Health Outcomes, Policy and Economics Center

Welcome to the Health Outcomes, Policy and Economics Center (HOPE), part of the Radiology Department. This page was developed to provide you with useful information about the kind of outcomes, policy and economics studies we perform, our specific services, scientific staff and current projects.


The HOPE Center's goal is to perform robust studies in technologies assessment, health outcomes, quality of life, evidence-based clinical guidelines, cost-effectiveness analysis, quality improvement systems and error prevention programs which will benefit patient care in developed and developing countries.

On-going Projects

Quality Improvement and Error Prevention Systems

  • Sedation and contrast reaction computerized simulator.
  • Prospective trials of training programs in sedation and contrast reactions.

Evidence-Based Clinical Guidelines

  • Clinical and imaging predictors of surgical disorders in children with macrocrania.
  • Clinical predictors of surgical intracranial space occupying lesion in children with headache.

Decision Analysis and Cost Effectiveness Studies

  • The role and cost-effectiveness of imaging in children with headache suspected of having an intracranial space-occupying lesion.
  • The role and cost-effectiveness of imaging in newborns with suspected occult spinal dysraphism.
  • The role and cost-effectiveness of imaging in newborns with suspected craniosynostosis.

New Imaging Technology and Techniques

  • Advance three-dimensional reconstructions in craniosynostosis and complex calvarial fractures.
  • MR cholangiography and pancreatography.
  • CT angiography in the evaluation of extremity vascular trauma.
  • Functional MRI in children with learning disorders and seizures.

Imaging Protocol Optimization

  • Intracranial space-occupying lesions and brain tumors.
  • Occult spinal dysraphism in children.

Scientific Focus

Technology Assessment

The HOPE Center conducts diagnostic performance studies to determine the sensitivity, specificity and receiver operating characteristic (ROC) curves of emerging technologies. Intra and interobserver variability of new diagnostic and therapeutic test are also evaluated.

Decision Analysis Studies

Decision Analysis studies are those structured to assess a specific clinical question or problem over time, by creating a decision tree that illustrates sequential choice points for action and for information gathering, and when specific outcomes occur. The flow of the decision tree information is based on the available literature. Decision Analysis studies determine the best choice of diagnostic tests or treatments for specific diseases.

Error Prevention and Quality Improvement System

Medical error is one of the seven leading causes of death in the United States of America. The HOPE Center emphasizes the use of computerized simulators and education as important tools in the prevention of medical error and the improvement of our patient's quality of care.

Cost-Effectiveness Analysis

Cost-effectiveness analysis (CEA) provides information so society can prioritize the use of our limited healthcare resources. Ideally, CEA should be done from a societal prospective with long-term outcomes such as life years saved, or quality-adjusted life years saved. These long-term CEA outcomes allow comparison of different health care diagnostic studies and interventions.

Evidence-based Medicine and Imaging

The physicians and the medical staff should base medical decisions and actions on the best scientific evidence available. The HOPE Center performs extensive literature review, operational and research studies to provide our patients with the most updated medical information. Guidelines and decision trees are developed to optimize the diagnostic and therapeutic strategies for our patients.


  • L. Santiago Medina, M.D., M.P.H. - HOPE Center Director
  • Nolan R. Altman, M.D. - Director and Radiologist-in-Chief
  • David Zurakowski, Ph.D. - Statistician, Harvard Medical School


The following is a list of the staff's related publications.

Medina LS, Study Design and Analysis in Neuroradiology. A Practical Approach. American Journal of Neuroradiology. 1999; 20:1584-1596

Medina L. S., Frawley K., Zurakowski D., Buttros D., DeGrauw A.J.C., Crone K.R. Children with Macrocrania: Clinical and Imaging Predictors of Surgical Disorder. American Journal of Neuroradiology. In Press.

Medina L. S. Three-Dimensional CT Maximum Intensity Projections of the Calvaria: A New Approach for Diagnosis of Craniosynostosis and Fractures. American Journal of Neuroradiology. 2000; 21:1951-1954.

Medina L. S., Kuntz K.M., Pomeroy S. Children with Headache Suspected of Having a Brain Tumor: A Cost-Effectiveness Analysis of Diagnostic Strategies. Pediatrics 2001. 108:255-263

Medina L. S., Crone K., Kuntz K.M. Newborns with Suspected Occult Spinal Dysraphism: A Cost-Effectiveness Analysis of Diagnostic Strategies. Pediatrics 2001. 108.

Medina L. S., Altman N.A., Establishing a Health Outcomes and Economics Center in Radiology: Strategies and Resources Required. Pediatric Radiology. In Press.

Medina L. S., Aguirre E., Altman N.A. Cost Analysis of Vesicoureteral Reflux in Children by Using Time and Motion Analyses. Submitted to American Journal of Roentgenology (AJR).

Medina L. S. Changes in Brain Water Diffusion Durango the First Year of Life: Finally Starting to Understand the Age-and-Brain Tissue Related Normative Data. Radiology. 2002. 222:316-318

Jayakar P., Bernal B., Medina L. S., Altman M.A. False Lateralization of Language Cortex on Functional MRI After a Cluster of Focal Seizures. Neurology. In Press.

For more information on the HOPE Center at Nicklaus Children's Hospital please email
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