Memorial Sloan Kettering optimized prostate cancer seed placement in real time

Memorial Sloan-Kettering Cancer Center, the world's oldest private cancer center, treats prostate cancer with brachytherapy, the placement of radioactive seeds inside the tumor. Plans were computed before surgery, so the gap between planned and actual seed placement degraded outcomes and required costly pre-operative simulation and post-implant dosimetric analysis.

Working with Eva K. Lee of Georgia Tech, MSKCC's Marco Zaider built optimization models that plan seed placement in real time during the operation, using actual positions rather than the pre-surgery plan. The system needs roughly 20-30 percent fewer seeds and 15 percent fewer needles, shortens operating-room time, and makes the procedure less invasive.

The measured results are better patient outcomes and lower care costs: complications fall by up to 45-60 percent because less radiation reaches healthy structures, and eliminating the simulation and analysis steps could save hundreds of millions of dollars a year in the US alone. Mike Trick's announcement of the 2007 Edelman win cites Lee's conservative estimate of $450 million a year for prostate cancer care.

Optimize the treatment while the patient is open

Recomputing during surgery made the plan match reality instead of hoping it would.

Fewer seeds and needles shortened the procedure and reduced radiation to healthy tissue.

Removing pre-operative simulation and post-implant analysis cut cost at national scale.

When a plan cannot survive contact with reality, move the optimization to the point of execution: recomputing the plan during the procedure beat trying to make the old plan hold.

The work won the 2007 Franz Edelman Award, the first time the prize recognized a medical treatment. MSKCC later won the 2012 INFORMS Prize for organization-wide OR use, including linear-accelerator scheduling that avoided over $20 million in capital spending.