In the PATIENT SAFETY cluster, the most signi¯cant
Table 1. Local and global contributions of sub-criteria and global weights of

criteria with AHP.
Cluster Global weights (GW) Local weights (LW)
Performance (RW ¼ 0:16632)

Spatial resolution (S1) 0.03895 0.14385
Run Speed (S2) 0.04192 0.18857
Processing software (S3) 0.03909 0.14601
Image resolution (S4) 0.04988 0.31012
Number of cuts (S5) 0.04343 0.21145
Patient Safety (RW ¼ 0.36394)
Radiation dose (S6) 0.15669 0.38483

Ease of patient monitoring (S7) 0.0645 0.13294
Contrast control (S8) 0.13098 0.3843
Technology level (RW ¼ 0.15177)

Application software (S9) 0.05823 0.55669
Interoperativity (S10) 0.03966 0.19807
Automatic Handling (S11) 0.04211 0.24524
Financial aspects (RW ¼ 0.1691)
Price (S12) 0.04691 0.246
Maintenance cost (S13) 0.04699 0.25435
Ease of payment (S14) 0.05549 0.49965
Technical aspects (RW ¼ 0.14887)
Information storing (S15) 0.04181 0.25384
Energy consumption (S16) 0.0398 0.2125
Ease of maintenance (S17) 0.06394 0.53367
sub-criterion was RADIATION DOSE with 0.38483. However, with a similar score
(0.3843), CONTRAST CONTROL got the second place with respect to the de¯ni-
tion of this criterion. In the TECHNOLOGY cluster APPLICATION SOFTWARE
represented more than 50% of the criterion importance with 0.55669 which shows the
high relevance of these kinds of software in tomography operation. On the other
hand, in FINANCIAL ASPECTS cluster, EASE OF PAYMENT was chosen as
the most signi¯cant sub-criterion with almost 50% of the total criterion relevance
Fig. 5. Sub-criteria weights in a decision-making model designed for the purchase of tomography
equipment.
Fig. 6. Criteria contributions in a decision-making model designed for the purchase of tomography
equipment.
(Score: 0.49965). Finally, in TECHNICAL ASPECTS, EASE OF MAINTENANCE

represented more the 50% of the total criterion weight (0.53367).
Figure 5 shows the sub-criteria weights to select the best purchase option for
tomography equipment in a clinic.
It is worth noting that the three most important sub-criteria are concentrated in
PATIENT SAFETY: RADIATION DOSE (0.15669), CONTRAST CONTROL
(0.13098), and EASE OF PATIENT MONITORING (0.0645). This serves as evi-
dence that this clinic is a patient-centered institution and describes the importance of
protecting patient's health from radiation and indirectly from cancer.
The previous argument is also validated upon seeing Fig. 6 where it is noted that
PATIENT SAFETY (C2) with a global score of 0.36394 is the criterion that the
clinic has to consider as most relevant at the moment of purchasing tomography
equipment.
Table 1 and Figs. 5 and 6 present the global scores of each criterion and sub-
criterion; in addition to the local scores of the sub-criteria in their respective criterion.
The rest of the relevance is almost equally distributed among other criteria.
All matrices achieved acceptable consistency ratios (CR 0:1Þ; a reason for which
the decision-making model has a high level of reliability. The consistency ratios for
AHP matrixes are reported in Table 2. All matrixes obtained the required CR value
(CR 0:1Þ.
Table 2. Consistency ratios for AHP matrixes.
Matrix Consistency ratio (CR)
Criteria 0.01860
Performance 0.05623
Patient safety 0.09989
Technology level 0.00094
Financial aspects 0.00107
Technical aspects 0.00198
Table 3. Correlation coe±cients between departments' preferences with respect to PERFOR-

MANCE criterion.
PERFORMANCE CRITERION Radiology Administration and Finances Maintenance
Radiology 1 0.09 0.1339

Administration and Finances 1 0.1239
Maintenance 1
Speci¯cally, most of the 3 3 matrixes registered minimum ratios showing that

misperception and loss of interest are smaller in the decision-making group with the
presence of few elements in a decision cluster.

Tables 3 through 8 provide the correlation coe±cients between the responses of
tomography users (Radiology, Maintenance, and Administration and Finances) for

criteria. These coe±cients have been calculated to determine if these responses were
homogeneous with respect to a speci¯c criterion. The shaded cells in the tables mean
that the correlation coe±cient between the responses of the departments has been
de¯ned in another cell that links the same departments, e.g., \Radiology-Main-
tenance" and \Maintenance-Radiology". In detail, Table 3 presents r values between
department's responses with respect to PERFORMANCE criterion. It can be noted
that there are strong di®erences between the responses of participant departments.
None of the r values was equal or greater than 0.333. Tables 4 and 5 evidence the
same ¯nding as Table 3, i.e., signi¯cant di®erences between department's perception
as for TECHNOLOGY LEVEL and GOAL, respectively. While in PATIENT
SAFETY criterion (Table 6), both Radiology and Maintenance have similarities in
their perceptions (CC ¼ 0:6584). In Table 7, correlation between perceptions of
Radiology and Administration Finances achieved a medium-high score (CC
¼ 0:6735). In the same way, in Table 8, these departments evidenced many simi-
larities in their judgments upon considering FINANCIAL ASPECTS (CC ¼ 0:6430).
Table 4. Correlation coe±cients between departments' preferences with respect to TECHNOLOGY

LEVEL criterion.
TECHNOLOGY LEVEL CRITERION Radiology Administration and Finances Maintenance
Radiology 1 Undetermined 0.2453

Administration and Finances 1 Undetermined
Maintenance 1
Table 5. Correlation coe±cients between departments' preferences with respect to criterion

importance.
GOAL CRITERIA Radiology Administration and Finances Maintenance
Radiology 1 0.3203 0.1844

Maintenance 1
Table 6. Correlation coe±cients between departments' preferences with respect to

PATIENT SAFETY criterion.
PATIENT SAFETY Radiology Administration and Finances Maintenance
Radiology 1 0.2300 0.6584

Maintenance 1

TECHNICAL ASPECTS criterion.
TECHNICAL ASPECTS Radiology Administration and Finances Maintenance

Radiology 1 0.6735 0.1899

Maintenance 1

FINANCIAL ASPECTS criterion.
FINANCIAL ASPECTS Radiology Administration and Finances Maintenance
Radiology 1 0.6430 0.5362

Maintenance 1
Table 9 presents the TOPSIS decision matrix where purchase options with re-
spect to criteria are shown. Sub-criteria values for each purchase option were entered
according to the description in Sec. 5.1. Positive and negative ideal solutions for each
sub-criterion have been de¯ned. The sub-criteria weights calculated through AHP
are also presented in this table as a link between the two MCDM methods. Table 10
denotes the normalized TOPSIS decision matrix according to Eq. (5.2) Table 11
shows a weighted, normalized decision matrix for TOPSIS. Closeness coe±cients and
a rank of purchase options from TOPSIS are shown in Fig. 7. On the other hand,
Fig. 8 and Table 12 describe the separation of each purchase option from the positive
ideal solution. Speci¯cally, Table 12 indicates the contribution of each sub-criterion
to the total separation from positive ideal solution. Meanwhile, Fig. 9 and Table 13
present the separation from the ideal negative solution. In detail, Table 13 shows the
speci¯c contribution of each sub-criterion to the total separation from negative ideal.
In this way, it can be noted which sub-criteria contribute to each measure.
Figure 7 shows that purchase option \P2" that corresponds to LIGHTSPEED 16
CUTS of the manufacturer \GENERAL ELECTRIC" obtained the ¯rst place of the
ranking with 0.6582 and purchase option \P3" got the lowest score with 0.3872. The
comparative view of closeness coe±cient of purchase options is seen in the ¯gure
Table 9. TOPSIS decision matrix.
S1 S2 S3 S4 S5 S6 S7 S8 S9 S10 S11 S12 S13 S14 S15 S16 S17 18
P1 2 6 1 2 16 8 0.5 5 1 1 1 195.000 1024.34 1 292 60 1

P2 2 6 1 2 16 6.3 0.4 5 1 1 1 280.000 1024.34 1 291 53.2 1
P3 2 6 1 2 16 7.5 0.5 4 1 1 1 150.000 1024.34 1 144 60 1
Aþ 2 6 1 2 16 6.3 0.4 5 1 1 1 150.000 1024.34 1 292 53.2 1
A 2 6 1 2 16 8 0.5 4 1 1 1 280.000 1024.34 1 144 60 1
W 0.03895 0.04192 0.03909 0.04998 0.04343 0.15669 0.0645 0.13098 0.05823 0.03966 0.04211 0.04641 0.04699 0.05549 0.04181 0.0398 0.06394
M. A. O. Barrios et al.
Table 10. Normalized TOPSIS decision matrix for purchase options with respect to criteria.
S1 S2 S3 S4 S5 S6 S7 S8 S9 S10 S11 S12 S13 S14 S15 S16 S17
P1 0.577 0.577 0.577 0.577 0.577 0.633 0.615 0.615 0.577 0.577 0.577 0.523 0.577 0.577 0.669 0.599 0.577
P2 0.577 0.577 0.577 0.577 0.577 0.498 0.492 0.615 0.577 0.577 0.577 0.751 0.577 0.577 0.666 0.531 0.577
P3 0.577 0.577 0.577 0.577 0.577 0.593 0.615 0.492 0.577 0.577 0.577 0.402 0.577 0.577 0.330 0.599 0.577
Aþ 0.577 0.577 0.577 0.577 0.577 0.498 0.492 0.615 0.577 0.577 0.577 0.402 0.577 0.577 0.669 0.531 0.577
A− 0.577 0.577 0.577 0.577 0.577 0.633 0.615 0.492 0.577 0.577 0.577 0.751 0.577 0.577 0.330 0.599 0.577
W 0.03895 0.04192 0.03909 0.04998 0.04343 0.15669 0.0645 0.13098 0.05823 0.03966 0.04211 0.04641 0.04699 0.05549 0.04181 0.0398 0.06394
Table 11. Weighted and Normalized TOPSIS decision matrix for purchase options with respect to criteria.
S1 S2 S3 S4 S5 S6 S7 S8 S9 S10 S11 S12 S13 S14 S15 S16 S17
P1 0.022 0.024 0.023 0.029 0.025 0.099 0.040 0.081 0.034 0.023 0.024 0.024 0.027 0.032 0.028 0.024 0.037
P2 0.022 0.024 0.023 0.029 0.025 0.078 0.032 0.081 0.034 0.023 0.024 0.035 0.027 0.032 0.028 0.021 0.037
P3 0.022 0.024 0.023 0.029 0.025 0.093 0.040 0.064 0.034 0.023 0.024 0.019 0.027 0.032 0.014 0.024 0.037
Aþ 0.022 0.024 0.023 0.029 0.025 0.078 0.032 0.081 0.034 0.023 0.024 0.019 0.027 0.032 0.028 0.021 0.037
A 0.022 0.024 0.023 0.029 0.025 0.099 0.040 0.064 0.034 0.023 0.024 0.035 0.027 0.032 0.014 0.024 0.037
Fig. 7. Closeness coe±cient for purchase options of tomography equipment in a clinic.

Fig. 8. Separation of tomography purchase options from positive ideal solution.
mentioned above. An explanation of this can be observed in Figs. 3 and 4 where

separations from positive and negative ideal solutions are shown.
Figure 8 and Table 12 show that sub-criterion S12 is the only element that is
apart from the positive ideal solution for purchase option P2. However, P1 presents
S12, S6, and S7 sub-criteria as far from this solution. Besides, P3 evidences the worst
scenario with S15, S8, S7, and S6 separated from the ideal situation. These separa-
tions show how each tomography purchase option performs according to an ideal
result. If the possible solution has a considerable amount of sub-criteria out of this
parameter, it will not be chosen as the most appropriate.
Figure 9 and Table 13 show that sub-criteria S15, S16, S6, and S7 are apart from
negative ideal solution for purchase option P2. Nonetheless, P1 present S16, S12, and
S8 as sub-criteria that do not represent this solution. Moreover, P3 shows the worst
scenario with S12 and S6 separated from the ideal situation. These separations show
how each tomography purchase option performs according to a negative result. If the
20
Table 12. Separation from positive solution.
S1 S2 S3 S4 S5 S6 S7 S8 S9 S10 S11 S12 S13 S14 S15 S16 S17 Si þ

M. A. O. Barrios et al.
P1 0.0000 0.0000 0.0000 0.0000 0.0000 0.0004 0.0001 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0234
P2 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0003 0.0000 0.0000 0.0000 0.0000 0.0000 0.0162
P3 0.0000 0.0000 0.0000 0.0000 0.0000 0.0002 0.0001 0.0003 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0002 0.0000 0.0000 0.0274
Table 13. Separation from negative solution.
S1 S2 S3 S4 S5 S6 S7 S8 S9 S10 S11 S12 S13 S14 S15 S16 S17 Si
P1 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0003 0.0000 0.0000 0.0000 0.0001 0.0000 0.0000 0.0002 0.0000 0.0000 0.0239
P2 0.0000 0.0000 0.0000 0.0000 0.0000 0.0004 0.0001 0.0003 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0002 0.0000 0.0000 0.0312
P3 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0003 0.0000 0.0000 0.0000 0.0000 0.0000 0.0173
Fig. 9. Separation of tomography purchase options from negative ideal solution.
possible solution has a few sub-criteria out of this constraint, it will not be chosen as
the most suitable. In conclusion, upon analyzing both scenarios P2 is considered
as the best because the solution adjusts to the positive ideal solution and separates
from the negative solution.
7. Conclusions
In recent years, because of the ease of use due to advancing technologies, combining
di®erent methods has become commonplace within multi criteria decision analysis.
The combination of multiple methods addresses de¯ciencies that may be seen in
certain methods. This paper utilized two of the more common methods of MCDM to
allow practitioners to choose a method for solving a speci¯c problem. The identi¯-
cation of the most important criteria at the moment of purchasing tomography
equipment is a fundamental part of operational performance, patient safety and
¯nancial management of a clinic. The hybrid method AHP–TOPSIS described in this
paper not only allowed for the identi¯cation of the criteria, but was useful to select
the best purchase option using quantitative and qualitative information which cor-
responded to each option. Additionally, the AHP–TOPSIS method provided an
understandable framework for the decision-making process which is really important
in the healthcare sector where DMs need to explain their selections. Speci¯cally,
TOPSIS involves analysis in which each alternative is compared to a positive and a
negative ideal solution which allows for the identi¯cation of the purchase options
that are nearer to a positive ideal solution and farther from negative scenarios. This
paper has shown that in this case of tomography equipment, department perceptions
di®er signi¯cantly with low or medium correlation coe±cients. These outcomes have
important implications for the manufacturers of tomography equipment in order to
improve this machine and satisfy all departments' needs of a clinic. This paper also
describes a decision-making model that will be more e®ective if key criteria are
established properly. This model should also be considered at the moment of

assigning budgets for medical equipment because both user requirements and e®ects
on a patient's health must be taken into account in order to guarantee both cost-
e®ective and patient-centered care. When using the AHP it is important to use a
limited scale for the participant's judgment in order to avoid loss of interest and
distractions that could a®ect the decision consistency. It is noteworthy that the
integration of AHP and TOPSIS has highlighted the main strengths of both meth-
ods, since the TOPSIS method is a simple process and easy to use and program.
While in the AHP method the hierarchy structure can easily adjust to ¯t many sized
problems. Of course, the proposed methodological approach can be applied to similar

case studies in the ¯eld of medicine and in other ¯elds. Thus, the proposed method
can be applied as a guideline for a variety of future selection problems, and similar
models can be established to address di®erent problems regarding the medical ¯eld.
Based on the results, the proposed model can be widely used for the evaluation of
various policies. For future research, a comparative study will be conducted by using
another MCDM methods such as VIKOR and ELECTRE in order to validate the
present results. Furthermore, a fuzzy ANP approach could be explored to identify
the interactions between criteria and sub-criteria.
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International Journal of Information Technology & Decision Making

An AHP-Topsis Integrated Model for Selecting the Most

Miguel Angel Ortiz Barrio

Kevin Parra Negrete*, Brandon Aleman Romero†

Published 13 July 2016

Selecting a suitable Multi Criteria Decision-Making (MCDM) method is a crucial step in

provide a theoretical justi¯cation for decision support in selecting tomography

the most appropriate tomography equipment is identi¯ed through a hybrid model

Fig. 1. A typical tomography equipment.

PATIENT SAFETY (C2), TECHNOLOGY LEVEL (C3), FINANCIAL ASPECTS

that is used to manipulate images to perform operations. IMAGE RESOLUTION is

Finally, NUMBER OF CUTS criterion is related to the amount of body/head sec-

MAINTENANCE refers to how feasible is to keep the tomography equipment in

3. Description of Proposed Methodology

priority (w i Þ of the ith criterion by exploiting a multilevel hierarchical structure of

normalizing the geometric mean of the rows in the comparison matrix:

. Calculate matrix A3 and A4 as follows:

Fig. 4. Survey design (taken from Ref. 41).

4.1. Decision-making team

The expert team was formed by:

The Radiology Department was included in the decision-making team because it

4.2. Feedback of decision-making team

4.3. Criterion importance

4.4. Correlation coe±cient between departments of the clinic

x ¼ Standard deviation of responses from the user department \x",

. Calculate the weighted normalized decision matrix:

. Determine the positive and negative ideal solutions

J 0 ¼ fj ¼ 1; 2; . . . ; zjj associated with the cost sub criteriag:

. Calculate the positive and negative ideal separation

Negative ideal separation

Determine the relative closeness coe±cient to the Ideal Solution:

Finally, the rank of purchase options is decided according to a descending order

5.1. Description of TOPSIS matrix

6. Results and Discussion

Table 1. Local and global contributions of sub-criteria and global weights of

Cluster Global weights (GW) Local weights (LW)

Performance (RW ¼ 0:16632)

Radiation dose (S6) 0.15669 0.38483

Technology level (RW ¼ 0.15177)

(Score: 0.49965). Finally, in TECHNICAL ASPECTS, EASE OF MAINTENANCE

Table 2. Consistency ratios for AHP matrixes.

Matrix Consistency ratio (CR)

Table 3. Correlation coe±cients between departments' preferences with respect to PERFOR-

PERFORMANCE CRITERION Radiology Administration and Finances Maintenance

Radiology 1 0.09 0.1339

Speci¯cally, most of the 3  3 matrixes registered minimum ratios showing that

presence of few elements in a decision cluster.

tomography users (Radiology, Maintenance, and Administration and Finances) for

Table 4. Correlation coe±cients between departments' preferences with respect to TECHNOLOGY

TECHNOLOGY LEVEL CRITERION Radiology Administration and Finances Maintenance

Radiology 1 Undetermined 0.2453

Table 5. Correlation coe±cients between departments' preferences with respect to criterion

GOAL CRITERIA Radiology Administration and Finances Maintenance

Radiology 1 0.3203 0.1844

Table 6. Correlation coe±cients between departments' preferences with respect to

PATIENT SAFETY Radiology Administration and Finances Maintenance

Radiology 1 0.2300 0.6584

Table 7. Correlation coe±cients between departments' preferences with respect to

TECHNICAL ASPECTS Radiology Administration and Finances Maintenance

Radiology 1 0.6735 0.1899

Table 8. Correlation coe±cients between departments' preferences with respect to

FINANCIAL ASPECTS Radiology Administration and Finances Maintenance

Radiology 1 0.6430 0.5362

Speci¯cally, most of the 3 3 matrixes registered minimum ratios showing that