A case is one patient's surgical workflow: it holds the imaging, segmentation, planning steps, PSI design and final outputs. This guide walks you through creating a case, from choosing the procedure to starting segmentation. It is for everyone in your organization who creates cases: every organization role can create cases except Technician.
Before you start
Have the CT scan ready as a DICOM export: a ZIP file, a folder or individual DICOM files. See Preparing & Uploading Your CT Scan (DICOM).
Check that the scan covers all the anatomy the procedure needs.
The new case page at a glance
The new case page has four sections, filled in from top to bottom. The numbers in the screenshot match Steps 2 to 5 below.
Prefer to watch? This video shows a case being set up from start to finish.
Step 1: Choose the procedure
On the home page, under Create New Case, click the card for the procedure you want to plan. The procedure sets the workflow, the required anatomy and the planning tools.
The Demo button on a card opens a ready-made example case instead. See Exploring with Demo Cases.
A card marked Demo Only means your organization has no cases left for that procedure, or its case limit has expired. Clicking it opens the demo. Ask your administrator to add cases (see Case Quotas & Billing Alerts).
If your procedure is not listed, see Case Creation & Setup Issues.
Step 2: Add the imaging
The first section of the new case page, Input Files, is the upload area.
Drag your files onto the area that says Drag & Drop or Choose file to upload, or click it to browse. You can add a ZIP file (ZIPs inside ZIPs are fine), a folder or individual DICOM files.
CustoMED checks the files and shows a preview of every series it found, grouped as CT Imaging, MRI, X-ray and Others. Series that cannot be used are listed under Unsupported with the reason.
Click the series to use for segmentation. The preview opens with the most suitable series selected (fewest warnings, most recent scan, highest resolution), so check that it shows the right anatomy.
Click Upload All.
Every valid series is uploaded with the case; the one you selected is used for segmentation. To leave a series out, hover over it and click the trash icon (Don't upload this series).
If your organization uses the CustoMED PACS Gateway, you can click Remote import instead to pick a study from PACS. See PACS Gateway & Pending DICOM.
Note: Clinicians, Medical Assistants and Sales Reps can upload DICOM only. Other roles can also upload STL models. See Supported File Formats & Scan Protocols.
Anonymization in your browser
Before anything is uploaded, your browser removes patient-identifying information from the DICOM files. Only the imaging and technical data needed to process the case are kept, plus a short reference made of the patient's initials and the last 4 digits of the patient ID. CustoMED uses this reference to fill in the Patient Hint so you can recognize the case. You don't need to do anything.
Keep the browser tab open until the upload finishes.
No scan yet? Upload later
Click Skip. You can then enter an optional Scan Date and Scan Identifier to note which scan is expected, and click Upload Later. The case is created with the status Awaiting Scan Files.
Important: Once a case exists, only your Organization Back Office or the CustoMED back-office team can add or replace its imaging. Whenever you can, upload the scan while you create the case, and check that you picked the right study and series.
Step 3: Surgery Details
Fill in the Surgery Details section, then click Next. The fields depend on the procedure and your organization:
Clinician: the treating clinician. If you are a Clinician, this is you, so the field is hidden.
Medical Center: shown when your organization has medical centers set up.
Surgery Date (required).
Procedure-specific fields, such as the Operational Side (left or right). These are required.
PSI Type: for cranioplasty cases that include a PSI. See Implant Templates & PSI Design.
Set: for implant manufacturer organizations that require one.
Step 4: Case Details
Case Output Configuration: for RSA, TKR, HRA and THR, choose Plan and PSI or Plan Only. See Plan Only vs. Plan + PSI. Other procedures don't show this choice.
Patient Hint: a short reference for your own recognition (up to 50 letters, numbers, spaces or hyphens). It is filled in from the scan and added to the end of the case identifier and printable label.
Case Identifier (required): your reference for the case, 4 to 24 characters.
Printable Label (required): the text printed on anatomical models and PSIs. 2 to 16 characters per row, up to 3 rows.
Case Notes: optional notes, up to 2000 characters.
Note: Clinicians, Medical Assistants and Sales Reps don't see Case Identifier, Printable Label and Case Notes. CustoMED fills in the identifier and label for them.
Step 5: Case Collaborators (optional)
In Case Collaborators, type the person's email in Invite others. Clinicians, Medical Assistants and Sales Reps enter an email address; other roles can also search by name.
Choose a role: Viewer, Manager, Editor or Approver.
Click Invite.
People in your own organization always get the case role that comes with their organization role, whatever you pick; you choose the role only for people outside your organization. If the treating clinician has default collaborators, they are already in the list. See Sharing a Case with Others.
Step 6: Create the case
Click Create Case. If the button is disabled, hover over it to see what is missing, for example "Surgery date is required before creating the case". If your files are still uploading, CustoMED waits for the upload to finish and then creates the case.
The case page then shows the progress, for example Segmenting....
Multiple series and wrong imaging
If you uploaded more than one series, the segmentation viewer has a Series selection list so you can switch the displayed series and check it matches the anatomy used for the 3D models. It is not available on archived or locked cases.
If the wrong study was uploaded and no usable series is available, archive the case and create a new one with the correct imaging.
Cases with more than one anatomical group
Some procedures include several anatomical groups, for example scapula and humerus for shoulder cases, or femur and tibia for knee cases. Each group has its own workflow, planning and files, so always check which group you are working on.
What happens next
While the scan is processed, the case shows Segmenting....
The segmentation is typically ready for your review within 24 hours. The case status then changes to Segmentation.
If a case is clinically urgent, contact the CustoMED team directly after creating it. We will do our best to prioritize it.