K Number
K243038
Device Name
Salix Central
Manufacturer
Date Cleared
2025-03-27

(181 days)

Product Code
Regulation Number
892.2050
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdparty
Intended Use
Salix Central is a web-based software application that is intended to be used for viewing, post-processing, and analyzing cardiac computed tomography (CT) images acquired from a CT scanner in a Digital Imaging and Communications in Medicine (DICOM) Standard format. This software provides tools that can be used for the qualitative and quantitative assessment of physician-identified coronary plaques and stenosis in coronary computed tomography angiography (CCTA) and to perform calcium scoring in non-contrast cardiac CT. Salix Central is intended to complement standard care as an adjunctive tool and is not intended as a replacement to a medical professional's comprehensive diagnostic decision-making process. The software's semi-automated features are intended for an adult population and should only be used by qualified medical professionals experienced in examining and evaluating cardiac CT images.
Device Description
Salix Central is a web-based software application, hosted on AWS cloud services, delivered using a SaaS model. The software provides interactive, post-processing tools for trained radiologists or cardiologists for viewing, and characterizing cardiac computed tomography (CT) image data obtained from a CT scanner. The physician-driven coronary analysis is used to review CT image data to prepare a standard coronary report that may include the presence and extent of physician-identified coronary plaques (i.e., atherosclerosis) and stenosis, and assessment of calcified plaque (calcium scoring). The Cardiac CT image data are physician-ordered and typically obtained from patients who underwent CCTA or CAC CT for evaluation of CAD or suspected CAD.
More Information

Yes
The document explicitly mentions "machine (ML) enabled algorithms" and describes the training and validation datasets used for these algorithms.

No
The device is a software application for viewing, post-processing, and analyzing medical images for diagnostic purposes, not for providing therapy.

Yes
The device is described as an "adjunctive tool" for the "qualitative and quantitative assessment of physician-identified coronary plaques and stenosis" and to "perform calcium scoring" to "complement standard care." These functions directly contribute to diagnostic decision-making, even if they are not intended as replacements for a medical professional's comprehensive diagnostic process.

Yes

The device description explicitly states "Salix Central is a web-based software application, hosted on AWS cloud services, delivered using a SaaS model." There is no mention of accompanying hardware components.

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. They are used to examine these samples outside of the body.
  • Salix Central's Function: Salix Central processes and analyzes images acquired from a CT scanner. It works with medical images, not biological samples.
  • Intended Use: The intended use clearly states it's for "viewing, post-processing, and analyzing cardiac computed tomography (CT) images." This is image analysis, not in vitro testing.

While Salix Central is a medical device that aids in diagnosis, its function falls under the category of medical image analysis software, not in vitro diagnostics.

No
The letter does not explicitly state that the FDA has reviewed and approved or cleared a PCCP for this specific device.

Intended Use / Indications for Use

Salix Central is a web-based software application that is intended to be used for viewing, post-processing, and analyzing cardiac computed tomography (CT) images acquired from a CT scanner in a Digital Imaging and Communications in Medicine (DICOM) Standard format.

This software provides tools that can be used for the qualitative assessment of physicianidentified coronary plaques and stenosis in coronary computed tomography angiography (CCTA) and to perform calcium scoring in non-contrast cardiac CT.

Salix Central is intended to complement standard care as an adjunctive tool and is not intended as a replacement to a medical professional's comprehensive diagnostic decision-making process. The software's semi-automated features are intended for an adult population and should only be used by qualified medical professionals experienced in examining cardiac CT images.

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

OIH

Device Description

Salix Central is a web-based software application, hosted on AWS cloud services, delivered using a SaaS model. The software provides interactive, post-processing tools for trained radiologists or cardiologists for viewing, and characterizing cardiac computed tomography (CT) image data obtained from a CT scanner. The physician-driven coronary analysis is used to review CT image data to prepare a standard coronary report that may include the presence and extent of physician-identified coronary plaques (i.e., atherosclerosis) and stenosis, and assessment of calcified plaque (calcium scoring). The Cardiac CT image data are physician-ordered and typically obtained from patients who underwent CCTA or CAC CT for evaluation of CAD or suspected CAD.

Mentions image processing

Yes

Mentions AI, DNN, or ML

Yes

Input Imaging Modality

CT

Anatomical Site

Cardiac

Indicated Patient Age Range

Adult population

Intended User / Care Setting

Qualified medical professionals experienced in examining cardiac CT images (Radiologists or Cardiologists)

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

A reference standard was created to train the machine (ML) enabled algorithms in Salix Central. Data for training and validation sampled from our database based on pre-defined exclusion criteria. Data were also selected to ensure no site was shared by training and validation cohorts. The training dataset included 3835 unique patient cases from 6 unique sites from the USA, Canada, Australia and Japan.

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

Data for the validation was sourced from multiple unique centers in the USA that did not contribute any data to the training datasets for any Salix Central algorithm.

The validation dataset consisted of 363 unique, de-identified cardiac CT studies from six (6) centers across three (3) US states. This consisted of 302 non-contrast series for the testing of calcium scoring, 116 contrast-enhanced series for the testing of centerline extraction and vessel labelling, and 63 contrast-enhanced series for the testing of wall segmentation. Each validation test included representation of multiple scanner manufacturers (i.e., Canon, GE, Philips, and Siemens) and disease severity based on calcium score and maximum stenosis (CAD-RADS classification) based on the source clinical radiology reports.

The combined dataset consisted of:

  • 36% age 65 and above (median age 60)
  • 57% Female
  • 67% White, 18% Black or African American, and 13% Asian
  • 19% Hispanic or Latino

Performance validation testing was performed for the ML-enabled Salix Central outputs for calcium scoring. centerline extraction, vessel labelling, and lumen and vessel wall segmentation against reference ground truth established by board certified cardiologists with SCCT Level 3 certification (or equivalent experience) using manual annotation tools. In each case the reference was independently established from the source clinical image interpretation.

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

Performance validation testing was performed for the ML-enabled Salix Central outputs for calcium scoring. centerline extraction, vessel labelling, and lumen and vessel wall segmentation against reference ground truth established by board certified cardiologists with SCCT Level 3 certification (or equivalent experience) using manual annotation tools. In each case the reference was independently established from the source clinical image interpretation.

The validation dataset consisted of 363 unique, de-identified cardiac CT studies from six (6) centers across three (3) US states. This consisted of 302 non-contrast series for the testing of calcium scoring, 116 contrast-enhanced series for the testing of centerline extraction and vessel labelling, and 63 contrast-enhanced series for the testing of wall segmentation.

Salix Central performance exceeded all the pre-defined acceptance criteria for all validation tests.

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

Salix Central OutputStatisticEstimate [95% CI]Acceptance CriteriaResult
Calcium ScoringPearson Correlation0.958 [0.947, 0.966]0.90Pass
Centerline ExtractionTrue Placement Percentage90.4% [88.5%, 92.2%]78%Pass
Vessel LabellingF1 Score78.4% [76.1%, 80.5%]70%Pass
Lumen Wall SegmentationDice Score0.8996 (0.8938, 0.9055)0.80Pass
Vessel Wall SegmentationDice Score0.9016 (0.8962, 0.9070)0.80Pass

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.

K213998

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.

K191585

Predetermined Change Control Plan (PCCP) - All Relevant Information

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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Artrya Limited Gabriela Quijada Quality and Regulatory Manager 1257 Hay Street West Perth PERTH. WA 6005 AUSTRALIA

March 27, 2025

Re: K243038 Trade/Device Name: Salix Central Regulation Number: 21 CFR 892.2050 Regulation Name: Medical image management and processing system Regulatory Class: Class II Product Code: OIH Dated: February 27, 2025 Received: February 27, 2025

Dear Gabriela Quijada:

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.

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"

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(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 OS 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 Rue"). 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-devices/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-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).

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Sincerely,

Jessica Lamb

Jessica Lamb, Ph.D. Assistant Director Imaging Software 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

Submission Number (if known)

K243038

Device Name

Salix Central

Indications for Use (Describe)

Salix Central is a web-based software application that is intended to be used for viewing, post-processing, and analyzing cardiac computed tomography (CT) images acquired from a CT scanner in a Digital Imaging and Communications in Medicine (DICOM) Standard format.

This software provides tools that can be used for the qualitative assessment of physicianidentified coronary plaques and stenosis in coronary computed tomography angiography (CCTA) and to perform calcium scoring in non-contrast cardiac CT.

Salix Central is intended to complement standard care as an adjunctive tool and is not intended as a replacement to a medical professional's comprehensive diagnostic decision-making process. The software's semi-automated features are intended for an adult population and should only be used by qualified medical professionals experienced in examining cardiac CT images.

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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K243038

510(k) Summary

This summary of 510(k) safety and effectiveness information is submitted in accordance with the requirements of SMDA 1990 and 21 CFR 807.92.

Date Prepared:February 25, 2025
Submitter:Artrya Ltd.
Official Contact:Gabriela Quijada
1257 Hay Street
West Perth, 6005, Australia
Phone: +61 405 653 605
Proprietary Name:Salix Central
Common Name:System, Image Processing, Radiological
Classification:Class II Medical Device
Requlation Number: 21 CFR 892.2050
Product Code: QIH
Predicate Device:cvi42 Auto Imaging Software Application (K213998)
Reason For Submission:New Traditional 510(k)

Indications for Use

Salix Central is a web-based software application that is intended to be used for viewing, postprocessing, and analyzing cardiac computed tomography (CT) images acquired from a CT scanner in a Digital Imaging and Communications in Medicine (DICOM) Standard format.

This software provides tools that can be used for the qualitative and quantitative assessment of physician-identified coronary plaques and stenosis in coronary computed tomography angiography (CCTA) and to perform calcium scoring in non-contrast cardiac CT.

Salix Central is intended to complement standard care as an adjunctive tool and is not intended as a replacement to a medical professional's comprehensive diagnostic decision-making process. The software's semi-automated features are intended for an adult population and should only be used by qualified medical professionals experienced in examining and evaluating cardiac CT images.

Device Description

Salix Central is a web-based software application, hosted on AWS cloud services, delivered using a SaaS model. The software provides interactive, post-processing tools for trained radiologists or cardiologists for viewing, and characterizing cardiac computed tomography (CT)

5

image data obtained from a CT scanner. The physician-driven coronary analysis is used to review CT image data to prepare a standard coronary report that may include the presence and extent of physician-identified coronary plaques (i.e., atherosclerosis) and stenosis, and assessment of calcified plaque (calcium scoring). The Cardiac CT image data are physicianordered and typically obtained from patients who underwent CCTA or CAC CT for evaluation of CAD or suspected CAD.

A reference standard was created to train the machine (ML) enabled algorithms in Salix Central. Data for training and validation sampled from our database based on pre-defined exclusion criteria. Data were also selected to ensure no site was shared by training and validation cohorts. The training dataset included 3835 unique patient cases from 6 unique sites from the USA, Canada, Australia and Japan.

Substantial Equivalence Discussion

Salix Central is substantially equivalent to the predicate, cvi42 Auto Imaging Software Application (K213998). Both devices and the reference device, iNtuition-Structural Heart Module (K191585), have the same Intended Use/Indications for Use and are similar with respect to key features and performance characteristics. The Predicate Device & Reference Device Comparison Table below provides a comparison between the Salix Central and the predicate device cvi42 Auto Imaging Software Application (K213998) and reference device, iNtuition-Structural Heart Module (K191585):

Predicate Device & Reference Device Comparison
TopicProposed DevicePredicate DeviceReference Device
ManufacturerArtrya Ltd.Circle Cardiovascular
Imaging Inc.TeraRecon, Inc.
Model NameSalix Centralcvi42 Auto Imaging
Software ApplicationiNtuition-Structural Heart
Module
510(k) NumberSubject Device: K243038K213998K191585

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Predicate Device & Reference Device Comparison
TopicProposed DevicePredicate DeviceReference Device
ManufacturerArtrya Ltd.Circle Cardiovascular
Imaging Inc.TeraRecon, Inc.
Model NameSalix Centralcvi42 Auto Imaging
Software ApplicationiNtuition-Structural Heart
Module
510(k) NumberSubject Device: K243038K213998K191585
Intended Use /
Indications for
UseSalix Central is a web-
based software application
that is intended to be used
for viewing, post-
processing, and analyzing
cardiac computed
tomography (CT) images
acquired from a CT
scanner in a Digital Imaging
and Communications in
Medicine (DICOM)
Standard format.
This software provides
tools that can be used for
the qualitative and
quantitative assessment of
physician-identified
coronary plaques and
stenosis in coronary
computed tomography
angiography (CCTA) and to
perform calcium scoring in
non-contrast cardiac CT.cvi42 Auto is intended to
be used for viewing, post-
processing, qualitative
and quantitative
evaluation of
cardiovascular magnetic
resonance (MR) and
computed tomography
(CT) images in a Digital
Imaging and
Communications in
Medicine (DICOM)
Standard format. It
enables a set of tools to
assist physicians in
qualitative assessment of
cardiac images and
quantitative
measurements of the
heart and adjacent
vessels; perform calcium
scoring; and to confirm
the presence or absence
of physician-identified
lesion in blood vessels.iNtuition-Structural Heart
Module is a software
solution that is intended to
assist Cardiologists,
Radiologists and Clinical
Specialists with the
visualization and
measurements of
structures of the heart and
vessels. iNtuition-
Structural Heart Module
enables the user to: -
Visualize and measure
(diameters, lengths,
angles, areas and
volumes) structures of the
heart and vessels for pre-
operative planning and
sizing for cardiovascular
interventions and surgery,
and for post- operative
evaluation. - Quantify
calcium (volume, density)
  • iNtuition-Structural Heart
    Module has the following |
    | Predicate Device & Reference Device Comparison | | | |
    | Topic | Proposed Device | Predicate Device | Reference Device |
    | Manufacturer | Artrya Ltd. | Circle Cardiovascular
    Imaging Inc. | TeraRecon, Inc. |
    | Model Name | Salix Central | cvi42 Auto Imaging
    Software Application | iNtuition-Structural Heart
    Module |
    | 510(k) Number | Subject Device: TBD | K213998 | K191585 |
    | | Salix Central is intended to
    complement standard care
    as an adjunctive tool and is
    not intended as a
    replacement to a medical
    professional's
    comprehensive diagnostic
    decision-making process.
    The software's semi-
    automated features are
    intended for an adult
    population and should only
    be used by qualified
    medical professionals
    experienced in examining
    and evaluating cardiac CT
    images. | The target population for
    cvi42 Auto's manual
    workflows is not
    restricted; however, Salix
    Central's semi-automated
    machine learning
    algorithms are intended
    for an adult population.
    cvi42 Auto shall be used
    only for cardiac images
    acquired from an MR or
    CT scanner. It shall be
    used by qualified medical
    professionals,
    experienced in examining
    and evaluating
    cardiovascular MR or CT
    images, for the purpose of
    obtaining diagnostic
    information as part of a
    comprehensive diagnostic
    decision-making process. | tools and features that
    facilitate: - Automatic and
    manual centerline
    detection. - Segmentation
    of cardiovascular
    structures |
    | Device Class | II | II | II |
    | Device
    Classification | QIH | LLZ, QIH | LLZ |
    | Intended Users | Cardiologists, Radiologists
    and Clinical Specialists | Qualified Medical
    Professionals | Cardiologists,
    Radiologists and Clinical
    Specialists |
    | Operating
    Platform | Client-Server Google
    Chrome Application | macOS, Microsoft
    Windows | Microsoft Windows |
    | DICOM
    Compliant | Yes; DICOM 3.0 or higher | Yes | Yes |
    | Image
    Acquisition | CT | MR and CT | CT, MR, Nuc, PET, Angio,
    US/Echo, SPECT |
    | Secured
    Network Server
    Integration | Yes | Yes | Yes |
    | Store Images | Yes | Yes | Yes |
    | 2D Imaging | Yes | Yes | Yes |
    | 3D Imaging | Yes | Yes | Yes |
    | Multiplanar
    Reformat
    (MPR) | Yes | Yes | Yes |
    | Study Analysis
  • Navigation
    Tools | Panning
    Windowing
    Zooming | Panning
    Windowing
    Zooming | Yes |
    | Predicate Device & Reference Device Comparison | | | |
    | Topic | Proposed Device | Predicate Device | Reference Device |
    | Manufacturer | Artrya Ltd. | Circle Cardiovascular
    Imaging Inc. | TeraRecon, Inc. |
    | Model Name | Salix Central | cvi42 Auto Imaging
    Software Application | iNtuition-Structural Heart
    Module |
    | 510(k) Number | Subject Device: TBD | K213998 | K191585 |
    | | Series, slices, and phases | Series, slices, and phases | Series, slices, and phases |
    | Study Analysis
  • Visualization
    and Editing | Centerline
    Wall
    Signal Intensity Overlay | Yes | Yes |
    | Measurements | Distance
    Diameter
    Area
    Hounsfield Unit (HU)
    Lumen % diameter
    reduction | Distance
    Perimeter
    Area
    Hounsfield Unit (HU)
    Volume | Yes |
    | Centerline
    Extraction and
    Wall
    Segmentation | Manual and semi-automatic
    / user-editable | Manual and semi-
    automatic using Machine
    Learning technique | Semi-automatic |
    | Calcium
    Scoring | Yes | Yes | Yes |
    | Reporting | Yes | Yes | Yes |

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Performance Testing

Performance testing was conducted to verify compliance with specified design requirements in accordance with FDA 21 CFR Part 820.30, IMDRF/SaMD WG/N12FINAL:2014, ISO 13485:2016, IEC 62304:2015, ISO 14971:2019 and NEMA 3.1-3.20 (2016) DICOM standards.

Verification and validation testing were conducted to ensure specifications and performance of the device and were performed per the FDA Guidance documents "Guidance for the Content of Premarket Submissions for Software Contained in Medical Devices" and "Content of Premarket Submission for Management of Cybersecurity in Medical Devices".

Salix Central has been tested according to the specifications that are documented in a master Software Verification and Validation Plan. Performance testing is an integral part of Artrya's software product development process as described in the company's Quality Management System Policies and Procedures.

Performance Validation Testing:

Performance validation testing was performed for the ML-enabled Salix Central outputs for calcium scoring. centerline extraction, vessel labelling, and lumen and vessel wall segmentation against reference ground truth established by board certified cardiologists with SCCT Level 3 certification (or equivalent experience) using manual annotation tools. In each case the reference was independently established from the source clinical image interpretation.

Data for the validation was sourced from multiple unique centers in the USA that did not contribute any data to the training datasets for any Salix Central algorithm.

The validation dataset consisted of 363 unique, de-identified cardiac CT studies from six (6) centers across three (3) US states. This consisted of 302 non-contrast series for the testing of calcium scoring, 116 contrast-enhanced series for the testing of centerline extraction and vessel labelling, and 63

9

contrast-enhanced series for the testing of wall segmentation. Each validation test included representation of multiple scanner manufacturers (i.e., Canon, GE, Philips, and Siemens) and disease severity based on calcium score and maximum stenosis (CAD-RADS classification) based on the source clinical radiology reports.

The combined dataset consisted of:

  • 36% age 65 and above (median age 60) ●
  • 57% Female .
  • 67% White, 18% Black or African American, and 13% Asian ●
  • . 19% Hispanic or Latino

Salix Central performance exceeded all the pre-defined acceptance criteria for all validation tests.

Salix Central OutputStatisticEstimate [95% CI]Acceptance CriteriaResult
Calcium ScoringPearson Correlation0.958
[0.947, 0.966]0.90Pass
Centerline ExtractionTrue Placement
Percentage90.4%
[88.5%, 92.2%]78%Pass
Vessel LabellingF1 Score78.4%
[76.1%, 80.5%]70%Pass
Lumen Wall SegmentationDice Score0.8996
(0.8938, 0.9055)0.80Pass
Vessel Wall SegmentationDice Score0.9016
(0.8962, 0.9070)0.80Pass

Conclusion

In summary, the comprehensive performance testing and comparison to the predicate cvi42 Auto Imaging Software Application (K213998) demonstrates that Salix Central is substantially equivalent to the named predicate device.