K Number
K241819
Device Name
CephNinja
Manufacturer
Date Cleared
2025-01-23

(213 days)

Product Code
Regulation Number
892.2050
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdparty
Intended Use
CephNinja software is designed for use by dental practices for cephalometric tracing and presenting patient images which are utilized by dental professionals to assist in treatment planning and case diagnosis. Results produced by the software's diagnostic and treatment planning tools are dependent on the interpretation of trained and licensed dental practitioners. Mobile application is not for diagnostic use.
Device Description
CephNinja is a software-only dental image device which allows the user to digitize landmarks on a patient's digital lateral cephalometric x-ray image, trace cephalometric structures, conduct cephalometric analysis, and view cephalalometric results. CephNinja is imaging software designed for use in dentistry. The main CephNinja software functionality includes image visualization and cephalometric tracing and measurements. CephNinja is used by dental professionals for the visualization of patient images retrieved from a dental cephalometric imaging device scanner for assisting in case diagnosis, review, and treatment planning for orthodontic and orthognathic applications. If a suitable image file (specifically, a lateral cephalometric x-ray) has been imported into the software, the software can be used to define a number of structures and landmarks to establish specific anatomical features. The positions of specific landmarks are used to render tracing lines and calculate measurements used in orthodontic treatment planning. The software operates on standard Mac/iMac (OS Big Sur M1) hardware, and when not used for diagnostic purposes, iPhone/iPad (OS 9.0 or higher) hardware. When iMac hardware is used, images are displayed on the connected display/monitor. CephNinja is a standalone product.
More Information

No
The document explicitly states "Mentions AI, DNN, or ML: Not Found" and describes the software's functionality as digitizing landmarks, tracing structures, and conducting analysis based on user input, without mentioning any automated or learning-based processes.

No

The device is described as software for cephalometric tracing and analysis used to assist in treatment planning and case diagnosis, which are not therapeutic actions. It does not exert any direct therapeutic effect on a patient.

Yes

The "Intended Use / Indications for Use" section explicitly states that the software's "diagnostic and treatment planning tools" produce results that assist in "case diagnosis." It also states it is for "assisting in case diagnosis, review, and treatment planning".

Yes

The device description explicitly states "CephNinja is a software-only dental image device" and details its functionality as software operating on standard hardware.

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 (like blood, urine, or tissue) to detect diseases, conditions, or infections. They are used to provide information for diagnosis, monitoring, or screening.
  • CephNinja's Function: CephNinja operates on digital images (lateral cephalometric x-rays) of a patient's head. It performs measurements and analysis directly on these images, not on biological samples.
  • Intended Use: The intended use clearly states it's for "cephalometric tracing and presenting patient images which are utilized by dental professionals to assist in treatment planning and case diagnosis." While it assists in diagnosis, it does so by analyzing images, not by testing biological samples.
  • Device Description: The description reinforces that it's "software-only dental image device" and "imaging software."

Therefore, CephNinja falls under the category of medical imaging software, not In Vitro Diagnostics.

N/A

Intended Use / Indications for Use

CephNinja software is designed for use by dental practices for cephalometric tracing and presenting patient images which are utilized by dental professionals to assist in treatment planning and case diagnosis. Results produced by the software's diagnostic and treatment planning tools are dependent on the interpretation of trained practitioners. Mobile application is not for diagnostic use.

Product codes

LLZ

Device Description

CephNinja is a software-only dental image device which allows the user to digitize landmarks on a patient's digital lateral cephalometric x-ray image, trace cephalometric structures, conduct cephalometric analysis, and view cephalometric results. CephNinja is imaging software designed for use in dentistry. The main CephNinja software functionality includes image visualization and cephalometric tracing and measurements. CephNinja is used by dental professionals for the visualization of patient images retrieved from a dental cephalometric imaging device scanner for assisting in case diagnosis, review, and treatment planning for orthodontic and orthognathic applications. If a suitable image file (specifically, a lateral cephalometric x-ray) has been imported into the software, the software can be used to define a number of structures and landmarks to establish specific anatomical features. The positions of specific landmarks are used to render tracing lines and calculate measurements used in orthodontic treatment planning. The software operates on standard Mac/iMac (OS Big Sur M1) hardware, and when not used for diagnostic purposes, iPhone/iPad (OS 9.0 or higher) hardware. When iMac hardware is used, images are displayed on the connected display/monitor. CephNinja is a standalone product.

Mentions image processing

Yes

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

digital lateral cephalometric x-ray image

Anatomical Site

Not Found

Indicated Patient Age Range

Not Found

Intended User / Care Setting

dental practices / dental professionals

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)

Non-clinical bench testing of CephNinja included evaluation of device outputs when compared to the conventional reference standard of manual tracing (i.e., all differences in individual angular and linear measurement values between the measurement methods must be within the clinically meaningful threshold of

§ 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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January 23, 2025

Cyncronus LLC % Dave Yungvirt CEO Third Party Review Group, LLC 25 Independence Blvd WARREN, NJ 07059

Re: K241819

Trade/Device Name: CephNinja Regulation Number: 21 CFR 892.2050 Regulation Name: Medical Image Management And Processing System Regulatory Class: Class II Product Code: LLZ Dated: December 26, 2024 Received: December 26, 2024

Dear Dave Yungvirt:

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 (the 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 available 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.

1

Additional information about changes that may require a new premarket notification are provided in the FDA guidance documents entitled "Deciding When to Submit a 510(k) for a Change to an Existing Device" (https://www.fda.gov/media/99812/download) and "Deciding When to Submit a 510(k) for a Software Change to an Existing Device" (https://www.fda.gov/media/99785/download).

Your device is also subject to, among other requirements, the Quality System (QS) regulation (21 CFR Part 820), which includes, but is not limited to, 21 CFR 820.30. Design controls; 21 CFR 820.90. Nonconforming product; and 21 CFR 820.100, Corrective and preventive action. Please note that regardless of whether a change requires premarket review, the QS regulation requires device manufacturers to review and approve changes to device design and production (21 CFR 820.30 and 21 CFR 820.70) and document changes and approvals in the device master record (21 CFR 820.181).

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 of medical device-related adverse events) (21 CFR Part 803) for devices or postmarketing safety reporting (21 CFR Part 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 Part 4, Subpart A) for combination products; and, if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR Parts 1000-1050.

All medical devices, including Class I and unclassified devices and combination product device constituent parts are required to be in compliance with the final Unique Device Identification System rule ("UDI Rule"). The UDI Rule requires, among other things, that a device bear a unique device identifier (UDI) on its label and package (21 CFR 801.20(a)) unless an exception or alternative applies (21 CFR 801.20(b)) and that the dates on the device label be formatted in accordance with 21 CFR 801.18. The UDI Rule (21 CFR 830.300(a) and 830.320(b)) also requires that certain information be submitted to the Global Unique Device Identification Database (GUDID) (21 CFR Part 830 Subpart E). For additional information on these requirements, please see the UDI System webpage at https://www.fda.gov/medical-device-advicecomprehensive-regulatory-assistance/unique-device-identification-system-udi-system.

Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR 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-regulatory

2

assistance/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,

Lu Jiang

Lu Jiang, Ph.D. Assistant Director Diagnostic X-ray Systems Team DHT8B: Division of Radiologic Imaging Devices and Electronic Products OHT8: Office of Radiological Health Office of Product Evaluation and Quality Center for Devices and Radiological Health

Enclosure

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Indications for Use

510(k) Number (if known) K241819

Device Name CephNinja

Indications for Use (Describe)

CephNinia software is designed for use by dental practices for cephalometric tracing and presenting patient images which are utilized by dental professionals to assist in treatment planning and case diagnosis. Results produced by the software's diagnostic and treatment planning tools are dependent on the interpretation of trained practitioners. Mobile application is not for diagnostic use.

Type of Use (Select one or both, as applicable):

Prescription Use (Part 21 CFR 801 Subpart D)Over-The-Counter Use (21 CFR 801 Subpart C)
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510(k) Summary: K241819

A. Applicant Information

Date Prepared: 23 January 2025

Corporate Name: Cyncronus LLC

Address: 3719 221st Pl SE, Bothell, WA 98021 USA

Device Trade Name: CephNinja

Manufacturer: Cyncronus LLC

Classification Name: Medical image management and processing system

Product Code: LLZ

Common Name: System, Image Processing, Radiological

Classification: Class II

Panel: Radiology

Regulation Number: 21 C.F.R. 892.2050

Submitter/Contact Person: Rohit Madan

Telephone Number: +1 (425) 241-5196

B. Predicate Device

CephNinja is substantially equivalent to the following FDA cleared SmartCeph predicate with regards to indications for use, intended use, performance and technological characteristics:

Proprietary Name: SmartCeph

Corporate Name: Ortho2, LLC

510(k) Number: K190162

Classification Name: Medical image management and processing system

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Product Code: LLZ

Common Name: System, Image Processing, Radiological

Classification: Class II

Panel: Radiology

Regulation Number: 21 C.F.R. 892.2050

C. Reference Device

Proprietary Name: Dolphin Blue Imaging 2.0

Corporate Name: Patterson Companies

510(k) Number: K221478

Classification Name: Medical image management and processing system

Product Code: LLZ

Common Name: System, Image Processing, Radiological

Classification: Class II

Panel: Radiology

Regulation Number: 21 C.F.R. 892.2050

D. Device Description

CephNinja is a software-only dental image device which allows the user to digitize landmarks on a patient's digital lateral cephalometric x-ray image, trace cephalometric structures, conduct cephalometric analysis, and view cephalometric results. CephNinja is imaging software designed for use in dentistry. The main CephNinja software functionality includes image visualization and cephalometric tracing and measurements. CephNinja is used by dental professionals for the visualization of patient images retrieved from a dental cephalometric imaging device scanner for assisting in case diagnosis, review, and treatment planning for orthodontic and orthognathic applications. If a suitable image file (specifically, a lateral cephalometric x-ray) has been imported into the software, the software can be used to define a number of structures and landmarks to establish specific anatomical features. The positions of specific landmarks are used to render tracing lines and calculate measurements used in orthodontic treatment planning. The software operates on standard Mac/iMac (OS Big Sur M1) hardware, and when not used for diagnostic

6

purposes, iPhone/iPad (OS 9.0 or higher) hardware. When iMac hardware is used, images are displayed on the connected display/monitor. CephNinja is a standalone product.

E. Intended Use/Indications for Use

CephNinja software is designed for use by dental practices for cephalometric tracing and presenting patient images which are utilized by dental professionals to assist in treatment planning and case diagnosis. Results produced by the software's diagnostic and treatment planning tools are dependent on the interpretation of trained and licensed practitioners. Mobile application is not for diagnostic use.

F. Technical Characteristics

CephNinja is a software only device that handles digital images. CephNinja neither contacts the patient nor controls any life sustaining devices. Diagnosis is not performed by this software but rather by doctors and other qualified individuals. A physician, providing ample opportunity for competent human intervention, interprets images and information being displayed.

CephNinja allows the user to digitize landmarks on a patient's digital lateral cephalometric x-ray image, trace cephalometric structures, conduct cephalometric analysis, and view cephalometric results.

CephNinja is a macOS/iOS/iPadOS Executable written in Objective C, Swift, C++ language that is intended for use on modern Macs/iMacs, and when not used for diagnostic purposes, iPhones/iPads. CephNinja operates on most computer workstations with minimum specifications of macOS Big Sur M1 and operates on most iPhones/iPads with OS 9.0 or higher.

G. Recognized Standards

CephNinja is software that conforms to the following recognized standards:

ISO 14971 Medical Devices-Application of Risk Management to Medical Devices

IEC 62304 Medical Device Software Life Cycle Processes

H. Comparing the SmartCeph Predicate and Dolphin Blue Imaging 2.0 Reference Device to CephNinja

Table 1 below compares CephNinja to the predicate device, SmartCeph. Table 2 compares the subject CephNinja device with the reference device, Dolphin Blue Imaging 2.0 (K221478).

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Following the comparison tables is a substantial equivalence discussion that further elaborates on details in the tables and discusses how those details support a determination that the subject and predicate devices are substantially equivalent.

Subject DevicePredicate Device
510(k) NumberK241819K190162
Trade/Device
NameCephNinjaSmartCeph
Intended UseCephNinja software is designed for use
by dental practices for cephalometric
tracing and presenting patient images
which are utilized by dental
professionals to assist in treatment
planning and case diagnosis. Results
produced by the software's diagnostic
and treatment planning tools are
dependent on the interpretation of
trained and licensed dental
practitioners. Mobile application is not
for diagnostic use.SmartCeph software is designed for use
by dental practices for cephalometric
tracing and presenting patient images
which are utilized by dental
professionals to assist in treatment
planning and case diagnosis. Results
produced by the software's diagnostic
and treatment planning tools are
dependent on the interpretation of
trained and licensed dental
practitioners.
Operating
SystemmacOS, iPadOS, iOSWindows
User InterfaceMouse, KeyboardMouse, Keyboard
Indications for
UseCephNinja software is designed for use
by dental practices for cephalometric
tracing and presenting patient images
which are utilized by dental
professionals to assist in treatment
planning and case diagnosis. Results
produced by the software's diagnostic
and treatment planning tools are
dependent on the interpretation of
trained and licensed dental
practitioners.
Mobile application is not for diagnostic
use.SmartCeph software is designed for use
by dental practices for cephalometric
tracing and presenting patient images
which are utilized by dental
professionals to assist in treatment
planning and case diagnosis. Results
produced by the software's diagnostic
and treatment planning tools are
dependent on the interpretation of
trained and licensed dental
practitioners.
Technology
PlatformMac/Apple basedPC
Image
Rendering2D2D
Image
ManipulationPreview, Rotate, Enhance, Zoom,
Brightness, Contrast,
SharpnessPreview, Rotate, Enhance, Zoom,
Brightness, Contrast,
Sharpness
Basic Image
MeasurementDistance, angleDistance, angle
Standalone
SoftwareYesYes
Cephalometric
MeasurementDistance, angle, ratio, differenceDistance, angle, ratio, difference
Cephalometric
TracingManual point picking and
structure/outline drawing. Software
provides predefined structures that
can be manually moved around the
cephalogram.Manual point picking, auto and manual
structure drawing. Software provides
predefined landmarks, structures and
allows user to define their own.
Cephalometric
AnalysisProvides 2D analysis on photo or
lateral x-ray. User-configurable and
standard orthodontic tracing analyses
including:
  • Downs

  • McNamara

  • Ricketts

  • Steiner

  • Tweed

  • Wits

  • Jarabak's/COGS

  • Burstone's/COGS

  • Alexander

  • Composite | Provides 2D analysis on photo or lateral
    x-ray. User-configurable and standard
    orthodontic tracing analyses including:

  • ABO Analysis

  • Alabama

  • Downs

  • McLaughlin

  • McNamara

  • Ricketts

  • Steiner

  • Tweed

  • Wits |
    | Tracing
    Superimposition | Yes | Yes |
    | Wiggle Gram | No | Yes |
    | 2D Growth
    Simulation | No | No |
    | Treatment
    Planning and
    Simulation | Orthodontic and orthognathic
    applications using predefined and
    custom analysis. No simulation. | Orthodontic and orthognathic
    applications using predefined and
    custom analysis. No simulation. |
    | Soft Tissue
    Deformation
    Photo Wrapping
    Implant Module
    Scanner
    Connection
    DICOM Support | No
    No
    No
    No
    No | No
    No
    No
    No
    No |
    | Regulation
    Number | 21 CFR 892.2050 | 21 CFR 892.2050 |
    | Regulation
    Name: System | Medical image management and
    processing system | Medical image management and
    processing system |
    | Regulatory Class | Class II | Class II |
    | Product Code | LLZ | LLZ |
    | Manufacturer | Cyncronus LLC | Ortho2, LLC |

Table 1. Comparison of Subject and Predicate Device

8

9

| | Subject Device: CephNinja | Reference Device: Dolphin Blue Imaging
2.0 |
|-----------------------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| 510(k) Number | K241819 | K221478 |
| Operating
System | macOS, iPadOS, iOS | Mac OS or any other computing
platform operating system |
| User Interface | Mouse, Keyboard | Mouse, Keyboard |
| Technology
Platform | Mac/Apple based | Mac/Apple based
or any other computing platform |
| Image
Rendering | 2D | 2D |
| Image
Manipulation | Preview, Rotate, Enhance, Zoom,
Brightness, Contrast,
Sharpness | Preview, Rotate, Enhance, Zoom,
Brightness, Contrast,
Sharpness |
| Basic Image
Measurement | Distance, angle | Distance, angle |
| Standalone
Software | Yes | Yes |
| Cephalometric
Measurement | Distance, angle, ratio, difference | Distance, angle, ratio, difference |
| Cephalometric
Tracing | Manual point picking and
structure/outline drawing. Software
provides predefined structures that can
be manually moved around the
cephalogram. | Manual point picking, auto and manual
structure drawing. Inter-relational
positions of these landmarks are used to
render tracing lines. |
| Cephalometric
Analysis | Provides 2D analysis on photo or lateral
x-ray. User-configurable and standard
orthodontic tracing analyses including:

  • Downs

  • McNamara

  • Ricketts

  • Steiner

  • Tweed

  • Wits

  • Jarabak

  • Burstone/COGS

  • Alexander

  • Composite | Provides 2D analysis on photo or lateral
    x-ray. User-configurable and standard
    orthodontic tracing analyses including:

  • Ricketts

  • McNamara

  • Steiner (Tweed)

  • Jarabak

  • Roth

  • Sassouni

  • McLaughlin

  • Downs-Northwestern

  • Bjork

  • Alexander (Vari-Simplex)

  • Holdaway

  • Alabama

  • Burstone

  • Gerety |
    | | | |
    | Tracing Super- imposition | Yes | Yes |
    | Wiggle Gram | No | Yes |
    | 2D Growth
    Simulation | No | No |
    | Treatment
    Planning and
    Simulation | Orthodontic and orthognathic
    applications using predefined and
    custom analysis. No simulation. | Orthodontic and orthognathic
    applications using predefined and
    custom analysis. No simulation. |
    | Soft Tissue
    Deformation | No | No |
    | Photo
    Wrapping | No | No |
    | Implant
    Module | No | No |
    | Scanner
    Connection | No | Yes |
    | DICOM
    Support | No | Yes |
    | Regulation
    Number | 21 CFR 892.2050 | 21 CFR 892.2050 |
    | Regulation
    Name: System | Medical image management and
    processing system | Medical image management and
    processing system |
    | Regulatory
    Class | Class II | Class II |
    | Product Code | LLZ | LLZ |
    | Manufacturer | Cyncronus LLC | PATTERSON DENTAL SUPPLY, INC. |

Table 2. Comparison of Subject and Reference Device

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l. Substantial Equivalence Discussion

There are some differences between CephNinja and the SmartCeph predicate such that CephNinja does not operate on PC platforms with Windows operating systems but rather on Mac/Apple based platforms and operating systems.

CephNinja can be operated on desktop and mobile platforms with a mouse/keyboard, trackpad, or touchscreen interface, but mobile platforms are not indicated for diagnostic use. The SmartCeph predicate can be operated only on desktop platforms with a mouse/keyboard interface.

CephNinja does not feature some of the cephalometric analyses featured in the SmartCeph predicate such as the ABO, Alabama, and McLaughlin analyses.

Both CephNinja and the SmartCeph predicate perform cephalometric analyses on 2D images only.

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Like the SmartCeph predicate, CephNinja provides tracing superimposition. However, CephNinja does not provide wiggle gram features like SmartCeph.

None of the above-mentioned differences change the safety, effectiveness, or indications for use of CephNinja as compared to the SmartCeph predicate.

Table 1 compares CephNinja to the SmartCeph predicate with respect to intended use, indications for use, environment of use, limitations of use, and technological characteristics. This comparison table provides additional information regarding the basis for the determination of substantial equivalence. As shown in Table 2, the characteristics of CephNinja are also highly similar to the reference device characteristics.

Although there are some differences between CephNinja and the SmartCeph predicate, the subject CephNinja device and the SmartCeph predicate are substantially equivalent as demonstrated by comparison of the intended use, indications for use, device description, technical characteristics, and performance testing of the devices.

J. Summary of Performance Testing

All the different components of CephNinja have been stress tested to ensure that it provides all the capabilities necessary to operate in a manner substantially equivalent to the SmartCeph predicate.

Using a risk-based approach and general use of ISO 14971-19 Medical Devices-Application of Risk Management to Medical Devices, the CephNinja safety hazard analysis has identified and sufficiently mitigated risks to users (i.e., overall risks reduced to low). CephNinja has successfully passed software unit, integration, and system level verification testing according to test-specific a priori pass/fail criteria in accordance with FDA guidance document, "General Principles of Software Validation" and general use of IEC 62304-06 Medical Device Software Life Cycle Processes standard.

CephNinja cybersecurity hazards have been evaluated and controlled to an acceptable level (i.e., low risk) in accordance with FDA guidance document, "Cybersecurity in Medical Devices: Quality System Considerations and Content of Premarket Submissions". Cybersecurity risks were identified and suitably addressed though penetration and vulnerability testing activities, and all implemented security controls have passed testing with pre-determined pass/fail criteria.

Non-clinical bench testing of CephNinja included evaluation of device outputs when compared to the conventional reference standard of manual tracing (i.e., all differences in individual angular

12

and linear measurement values between the measurement methods must be within the clinically meaningful threshold of