A Predictive-Prescriptive Analytics Framework for Fair Computed Tomography Scheduling and Radiologist Workload Allocation

Abstract

Scheduling follow-up Computed Tomography (CT) examinations requires balancing two competing objectives: assigning patients as close as possible to their recommended examination dates while ensuring an equitable distribution of radiologists' workload. Existing approaches optimize scanner utilization or patient waiting times, overlooking reporting activities and the need to balance fairness across multiple stakeholders. This paper proposes a predictive-prescriptive framework for fairness-aware follow-up CT scheduling. Patient-specific Machine Learning (ML) models are first developed to predict both examination and reporting durations. These predictions are then embedded into a multi-objective Mixed-Integer Linear Programming (MILP) model that simultaneously minimizes deviations from patients' preferred examination dates and balances radiologists' reporting workloads through a lexicographic min-max fairness criterion. We derive a dominance reduction property within an $\epsilon$-constraint framework that substantially reduces the number of optimization problems required to generate the Pareto frontier. Computational experiments based on data from a real-world emergency radiology department show that allowing patients a scheduling flexibility of only one to two days is sufficient to substantially improve workload equity among radiologists while preserving timely access to follow-up examinations. The proposed dominance reduction strategy eliminates most $\epsilon$-constraint evaluations without affecting the Pareto frontier. Finally, evaluating predictive models through downstream optimization regret demonstrates that XGBoost provides the most effective support for scheduling decisions, outperforming models that achieve lower prediction errors according to conventional predictive metrics.