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A heart image using the "mixing cup" program is displayed on a monitor.

Helping Patients See Their Hearts

Doctor creates app that makes it possible to share images in an easy-to-understand format

It’s perhaps a person’s greatest fear: being told you have a life-threatening condition that you've never heard of. 

Chester Grundy of Lexington had that experience about two years ago when he arrived at UK HealthCare's Chandler Emergency Department with chest pain. But a clever tool – developed by a doctor at the UK Gill Heart & Vascular Institute – helped inform Chester and his wife, Ann, about his condition and ease their anxiety.

  • A confusing diagnosis

    Chester and Ann Grundy
    Chester and Ann Grundy at the pool.

    Ann had persuaded Chester to join her at her weekly water aerobics class at the YMCA.  About 10 minutes into the class, however, he began to have chest pain. "He told me he felt as if a horse was sitting on his chest," she recalled. The instructor and the YMCA director called for an ambulance.   

    "The doctors were all over my situation," Chester said of his arrival at the emergency department. After some tests, cardiologist Dr. John Kotter sat down with Chester and Ann and told them that Chester had a condition called aortic dissection. 

    "When I heard the words aortic dissection, I said, 'What is that?’ I know what an aorta is, but I've never heard of that," Ann said.   

    Then came a confusing tangle of explanations: ascending, descending, rupture, self-repair. "Doctors were reassuring us that Chester would be OK, but they were drawing in the air with their fingers. It was so hard to follow." 

  • How mixing cup helps

    Enter Dr. Michael Winkler with an answer. Part Thomas Edison, part Willy Wonka, Winkler has made his mark at Gill by merging his background in visual arts with his scientific expertise to create elegant solutions to imaging problems.

    Medical imaging creates vast amounts of data in "slices," which can then be reassembled into animated 3D images. Numerous software companies offer products capable of performing this task, known as post-processing, but the resulting computer files are very large. With his background in art and visual media, Winkler was convinced there was a way to make sophisticated animations that would yield imaging files small enough for easy display on a computerized device with a screen.

    Winkler collaborated with UK undergraduate student Leon Lin to develop an open-access, small and easy-to-use computer application that accomplishes these tasks. The app, called Mixing Cup, improves the quality of a patient's 3D animations. Patients can then see their medical problems illustrated in stunning detail on a cell phone. The files are small enough that they can be easily emailed or displayed in a web browser.

    "Images are as powerful for communication as words, and we all tend to remember images more than we do our conversations,” Winkler said. “However, a lay person has trouble understanding the images that we as radiologists review. 3D animations are easy for patients to understand, which is why Mixing Cup is such a useful tool for communication with patients.”

  • Understanding the condition immediately

    Using Mixing Cup, Winkler created an animation of Chester's aorta, which he brought to Chester's bedside to view on his cell phone.

    Chester's first thought was, "Wow."

    "I understood immediately what I was looking at and what was going on. I felt more at ease right away because I was more informed,” Chester said.

    With the video, Winkler and Kotter helped Chester and Ann understand what the aortic dissection in his own heart was. Chester, luckily, had the less dangerous "Type B" dissection, which can often be managed medically.  After hospitalization for aggressive blood pressure control, Chester was able to return to his normal lifestyle without surgery.

    Chester is back to life as usual: walking three times a week, continuing his work as an influential civil rights activist and teasing his wife. "I won't be suggesting water aerobics again for a long time," she laughed. "I'm still paying for it!"

    Winkler chose to publish Mixing Cup as an "open-access app" so that patients and physicians everywhere can take advantage of the service quickly and easily. Anyone can download the app at no cost from Winkler’s YouTube page, WinklerLab.

    "UK is a public institution and, as such, we must factor in our mission to serve the immediate needs of Kentuckians,” Winkler explained. “In the case of Mixing Cup, we felt it was important that the application be available to anyone for free.”