CAD CAM Reults02

CAD CAM Reults02

Charles H. Pritham

3/29/2006

Second post

 

Charles H. Pritham, CPO

I've been using the Otto Bock ETS System since it's inception approximately
7 years ago. I was involved in the beta testing with the original software
and have taken the course three times as new upgrades were made available.

 Prior to the ETS I was using Seattle Shapemaker when employed with another
company, so I was able to compare systems and pick which worked best in my
experience. I also had some limited familiarity with TracerCad having taken
the course some years ago.

With all that said, I can report that I use the ETS system exclusively in my
day to day practice. Rarely do I find the need to hand cast or hand modify
for most residual limb shapes. I feel the software is consistent, and
produces a well fitting socket wether using liners of all types (and
manufacturers other than Otto Bock), straight suction, in conjunction with a
soft insert, or simply a sock fit.

 I use the digital camera impression taking for transtibial shapes, and
measurements for transfemorals. Naturally the shapes are not always perfect
but the system incorporates use of Thermolin thermoplastic which affords
easy modification using a heat gun. This plastic also allows the patient to
use the device outside of the office for a prolonged trial period.

 The system works very well but unfortunately I have experienced numerous
problems in fabrication from Otto Bock's Tech Center. There are no
alternative sources for fabrication as Otto Bock holds the software rights
closely. I have been patient and worked through most repeated problems but
still experience difficulties from time to time. I must praise the Tech
Center on their quick turn around time, as I receive my sockets usually
within two or three days of sending the files.

 I have no technicians in my practice and chose not to do my own
fabrication. The ETS system allows me to operate my practice efficiently and
cost effectively. I don't have an oven, vacuum pump, or the wonderful dust
and odors problems associated with in-house fabrication and are common in
most prosthetic facilities.

***

 

In my humble opinion, when it comes to CAD, the huge Pro is TIME savings!

I've been working with the Tracer/Omega system for the past 5 years. My
experience is once past the learning curve, the true value is in the time
saved by the prosthetist or orthotist. Time saved in modification of the
positive model by the clinician provides more time to spend with the
patients!

 

Its really nothing more that a tool that allows you to become more
efficient, more productive, and quicker at what you already do....oh, and
organized as well. If forgot to mention it allows you to keep a digital
file of the patient's model so you no longer need that store area for cast
and check sockets.

 

Cons-

 

Did I mention the learning curve? You have to be committed to go through
that learning curve, but that's a bout it. A few years ago cost for a
system was fairly expensive, but now that's not even the case. OWW for one,
I know has made it extremely reasonable to have the most up to date state of
the art technology for a fraction of what CAD was 10 years ago.

***

 

We have had good and bad success with CAD. We currently use the Tracer
Omega system. It is an excellent tool for capturing the image and managing
and documenting the patient's limb volume as well as designing custom Alpha
liners. We have had excellent success with the custom design liner product.
The system also does a very good job at capturing an accurate shape of a
below knee residual limb, and allowing the practitioner to make an initial
check socket from the image. I will usually have to make some modifications
to the check socket and another plaster mold (and check socket before
finishing), but it most definitely gives you a good start. The system also
works well for AK check sockets, either by measurement or by imaging the
distal end of the limb and merging it with the brim. Both methods will give
you a reasonably good start to fitting an AK socket. However, as you know
fitting an AK is not just 1, 2, 3, and I feel that the brim shapes as they
stand right now, are just too generic to actually choose one for a patient
and have it work well. There are so many measurements that I like to use in
fitting a good AK like, ML, AP, DML, and ramus exit, and the CAD sockets do
not really allow you to make these intricate socket modifications. I would
have to say, however that I have not spent hours upon hours mastering the
system. So these modifications are most likely possible to be done, but it
would just take lot's of time and practice. I have had much more success
hand casting and modifying my AK's, the CAD system definitely eliminates the
hassle factor, which everyone is trying to achieve. I believe CAD is an
excellent tool. As soon as a practitioner looks at it as more than a tool,
and a solution to a problem, well then there is bigger PROBLEMS. I think
CAD is the future, and will continue to evolve and grow into a more
functional tool for a practitioner to use in order to create as good if not
better outcomes for their patient's.

However, I never want to take away from what we do with our hands, and I do
not believe a computer will ever be able to fit a prosthesis with out a
Prosthetists experience, expertise, and hands.

***

 

I have been using the Otto Bock CAD system since it came out and currently
use the latest version of the software here at the VA Polytrauma Center in
Minneapolis.

 

It is a tool that gets me to first base with a test socket. After that it
requires the skill set of an experienced prosthetist in the art of
prosthetics. It is much like flying a plane anyone can get it to go up and
down, but it takes skill not to have it crash.

 

CAD does not replace the prosthetist it only give them a tool to get to
certain points faster and keep a record of were they have been. In small
practices with limited staffing it can be a great time saver. It is the
future of prosthetics and I look forward to the next generation of CAD
systems.

***

 

For the past several years we have been using the Omega T-ring system from
Ohio Willow Wood. This is primarily used in conjunction with gel liners and
total-surface-bearing sockets. The system is relatively easy to use and we
get good results from it. And recently they added the capability to make
custom liners.

 

I would recommend it. I need to also add that I don't have any direct
experience with other cad-cam systems, so I can't comment on how it relates
to other systems

***

 

I have been a CAD-CAM user since 1990 and am now on my 3rd hardware system
after multiple software applications. We operate 9 offices that are linked
together for all of our prosthetic imaging and fabrication. After ABT and
Seattle Systems programs have bit the dust, we are now Tracer fanatics and
utilize the T-Ring technology from OWW for our current hi-tech patient care.


 

I truly cannot imagine life without CAD-CAM and am a huge fan of the work
begun by Greg Pratt at Tracer and now continued by the very capable folks at
OWW. I have 1 carver in our home facility that serves all nine offices and
do carving for one other private facility to help offset the expense of the
pricey Nexform and keep my staff busy. I depend on the successful outcomes
provided by the T-Ring technology and am completely satisfied with support
and commitment of OWW.

***

 

I have worked with Shapemaker CAD-CAM System since 1993 and have found it to
be a very valuable tool. I like being able to take the cast, digitize,
modify, and send the shape to a carver in a matter of minutes and not having
to pour a cast and modify it. It is a great time saver, once you learn the
system. I like being able to get other jobs done, while waiting to get the
test socket back. I like the accuracy and speed of the modifications,
especially with global volume changes, lengthening, the templates, and
modifying the regions. Not having an in-house carver is not as convenient
as having one, therefore, there is a time delay and added cost to the
fabrication of the prosthesis.

Shapemaker is an aging system and I'm sure there are newer and better
systems out there now.

OWW.

***

 

I gave Tracer a spin back when Flex-Foot was the distributor. I am certain
that the software is much improved since then. While technical issues with
the function of the measurement device and software were issues I'm
reasonable certain that they could be overcome. My problems with CAD are
much more basic and user related. While I'm a great fan of technology and
have followed CASD/CASM since it's introduction at the ISPO world congress
in London, I also believe in the appropriate use of technology. In my
setting and for me it just does not make financial sense. The software is
quite expensive and while it does offer some efficiencies of time in
modifications it does not pay off very quickly unless you use it
intensively. My office is a small practice in a small town. I just don't
have even the potential for that kind of volume. Additionally much of the
cost and time savings efficiencies are only available if you have the
milling equipment on premises. Havin to pay a central fab to pull my test
sockets does not save me money

 

***

 

I have had TracerCad for about 4 years now. After initially being gung-ho
about it, I have come to use it only for Total Surface Bearing sockets after
hand casting, (or copying existing sockets) by using the wand to digitize.

For me, it works great for these procedures. I don't use it for weight
bearing specific sockets, I still hand cast and hand modify those. I feel
that there is nothing like hands on when capturing shape and volume. I
never felt comfortable using the pen to trace over the patient, and
intricately modifying a digital file for me was difficult at best, totally
off at worst. I was also upgraded to the T Ring when OWW acquired
TracerCad. I tried that a couple of times but now it is sitting in its
stand in my fitting room as a dusty conversation piece.