A recently developed, extended balanced realization, reduced order modelling technique for large-scale distributed systems is applied to the problem of optimal actuator placement for hyperthermia treatments. Extended balanced realization develops low-order models whose state reconstructions are robust to actuator and sensor placement changes, and hence can be effectively used to find optimal placements in a computationally efficient manner. This optimization approach has been tested on simulations of a scanned focused, ultrasound hyperthermia system and found to be robust and accurate over a wide range of models, and the savings in computational costs were found to be significant.