A custom case lets back office build a plan for a procedure that has no predefined workflow. You decide the steps, the files on each step, how every object looks and whether the clinician can move it. This guide is for CustoMED back office and organization back office users.
The screens follow one demo pelvic tumor case, built on an anonymized sample scan, with four steps: Tumor, Cutting planes, Cutting guides and Implant positioning. For the clinician's side of the same case, see Reviewing and Signing Off a Custom Case (Clinician).
1. Add your files to the Files Library
Every file in a custom case lives in one Files Library at the top of the side panel. A file you add once can be used on any step, in any view.
Open Files Library and drag files onto Drag & Drop or click to add, or click it to browse. STL, GLB and GLTF are supported, one or many at a time, and folders and ZIPs work too.
In Files Upload, choose a Type for each file: Custom for an element such as a cutting plane, guide or implant, Template for an implant template, or Anatomy for a bone.
For an anatomy, also choose its Phase: Pre-Op or Post-Op.
Click Add Files.
The library groups your files under Pre-Op Anatomies, Post-Op Anatomies and Custom Elements. Click + next to a file to add it to the current step, or the bin icon to take it off the step. Taking a file off a step keeps it in the library.
2. Create and name the steps
A new custom case starts with one step, Step 1.
Click the step name in the header to open the step list.
To rename a step, click its three dots and choose Rename. Type the name and press Enter.
Click Add Step to add a step at the end of the list. Its name is ready to type over, so type it and press Enter.
A new step starts with the same scene as the last step. Clone Step in the step menu adds a step that starts as a copy of the step you chose, measurements included.
Keep a step in one phase
Click the step's three dots and choose Lock anatomy phase.
Choose Pre-Op only or Post-Op only and click Lock.
The Pre-Op / Post-Op toggle is then disabled for everyone working the case, and the step always opens in that phase. The hidden phase's setup is kept and comes back if you unlock.
3. Set up each step
Each step has its own scene: which files are on it, and how each object looks in that step. Use the eye icon in the side panel to show or hide an object. Right-click an object in the 3D view to open its settings.
Change an object's colour
Right-click the object in the 3D view.
Under Color, click the arrow next to the colour swatch to open the picker.
Pick a hue on the colour bar, then a shade in the square. Drag Alpha to make the object see-through.
Let the clinician move an object
Positioning decides whether the clinician can move an object while reviewing the step. Fixed keeps it where you placed it. Translatable lets them move it.
Right-click the object and click Translatable. The move handle appears on it.
To try it, drag an arrow. The object moves along that axis and the distance shows next to the handle.
Use Undo in the toolbar to put it back.
Change several objects at once
Click an object, then Ctrl + click (⌘ + click on Mac) the others.
Right-click one of them. The settings show how many objects you selected, and every change applies to all of them.
4. Draw, add cylinders and fit planes
Open Tools from the toolbar above the side panel. It has three tools:
Draw: paint a line on a surface, for example to mark a landmark or an approach. Choose Draw or Erase, the brush thickness and the colour.
Cylinder: click a surface to place a cylinder along its normal, for example a drill or pin path. Set its thickness and length before you click.
Plane: paint over an area and a plane is fitted to it. Set the brush and plane thickness.
A new cylinder or plane opens with its move handle, so you can adjust it straight away.
5. Add measurements
Each step has a measurements section for its phase, for example Post-Op Measurements. Click a measurement type next to Add Measurement, then click the points on the model. The value shows in the list, and you can give each measurement a description.
6. Save and send for review
Click the save icon in the header.
Click Send for review. It sends the step you're on.
If other steps have drafts that weren't sent yet, choose Only This Step or All Draft Steps.
In the share window, check the collaborators, add a note for the clinician and click Share With Clinician. They get an email.
The clinician sees only the steps you sent. In the step list, a sent step reads Sent for review. Waiting for the clinician to sign. when you hover it.
Note: To change a step that is in review but not signed yet, choose Create new version in its step menu, then send it again. Once the clinician signs a step, it is final and can't be edited or versioned.
7. Answer the clinician's comments
When the clinician mentions you in a comment, you get a notification in the bell at the top of the home page. Click it to open the case at that comment.
Click a comment in the Comments panel to jump to its pin. Type in Reply and press Enter to answer, and click the check mark to resolve the thread when it's done.
8. Open the case for sign-off
When the clinician sends the case back, it is locked and comes to back office. Open Approve to check the output pack before the clinician signs off:
Each step is listed with its version. Pick another version from the list if needed.
Click the eye icon to preview a step, the download icon to download it, or the bin icon to leave it out of the pack.
Create New Output Pack starts another pack for a different combination of versions.
If the clinician moved a Translatable object, their signed step shows as a new version, for example V2.
Click Open for Clinician Sign-Off.
Click the lock icon in the header to unlock the case. The share window opens.
Add a note and click Share With Clinician.
The clinician then approves the case. See Approving a Case for what happens after approval.