I. Open ‘Axis Three’

software icon to Home Screen

II. Open Patient’s Tab from Menu Bar

III. New Patients

1. To add new patient select “Add New Patient” – Enter First/Last and scan type then ok.
2. To select existing patient begin typing patient name, in Name field, to narrow results.
3. Double click patient thumbnail to open case data with existing scans and simulations.
4. Select OK
5. Select New Torso Scan to enter scan window

IV. New Scans

Positioning

• Distance - Face about 32 inches away from scanner (just over an arm’s length)
• Red Guidelines – Center point at sternal notch
• Vertical Line - not as important right down the middle, may be off to the side a bit
• Horizontal line - across the sternal notch. (for patients with ptosis lower scanner position While still keeping view of shoulders in view ports)
• Side views – View wall space behind the arch of back
• Stand with good posture – Patient to stand with hands to the side (45dg), palms forward. Larger breast can go to about shoulder level, but never higher.
• Hair is behind shoulders or in a pony tail.
• Jewelry – Remove or put behind neck.

1. Room to be as dark as possible (If too light, may see “Point Cloud Generation Error”) Lights off, Curtains Closed, Door Closed, etc
2. Hold Still
   
   • Will see 3 lights flash in sequence, when all 3 have flashed tell patient to relax
   • Uncomfortable if the scan is taken and patient is still holding pose.

V. Point Cloud Scan

1. Point Cloud Mesh – Look at patient make sure the picture is cohesive
2. Rotate mesh image - look under breasts and over complete image to check for lakes (solid blue areas with boundaries), and rivers. Lakes will usually fill in during processing, but rivers will not - in which case take another scan.
3. Cropping – Leave as much torso as possible to exemplify beautiful image.
   Crop off arms and from Chin down
   Take out distractions (if trying to sell tummy tuck, leave that in, otherwise crop off)

VI. Final scan – Process takes about 90 seconds. Wait and verify that the final image is acceptable.
i.e. no double nipples, coloring is ok. If doing simulation in another room, have patient redress
to increase comfort level, before having them join you for simulation process. (you can
plot points and begin process while they are dressing).

If you are not happy with the scan, always take another one. The simulation is only as good as the pre-op image!!!

VII. Point Plotting

• Where affected breast tissue will be. Plot all points first. When the pink shading fills in, it is easier to make adjustments to cover the affected area completely. The points can be moved at any time during the entire process, after initial plotting.
• Always rotate to the point to plot, otherwise the point will not end up where you would expect it to.
• Top outside gray point on each breast, usually needs to be adjusted toward outer edge a bit
• Lighting will help show definition of tissue area. Turn off for simulation

User can return to the pre-simulation screen, at any time during the simulation process to adjust points
to correlate to accurate simulation.

VIII. Simulation

1. Add/Delete Simulations –
• Select Add to begin new simulation
• Select Delete to remove existing simulation
2. Working Through Menu selections
• Defaults to Right breast first

Augmentation Tab

1. Tissue Behavior Setting – TBS
   • How tissue will behave specific to the patient
   • 5 stopping points (tight, fairly tight, medium, somewhat loose and loose)
2. Implant – Select implant that fits base width measurement, then size of implant
   • System will place in pocket based on algorithm
   • Sort by selecting column headers
   • If symmetry is not common, will need to resize the implant at simulation, otherwise Copy from right to left
3. Implant Position
   • Sub pectoral
   • Sub glandular
4. Implant Rotation
   • Allows user to rotate implant side to side
5. Over Fill Implant (Saline Only)
   • For Saline Implants user can simulate the overfill which might normally be done in surgery

Fine Adjustment Tab

1. Nipple Lift
   • Adjust slider to simulate nipple rotation up or down
2. Lower Pole Adjustment
   • Adjust slider to adjust Lower Pole vertically
3. Upper Pole Adjustment
   • Adjust slider to move Upper Pole
4. Cleavage Adjustment –
   • Adjust slider to move breast to or from center

Have nipple facing you on screen and center implant around the nipple – front view is not recommended for making adjustments


5. Gizmos will turn the implants off – be sure to know which implant you are working on, will be highlighted in blue on the right side panel
   
   
6. Lower and Upper Poles – If bringing the Upper Pole Slider down, will have to increase Lower Pole slider –

Always have the Doctor Signoff on the simulation, as they are really the only ones who know what will
happen in surgery.

Be sure to make the same adjustments on both breasts when using varying sized implants

IX. Compare

• Pre-op, Simulation (show up to three, 1 pre-op and 2 simulations) for comparison.
• Choose PreOp Scan first then any corresponding simulation. Limit to two for optimal display

X. Screen Shot Tool

• Choosing Screen Shot will open windows save dialogue box for user to save image, as a .jpeg file, to specific location
  
• Once saved, user may open, print and share file

XI. Reports

• Choosing Reports will open windows save dialogue box for user to save image, as a .pdf, to a specific location
  
• Once saved, select file to open document. One page will be created for each torso selection in the compare screen. Example was 1 PreOp and 1 Simulation. Below is example of two-page Report Output

1. PreOp Page with Measurement Details
   
2. Simulation Page with Measurement Details
   

Appendix A

Menu Definitions – Drop Down and Menu Button Bar

Drop Down Menu’s

File -

1. Patients – Will Open the patients screen. This is the same option as selecting Patients from the Button Bar
2. Open Recent- This will give you the 9 most recent opened patient cases
3. Exit – This will exit the software

Edit –

1. Disclaimer – Enter the practices legal disclaimer which will be noted on scans and print outs
2. Surgery Info – Enter details specific to practice

Settings –

1. Implant Range Options –
   Allows practice to add/remove specific implant types to the pick list in simulations
   
2. Database Backup Options –
   Allows practice administrator to select location and schedule for database backup
   
3. Simulation Settings
   Options default to selected and should remain this way
   

Display

1. Change Background color – This will change the background from the defaulted blue color
2. Change Backface Color – This will change the color of the back of the patients scan
3. Change Selection Color – On torso point plotting this will change the color of the tissue
   pocket created by the user.
4. Change Invalid Selection Color – This will change the color of invalid selected points on the
   torso tissue pocket

Preferences

1. Warn when deleting Simulations – User will be required to choose Yes when deleting simulation
2. Warn when deleting PostOps – User will be required to Choose Yes when deleting PostOp Scan
3. Show license renewal information – On start of software, within 30 days of license expiration, message will remind user to call support for renewal of software license
4. Reset All – Selecting this option will check each of the three options above

View

1. Show Toolbar – Selecting this option will show the menu button bar below the Menu drop Downs. Deselecting the option will remove the Menu Button bar from view
2. Gizmos – Option Highlighted only when patient scan selected. This will show the plotted points made by the user on the patients face for various simulation landmarks
3. Lighting - Option Highlighted only when patient scan selected. This will show the shading on the patients face when scan was taken. Activating this will help user place points on patients desired simulated area
4. Pen Overlay – Option Highlighted only when patient scan selected. If user utilizes the Pen Tool, activating or deactivating will show/remove the lines from affected drawing area without completely deleting the lines drawn

Tools

1. Pen Tool – Utilizing the Pen tool will allow user to mark areas of incision, scaring etc made during procedure
2. Linear Measurements – Create Straight or Contoured lines (select appropriate option) Length of line will display in Length field allowing user to gain accurate measurements of the patient. Place points by holding down ctrl key and using right button on mouse to place points. Multiple points may be added for shaped areas
   
3. Volume/Area Measurements – Plotting points in complete circular area on patient will give accurate area and volume measurements.
   
4. Automated Measurements- Face- System will generate measurements for Nasal area of face. Height, Length, Projection and Width will be generated
   
5. Patient brochure (same option as on Menu Button Bar) – takes user into pre-created brochure which can be saved as a PDF file, emailed to patients apple device or printed to hard copy
6. Save Screen Shot (Same Option as on Menu Button Bar) – will create a screen shot of current screen and allow user to save .jpeg file to desired location on system. Once saved this screen shot can be printed.
7. Practice Report - (Option for torso scans/simulations only) will print report with patient
   volumetric information and implant details. This will be saved as a PDF file on system and available for printout to add to patient practice chart
8. Comparison overlay – (Option for torso scan/simulation only) will display simulated implants over patients current breast area.

Help

1. Homepage – selecting this will take user to www.axisthree.com
2. Send Simulation Feedback – email client allows user to send feedback directly to Axis Three’s development team for consideration
3. About – Displays current software version
4. Change License Key- When support contract is renewed, updated License Key will be distributed. Maintaining a current license keys ensures practices software will be kept up to latest released version