K Number
K143079
Device Name
Endovascular Stent Planning Software
Manufacturer
Date Cleared
2014-12-04

(38 days)

Product Code
Regulation Number
892.2050
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
Vitrea® is a medical diagnostic system that allows the processing, review, analysis, communication and media interchange of multi-dimensional digital images acquired from a variety of imaging devices. Vitrea is not meant for primary image interpretation in mammography. Vitrea has the following additional indication: The Endovascular Stent Planning Software application is intended for use with CT (computed tomography) images to assist medical professionals in the analysis, treatment and follow-up of aortic vascular disorders that may require a stent procedure. The software provides 3D segmentation of the aorta and initializes stent measurements based on a template provided by the stent manufacturers. The user can review the 2D and 3D images, verify and correct the results of the segmentation and initialization, and generate a report with the stent measurements.
Device Description
The Endovascular Stent Planning software is intended for use with CT (computed tomography) images to assist medical professionals in the analysis, treatment and follow-up of aortic vascular disorders that may require a stent procedure. The endovascular stent planning application module enables visualization and measurements of the aortic vessel for evaluation, treatment and follow up for aortic vascular disorders that may require a stent procedure. The software performs automated 3D segmentation of the aorta and initializes stent measurements based on a template provided by the stent manufacturers. The physicians can review the 2D and 3D images, verify and correct the results of the segmentation and initialization, and generate a report with the stent measurements, in a fast and efficient manner. The software provides imaging information as an assist to the physician. The software does not provide diagnostic information or determine recommended medical care. In summary, the software provides: - Automated segmentation of the aortic vessel, including thrombus with centerline . and contour editing tools - . Stent-graft templates for abdominal and thoracic aortic aneurysms - User-quided workflow with automated identification of anatomical landmarks and automated initialization of endovascular measurements (diameters, lengths, angles, volumes) based on the stent template selection, with easy centerline and contour editing tools - Auto-populated reporting worksheet with selected stent template measurements ● - Key measurements that helps medical professionals to identify location of . fenestrations to support fenestrated stent planning by adding the clock angle tool and the clock angle overlay functionality - . Create new, add/or modify, stent planning templates with the Custom Device Template Editor - Data tables export results to CSV ● - Multi-study support for longitudinal comparison ● - 3D measurement overview for streamlined communication of results ● - Volume measurements for pre and post aneurysmal size measurement ● - Workflows for pre-treatment (stent, surgery) planning and post-treatment follow ● up, including a side-by-side comparative review layout and longitudinal measurements
More Information

Not Found

Unknown
The description mentions "automated 3D segmentation" and "automated identification of anatomical landmarks," which could be implemented using AI/ML techniques, but the document does not explicitly state that AI/ML is used. The "Mentions AI, DNN, or ML" section is marked as "Not Found," further suggesting the absence of explicit AI/ML claims.

No
The device is described as a medical diagnostic system and a planning tool, which assists medical professionals in the analysis, treatment, and follow-up of aortic vascular disorders, but it does not directly perform any therapeutic action.

No

The "Intended Use / Indications for Use" section states: "Vitrea® is a medical diagnostic system... Vitrea is not meant for primary image interpretation in mammography." However, the "Device Description" explicitly states, "The software does not provide diagnostic information or determine recommended medical care." This indicates that while the broader Vitrea system may have diagnostic capabilities, the specific Endovascular Stent Planning software described is not a diagnostic device.

Yes

The device description explicitly states it is "software" and details its functions related to processing and analyzing CT images for stent planning. There is no mention of accompanying hardware components being part of the device itself.

Based on the provided information, this device is not an IVD (In Vitro Diagnostic).

Here's why:

  • IVD Definition: In Vitro Diagnostics are tests performed on samples taken from the human body, such as blood, urine, or tissue, to detect diseases, conditions, or infections.
  • Device Function: The description clearly states that Vitrea® and its Endovascular Stent Planning software process and analyze digital images acquired from imaging devices (specifically CT scans). It does not involve the analysis of biological samples.
  • Intended Use: The intended use is to assist medical professionals in the analysis, treatment, and follow-up of aortic vascular disorders using imaging data. It explicitly states it's not for primary image interpretation in mammography (which is also image-based, not IVD).
  • Device Description: The description focuses on image processing, segmentation, measurement, and reporting based on CT images. There is no mention of handling or analyzing biological samples.

Therefore, this device falls under the category of medical imaging software or a medical image analysis system, not an In Vitro Diagnostic device.

N/A

Intended Use / Indications for Use

Vitrea® is a medical diagnostic system that allows the processing, review, analysis, communication and media interchange of multi-dimensional digital images acquired from a variety of imaging devices. Vitrea is not meant for primary image interpretation in mammography. Vitrea has the following additional indication:

The Endovascular Stent Planning Software application is intended for use with CT (computed tomography) images to assist medical professionals in the analysis, treatment and follow-up of aortic vascular disorders that may require a stent procedure. The software provides 3D segmentation of the aorta and initializes stent measurements based on a template provided by the stent manufacturers. The user can review the 2D and 3D images, verify and correct the results of the segmentation and initialization, and generate a report with the stent measurements.

Product codes (comma separated list FDA assigned to the subject device)

LLZ

Device Description

The Endovascular Stent Planning software is intended for use with CT (computed tomography) images to assist medical professionals in the analysis, treatment and follow-up of aortic vascular disorders that may require a stent procedure. The endovascular stent planning application module enables visualization and measurements of the aortic vessel for evaluation, treatment and follow up for aortic vascular disorders that may require a stent procedure. The software performs automated 3D segmentation of the aorta and initializes stent measurements based on a template provided by the stent manufacturers. The physicians can review the 2D and 3D images, verify and correct the results of the segmentation and initialization, and generate a report with the stent measurements, in a fast and efficient manner.

The software provides imaging information as an assist to the physician. The software does not provide diagnostic information or determine recommended medical care. In summary, the software provides:

  • Automated segmentation of the aortic vessel, including thrombus with centerline . and contour editing tools
  • . Stent-graft templates for abdominal and thoracic aortic aneurysms
  • User-quided workflow with automated identification of anatomical landmarks and automated initialization of endovascular measurements (diameters, lengths, angles, volumes) based on the stent template selection, with easy centerline and contour editing tools
  • Auto-populated reporting worksheet with selected stent template measurements ●
  • Key measurements that helps medical professionals to identify location of . fenestrations to support fenestrated stent planning by adding the clock angle tool and the clock angle overlay functionality
  • . Create new, add/or modify, stent planning templates with the Custom Device Template Editor
  • Data tables export results to CSV ●
  • Multi-study support for longitudinal comparison ●
  • 3D measurement overview for streamlined communication of results ●
  • Volume measurements for pre and post aneurysmal size measurement ●
  • Workflows for pre-treatment (stent, surgery) planning and post-treatment follow ● up, including a side-by-side comparative review layout and longitudinal measurements

Mentions image processing

Yes

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

CT (computed tomography)

Anatomical Site

aortic vascular disorders, aorta, aortic vessel

Indicated Patient Age Range

Not Found

Intended User / Care Setting

medical professionals, vascular surgeon or interventional cardiologist

Description of the training set, sample size, data source, and annotation protocol

Not Found

Description of the test set, sample size, data source, and annotation protocol

Not Found

Summary of Performance Studies (study type, sample size, AUC, MRMC, standalone performance, key results)

Study Type: Verification, validation, and evaluation

Sample Size: Not specified

Key Results:
Software testing was completed to ensure the new feature operates according to its requirements. Testing included verification, validation, and evaluation on previously acquired medical images.

Verification: Test cases were executed against the system features and requirements to assure that the software fully satisfies all expected system requirements and features.

Validation: Workflow testing was conducted to assure the software conforms to user needs and intended use.

External Validation: Experienced medical professionals evaluated the application and confirmed that the Fenestrated Stent Planning using Endovascular Stent Planning software was safe and effective and met the intended use.

Summary of Clinical Tests: The subject of special 510(k) notification, Endovascular Stent Planning software, did not require clinical studies to support safety and effectiveness of the software.

Key Metrics (Sensitivity, Specificity, PPV, NPV, etc.)

Not Found

Predicate Device(s): If the device was cleared using the 510(k) pathway, identify the Predicate Device(s) K/DEN number used to claim substantial equivalence and list them here in a comma separated list exactly as they appear in the text. List the primary predicate first in the list.

K091498

Reference Device(s): Identify the Reference Device(s) K/DEN number and list them here in a comma separated list exactly as they appear in the text.

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information for the subject device only (e.g. presence / absence, what scope was granted / cleared under the PCCP, any restrictions, etc).

Not Found

§ 892.2050 Medical image management and processing system.

(a)
Identification. A medical image management and processing system is a device that provides one or more capabilities relating to the review and digital processing of medical images for the purposes of interpretation by a trained practitioner of disease detection, diagnosis, or patient management. The software components may provide advanced or complex image processing functions for image manipulation, enhancement, or quantification that are intended for use in the interpretation and analysis of medical images. Advanced image manipulation functions may include image segmentation, multimodality image registration, or 3D visualization. Complex quantitative functions may include semi-automated measurements or time-series measurements.(b)
Classification. Class II (special controls; voluntary standards—Digital Imaging and Communications in Medicine (DICOM) Std., Joint Photographic Experts Group (JPEG) Std., Society of Motion Picture and Television Engineers (SMPTE) Test Pattern).

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Food and Drug Administration 10903 New Hampshire Avenue Document Control Center - WO66-G609 Silver Spring, MD 20993-0002

December 4, 2014

Vital Images, Inc. % Mr. Parthiv Shah Sr. Regulatory Affairs Specialist 5850 Opus Parkway, Suite 300 MINNETONKA MN 55343

Re: K143079

Trade/Device Name: Endovascular Stent Planning Software Regulation Number: 21 CFR 892.2050 Regulation Name: Picture archiving and communications system Regulatory Class: II Product Code: LLZ Dated: October 24, 2014 Received: October 27, 2014

Dear Mr. Shah:

We have reviewed your Section 510(k) premarket notification of intent to market the device referenced above and have determined the device is substantially equivalent (for the indications for use stated in the enclosure) to legally marketed predicate devices marketed in interstate commerce prior to May 28, 1976, the enactment date of the Medical Device Amendments, or to devices that have been reclassified in accordance with the provisions of the Federal Food. Drug. and Cosmetic Act (Act) that do not require approval of a premarket approval application (PMA). You may, therefore, market the device, subject to the general controls provisions of the Act. The general controls provisions of the Act include requirements for annual registration, listing of devices, good manufacturing practice, labeling, and prohibitions against misbranding and adulteration. Please note: CDRH does not evaluate information related to contract liability warranties. We remind you, however, that device labeling must be truthful and not misleading.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to additional controls. Existing major regulations affecting your device can be found in the Code of Federal Regulations, Title 21. Parts 800 to 898. In addition, FDA may publish further announcements concerning your device in the Federal Register.

Please be advised that FDA's issuance of a substantial equivalence determination does not mean that FDA has made a determination that your device complies with other requirements of the Act or any Federal statutes and regulations administered by other Federal agencies. You must comply with all the Act's requirements, including, but not limited to: registration and listing (21 CFR Part 807); labeling (21 CFR Part 801); medical device reporting (reporting of medical device-related adverse events) (21 CFR 803); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820); and if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

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If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please contact the Division of Industry and Consumer Education at its toll-free number (800) 638 2041 or (301) 796-7100 or at its Internet address

http://www.fda.gov/MedicalDevices/Resourcesfor You/Industry/default.htm. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR Part 807.97). For questions regarding the reporting of adverse events under the MDR regulation (21 CFR Part 803), please go to

http://www.fda.gov/MedicalDevices/Safety/ReportaProblem/default.htm for the CDRH's Office of Surveillance and Biometrics/Division of Postmarket Surveillance.

You may obtain other general information on your responsibilities under the Act from the Division of Industry and Consumer Education at its toll-free number (800) 638-2041 or (301) 796-7100 or at its Internet address

http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm.

Sincerely yours,

Robert A Ochs

for

Janine M. Morris Director Division of Radiological Health Office of In Vitro Diagnostics and Radiological Health Center for Devices and Radiological Health

Enclosure

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Indications for Use

510(k) Number (if known) K143079

Device Name Endovascular Stent Planning Software

Indications for Use (Describe)

Vitrea® is a medical diagnostic system that allows the processing, review, analysis, communication and media interchange of multi-dimensional digital images acquired from a variety of imaging devices. Vitrea is not meant for primary image interpretation in mammography. Vitrea has the following additional indication:

The Endovascular Stent Planning Software application is intended for use with CT (computed tomography) images to assist medical professionals in the analysis, treatment and follow-up of aortic vascular disorders that may require a stent procedure. The software provides 3D segmentation of the aorta and initializes stent measurements based on a template provided by the stent manufacturers. The user can review the 2D and 3D images, verify and correct the results of the segmentation and initialization, and generate a report with the stent measurements.

Type of Use (Select one or both, as applicable)X Prescription Use (Part 21 CFR 801 Subpart D)

Over-The-Counter Use (21 CFR 801 Subpart C)

CONTINUE ON A SEPARATE PAGE IF NEEDED.

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Image /page/3/Picture/0 description: The image shows the word "VITAL" in large, bold, black letters. Below the word "VITAL" is the text "A Toshiba Medical Systems Group Company" in a smaller, red font. The dot on the "i" in "VITAL" is a circle.

510(k) Summary

This 510(k) summary is submitted in accordance with the requirements of 21 C.F.R. Part 807.92(c)

| Purpose of
Submission: | Vital Images, Inc. hereby submits this special 510(k) to provide a
notification submission for proposed software changes in the already
510(k) cleared Endovascular Stent Planning software (K091498). |
|-----------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Submitter: | Vital Images, Inc.
5850 Opus Parkway
Suite 300
Minnetonka, MN, 55343-4414 |
| Establishment
Registration: | 2134213 |
| Contact Person: | Parthiv Shah
Sr. Regulatory Affairs Specialist
Phone : 952-487-9574
Fax: 952-487-9510
E-mail: pshah@vitalimages.com |
| 510(k) Type: | Special |
| Summary Date: | October 24, 2014 |
| Device Trade Name: | Endovascular Stent Planning Software |
| Device Common
Name: | Radiological Image Processing Software |
| Device
Classification
Name: | System, Image Processing, Radiological |
| Regulatory
Description: | Picture Archiving and Communications System |
| Regulation Number: | 21 CFR 892.2050 |
| Product Code: | LLZ |
| Regulatory
Classification: | Class II |

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Image /page/4/Picture/0 description: The image shows the word "VITAL" in large, bold, black letters. Below the word "VITAL" is the phrase "A Toshiba Medical Systems Group Company" in a smaller, red font. The word "VITAL" is the main focus of the image, with the company affiliation provided as additional context.

Predicate Device:

Predicate DeviceManufacturerFDA 510(k) number
Endovascular Stent Planning
(Legally Marketed Device)Vital Images, Inc.K091498

Device Description:

The Endovascular Stent Planning software is intended for use with CT (computed tomography) images to assist medical professionals in the analysis, treatment and follow-up of aortic vascular disorders that may require a stent procedure. The endovascular stent planning application module enables visualization and measurements of the aortic vessel for evaluation, treatment and follow up for aortic vascular disorders that may require a stent procedure. The software performs automated 3D segmentation of the aorta and initializes stent measurements based on a template provided by the stent manufacturers. The physicians can review the 2D and 3D images, verify and correct the results of the segmentation and initialization, and generate a report with the stent measurements, in a fast and efficient manner.

The software provides imaging information as an assist to the physician. The software does not provide diagnostic information or determine recommended medical care. In summary, the software provides:

  • Automated segmentation of the aortic vessel, including thrombus with centerline . and contour editing tools
  • . Stent-graft templates for abdominal and thoracic aortic aneurysms
  • User-quided workflow with automated identification of anatomical landmarks and automated initialization of endovascular measurements (diameters, lengths, angles, volumes) based on the stent template selection, with easy centerline and contour editing tools
  • Auto-populated reporting worksheet with selected stent template measurements ●
  • Key measurements that helps medical professionals to identify location of . fenestrations to support fenestrated stent planning by adding the clock angle tool and the clock angle overlay functionality
  • . Create new, add/or modify, stent planning templates with the Custom Device Template Editor
  • Data tables export results to CSV ●
  • Multi-study support for longitudinal comparison ●
  • 3D measurement overview for streamlined communication of results ●
  • Volume measurements for pre and post aneurysmal size measurement ●
  • Workflows for pre-treatment (stent, surgery) planning and post-treatment follow ● up, including a side-by-side comparative review layout and longitudinal measurements

Intended Use / Indications for Use:

Vitrea is a medical diagnostic system that allows the processing, review, analysis, communication and media interchange of multi-dimensional digital images acquired from a variety of imaging devices. Vitrea is not meant for primary image interpretation in mammography. Vitrea has the following additional indication:

The Endovascular Stent Planning Software application is intended for use with CT (computed tomography) images to assist medical professionals in the analysis, treatment and follow-up of aortic vascular disorders that may require a stent procedure. The software provides 3D

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segmentation of the aorta and initializes stent measurements based on a template provided by the stent manufacturers. The user can review the 2D and 3D images, verify and correct the results of the segmentation and initialization, and generate a report with the stent measurements.

Rationale for Adding Clock Angle Tool in the Software

Typically, a vascular surgeon or interventional cardiologist is responsible for all necessary stent planning procedures, which includes identifying necessary anatomical measurements from patient's CT scan data for proper size stent selection including fenestrated stents, which is required for patients whose aneurysm begins close to the renal arteries (i.e. an inadequate length of suitable aorta for the standard stent.) The surgeon/ cardiologist prefer to have a "Clock Angle" tool in the software that can provide additional measurements required to fill order sheet for ordering fenestrated stent.

The clock angle tool provides a special set of measurements required on fenestrated stent sizing worksheet. The Clock Angle tool provides a time relative to a noon marker. This provides information for designating vessel locations relative to a common frame of reference.

Generally, the responsible surgeon/cardiologist and manufacturer will re-verify software provided measurements by other standardized methods before finalizing fenestrated stent sizing for a patient.

Intended for Disease / Condition / Patient Population:

The Endovascular Stent Planning Software application is intended for assisting medical professionals in the analysis, treatment and follow-up of aortic vascular disorders that may require a stent procedure.

Substantial Equivalence Comparison:

| Criteria | Legally Marketed Device
Endovascular Stent Planning
Software (K091498) | Modified Subject
Device | Comparison |
|---------------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|------------|
| Device Type /
Classification Name | System, Image Processing,
Radiological | System, Image
Processing,
Radiological | Same |
| Common Name | Radiological Image
Processing Software | Radiological Image
Processing Software | Same |
| Regulation /
Classification Number | 21 CFR 892.2050 | 21 CFR 892.2050 | Same |
| Product Code | LLZ | LLZ | Same |
| Classification | Class II | Class II | Same |
| Review Panel | Radiology | Radiology | Same |
| Criteria | Legally Marketed
Device
Endovascular Stent
Planning Software
(K091498) | Modified Subject
Device | Comparison |
| Indications for Use | Vitrea® is a medical
diagnostic system that
allows the processing,
review, analysis,
communication and
media interchange of
multi-dimensional
digital images
acquired from a
variety of imaging
devices. Vitrea is not
meant for primary
image interpretation in
mammography. Vitrea
has the following
additional indication:
| Vitrea® is a medical
diagnostic system that
allows the processing,
review, analysis,
communication and
media interchange of
multi-dimensional
digital images
acquired from a
variety of imaging
devices. Vitrea is not
meant for primary
image interpretation in
mammography. Vitrea
has the following
additional indication:

The Endovascular
Stent Planning
Software application is
intended for use with
CT (computed
tomography) images
to assist medical
professionals in the
analysis, treatment
and follow-up of aortic
vascular disorders that
may require a stent
procedure. The
software provides 3D
segmentation of the
aorta and initializes
stent measurements
based on a template
provided by the stent
manufacturers. | Same |
| Criteria | Legally Marketed
Device
Endovascular Stent
Planning Software
(K091498) | Modified Subject
Device | Comparison |
| | The user can review
the 2D and 3D
images, verify and
correct the results of
the segmentation and
initialization, and
generate a report with
the stent
measurements. | The user can review
the 2D and 3D
images, verify and
correct the results of
the segmentation and
initialization, and
generate a report with
the stent
measurements. | |

Regulatory Comparison .

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Image /page/6/Picture/0 description: The image shows the word "VITAL" in a bold, sans-serif font. The "i" in "VITAL" has a circular dot above it. Below the word "VITAL" is the text "A Toshiba Medical Systems Group Company" in a smaller, red font.

Intended Use Comparison ●

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Image /page/7/Picture/0 description: The image shows the word "VITAL" in large, bold, black letters. Below the word "VITAL" is the text "A Toshiba Medical Systems Group Company" in a smaller, red font. The text is centered below the word "VITAL".

Technology Comparison ●

| Feature | Legally Marketed
Device
Endovascular Stent
Planning Software
(K091498) | Modified Subject
Device | Comparison |
|--------------------------------------------------------------------------------------------------------------------------------------|------------------------------------------------------------------------------------|---------------------------------|------------|
| Vessel segmentation
of the aortic vessel,
including thrombus
and centerline
extraction | Yes | Yes | Same |
| Custom or
manufacture stent
graft specific
worksheet templates | Yes | Yes | Same |
| Yes
Initialization of
endovascular
measurements | | Yes | Same |
| Display of image side
Yes
by side in 3D and
MPR | | Yes | Same |
| Yes
Manual centerline
and contour editing
tools | | Yes | Same |
| Feature | Legally Marketed Device
Endovascular Stent
Planning Software
(K091498) | Modified Subject
Device | Comparison |
| Sequential viewing | Yes | Yes | Same |
| Diameter, Area,
Lengths, Stenosis
measurements | Yes | Yes | Same |
| Tortuosity, Angle,
Volume
measurements | Yes | Yes | Same |
| Intensity (HU) based
color coding of vessel
lumen and wall
regions | Yes | Yes | Same |
| DICOM Modality | CT | CT | Same |
| Hardware
Requirements | Identical to Vitrea
platform | Identical to Vitrea
platform | Same |
| Software
Requirements | Identical to Vitrea
platform | Identical to Vitrea
platform | Same |
| Tool: Ruler
It provides a length
measurement
between 2
points. Used
commonly for
diameters of vessels. | Yes | Yes | Same |
| Tool: Length
It provides a length
between 2 centerline
points along the
centerline. | Yes | Yes | Same |
| Feature | Legally Marketed
Device
Endovascular Stent
Planning Software
(K091498) | Modified Subject
Device | Comparison |
| Tool: Angle
It provides an angle in
degrees derived from
3 points which create
2 line segments. | Yes | Yes | Same |
| Tool: Volume
It provides a volume
of a given region by
adding all the voxels
contained within the
region of interest. | Yes | Yes | Same |

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Image /page/8/Picture/0 description: The image shows the word "VITAL" in large, bold, black letters. Below the word "VITAL" is the text "A Toshiba Medical Systems Group Company" in a smaller, red font. The text is centered below the word "VITAL".

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Image /page/9/Picture/0 description: The image shows the word "VITAL" in large, bold, black letters. Below the word "VITAL" is the phrase "A Toshiba Medical Systems Group Company" in a smaller, red font. The word "VITAL" is the main focus of the image, with the company affiliation provided as additional context.

● Differences in Technology

| Feature | Legally Marketed
Device
Endovascular Stent
Planning Software
(K091498) | Modified Subject
Device | Comparison |
|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------|------------------------------------------------------------------------------------|----------------------------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Tool: Clock Angle
It provides a time
relative to a noon
marker. This is a way
of designating vessel
locations relative to a
common frame of
reference. | No | Yes | The added feature
does not affect the
intended use or
fundamental scientific
technology of already
cleared Endovascular
Stent Planning
Software (K091498). |

● Substantial Equivalence Analysis

The addition of Clock Angle tool and related measurements do not affect the intended use or alter the fundamental scientific technology of legally marketed Endovascular Stent Planning software (K091498). The modified Endovascular Stent Planning software has the same indications for use, principle of operation, and performs the same technological functions as already cleared Endovascular Stent Planning software - K091498 (Predicate Device). The modifications are not consequential from the standpoint of device operation, safety, effectiveness or intended use.

Any minor differences noted have been explained and do not raise any new questions of safety or effectiveness when used as labeled. The implemented design mitigations,

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Image /page/10/Picture/1 description: The image shows the word "VITAL" in large, bold, black letters. Below the word "VITAL" is the phrase "A Toshiba Medical Systems Group Company" in a smaller, red font. The text is centered and the background is white. The logo is simple and modern.

labeling, and the performed verification and validation tests demonstrate the safety and efficacy of the device is equivalent to the predicate device. Based on the comparison data and test data. Vital Images believes the subject device should be found substantially equivalent to the predicate device.

Summary of Non-Clinical Tests:

The changes to the Endovascular Stent Planning software was designed developed and tested according to written procedures that included applying risk management. Software testing was completed to ensure the new feature operates according to its requirements.

Testing included verification, validation, and evaluation on previously acquired medical images. The following quality assurance measures were applied to the development:

  • Risk Management
  • . Requirements reviews
  • Code designs ●
  • Code reviews .
  • Design reviews ●
  • Verification of the software - that included performance, phantom, and safety testing
  • Validation of the software that included simulated usability testing by independent ● experienced medical professionals.

Risk Management:

Each risk pertaining to this feature has been individually assessed to determine if the benefits outweigh the risk. Every risk has been reduced as low as possible and has been evaluated to have a probability of occurrence of harm of "Improbable." All risks for this feature were collectively reviewed to determine if the benefits outweigh the risk. Based on the post market information contained in our Clinical Evaluation Report, injury or death is very rare for our product and products similar to ours. Because of this history and because of the risk control measures included in this feature, it is believed that the risk for the feature as a whole is extremely low. Taking into account all risks against the benefits of this feature, it has been assessed that the benefits do outweigh the risks for this feature.

During the design review, the following conclusions were reached:

  • All risks were reduced as low as possible ●
  • The medical benefits of the device outweigh the residual risk for each individual risk ● and all risks together
  • o The overall residual risk for the project is deemed acceptable

Verification:

The software verification team's primary goal was to assure that the software fully satisfies all expected system requirements and features. Test cases were executed against the system features and requirements. As a part of creating the test cases, the verification team reviewed and monitored the Requirements Traceability Matrix ("RTM") to ensure coverage of the items within the RTM.

Validation:

The software validation team's primary goal was assuring the software conforms to user needs and intended use. The validation team conducted workflow testing that provided evidence that the system requirements and features were implemented, reviewed and met.

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Image /page/11/Picture/1 description: The image shows the word "VITAL" in large, bold, black letters. Below the word "VITAL" is the phrase "A Toshiba Medical Systems Group Company" in a smaller, red font. The word "VITAL" is the main focus of the image, with the company affiliation provided as additional context.

External Validation:

During external validation of enhanced Endovascular Stent Planning software, experienced medical professionals evaluated the application. Both validators confirmed that the Fenestrated Stent Planning using Endovascular Stent Planning software was safe and effective and met the intended use of assisting medical professionals in the analysis, treatment, and follow-up of aortic vascular disorders that may require a stent procedure.

Summary of Clinical Tests:

The subject of special 510(k) notification, Endovascular Stent Planning software, did not require clinical studies to support safety and effectiveness of the software.

Cyber and Information Security:

  • Confidentiality .
    The Vitrea platform (K071331) relies on built in Windows Login security to limit access to the system. The Vitrea platform can only be installed and configured by an administrator of the Windows machine.

  • . Intearitv
    The Vitrea platform complies with the DICOM standard for transfer and storage of this data and does not modify the contents of DICOM instances. The Vitrea platform identifies the data it produces, marking and encoding the appropriate DICOM fields.

  • o Availabilitv
    The Vitrea platform is always available to the logged on user as long as the Windows machine itself is properly maintained.

  • Accountability
    The Vitrea platform includes an audit capability that enables accountability by tracking authenticated and authorized user operations along with information accessed. Vitrea audit logs are time stamped, enabling correlation with Windows system logging to track information accessed by a user.

Performance Standards:

The FDA has not established mandatory performance standards and no special controls exist for this device. General software verification and validation tests were conducted to confirm proper function of the device's features.

The Endovascular Stent Planning software complies with the following voluntary recognized consensus standards:

| Standard No. | Standards
Organization | Standard Title | Version | Date |
|----------------------------------------------------------|---------------------------|---------------------------------------------------------------------------------|---------|------------|
| PS 3.1- 3.20
(2011)
(Recognition
Number 12-238) | NEMA | Digital Imaging and
Communications in
Medicine (DICOM) Set
(Radiology) | 3 | 03/16/2012 |
| ISO 14971:2007
(Recognition
Number 5-70) | AAMI / ANSI
/ ISO | Medical Devices -
Applications of Risk
Management to Medical
Devices | 2007 | 03/16/2012 |

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Image /page/12/Picture/0 description: The image shows the word "VITAL" in large, bold, black letters. The dot on the "i" is a perfect circle. Below the word "VITAL" is the phrase "A Toshiba Medical Systems Group Company" in a smaller, red font. The text is centered.

| Standard No. | Standards
Organization | Standard Title | Version | Date |
|-------------------------------------------------|---------------------------|-------------------------------------------------------------------------------------------|---------|------------|
| IEC 62304:2006
(Recognition
Number 13-32) | AAMI / ANSI
/ IEC | Medical Device Software -
Software Life Cycle
Processes (Software /
Informatics) | 2006 | 08/20/2012 |

Conclusion:

Vital Images believes that Endovascular Stent Planning software application has a substantially equivalent intended use, indications for use, principle of operation, and technological characteristics as the predicate device. Any minor differences noted have been explained and do not raise any new questions of safety or effectiveness as the predicate device. The implemented design mitigations, labeling, and performed tests demonstrate the safety and efficacy of the device in comparison to the predicate device. Based on the comparison data and test data Vital Images believes, the subject device should be found substantially equivalent to the predicate device. The Endovascular Stent Planning software device is as safe and effective as the predicate device.