CustoMED 1.1.2 makes the viewer faster to open and clearer to read, lets one measurement span the 3D model and the CT, adds collision depth shading for hip planning, gives cranioplasty better shaping tools and brings a full review flow to custom cases. This article walks through what's new. The screens use CustoMED demo cases and an anonymized sample scan.
Released: October 11, 2026.
Highlights
Faster to open: 57% less to download on first load, and editor files download in parallel.
Measure across 3D and CT: place measurement points on CT slices, on the 3D model, or one of each.
Clearer hover in 3D: a soft blue glow shows what you're pointing at, and bones keep their own colours.
Easier segmentation review: colour dots match each bone's CT outline, and hovering a card emphasises that bone on every slice.
Collision depth shading: in hip planning, see how close the femoral stem comes to the outer cortex.
Cranioplasty shaping: Curve, Smooth and Stitch brushes that work as you drag, and cleaner patch edges.
Custom case review: step-by-step review, a shared Files Library and new Cylinder and Plane tools.
Combine a scan taken in sections: merge several CT series into one before segmentation.
The viewer
Measurements across 3D and CT
Custom measurement points can now be placed on the CT views as well as on the 3D model, and one measurement can mix both. For example, put the first point on the 3D bone and the second on a CT slice.
While you place a point, the CT views show the same preview point, guide line and label as 3D.
A CT point snaps to a landmark within 3 mm. Otherwise it attaches to the object under the click, or to the scan itself, so it keeps its CT position if the anatomy moves.
Points of the selected measurement can be dragged on CT. Placing and dragging on CT isn't available in Average mode, which has no slice depth.
Clearer hover in 3D
Pointing at an object in the 3D editor now draws a soft blue glow around it. This works for bones, PSI, implant templates and their parts, planes, spheres and surfaces. Bones keep their own colour, so the colour coding stays readable. The glow stays smooth when you zoom in, and closer objects hide it.
Easier segmentation review
Each bone card has a colour dot that matches its outline on the CT. Left-side bones get the lighter shade.
Hovering a bone card emphasises that bone's outline on every slice, and hovering a bone on the CT highlights its card.
The page is much lighter on your computer: on single-bone cases, idle work per frame dropped from 15.9 ms to 0.6 ms.
Bone outlines on the CT views no longer go blank.
Faster to open
57% smaller first download (3.73 MB to 1.59 MB compressed), and 46% less JavaScript overall.
Editor files (anatomies, landmarks, surgery plan and PSI) download in parallel instead of one after another.
Large files download in parallel chunks, and the CT download waits until the current view is ready.
New cases store each DICOM series separately, so the editor downloads only the series in use.
Back office pages and the heavier home page widgets load only when opened.
Smaller improvements
Hovering an object's row in the side menu shows a rotating preview of it in its own colour and material.
Completed steps keep their normal title and icon with a green check. Approve and Logistics titles stay green once done.
Version labels use a lowercase v (v1, v2) and sit right next to the step name.
The section slider remembers the last slicing axis, axial by default.
Comment threads stay inside the 3D canvas and can be dragged by their header.
Long comments open collapsed to three lines, with Show more and Show less.
Planning
Collision depth shading
Collision depth shading is built mainly for total hip replacement (THR) planning on the femur. In Surgery Planning, on the femur, slide the view control toward Internal to look inside the bone. Where the femoral stem presses into cortical bone, the cortex is shaded from Inner cortex (yellow) to Outer cortex (red), with a legend under the control, so you can see how close the stem comes to the outer surface of the femur. Slide on to Surrounding to see the plan against the surrounding CT.
The same inner to outer cortex shading works on the humerus for RSA stems.
On the THR pelvis, the scale runs from Bone surface to Deep bone.
Collision shading appears only in Surgery Planning, so k-wires on PSI Design aren't shown as collisions.
Total hip replacement measurements
Two new post-operative femur measurements: Neck Angle and Global Version.
Editing the Neck Angle lands exactly on the value you type.
The post-operative Neck Angle shows for every femoral head.
Implant template on PSI Design
On PSI Design, every procedure keeps the implant template in the side menu with its eye closed. Open the eye to see the implant next to the guide, and close it to hide it again. The template still can't be moved on this step.
Cranioplasty
Shape the patch with brushes
The Shape tool now has three brushes, Curve, Smooth and Stitch, and each shows only its own settings.
Brushes work while you drag, not only on a click, and each stroke is one undo step.
Stitch lays the patch onto the bone behind it, or pulls it out where it has sunk in.
A press on the patch or skull is always a stroke. It no longer selects the mesh or turns the camera, and you don't need to select the patch first.
Ctrl or ⌘ + scroll over the canvas resizes the brush, and strokes respond faster.
Cleaner patch edges
The patch is rebuilt without the slit that ragged rims could cause.
Boundary points follow your pointer, and points released within 5 mm of bone snap onto it.
Adding a fixation drill can be undone in order with your other edits, and clicking while a drill is selected only deselects it.
No more flicker where the patch rests on bone.
Case creation and upload
Combine a scan taken in sections
When a CT arrives as several series, for example a scan taken in sections, you can combine them into one series before segmentation.
In the CT Imaging preview, click the merge icon to turn on merge mode.
Click each series you want to combine.
Click Merge Selected. The series become one series, marked with a C, and Upload All is available again.
Series that wouldn't make one clean volume can't be merged, and the preview lists why: for example overlapping slices, a different orientation, matrix size or spacing, or a gap that would have to be filled in.
Segmentation keeps the bone from every part of the combined scan.
More imaging types and better upload control
Case creation accepts MRI, X-ray and CBCT (and other DICOM modalities) alongside CT, for preview and for the case. The preview groups series by modality.
The upload button is now Upload All, and Cancel stops an upload without changing the case.
Add a scan after creating the case
A case created without files can now receive its scan later, from anyone who could upload while creating it. View-only users still can't upload.
Import from Nuance PowerShare
Organizations connected to Nuance PowerShare can pick up studies that surgeons share when they create a case. Patient identifiers are pseudonymized when a study arrives.
Bone fragments in any procedure
Any case whose segmentation contains bone fragments now starts with a reduction step before landmarks, not only distal radius fractures. Confirming the reduction starts landmark detection on the reduced anatomy.
Custom cases
A custom case is for a procedure that has no predefined workflow. Back office builds the plan as a series of steps, and the clinician reviews, comments on and signs each one. 1.1.2 brings a shared Files Library, a Tools panel and a full step-by-step review flow.
Here is how one case runs, using a demo pelvic tumor case with four steps: Tumor, Cutting planes, Cutting guides and Implant positioning.
Back office adds the bones and custom elements, names the steps, and sets each object's colour, transparency and whether the clinician can move it.
Back office adds drawings, cylinders, planes and measurements, then sends the steps for review.
The clinician pins comments, moves the objects back office made movable, and signs each step with Continue. On the last step, Send for review hands the case back.
Back office answers the comments, checks the output pack on Approve and opens the case for the clinician's sign-off.
The clinician approves the case, and CustoMED creates the Plan Report.
Step-by-step guides: Building a Custom Case Plan (Back Office) and Reviewing and Signing Off a Custom Case (Clinician).
Authoring
Files Library replaces Add Files with one shared library per case. An uploaded element or bone can be used on a step in another view, bones can leave a step and come back, and several files can be uploaded at once.
A custom case can hold several implant templates, one per bone.
A Tools panel brings Draw, Cylinder and Plane together. Click a surface to place a cylinder along its normal, or paint an area to fit a plane to it.
Each step keeps its own Pre-Op and Post-Op appearance.
Clone Step in the step menu, Ctrl or ⌘ + click to select several objects and edit their colour, visibility and position together, and a warning before you leave with unsaved changes.
Organization back office users can now author custom cases in the same way as CustoMED back office.
Name your steps. Click the step name in the header. Choose Rename from a step's three dots, and click Add Step for the next one.
Add files. Drop STL, GLB or GLTF files on the Files Library, choose a type for each and click Add Files.
Change an object's colour. Right-click it in the 3D view and pick a colour under Color. Alpha makes it see-through.
Let the clinician move an object. Right-click it and choose Translatable under Positioning. Fixed objects stay where you placed them.
Draw, place a cylinder or fit a plane from the Tools panel.
Review and approval
Back office sends each step for review on its own. Clinicians see only what was sent, and a step the clinician signs is final.
Back office sees which steps are in review (a clock) and approved (a check), and which version is in review.
Approve shows each step in its real phase, with a Pre-Op / Post-Op toggle when a step has both.
An approved pack can't be changed afterwards.
Send for review. Back office chooses which draft steps to send and adds a note for the clinician.
Comment on the plan. The clinician clicks a spot on the model and types the comment. Typing @ mentions someone.
Approve. The clinician clicks Approve Case and accepts the Responsibility Acknowledgment, and CustoMED creates the Plan Report.
Fixes
Custom cases save exactly what the editor shows, and leaving a step never drops its unsaved edits.
Uploaded objects stay visible inside see-through bone.
Switching Shadow Bone off now restores a bone that was saved as a shadow.
Links no longer open the editor before the pre-anatomy is approved.
Downloads, reports and approval
One naming scheme for every download
Every case download now uses one naming scheme, {case}_{name}_OP-N, where OP-N is the output pack number (archived packs included). Files to Print, Logistics Files, Download pack and Source Case each have a fixed folder layout. Labels and the Delivery Note move to Logistics Files, so Files to Print holds print STLs only.
On demo cases, the files row on Approve is called Case Files and holds the output pack folders and documents.
Reports and packs
Approved packs and plan reports keep the view and step names they were approved under. A later rename no longer changes them.
Plan report images no longer turn blank after approval in a long session.
The case number engraved on round anatomy holding disks can use up to half the rim, so long case numbers stay legible.
Saving a long shipment tracking number no longer fails: the field stops at 255 characters.
CORA
CORA reads the plan and uses the editor's own controls: implants, workflow, PSI, Plan Report, axis, section, versions, comments, measurements and the CT panel.
It answers data questions in place and turns a goal you describe into a proposal you accept or reject. Clinical changes happen only on the surgeon's own words or an explicit yes.
Approve, Logistics and custom cases are covered. Every action follows the same role and lock rules as the button it stands in for.
When you ask CORA on WhatsApp to switch account, it works out whether you mean another organization, Admin Mode or another user, and asks a short question when it can't tell.
Voice and chat sessions are more reliable and respond faster.
Settings and notifications
My Account is split into collapsible sections: Profile, Organizations, Default Collaborators, Notifications and CORA.
Comment and mention, case shared, review and case completed notifications can also come from CORA on WhatsApp. Each type has its own Email and WhatsApp switch, so you choose email, WhatsApp, both or neither.
A WhatsApp number is linked only after that phone sends the LINK code shown on the page.
CORA is available to users that CustoMED has given access.
Security, privacy and fixes
Downloads from the case drawer's Files and Activity tabs follow the Viewer rule: read-only Viewers can't download case files, while Technicians of the organization that owns the case can.
The app no longer writes debug information to the browser console.
We further strengthened our cloud infrastructure security and audit logging.
Total hip replacement: femur guide generation no longer fails at the greater trochanter tab on some left anterior cases.
Reverse shoulder: PSI landmarks no longer appear in plan report images.
Leaving a case while it is still loading no longer marks the next case as unavailable.
Live notifications no longer stop for minutes after a long session.
Demo cases: pack downloads include the session's real files, and Plan Only demos no longer pick up a PSI.