K Number
K203679
Device Name
Automatic Registration
Manufacturer
Date Cleared
2021-03-18

(91 days)

Product Code
Regulation Number
882.4560
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
Automatic Registration is a surgical device for image guided surgery intended to be used in combination with compatible Brainlab navigation systems. Automatic Registration provides an image registration for intraoperatively acquired 3D CT/ CBCT or fluoroscopic images. It consists of the software module Automatic Registration and hardware accessories.
Device Description
The Subject Device is intended to be used in combination with compatible Brainlab navigation systems. Automatic Registration provides an image registration for intraoperatively acquired 3D CT/CBCT or fluoroscopic images. It consists of the software module Automatic Registration and hardware accessories. In a spinal context, Automatic Registration serves as accessory to the Spine & Trauma navigation system. The Matrices are reusable devices delivered in non-sterile condition. The devices makes the Correlation ("Registration") of Intraoperative acquired patient data to the surgical environment possible by determining its position in relation to the patient and the navigated instruments.
More Information

No
The summary describes an image registration process based on hardware accessories (Matrices) and software, but there is no mention of AI, ML, or related concepts like training/test sets for such algorithms. The performance testing focuses on traditional accuracy metrics and comparison to a predicate device, not on AI/ML model performance.

No.
The device is described as a surgical device for image-guided surgery, providing image registration for intraoperatively acquired images. Its function is to assist in surgery by correlating patient data to the surgical environment, rather than treating a disease or condition itself.

No

This device is described as a surgical device for image-guided surgery that provides image registration to correlate intraoperatively acquired patient data with the surgical environment. Its function is to facilitate navigation during surgery, not to diagnose a condition or disease.

No

The device description explicitly states that it "consists of the software module Automatic Registration and hardware accessories." It also mentions "Matrices" which are described as reusable devices used for correlation and determining position, indicating a physical component.

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

Here's why:

  • Intended Use: The intended use clearly states it is a "surgical device for image guided surgery." IVD devices are intended for use in vitro (outside the body) to examine specimens derived from the human body to provide information for diagnosis, monitoring, or treatment. This device is used in vivo (within the body) during surgery.
  • Device Description: The description reinforces its role in "image guided surgery" and as an "accessory to the Spine & Trauma navigation system." It facilitates the correlation of intraoperative images to the surgical environment, which is a surgical function, not an in vitro diagnostic function.
  • Function: The core function is "image registration" to align intraoperative images with the surgical environment for navigation. This is a tool for guiding surgical procedures, not for analyzing biological samples.

The device's purpose is to assist the surgeon during a procedure by providing accurate spatial information based on imaging, which is a characteristic of surgical navigation systems, not IVD devices.

N/A

Intended Use / Indications for Use

Automatic Registration is a surgical device for image guided surgery intended to be used in combination with compatible Brainlab navigation systems. Automatic Registration provides an image registration for intraoperatively acquired 3D CT/ CBCT or fluoroscopic images. It consists of the software module Automatic Registration and hardware accessories.

Product codes

OLO

Device Description

The Subject Device is intended to be used in combination with compatible Brainlab navigation systems. Automatic Registration provides an image registration for intraoperatively acquired 3D CT/CBCT or fluoroscopic images. It consists of the software module Automatic Registration and hardware accessories.

Automatic Registration is a surgical device for image guided surgery intended to be used in combination with compatible Brainlab navigation systems. Automatic Registration provides an image registration for intraoperatively acquired 3D CT/CBCT or fluoroscopic images. It consists of the software module Automatic Registration and hardware accessories.

In a spinal context, Automatic Registration serves as accessory to the Spine & Trauma navigation system.

The Matrices are reusable devices delivered in non-sterile condition. The devices makes the Correlation ("Registration") of Intraoperative acquired patient data to the surgical environment possible by determining its position in relation to the patient and the navigated instruments.

Mentions image processing

Yes

Mentions AI, DNN, or ML

Not Found.

Input Imaging Modality

intraoperatively acquired 3D CT/CBCT or fluoroscopic images.

Anatomical Site

Not Found. (However, "In a spinal context" and "cervical spine" are mentioned in the non-clinical testing section.)

Indicated Patient Age Range

Not Found.

Intended User / Care Setting

Not Found. (Implied: surgical setting by surgeons)

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

Non-Clinical Testing:

    1. Registration Accuracy Test
      It was performed in a simulated test environment.
      Total number of navigation points n=228 .
      Total number of scans used (m=50)

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

Non-Clinical Testing:

    1. Registration Accuracy Test Test Result:
    • Mean navigation accuracy: 0.93mm ●
    • . 95th percentile of single navigation accuracy: 1.80mm
    • Total number of navigation points n=228 .

Above listed non-clinical performance testing demonstrates the equivalence of the navigation registration accuracy of the subject device to the predicate device. It was performed in a simulated test environment which matches the test scenario of the cleared device, where a mean registration accuracy of 1.26mm was measured.

Minor modifications to the test setup were required due to the device change where a Registration Matrix within the scan volume is used for automatic registration instead of infrared scanner markers in combination with a navigation calibration as in the cleared device. The navigated region of interest and measurement methods were not changed since these parameters are not affected by the device change.

An additional performance test demonstrated that the registration method is also applicable for the cervical spine and navigation accuracy in this region is consistent with the initial results listed above.

Test results generated demonstrated better mean navigation accuracy and met stricter acceptance criteria (mean navigation accuracy:

§ 882.4560 Stereotaxic instrument.

(a)
Identification. A stereotaxic instrument is a device consisting of a rigid frame with a calibrated guide mechanism for precisely positioning probes or other devices within a patient's brain, spinal cord, or other part of the nervous system.(b)
Classification. Class II (performance standards).

0

March 18, 2021

Image /page/0/Picture/1 description: The image shows the logo of the U.S. Food and Drug Administration (FDA). On the left is the Department of Health & Human Services logo. To the right of that is a blue square with the letters "FDA" in white. To the right of the blue square is the text "U.S. FOOD & DRUG ADMINISTRATION" in blue.

Brainlab AG Chiara Cunico Manager Regulatory Affairs Olof-Palme-Str. 9 Munich, Bavaria 81829 Germany

Re: K203679

Trade/Device Name: Automatic Registration Regulation Number: 21 CFR 882.4560 Regulation Name: Stereotaxic Instrument Regulatory Class: Class II Product Code: OLO Dated: February 12, 2021 Received: February 16, 2021

Dear Chiara Cunico:

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. Although this letter refers to your product as a device, please be aware that some cleared products may instead be combination products. The 510(k) Premarket Notification Database located at https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm identifies combination product submissions. 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

1

801); medical device reporting of medical device-related adverse events) (21 CFR 803) for devices or postmarketing safety reporting (21 CFR 4, Subpart B) for combination products (see https://www.fda.gov/combination-products/guidance-regulatory-information/postmarketing-safety-reportingcombination-products); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820) for devices or current good manufacturing practices (21 CFR 4, Subpart A) for combination products; and, if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

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 https://www.fda.gov/medical-device-safety/medical-device-reportingmdr-how-report-medical-device-problems.

For comprehensive regulatory information about medical devices and radiation-emitting products, including information about labeling regulations, please see Device Advice (https://www.fda.gov/medicaldevices/device-advice-comprehensive-regulatory-assistance) and CDRH Learn (https://www.fda.gov/training-and-continuing-education/cdrh-learn). Additionally, you may contact the Division of Industry and Consumer Education (DICE) to ask a question about a specific regulatory topic. See the DICE website (https://www.fda.gov/medical-device-advice-comprehensive-regulatoryassistance/contact-us-division-industry-and-consumer-education-dice) for more information or contact DICE by email (DICE@fda.hhs.gov) or phone (1-800-638-2041 or 301-796-7100).

Sincerely,

For: Shumaya Ali, M.P.H. Assistant Director DHT6C: Division of Restorative, Repair, and Trauma Devices OHT6: Office of Orthopedic Devices Office of Product Evaluation and Quality Center for Devices and Radiological Health

Enclosure

2

Indications for Use

510(k) Number (if known) K203679

Device Name Automatic Registration

Indications for Use (Describe)

Automatic Registration is a surgical device for image guided surgery intended to be used in combination with compatible Brainlab navigation systems. Automatic Registration provides an image registration for intraoperatively acquired 3D CT/ CBCT or fluoroscopic images. It consists of the software module Automatic Registration and hardware accessories.

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

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3

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510(k) Summary

March 17, 2021

General Information
ManufacturerBrainlab AG
Establishment Registration8043933
Device NameOrthopedic Stereotaxic Instrument
Trade NameAutomatic Registration
Classification NameStereotaxic instrument
Product CodeOLO
Regulation Number882.4560
Regulatory ClassII
PanelOrthopedic
Predicate Device and K NumberSpine & Trauma Navigation System - K183605
ManufacturerBrainlab AG
Contact Information
Primary ContactAlternate Contact
Chiara CunicoRegulatory Affairs Brainlab
Manager RAPhone: +49 89 99 15 68 0
Phone: +49 89 99 15 68 0Fax: +49 89 99 15 68 5033
Email: chiara.cunico@brainlab.comEmail: regulatory.affairs@brainlab.com

1. Indications for Use

Automatic Registration is a surgical device for image guided surgery intended to be used in combination with compatible Brainlab navigation systems. Automatic Registration provides an image registration for intraoperatively acquired 3D CT/CBCT or fluoroscopic images. It consists of the software module Automatic Registration and hardware accessories.

2. Device Description

The Subject Device is intended to be used in combination with compatible Brainlab navigation systems. Automatic Registration provides an image registration for intraoperatively acquired 3D CT/CBCT or fluoroscopic images. It consists of the software module Automatic Registration and hardware accessories.

K203679 510(k) Summary

4

Image /page/4/Picture/0 description: The image is an abstract design featuring a series of triangles in varying shades of blue. The triangles are arranged in a pattern that creates a sense of movement and depth. The triangles on the left side of the image are a darker blue, while the triangles on the right side of the image are a lighter blue. The triangles are separated by white lines, which add to the overall visual interest of the design.

Image /page/4/Picture/1 description: The image shows the word "BRAINLAB" in all capital letters. To the left of the word is a logo that appears to be three curved lines stacked on top of each other. The logo and the word are both in black and the background is white.

Automatic Registration is a surgical device for image guided surgery intended to be used in combination with compatible Brainlab navigation systems. Automatic Registration provides an image registration for intraoperatively acquired 3D CT/CBCT or fluoroscopic images. It consists of the software module Automatic Registration and hardware accessories.

In a spinal context, Automatic Registration serves as accessory to the Spine & Trauma navigation system.

The Matrices are reusable devices delivered in non-sterile condition. The devices makes the Correlation ("Registration") of Intraoperative acquired patient data to the surgical environment possible by determining its position in relation to the patient and the navigated instruments.

3. Substantial Equivalence

DevicesNameK-NumberManufacturer
Subject DeviceAutomatic RegistrationK203679Brainlab AG
Predicate DeviceSpine & Trauma Navigation
SystemK183605Brainlab AG

| Feature / Topic | Area | Changes of Automatic Registration in relation to the
predicate device K183605 |
|--------------------------------------------------------------------|----------------------------------------------------------------|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Indications for use | General | Same as in predicate device; minor expansion for automatic
registration specific feature |
| Integration of
Brainlab IGS
(computer) platforms | Compatibilities
and Hardware
Components | Same basic functionality; added compatibility to a platform with
minor differences |
| Automatic Image
Registration | Compatibilities to
external imaging
devices | Same basic functionality; further compatibilities added with
minor differences |
| | | Compatibility was added for a new intraoperative 3D imaging
device for pre-calibration. |
| Instruments that can
be employed –
Navigation
Accessories | Compatible
Instruments and
software relevant
Hardware | Addition of hardware parts with minor differences.

Same principle in registration of 2D and 3D images.

Material and design adapted to fit requirements of Universal
AIR (Registration Matrix) |

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Image /page/5/Picture/0 description: The image is an abstract design featuring a series of interconnected triangles. The triangles vary in size and are arranged in a pattern that spans across the image. The color palette consists of shades of blue, with the intensity of the blue gradually decreasing from left to right, creating a gradient effect.

Image /page/5/Picture/1 description: The image shows the word "BRAINLAB" in all capital letters. To the left of the word is a logo that appears to be three curved lines stacked on top of each other. The text and logo are in black and the background is white.

| Feature / Topic | Area | Changes of Automatic Registration in relation to the
predicate device K183605 |
|-----------------------------------|-----------------------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Automatic patient
registration | Software relevant
behavior and
features | Same basic functionality; minor modifications in
GUI/functionality.
The main functionality components of the software system stay
the same.
Additional instructions were added for automatic patient
registration using Universal AIR.
Icons and graphical representations of scanner reference
arrays were added to visualize the additionally integrated
scanning devices.
The basic concept of verification of registration accuracy prior
to navigation remains unchanged. |

Non-Clinical Testing:

    1. Registration Accuracy Test Test Result:
    • Mean navigation accuracy: 0.93mm ●
    • . 95th percentile of single navigation accuracy: 1.80mm
    • Total number of navigation points n=228 .

Above listed non-clinical performance testing demonstrates the equivalence of the navigation registration accuracy of the subject device to the predicate device. It was performed in a simulated test environment which matches the test scenario of the cleared device, where a mean registration accuracy of 1.26mm was measured.

Minor modifications to the test setup were required due to the device change where a Registration Matrix within the scan volume is used for automatic registration instead of infrared scanner markers in combination with a navigation calibration as in the cleared device. The navigated region of interest and measurement methods were not changed since these parameters are not affected by the device change.

An additional performance test demonstrated that the registration method is also applicable for the cervical spine and navigation accuracy in this region is consistent with the initial results listed above.

K203679 510(k) Summary

6

Image /page/6/Picture/0 description: The image is an abstract design featuring a series of interconnected triangles. The triangles are arranged in a pattern that creates a sense of depth and movement. The color palette consists of varying shades of blue, with the darker shades concentrated on the left side of the image and gradually transitioning to lighter shades on the right. The overall effect is modern and visually appealing.

Image /page/6/Picture/1 description: The image shows the word "BRAINLAB" in all capital letters. To the left of the word is a logo that appears to be three curved lines stacked on top of each other. The logo and the word are both in black and are set against a white background. The image is simple and clean, with a focus on the company name and logo.

Test results generated demonstrated better mean navigation accuracy and met stricter acceptance criteria (mean navigation accuracy: