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Modus IR used with the Synaptive Surgical Exoscope is indicated for fluorescence imaging in conjunction with indocyanine green to aid in the visualization of vessels (micro- and macro-vasculature) and blood flow in the cerebrovasculature before, during, and after neurosurgery, plastic, and reconstructive surgeries.

Modus IR is an accessory of the Synaptive surgical exoscope. Modus IR provides surgical staff with a means to visualize vessels and blood flow during surgical procedures that may not be visible under white light conditions. When used with the appropriate imaging agent, light output at a specific wavelength excites the imaging agent, which emits light at a specific wavelength that is detected by the optical system, thereby allowing the user to differentiate the structure that the imaging agent has concentrated in. The imaging agent is not packaged or sold as part of Modus IR. It is the responsibility of the user to source and administer the applicable imaging agent according to the excitation and observation wavelengths of Modus IR. Modus IR is selectively enabled by authorized personnel using software configuration management.

The Synq Software is indicated for use in conjunction with Synq, a magnetic resonance diagnostic device (MRDD) that produces axial, sagittal, coronal, and oblique cross-sectional images and displays the internal structure and/or function of the head. Depending on the region of interest, contrast agents may be used. These images when interpreted by a trained physician yield information that may assist in diagnosis.

The Synq Software allows a user to configure and initiate a magnetic resonance scan of a subject. In doing so, the software coordinates the interactions of the magnetic field, gradients, radio frequency (RF) transmitter and receiver coil in Synq (Previously known as EVRY, K200327) to produce axial, sagittal, coronal, and oblique cross-sectional images that represent the spatial distribution of protons with spin. The Synq Software Version 1.3 upgrades the current software version in the Synq system to include additional imaging applications, functionality, and minor bug fixes. The Software should be used only by qualified medical professionals who are trained in magnetic resonance diagnostic devices.

Evry is indicated for use as a magnetic resonance diagnostic device (MRDD) that produces axial, sagittal, coronal, and oblique cross-sectional images and displays the internal structure and/or function of the region of interest, contrast agents may be used. These images when interpreted by a trained physician yield information that may assist in diagnosis.

Evry is a magnetic resonance diagnostic device (MRDD) that uses a superconducting magnet to produce axial, sagittal, coronal, and oblique cross-sectional images, and displays the internal structure and/or function of the head. The system features various pulse sequences, imaging techniques and conform to NEMA DICOM standards (Digital Imaging and Communications in Medicine). Integrated into the Magnetic Resonance Imaging system are a set of gradient coils which vary the strength of the applied magnetic field as a function of position and time, and are used to spatially encode the radio signals. Computed image reconstruction algorithms are then able to convert the encoded, digitized signals into images which can then be displayed to the user. As with the predicate device, Evry includes the following technological components: Magnet scanner unit, gradient system and RF transmit coil, Equipment room containing the equipment needed to support the scanner unit functionality, Patient Transporter, 16-Channel Receive-Only Head Coil, Patient Communication System, Operator Console.

Modus Nav is intended as a planning and intraoperative guidance system to enable open and percutaneous computer assisted surgery. The system is indicated for medical conditions requiring neurosurgical cranial procedures where the use of computer assisted planning and surgery may be appropriate. The system can be used for intra-operative guidance where a reference to a rigid anatomical structure can be identified. The user should consult the "Accuracy Characterization" section of the User Manual to assess if the accuracy of the system is suitable for their needs.

The subject device, Modus Nav, is a modified version of its predicate, BrightMatter Guide with SurfaceTrace Registration. The system is a surgical planning and image guided surgical system that enables open or percutaneous computer-assisted cranial surgery. The system uses optical 3D tracking technology to display the location and orientation of tracked (also known as navigated) surgical instruments relative to the pre-operative scan images of the patient. The system consists of a software application installed on a computer, tracked surgical instruments, and accessories to enable the tracking of those instruments. The planning functionality of the device is provided by an already cleared device called BrightMatter Plan 1.6.0 (K180394). The remaining functionality of the system can be broadly grouped into data preparation, registration and visualization of surqical tools. Data preparation and registration is performed during the initial stages of a surgical procedure and visualization of the tools is performed as needed during the surgical procedure. General use of the system as an image guided surgical tool is composed of the following key steps: - . Equipment setup - . Plan selection and data preparation - Patient registration . - . Tool localization and visualization An optical Tracking Camera provides the position and orientation of the tools with respect to the tracking origin. The navigated surgical tools are tracked using singleuse passive reflective markers (K033621) that are attached to the surgical tools prior to each surqical procedure. An external display can be used by the surgical staff if needed, given that the Tracking Camera mounted on a cart maintains a line of sight between the Cranial Reference and the Tracked Surqical Tools. Both the User Cart (also known as Navigation Cart) and Auxiliary Carts are placed outside the sterile field. The primary purpose of this 510(k) submission is to introduce new navigated tools such as the Short Pointer, Shunt Stylet, and the corresponding Calibration Device. It also introduces new software features to support the navigation of these tools, the ability to navigate with Synaptive's Trackable Suction tools, and minor workflow improvements to facilitate the surgical procedure.

BrightMatter Plan is indicated for: · Viewing, presentation and documentation of medical imaging, including different modules for image processing, image fusion, and image segmentation where the output can be used for image guided surgery. · Planning and simulation of cranial surgical procedures. · Reviewing of existing treatment plans. Typical users of the software are medical professionals, including but not limited to surgeons and radiologists.

BrightMatter Plan is a treatment planning software that enables the user to view and process medical image data. The software is intended for pre-operative planning of neuro-surgical treatments based on image guided surgical systems. The planning software system provides the ability to visualize diagnostic images in 2D and 3D formats and fusion of image datasets. The software automatically segments the skull from the acquired image and generates diffusion tracts from Diffusion Tensor Imaging (DTI) data. The user can also manually annotate regions of interest, resulting in structures which can subsequently be visualized in 3D. A trained person can use the software to segment structures, define regions of interest and establish one or more trajectories. The software, operated on a stand-alone computer workstation, is expected to be used by a Clinician in an office or home setting, in preparation for one of several possible surgical procedures. The end of the processing is a surgical plan which can be exported to a Picture Archiving and Communication Systems (PACS) for subsequent use in image guided surgery.

BrightMatter Guide is intended as a planning and intraoperative guidance system to enable open and percutaneous computer assisted surgery. The system is indicated for medical conditions requiring neurosurgical cranial procedures where the use of computer assisted planning and surgery may be appropriate. The system can be used for intraoperative guidance where a reference to a rigid anatomical structure can be identified. The user should consult the "Accuracy Characterization" section of the User Manual to assess if the accuracy of the system is suitable for their needs. The BrightMatter Pointer is intended to be used for anatomy palpation and as a pointing tool to enable spatial localization and identification by BrightMatter Guide navigational systems.

BrightMatter Guide is a planning and image guided surgical system that enables computer assisted surgery where use of stereotactic image guidance may be considered appropriate. The BrightMatter Pointer is a handheld passive instrument which can be used for anatomy palpation using its tip. This tool can be tracked using passive reflective markers in order for BrightMatter Guide to identify and spatially track its location. There are rigid features on the subject device where the markers (passive spheres) that reflect infrared (IR) signals can be attached. The markers are arranged in a unique pattern on the device so that the BrightMatter Guide can differentiate it from other instruments. The Pointer portion of the device is provided non sterile and requires steam sterilization before use. The passive reflective markers are single-use. The BrightMatter Pointer is made of either titanium alloy conforming to ASTM F136, Standard Specification for Wrought Titanium-6 Aluminum-4 Vanadium ELI (Extra Low Interstitial) Alloy for Surgical Implant Applications (UNS R56401) or 17-4 stainless steel conforming to ASTM A564 Standard Specification for Hot-Rolled and Cold-Finished Age-Hardening Stainless Steel Bars and Shapes.

BrightMatter Guide with SurfaceTrace Registration is intended as a planning and intraoperative guidance system to enable open and percutaneous computer assisted surgery. The system is indicated for medical conditions requiring neurosurgical cranial procedures where the use of computer assisted planning and surgery may be appropriate. The system can be used for intraoperative guidance where a reference to a rigid anatomical structure can be identified. The user should consult the "Accuracy Characterization" section of the User Manual to assess if the system is suitable for their needs.

The subject device, BrightMatter Guide with SurfaceTrace Registration is a modification of the software component of BrightMatter Navigation system that is presented in K142024. The system is a planning and image guided surgical system that enables computer assisted surgery where use of stereotactic image guidance may be considered appropriate. In particular, the device is suitable for neurosurgical cranial procedures. The planning functionality of the device is provided by an already cleared device, BrightMatter Planning (K140337). The remaining system provides a sequence of discrete workflow activities (or phases) that guide a surgeon through the process of data preparation for the surgical procedure. Then the device aids the surgeon in visualizing the location of the surgical tools relative to clinical images and physical location of the patient. Following is a summary of steps involved in data preparation and registration of the patient's head position relative to pre-surgical clinical images: - . Importing plan and imaging data - Reviewing and selecting a previously generated surgical plan . - . Optionally fusing (merging or co-registering) additional imaging data - Registering the clinical images to the patient using either Point registration or . SurfaceTrace based registration. Following steps are provided as visualization tools during the execution of the surgical procedure: - . Aid in visualizing location of the surgical site as planned by the surgeon (using BrightMatter Planning software, K140337) - . For trajectory-centric procedures, help visualize insertion of tracked surgical tools by identifying location of surgical tool's position and orientation relative to clinical images and the surgical plan developed by the surgeon - . Visualize location of tracked surgical tools after the intended target location has been reached - . The purpose of this 510k submission is introduce a new registration methodology using changes that are limited to the software component of the previously cleared system. Key functional components of the system are an optical tracking sub-system, navigated surgical tools, custom software application and an external display. The navigated surgical tools are tracked using single-use passive reflective markers (K033621) that are attached to the surgical tools prior to each surgical procedure. The surgical display and tracking camera are mounted on an Auxiliary Cart. The computer is housed in a Navigation Cart. These components have been cleared as part of the BrightMatter Navigation system (K142024). As with many systems in the OR, not all components need to be sterile during use. The only subcomponents that come in contact with the patient are the Pointing Tool, Port Reference Tool and Calibration Block. These tools fit in the limited contact duration category. The tools have been cleared as part of the BrightMatter Navigation system (K142024).

Synaptive ImageDrive Pro is a device that displays medical images (including mammograms) and data from various imaging sources. Images and data can be viewed, communicated, processed and displayed within the system or across computer networks at distributed locations. Lossy compressed mammographic images and digitized film screen images must not be reviewed for primary image interpretations. Mammographic images may only be interpreted using an FDA approved monitor that offers at least 5 Megapixel resolution and meet other technical specifications reviewed and accepted by the FDA. Typical users of this system are trained professionals, including but not limited to radiologists, physicians, nurses, medical technicians, and assistants.

Synaptive ImageDrive Pro is a medical imaging informatics system that allows the storage, management, display and analysis of imaging and non-imaging data. The Synaptive ImageDrive Pro data repository can be populated either by manually uploading data through the user interface (UI) or in an unattended fashion by automatically receiving DICOM objects or HL7 messages from other information systems such as PACS and EMRs. Automatic data processing rules can be configured to process data when it arrives in the system. An example of this is when pre-operative MR scans are done and sent to ImageDrive to ensure that they were acquired using appropriate scan protocol before they are consumed downstream by other Synaptive applications, such as BrightMatter Plan (cleared as a Class-II device, K140337). Once in the system, the data is indexed so that it can be easily searched in the future. Imaging data can also be de-identified and securely shared with authorized persons. Further, the system provides an extensible architecture to enable local or distributed processing of the data. As data accumulates in the system, analytics can be generated to summarize, for example, intra- and inter-patient statistics and trends in surgical treatment planning based on surgical plan data that is output from external software that can generate data in compatible formats. An example of such external system is the surgical planning software manufactured by this applicant - - BrightMatter Plan. The subject device is composed of the following key features: A hierarchical folder system Three data storage areas Data processing functionality Analytics capability Image viewing capability

BrightMatter Navigation System is intended as a planning and intraoperative guidance system to enable open and percutaneous computer assisted surgery. The system is indicated for medical conditions requiring neurosurgical cranial procedures where the use of computer assisted planning and surgery may be appropriate. The system can be used for intra-operative guidance where a reference to a rigid anatomical structure can be identified.

The subject device, BrightMatter Navigation system, is a planning and image guided surgical system that enables computer assisted surgery where use of stereotactic image guidance may be considered appropriate. In particular, the device is suitable for neurosurgical cranial procedures. The planning functionality of the device is provided by an already cleared device, BrightMatter Planning (K140337). The remaining system provides a sequence of discrete workflow activities (or phases) that guide a surgeon through the process of data preparation for the surgical procedure. Then the device aids the surgeon in visualizing the location of the surgical tools relative to clinical images and physical location of the patient. Following is a summary of steps involved in data preparation and registration of the patient's head position relative to pre-surgical clinical images: - Importing plan and imaging data - Reviewing and selecting a previously generated surgical plan - Optionally fusing (merging or co-registering) additional imaging data - Preparing and executing point-based registration Following steps are provided as visualization tools during the execution of the surgical procedure: - Aid in visualizing location of the surgical site as planned by the surgeon (using BrightMatter Planning software, K140337) - For trajectory-centric procedures, help visualize insertion of tracked surgical tools by identifying location of surgical tool's position and orientation relative to clinical images and the surgical plan developed by the surgeon - Visualize location of tracked surgical tools after the intended target location has been reached Key functional components of the subject device are an optical tracking sub-system, navigated surgical tools, custom software application and an external display. The navigated surgical tools are tracked using single-use passive reflective markers (K033621) that are attached to the surgical tools prior to each surgical procedure. The surgical display and tracking camera are mounted on an Auxiliary Cart. The computer is housed in a Navigation Cart. As with many systems in the OR, not all components need to be sterile during use. The only subcomponents that come in contact with the patient are the Pointing Tool, Port Reference Tool and Calibration Block. These tools fit in the limited contact duration category.

BrightMatter Planning's indications for use are the viewing, simulation of cranial surgical procedures and reviewing of existing treatment plans. Typical users of the software are medical professionals, including but not limited to surgeons and radiologists.

BrightMatter Planning is a treatment planning software that enables the user to view and process medical image data. The software is intended for pre-operative planning of neuro-surgical treatments based on image guided surgical systems. The planning software system provides the ability to visualize diagnostic images in 2D and 3D formats and fusion of image datasets. The software automatically segments the skull from the acquired image and generates diffusion tracts from DTI data. The user can also manually annotate regions of interest, resulting in structures which can subsequently be visualized in 3D. The end result of such processing is a set of images that can be used to develop a treatment plan for a neuronavigational procedure. The treatment plan is developed by a trained person. A trained person can use the software to segment structures, define regions of interest and establish one or more trajectories. The software, operated on a stand-alone computer workstation, is expected to be used by a Surgical Planner in an office setting, in preparation for one of several possible surgical procedures. The resulting treatment plan can be exported to a PACS for subsequent use in image guided surgery.