Two choices shape the hardware side of a case: the implant template you plan with, and the PSI type that defines the patient-specific guide. This article is for surgeons and planning staff who build surgical plans in CustoMED.
Implant templates
Templates are the manufacturer implant models you position on the anatomy during Surgery Planning. They are used in shoulder, knee, hip and distal radius planning. Cranioplasty cases do not use templates.
The templates you can pick come from the catalog CustoMED has set up for your organization.
Change the template
Open the case at the Surgery Planning step.
In the side menu, expand the row of the implant you want to change.
Pick values in the dropdowns. Each one narrows the next: Manufacturer, Sets, then the fields that apply to that implant, such as Type, Size, Width, Length, Diameter, Cutting Block, Multicut Block or Lateralization.
Click Select Template. The new template loads in the 3D view.
Some templates are made of parts that you can swap on their own. Expand the part and use Select Template Part.
Note: A dropdown is greyed out when it has only one value to choose. If you see no dropdowns at all, your catalog has only one matching template for this implant.
Set chosen at case creation
Implant manufacturer organizations can be set up to require a Set in Surgery Details when you create the case. That set then stays fixed in Surgery Planning. If you change the set later in the case details, the plan, PSI and export are archived and the case goes back to Landmarks.
PSI types
The PSI type is the design variant of the patient-specific guide. The types you can choose depend on the procedure and on your organization's catalog.
Cranioplasty: choose when you create the case
For Cranioplasty, the PSI Type field in Surgery Details is required. If you change it later in the case details, the PSI and export are archived and the case goes back to Surgery Planning.
Change the PSI type in PSI Design
Go to the PSI Design step.
Open the PSI Type selector at the top of the side menu. It lists the other types you can choose, each with a picture and description.
Click the type you want.
The button in the header changes from Confirm PSI to Update PSI. Click it to rebuild the guide with the new type. This can take a few minutes.
Review the result and click Confirm PSI.
The selector only appears when more than one PSI type is available for the case.
Edit the guide
You can change the guide in the PSI Design step if you can edit the plan (Editor or Approver case role) and the case is not yet approved.
Go to the PSI Design step.
Click the guide in the 3D view or in the side menu. It turns transparent so you can see the bone underneath.
Change the guide. The options depend on the procedure and PSI type:
Change the parameters on the guide's row in the side menu, such as Hole Type, Clearance, Thickness (mm), Dura Holes, legs, Add Rod or Handle Type.
Drag or resize editable elements in the 3D view, such as the cutting blade, where the guide has them.
Click Update PSI to rebuild the guide with your changes.
Review the result and click Confirm PSI when you are done.
Update PSI rebuilds the guide from your latest parameters and element positions. The main button changes from Confirm PSI to Update PSI as soon as you change something. Your changes are not applied to the guide until you click it.
Video: PSI design in a knee replacement (TKR) case
This walkthrough shows the femoral guide being reviewed and adjusted in a TKR case.
Tips
Nothing changes in the plan until you click Select Template or Update PSI.
You need permission to edit the plan (Editor or Approver case role) to change templates or PSI types. See User Roles & Permissions.
If an implant or PSI type you expect is missing, it is probably not in your organization's catalog. Contact CustoMED support to have it added.
If you see We couldn't find a file for the selected template, contact CustoMED support.
If PSI options are missing, see PSI Design Troubleshooting.