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The Signature Orthopaedics' Cambridge Partial Knee is designed for a single compartment replacement of the natural knee joint. The Cambridge Partial Knee is indicated for cemented use in partial knee arthroplasty procedures. Partial replacement of the articulating surfaces of the knee is indicated only when only one compartment of the joint is affected due to the compartmental primary degenerative or post-traumatic degenerative disease, previous tibial condyle or plateau fractures, deformity or revision of previous arthroplasty.

The Cambridge Partial Knee is a unicompartmental knee system consisting of a femoral component and tibial component (meniscal insert overmoulded onto the tibial baseplate). The femoral and tibial components are intended for use with bone cement. The implant is for fixed partial knee replacement. Each size tibial implant has two variants, right lateral/left medial (RLLM) and right medial/left lateral (RMLL) condyle.

The femoral component is a spherical, symmetrically designed prosthesis manufactured from cast cobalt chrome (CoCrMo). The meniscal bearing and tibial baseplate are a monobloc fixed tibial bearing consisting of a titanium (Ti6Al4V) baseplate overmoulded with UHMWPE GUR1020-E. The meniscal bearing is moulded over the tibial baseplate and machined to the correct size and geometry.

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The device is a diagnostic imaging system that combines Positron Emission Tomography (PET) and X-ray Computed Tomography (CT) systems. The CT component produces cross-sectional images of the body by computer reconstruction of X-ray transmission data. The PET component images the distribution of PET radiopharmaceuticals in the patient body. The PET component utilizes CT images for attenuation correction and anatomical reference in the fused PET and CT images.

This device is to be used by a trained health care professional to gather metabolic and functional information from the distribution of the radiopharmaceutical in the body for the assessment of metabolic and physiologic functions. This information can assist in the evaluation, detection, localization, diagnosis, staging, restaging, follow-up, therapeutic planning and therapeutic outcome assessment of (but not limited to) oncological, cardiovascular, neurological diseases and disorders. Additionally, this device can be operated independently as a whole body multi-slice CT scanner.

AiCE-i for PET is intended to improve image quality and reduce image noise for FDG whole body data by employing deep learning artificial neural network methods which can explore the statistical properties of the signal and noise of PET data. The AiCE algorithm can be applied to improve image quality and denoising of PET images.

Deviceless PET Respiratory gating system, for use with Cartesion Prime PET-CT system, is intended to automatically generate a gating signal from the list-mode PET data. The generated signal can be used to reconstruct motion corrected PET images affected by respiratory motion. In addition, a single motion corrected volume can automatically be generated. Resulting motion corrected PET images can be used to aid clinicians in detection, localization, evaluation, diagnosis, staging, restaging, follow-up of diseases and disorders, radiotherapy planning, as well as their therapeutic planning, and therapeutic outcome assessment. Images of lesions in the thorax, abdomen and pelvis are mostly affected by respiratory motion. Deviceless PET Respiratory gating system may be used with PET radiopharmaceuticals, in patients of all ages, with a wide range of sizes, body habitus and extent/type of disease.

The Cartesion Prime (PCD-1000A/3) V10.21 combines a high-end CT and a high-throughput PET designed to acquire CT, PET and fusion images.

The high-end CT system is a multi-slice helical CT scanner with a gantry aperture of 780 mm and a maximum scan field of view (FOV) of 700 mm. The high-throughput PET system has a digital PET detector utilizing SiPM sensors with temporal resolution of < 250 ps (238 ps typical). Cartesion Prime (PCD-1000A/3) V10.21 is intended to acquire PET images of any desired region of the whole body and CT images of the same region (to be used for attenuation correction or image fusion), to detect the location of positron emitting radiopharmaceuticals in the body with the obtained images. This device is used to gather the metabolic and functional information from the distribution of radiopharmaceuticals in the body for the assessment of metabolic and physiologic functions. This information can assist research, detection, localization, evaluation, diagnosis, staging, restaging, follow-up of diseases and disorders, as well as their therapeutic planning, and therapeutic outcome assessment. This device can also function independently as a whole body multi-slice CT scanner.

The subject device incorporates the latest reconstruction technology, AiCE-i for PET (Advanced Intelligent Clear-IQ Engine- integrated), intended to improve image quality and reduce image noise for FDG whole body data by employing deep learning artificial neural network methods which can more fully explore the statistical properties of the signal and noise of PET data. The AiCE algorithm will be able to better differentiate signal from noise and can be applied to improve image quality and denoising of PET images compared to conventional PET imaging reconstruction.

A Deviceless PET Respiratory gating system has been implemented for use with the subject device. With this subject device, respiration is extracted using a pre-trained neural network. Respiratory-gated reconstruction is performed at a speed equal to or faster than that with "Normal".

Here's a breakdown of the acceptance criteria and study details for the Cartesion Prime PET-CT System, based on the provided FDA 510(k) clearance letter:

Acceptance Criteria and Device Performance for Cartesion Prime PET-CT System (K251370)

The submission describes two primary feature enhancements: AiCE-i for PET (AiCE2) and Deviceless PET Respiratory gating system (DRG2).

1. Table of Acceptance Criteria and Reported Device Performance

2. Sample Size Used for the Test Set and Data Provenance

For AiCE-i for PET (AiCE2) - Clinical Images:

• Sample Size: 10 PET DICOM clinical 18F-FDG whole body cases.
• Data Provenance: Not explicitly stated, but the submission notes "selected to cover characteristics common to the intended U.S. patient population." The training data for AiCE2 is mentioned to have over half acquired from the U.S.

For Deviceless PET Respiratory Gating (DRG2) - Clinical Images:

• Sample Size: 10 patients.
• Data Provenance: Not explicitly stated, but the submission notes "selected to cover characteristics common to the intended U.S. patient population." The training data for DRG2 was acquired entirely from the U.S.

3. Number of Experts Used to Establish the Ground Truth for the Test Set and Qualifications

For AiCE-i for PET (AiCE2) - Clinical Images:

• Number of Experts: Three (3) physicians.
• Qualifications: At least 20 years of experience in nuclear medicine.

For Deviceless PET Respiratory Gating (DRG2) - Clinical Images:

• Number of Experts: Three (3) physicians.
• Qualifications: At least 20 years of experience in nuclear medicine.

4. Adjudication Method for the Test Set

The adjudication method is not explicitly stated as 2+1, 3+1, or none. However, for both clinical image evaluations, it states that "All three physicians reported/determined that..." This implies a consensus-based adjudication among the three experts was used to reach the conclusions. It does not indicate individual disagreements were arbitrated by a fourth reader.

5. If a Multi-Reader Multi-Case (MRMC) Comparative Effectiveness Study was Done

A formal MRMC comparative effectiveness study, designed to quantify the effect size of human readers improving with AI assistance, was not explicitly described in the provided text. The clinical image evaluations involved expert review and comparison, but the focus was on the algorithm's performance and image quality, not a direct measurement of human reader improvement with vs. without AI assistance.

6. If a Standalone (i.e. algorithm only without human-in-the loop performance) was Done

Yes, standalone performance was extensively evaluated for both features:

• AiCE-i for PET:
  • Bench tests for pediatric use (CRC, BGV, CNR, artifacts, SUVmean equivalence).
  • Bench tests for image intensity (SUV max/mean accuracy, tumor volume improvement).
  • Phantom testing (NEMA NU-2, Adult and Pediatric NEMA phantoms, Small Pool phantom) comparing AiCE2 to AiCE1 and conventional methods across quantitative metrics (SUVmean, BGV, CRC, SNR) and for artifact absence.
• Deviceless PET Respiratory Gating:
  • Bench tests for AI operational mode (equivalence to external device gating, improvements in SUV max/mean, tumor volume).
  • Evaluation against predicate DRG1 using reconstructed clinical raw data and quantified outputs.

7. The Type of Ground Truth Used

• For AiCE-i for PET (AiCE2):
  • Phantom Studies: Objective, physics-based ground truth (e.g., known sphere sizes, activity concentrations) for quantitative metrics like SUV, CRC, BGV, SNR.
  • Clinical Image Evaluation: Expert consensus/opinion of three nuclear medicine physicians for subjective assessments like diagnostic quality, image sharpness, and noise levels.
• For Deviceless PET Respiratory Gating (DRG2):
  • Bench Tests/Comparison to DRG1: Quantitative measurements of SUV (max and mean) and tumor volume from reconstructed data, likely compared against a known or established ground truth from reference reconstructions.
  • Clinical Image Evaluation: Expert consensus/opinion of three nuclear medicine physicians for subjective assessments related to diagnostic quality and motion correction effectiveness.

8. The Sample Size for the Training Set

• For AiCE-i for PET (AiCE2): Subset assembled from FDG studies of sixteen (16) cancer patients.
• For Deviceless PET Respiratory Gating (DRG2): FDG studies of 27 cancer patients.

9. How the Ground Truth for the Training Set was Established

The text indicates that both AI algorithms (AiCE2 and DRG2) use deep learning artificial neural network methods. The ground truth for training these networks is implicitly derived from the input PET data itself, with the algorithms learning statistical properties of signal and noise or motion patterns.

• For AiCE-i for PET: The algorithm was "trained to automatically adapt to different noise levels to produce consistently high-quality images." This suggests the training data contained examples of both "noisy" input and perhaps "ideal" or "denoised" outputs (or features that guided the network to achieve denoised outputs with improved image quality), where the "ground truth" was likely the desired image characteristics or underlying signal.
• For Deviceless PET Respiratory Gating: The neural network was "trained on FDG studies... to extract motion information from acquired PET data and to generate a corresponding gating signal." This implies the "ground truth" for training involved identifying and characterizing respiratory motion within the raw PET data, possibly using external motion tracking data if available during training, or highly curated datasets where experts delineated motion patterns. The text does not explicitly state how this ground truth was established, only that it was trained on these patient studies.

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The Carriere® Motion Pro® Clear Bite Corrector is intended to provide orthodontic movement and alignment of teeth during orthodontic treatment for Class II and Class III cases with symmetrical and asymmetrical malocclusions and Class I cases with mesially positioned maxillary molars or mandibular crowding. The appliance is indicated for use by dental and orthodontic professionals and is applicable to any patient demographic undergoing orthodontic treatment.

The Carriere Motion Pro Clear Bite Corrector is a single-use, direct bond, esthetic orthodontic appliance made of 17-4 stainless steel and polyethersulfone. It attaches the maxillary or mandibular canine or 1st premolar to the molar to provide a treatment solution for patients with malocclusions of primary, permanent, or mixed dentition. The Carriere Motion Pro Clear Bite Corrector is intended to provide orthodontic movement and alignment of teeth during orthodontic treatment for Class II and Class III cases with symmetrical and asymmetrical malocclusions and Class I cases with mesially positioned maxillary molars or mandibular crowding. The appliance is indicated for use by dental and orthodontic professionals and is applicable to any patient demographic undergoing orthodontic treatment. An optional drop-in hook, manufactured from 304 stainless steel, is included and is intended to work in conjunction with the Carriere Motion Pro Clear appliance to facilitate attachment of various orthodontic auxiliaries, such as elastomeric chain, nitinol springs, ligature wire, and elastics.

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The iCardio.ai CardioVision™ AI is an automated machine learning–based decision support system, indicated as a diagnostic aid for patients undergoing an echocardiographic exam consisting of a single PLAX view in an outpatient environment, such as a primary care setting.

When utilized by an interpreting clinician, this device provides information that may be useful in detecting moderate or severe aortic stenosis. iCardio.ai CardioVision™ AI is indicated in adult populations over 21 years of age. Patient management decisions should not be made solely on the results of the iCardio.ai CardioVision™ AI analysis. iCardio.ai CardioVision™ AI analyzes a single cine-loop DICOM of the parasternal long axis (PLAX).

The iCardio.ai CardioVision™ AI is a standalone image analysis software developed by iCardio.ai Corporation, designed to assist in the review of echocardiography images. It is intended for adjunctive use with other physical vital sign parameters and patient information, but it is not intended to independently direct therapy. The device facilitates determining whether an echocardiographic exam is consistent with aortic stenosis (AS), by providing classification results that support clinical decision-making.

The iCardio.ai CardioVision™ AI takes as input a DICOM-compliant, partial or full echocardiogram study, which must include at least one parasternal long-axis (PLAX) view of the heart and at least one full cardiac cycle. The device uses a set of convolutional neural networks (CNNs) to analyze the image data and estimate the likelihood of moderate or severe aortic stenosis. The output consists of a binary classification of "none/mild" or "moderate/severe," indicating whether the echocardiogram is consistent with moderate or severe aortic stenosis. In cases where the image quality is insufficient, the device may output an "indeterminate" result.

The CNNs and their thresholds are fixed prior to validation and do not continuously learn during standalone testing. These models are coupled with pre- and post-processing functionalities, allowing the device to integrate seamlessly with pre-existing medical imaging workflows, including PACS, DICOM viewers, and imaging worklists. The iCardio.ai CardioVision™ AI is intended to be used as an aid in diagnosing AS, with the final diagnosis always made by an interpreting clinician, who should consider the patient's presentation, medical history, and additional diagnostic tests.

Here's a breakdown of the acceptance criteria and the study proving the device meets them, based on the provided FDA 510(k) clearance letter for CardioVision™:

Acceptance Criteria and Reported Device Performance

Note: The document explicitly states that the levels of sensitivity and specificity exceed the predefined success criteria and those of the predicate device, supporting the claim of substantial equivalence. While exact numerical thresholds for the acceptance criteria aren't provided in terms of specific values, the narrative confirms they were met.

Study Details

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The Catalyst F1x Shoulder System is intended for use as a replacement of shoulder joints in anatomic or reverse arthroplasty. Should the need arise for a conversion from an anatomic total shoulder to a reverse total shoulder, the humeral stem can remain in place, while the articulating surfaces are exchanged.

ANATOMIC TOTAL SHOULDER OR HEMI-SHOULDER

The Catalyst F1x Shoulder System is indicated for use in skeletally mature individuals with degenerative diseases of the glenohumeral joint where hemi- or total shoulder arthroplasty is determined by the surgeon to be the preferred method of treatment. The Catalyst F1x Shoulder System is intended for use in patients with the following conditions where the humeral head, neck and glenoid vault are of sufficient bone stock and the rotator cuff is intact or reconstructable.

• Osteoarthritis
• Avascular Necrosis
• Rheumatoid Arthritis
• Post-traumatic Arthritis
• Correction of functional deformity

REVERSE TOTAL SHOULDER

The Catalyst F1x Shoulder System is a reverse total shoulder replacement for patients with a functional deltoid muscle and a grossly deficient rotator cuff joint suffering from pain and dysfunction due to:

• Severe arthropathy with a grossly deficient rotator cuff;
• Previously failed joint replacement with a grossly deficient rotator cuff;
• Fracture of glenohumeral joint from trauma or pathologic conditions of the shoulder including humeral head fracture, displaced 3- or 4-part fractures of proximal humerus, or reconstruction after tumor resection;
• Non-inflammatory degenerative disease including osteoarthritis and avascular necrosis of the natural humeral head and/or glenoid;
• Inflammatory arthritis including rheumatoid arthritis;
• Correction of functional deformity

Catalyst F1x press-fit stems are intended for cementless press-fit applications.

The Catalyst F1x cemented stems are intended for cemented fixation.

The Catalyst F1x stem is compatible with the implants from the Catalyst CSR System, Catalyst EA Convertible Shoulder System and R1 Shoulder Systems.

The Catalyst F1x Shoulder System is intended for use as a replacement of shoulder joints in anatomic or reverse arthroplasty. The stems can be used in conjunction with the Catalyst R1 Reverse Shoulder humeral articulating poly inserts and glenoid implants for use in reverse shoulder arthroplasty. The stems can also be used in conjunction with the Catalyst Convertible System and CSR System for use in total or hemi-shoulder arthroplasty. The design intent of the Catalyst F1x Shoulder System is to offer a unique solution for revision shoulder arthroplasty and for securing and immobilizing the greater and lesser tuberosities in the repair of proximal humerus fractures.

This submission for the Catalyst F1x Shoulder System is to add anatomic indications for the Catalyst F1x Shoulder System. This submission consists of proximal bodies, distal stems and locking screws. The fracture specific proximal bodies have asymmetric, right- and left-sided finned geometry to provide specific locations to reattach the greater and lesser tuberosities for a stable reconstruction of the proximal humerus. The proximal bodies will have a porous titanium structure on the bone engaging regions to enhance the mechanical fixation. The distal stems shall be provided in varying diameters to accommodate varying bone geometries. The distal stems will be offered in press-fit and cemented versions. The press-fit distal stems shall have a tapered, splined proximal geometry with an HA (hydroxyapatite) coating. The cemented stems shall have a smooth stem geometry. The proximal bodies and distal stems shall be secured together using a mechanical taper interface that is supplemented with a locking screw.

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The Carrier XL Delivery Catheter is intended for general intravascular use, including the peripheral, coronary and neuro vasculature for the infusion of diagnostic agents, such as contrast media, and to assist in the delivery of interventional devices, such as distal access catheters, in the neurovasculature.

The Carrier XL Delivery Catheter is a single lumen, variable stiffness, composite catheter. The design facilitates the advancement of the catheter and is intended to assist the delivery of interventional devices in the peripheral and neurovasculature. The outer surface of the Carrier XL Delivery Catheter is coated with a hydrophilic coating to increase lubricity. The proximal end of the Carrier XL Delivery Catheter incorporates a luer fitting for the attachment of accessories. Two radiopaque markers at the distal end help to facilitate fluoroscopic visualization. A Steam Shaping Mandrel and Peel-away Introducer Tube are included within the tray. The Carrier XL Delivery Catheter is provided sterile, non-pyrogenic, and is intended for single use only.

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The Intended Use of the Cannulated Screw and Kirschner (Kwire) System is for the treatment and fixation of bone fractures and osteotomies of various bones including the clavicle, acetabulum, pelvis, scapula, humerus, radius, ulna, femur, tibia, phalanges, carpals, metacarpals, tarsals, metatarsals and fibula.

Cannulated Screws and Kwires are a self-tapping, self-drilling screw with a cortico/cancellous or cancellous thread that can be guided into position by Kwire placement. Partial or fully threaded screws are available in various different lengths and diameters to provide fixation in various size bones. The screws are made of Titanium Alloy or Stainless Steel. The Kirschner Wires (Kwires) are threaded, spaded or blunt ranging from 0.8 to 1.4mm in diameter and ranging from 100 to 200mm in length and made of 316L Stainless Steel.

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The Carpentier-Edwards Physio annuloplasty ring is intended for the correction of mitral valve insufficiency, or mixed mitral insufficiency and stenosis, where treatment does not necessitate a replacement of the natural mitral valve.

The Carpentier-Edwards Physio annuloplasty ring, Model 4450 is constructed of Elgiloy bands separated by polyester film strips and has a sewing ring margin that consists of a layer of silicone rubber covered with a woven polyester cloth.

The mitral annuloplasty ring conforms to the configuration of a normal mitral annulus. It is kidney-shaped with one long curved segment corresponding to the posterior leaflet annulus. A rectilinear portion corresponds to the anterior leaflet annulus. Transverse colored threads indicate the anterior and posterior commissures.

The ring exhibits characteristics of differential flexibility. While retaining stiffness, the annuloplasty ring is also flexible in the portion corresponding to the anterior leaflet. The flexibility is increased in the posterior regions of the ring. Along the annular plane the ring is stable with a saddle-shaped curve for apposition to the aortic root.

The design is intended to provide support after annuloplasty surgery. The ring maintains a fixed maximum annular dimension to prevent excessive distension of the natural valve annulus while adapting to the dynamic motion of the mitral annulus throughout the cardiac cycle.

The holder, designed to facilitate ring implantation, is manufactured from an amorphous polymer. The annuloplasty ring is mounted on the holder with three retaining sutures.

The handle, Model 1150, may be utilized in conjunction with the holder to facilitate ease of suture placement and implantation. The middle section of the handle is malleable, allowing the handle to be adjusted (bent) in a configuration convenient for use. The handle is packaged separately. The snap assembly of the handle and holder allows for connecting and disconnecting the two components at appropriate times during the surgical procedure.

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