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Chex-All® Sterilization Pouches and Tubes are intended to be used to enclose another medical device, in a single or double pouch configuration, that is to be sterilized by a health care provider using:

Hospital size sterilizer cycles

• Gravity steam at 121°C (250°F) for 30 minutes; 25 minutes dry time
• Pre-vacuum steam at 132°C (270°F) for 4 minutes; 20 minutes dry time
• Pre-vacuum steam at 135°C (275°F) for 3 minutes; 16 minutes dry time

Tabletop sterilizer cycles:

• Pre-vacuum steam at 132°C (270°F) for 4 minutes; 30 minutes dry time

Ethylene Oxide sterilization cycles:

• Ethylene Oxide (EO) with a concentration of 736 mg/L at 55°C (131°F) and 50% to 60% relative humidity for 60 minutes. Aeration time of 8 hours at 60°C (140°F).

Chex-All sterilization pouches and tubes can be used for steam sterilization of devices with lumens at maximum load as the following:

Metal lumen: 7 inch long, 3.2mm internal diameter
Plastic lumen: 5 inch long, 2.0 mm internal diameter.

Suitable Lumen cycles:
Hospital size sterilizers: pre-vacuum cycles with 132°C-4.0 min exposure (20 minutes dry time) and 135°C-3.0 min exposure (16 minutes dry time).
Table-top sterilizers: pre-vacuum cycle with 132°C-4.0 min exposure (30 minutes dry time).

Chex-All sterilization pouches and tubes can be used for steam sterilization in double pouch configuration, in gravity 250°F-30 min exposure cycles (25 minutes dry time) and in pre-vacuum 270°F-4 min exposure cycles (20 minutes dry time).

The Process chemical indicators on the Chex-All sterilization pouches and tubes are intended to demonstrate that the device has been exposed to the steam or EO sterilization process and to distinguish between processed and unprocessed pouches. The chemical indicators change from crème to gray/black after exposure to steam and from beige-pink to green after exposure to ethylene oxide.

If stored according to the recommended conditions, the products before sterilization have a maximum shelf life of 2 years from the date of manufacture. The pouches are intended to allow sterilization of the enclosed medical device(s) and to maintain sterility (SAL≥10-6). The subject device is intended and has been validated to maintain sterility of the enclosed devices for 30 months after steam sterilization and 12 months after EO sterilization.

The maximum pouch load is 2.65 lb. (1.2 kg) or less. The maximum pouch load for table-top sterilizers is 1.10 lb. (0.5 kg) or less. The maximum pouch size for use in table-top sterilizers is 13"x18".

The Chex-All® Sterilization pouches and tubes are made from a medical grade porous paper thermally sealed to a plastic film on the left, right, and bottom of the pouch. The top side is open to insert medical devices to be sterilized and to seal the pouch. They are available either pre-manufactured self-seal or heat-seal sizes or in a roll of heat-seal tubing for the customer to cut the pouches to their required size.

The pouches also contain chemical process indicators used to demonstrate that the pouches have been a subject of either a steam or ethylene oxide sterilization process.

All Chex-All sterilization pouches and tubes are flat and include the following products: Chex-All Heat-seal sterilization pouch, flat; Chex-All Heat-seal sterilization tube, flat, sold in rolls; Chex-All II Self-seal sterilization pouch, flat; Chex-All III Self-seal sterilization pouch, flat.

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The Ceribell Instant EEG Headcap is intended for use in routine clinical settings where rapid placement of a number of EEG electrodes is desired. The headcap shall be placed on the head of infants, including newborns and preterm babies.

The Ceribell Instant EEG Headcap is a single-use, non-sterile, disposable EEG electrode device that includes a minimum of 9 EEG electrodes that are placed on the subject's scalp. The Headcap is intended to collect and provide EEG signals to an EEG recording or monitoring device.

The Ceribell Headcap includes the following components:

• An elastic fabric headcap
• An elastic fabric chin strap
• Nine (9) silver/silver chloride (Ag/AgCl) electrodes
• A cable attached to the headcap to allow connection to an EEG acquisition/recording device

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Intended Use

Viewing, post-processing, qualitative and quantitative evaluation of blood vessels and cardiovascular CT images in DICOM format.

Indications for Use

cvi42 Coronary Plaque Software Application is intended to be used for viewing, post-processing, qualitative and quantitative evaluation of cardiovascular 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 and quantitative assessment of cardiac CT images to determine the presence and extent of coronary plaques and stenoses, in patients who underwent Coronary Computed Tomography Angiography (CCTA) for evaluation of CAD or suspected CAD.

cvi42 Coronary Plaque's semi-automated machine learning algorithms are intended for an adult population.

cvi42 Coronary Plaque shall be used only for cardiac images acquired from a CT scanner. It shall be used by qualified medical professionals, experienced in examining cardiovascular CT images, for the purpose of obtaining diagnostic information as part of a comprehensive diagnostic decision-making process.

Circle's cvi42 Coronary Plaque Software Application ('cvi42 Coronary Plaque' or 'Coronary Plaque Module', for short) is a Software as a Medical Device (SaMD) that enables the analysis of CT Angiography scans of the coronary arteries of the heart. It is designed to support physicians in the visualization, evaluation, and analysis of coronary vessel plaques through manual or semi-automatic segmentation of vessel lumen and wall to determine the presence and extent of coronary plaques and luminal stenoses, in patients who underwent Coronary Computed Tomography Angiography (CCTA) for the evaluation of coronary artery disease (CAD) or suspected CAD. The device is intended to be used as an aid to the existing standard of care and does not replace existing software applications that physicians use. The Coronary Plaque Module can be integrated into an image viewing software intended for visualization of cardiac images, such as Circle's FDA-cleared cvi42 Software Application. The Coronary Plaque Module does not interface directly with any data collection equipment, and its functionality is independent of the type of vendor acquisition equipment. The analysis results are available on-screen, can be sent to report or saved for future review.

The Coronary Plaque Module consists of multiplanar reconstruction (MPR) views, curved planar reformation (CPR) and straightened views, and 3D rendering of the original CT data. The Module displays three orthogonal MPR views that the user can freely adjust to any position and orientation. Lines and regions of interest (ROIs) can be manually drawn on these MPR images for quantitative measurements.

The Coronary Plaque Module implements an Artificial Intelligence/Machine Learning (AI/ML) algorithm to detect lumen and vessel wall structures. Further, the module implements post-processing methods to convert coronary artery lumen and vessel wall structures to editable surfaces and detect the presence and type of coronary plaque in the region between the lumen and vessel wall. All surfaces generated by the system are editable and users are advised to verify and correct any errors.

The device allows users to perform the measurements listed in Table 1.

Here's a summary of the acceptance criteria and study details based on the provided FDA 510(k) Clearance Letter for the cvi42 Coronary Plaque Software Application:

1. Table of Acceptance Criteria and Reported Device Performance

Note: The acceptance criteria for each endpoint are not explicitly numerical in the provided text. They are inferred to be "met Circle's pre-defined acceptance criteria" and are presented here as the numeric value reported, implying that the reported value met or exceeded the internal acceptance threshold for a 'Pass'.

2. Sample Size Used for the Test Set and Data Provenance

• Sample Size for Test Set: Not explicitly stated. The document mentions "All data used for validation were not used during the development of the ML algorithms" and "Image information for all samples was anonymized and limited to ePHI-free DICOM headers." However, the specific number of cases or images in the test set is not provided.
• Data Provenance: Sourced from multiple sites, with 100% of the data sampled from US sources. The data consisted of images acquired from major vendors of CT imaging devices.

3. Number of Experts Used to Establish the Ground Truth for the Test Set and Qualifications

• Number of Experts: Three expert annotators were used.
• Qualifications of Experts: Not explicitly stated beyond "expert annotators." The document implies they are experts in coronary vessel and lumen wall segmentation within cardiac CT images.

4. Adjudication Method for the Test Set

The ground truth was established "from three expert annotators." While it doesn't explicitly state "2+1" or "3+1", the use of three annotators suggests a consensus-based adjudication, likely majority vote (e.g., if two out of three agreed, that constituted the ground truth, or a more complex consensus process). The specific method is not detailed.

5. If a Multi-Reader Multi-Case (MRMC) Comparative Effectiveness Study was done

No. The document states, "No clinical studies were necessary to support substantial equivalence." The evaluation was primarily based on the performance of the ML algorithms against a reference standard established by experts, not on how human readers improved their performance with AI assistance.

6. If a Standalone (i.e., algorithm only without human-in-the-loop performance) was done

Yes. The performance evaluation focused on the "performance of the ML-based coronary vessel and lumen wall segmentation algorithm... evaluated against pre-defined acceptance criteria and compared to a reference standard established from three expert annotators." This indicates a standalone performance assessment of the algorithm's output. The device is also described as having "semi-automated machine learning algorithms", implying the user can verify and correct.

7. The Type of Ground Truth Used

Expert Consensus. The ground truth was established "from three expert annotators," indicating that human experts' annotations formed the reference standard against which the algorithm's performance was measured.

8. The Sample Size for the Training Set

Not explicitly stated. The document mentions the ML algorithms "have been trained and tested on images acquired from major vendors of CT imaging devices," but it does not provide the specific sample size for the training set. It only clarifies that the validation data was not used for training.

9. How the Ground Truth for the Training Set Was Established

Not explicitly stated. The document describes how the ground truth for the validation/test set was established (three expert annotators). It does not provide details on how the ground truth for the training set was generated.

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Cryon-X Pro
The private-label Cryon-X Pro device combines cold, heat, contrast, and compression therapy. It is intended to treat post-surgical and acute injuries to reduce edema, swelling, and pain for which cold and compression are indicated. It is intended to treat post-traumatic and post-surgical medical and/or surgical conditions for which localized thermal therapy (hot or cold) is indicated.

The device may optionally provide DVT therapy, intended to reduce the risk of the formation of deep venous thrombosis (DVT) by aiding blood flow back to the heart via lower extremity limb compression.

This device is intended to be used by or on the order of licensed healthcare professionals in rehabilitation facilities, outpatient clinics, athletic training settings, and home settings.

Cryon-X One
The private-label Cryon-X One device combines cold and compression therapy. It is intended to treat post-surgical and acute injuries to reduce edema, swelling, and pain for which cold and compression are indicated. It is intended to be used by or on the order of licensed healthcare professionals in rehabilitation facilities/hospitals, outpatient clinics, athletic training settings, and home settings.

This submission includes two models JKH-152 (private labelled as Cryon-X Pro) and JKH-151 (private labelled as Cryon-X One) as the subject devices. The private-label Cryon-X Pro has all the same features of combining cold, heat, contrast, and compression therapies as its original 510(k) cleared device in K223541, and Cryon-X One has the simplified features of cold and compression, which are the same as those of its original 510(k) cleared device in K223541. Each of the subject devices is an AC powered, software-controlled multimodality device, intended to be used by or on the order of licensed healthcare professionals in rehabilitation facilities/hospitals, outpatient clinics, athletic training settings, and home settings.

The subject device is a prescriptive device, which is intended to treat post-surgical and acute injuries to reduce edema, swelling, and pain for which cold and compression are indicated. It is intended to treat post traumatic and post-surgical medical and/or surgical conditions for which localized thermal therapy are indicated. It is optionally intended to reduce the risk of the formation of deep venous thrombosis (DVT) by aiding blood flow back to the heart via lower extremity limb compression.

The subject device and its accessories are clean and non-sterile. The device has a power switch, and then conducts the remaining operations on its touch screen, including the treatment temperature adjustment, air compression adjustment, and treatment time adjustment. The device works by circulating cooled or heated water and air through a treatment wrap that is placed on the treatment body area. The cooled or heated water circulates through the treatment wrap and provides cold or hot therapy, and the air compression inflates and deflates the treatment wrap to compress around the treatment body area. A connecting tube/hose is used to connect the device to the treatment wrap. The disposable or reusable wraps come with a variety of options to cover different body areas, including the universal, back, shoulder, ankle/foot, hip, knee, etc. To avoid any potential adverse skin reactions such as redness, irritation, and cod/hot injury, the sock/clothing should be worn by the patient prior to use.

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Cocoon Solo (DX-7020s) is a portable x-ray system indicated for taking diagnostic dental x-rays for both pediatric and adult patients.

Cocoon Solo (DX-7020s) is a handheld, portable X-ray device designed for dental radiographic examination and diagnosis for pediatric and adult patients by exposing a X-ray image receptor to ionizing radiation.

The X-ray tube is located inside the device body to be used with conventional film (F-speed or greater film), PSP (Phosphor plates), or digital X-ray sensors.

The image detectors (an integral part of a fully-functional diagnostic x-ray system) are not part of the submission.

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CoroFlow is indicated to provide hemodynamic information for use in the diagnosis of patients with cardiovascular diseases.

CoroFlow is intended for use in catheterization and related cardiovascular specialty laboratories to compute and display various physiological parameters based on the output from one or more measuring devices.

CoroFlow Cardiovascular system is used to calculate, display and store physiological parameters based on pressure and temperature measurements from Abbott Medical's PressureWire and Wi-box.

Calculated parameters include physiological indices to assess coronary lesion severity (FFR, Pd/Pa, RFR) and indices to assess coronary micro-circulation (IMR, CFR).

The system also provides indices based on the same raw pressure and temperature measurements (IMR_Corr, RRR, Absolute Flow/ Resistance, dP/dt, Tau).

CoroFlow is installed on a personal computer and receives measurement data wirelessly via the CoroHub Receiver. Information is displayed on the computer screen which can optionally be slaved to a monitor inside the coronary cathlab. Data can be stored on a local storage unit or transferred to a network location.

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The CoaguChek XS Plus System is intended for use by professional healthcare providers for quantitative prothrombin time testing for the monitoring of warfarin therapy. The system uses fresh capillary or non-anticoagulated venous whole blood.

The CoaguChek XS Plus system is a portable coagulation monitoring system to monitor prothrombin time (PT) in patients receiving oral anticoagulant therapy. The system uses the amperometric detection of thrombin in the blood sample. A test strip is used to determine a PT value from 8 µL of whole blood. Onboard quality control is available on every test strip and the system also features an optional external quality control material (CoaguChek XS PT Control).

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The CD Horizon™ Spinal System with or without Sextant™ instrumentation is intended for posterior, non-cervical fixation as an adjunct to fusion for the following indications: degenerative disc disease (DDD - defined as back pain of discogenic origin with degeneration of the disc confirmed by history and radiographic studies), spondylolisthesis, trauma (i.e. fracture or dislocation), spinal stenosis, curvatures (i.e. scoliosis, kyphosis, or lordosis), tumor, pseudarthrosis, and/or failed previous fusion.

Except for hooks, when used as an anterolateral thoracic/lumbar system, CD Horizon™ Spinal System titanium, cobalt chrome, and stainless steel implants may also be used for the same indications as an adjunct to fusion. With the exception of DDD, CD Horizon™ Legacy™ 3.5mm rods and associated components may be used for the aforementioned indications in skeletally mature patients as an adjunct to fusion. The 3.5mm rods may be used for the specific pediatric indications noted below.

When used for posterior non-cervical pedicle screw fixation in pediatric patients, CD Horizon™ Spinal System titanium, cobalt chrome, and stainless steel implants are indicated as an adjunct to fusion to treat progressive spinal deformities (i.e. scoliosis, kyphosis, or lordosis) including idiopathic scoliosis, neuromuscular scoliosis, and congenital scoliosis. Additionally, the CD Horizon™ Spinal System is intended to treat pediatric patients diagnosed with the following conditions: spondylolisthesis/spondylolysis, fracture caused by tumor and/or trauma, pseudarthrosis, and/or failed previous fusion. These devices are to be used with autograft and/or allograft. Pediatric pedicle screw fixation is limited to a posterior approach.

The CD Horizon™ PEEK rods are intended to provide posterior supplemental fixation when used with an interbody fusion cage for patients diagnosed with DDD. These DDD patients may also have up to Grade 1 spondylolisthesis or retrolisthesis at the involved level. This device is intended for 1-2 level use in the lumbosacral spine (L2 - S1) in skeletally mature patients. The device is intended for use with an interbody fusion cage at the instrumented level and is not intended for stand-alone use.

The CD Horizon™ Spire™ plate is a posterior, single-level, non-pedicle supplemental fixation device intended for use in the non-cervical spine (T1-S1) as an adjunct to fusion in skeletally mature patients. It is intended for plate fixation/attachment to spinous processes for the purpose of achieving supplemental fixation in the following conditions: DDD (as previously defined), spondylolisthesis, trauma, and/or tumor.

To achieve additional levels of fixation, CD Horizon™ Spinal System rods may be connected to the Vertex™ Reconstruction System with the Vertex™ rod connector. Refer to the Vertex™ Reconstruction System package insert for a list of the Vertex™ indications of use.

The CD Horizon™ Spinal System consists of a variety of shapes and sizes of rods, hooks, screws, Crosslink™ Plates, staples, and connecting components, as well as implant components from other Medtronic spinal systems which can be rigidly locked into a variety of configurations, with each construct being tailor-made for the individual case.

A subset of CD Horizon™ Spinal System components may be used for posterior pedicle screw fixation in pediatric cases. These constructs may be comprised of a variety of shapes and sizes of rods (ranging in diameter from 3.5mm to 6.35mm), hooks, screws, Crosslink™ plates, and connecting components. Similar to the CD Horizon™ implants used in adult cases, these components can be rigidly locked into a variety of configurations, with each construct being tailor-made for the individual case.

Certain components within the CD Horizon™ Spinal System are specifically excluded for use in pediatric patients. These include PEEK rods and Spire™ plates. Screws used in pediatric cases are only cleared for use via a posterior approach. All components used in pediatric cases are fabricated from medical grade stainless steel, medical grade titanium, titanium alloy, and medical grade cobalt-chromium-molybdenum alloy.

Certain implant components from other Medtronic spinal systems can be used with the CD Horizon™ Spinal System in non-pediatric cases. These components include TSRH™ rods, hooks, screws, plates; Crosslink™ plates, connectors, staples, and washers; GDLH™ rods, hooks, and connectors; Crosslink™ bar and connectors and Medtronic multi-axial rods and screws.

Note that certain components are specifically designed to connect to specific rod diameters, while other components can connect to multiple rod diameters. Care should be taken so the correct components are used in the spinal construct.

CD Horizon™ hooks are intended for posterior use only. CD Horizon™ staples and associated screws are intended for anterior use only. However, for patients of smaller stature and pediatric patients, CD Horizon™ 4.5mm rods and associated components may be used posteriorly.

CD Horizon™ Spinal System implant components are fabricated from medical grade stainless steel, medical grade titanium, titanium alloy, medical grade cobalt-chromium-molybdenum alloy, or medical grade PEEK Optima-LT1. Certain CD Horizon™ Spinal System components may be coated with hydroxyapatite. No warranties, expressed or implied, are made. Implied warranties of merchantability and fitness for a particular purpose or use are specifically excluded.

Never use stainless steel and titanium implant components in the same construct.

Medical grade titanium, titanium alloy, and/or medical grade cobalt-chromium-molybdenum alloy may be used together. Never use titanium, titanium alloy, and/or medical grade cobalt chromium-molybdenum alloy with stainless steel in the same construct.

PEEK Optima-LT1 implants may be used with titanium or cobalt-chromium-molybdenum alloy implants. CD Horizon™ PEEK rods are not to be used in pediatric patients. PEEK rods are only to be used with the associated pedicle screws as well as interbody fusion devices in the anterior spinal column.

To achieve best results, do not use CD Horizon™ Spinal System implant components with components from any other system or manufacturer unless specifically allowed to do so in this or another Medtronic document.

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The Carrier XL Delivery Catheter is intended for general intravascular use, including the peripheral, coronary and neuro vasculature for the infusion of diagnostic agents, such as contrast media, and to assist in the delivery of interventional devices, such as distal access catheters, in the neurovasculature.

The Carrier XL Delivery Catheter is a single lumen, variable stiffness, composite catheter. The design facilitates the advancement of the catheter and is intended to assist the delivery of interventional devices in the peripheral and neurovasculature. The outer surface of the Carrier XL Delivery Catheter is coated with a hydrophilic coating to increase lubricity. The proximal end of the Carrier XL Delivery Catheter incorporates a luer fitting for the attachment of accessories. Two radiopaque markers at the distal end help to facilitate fluoroscopic visualization. A Steam Shaping Mandrel and Peel-away Introducer Tube are included within the tray. The Carrier XL Delivery Catheter is provided sterile, non-pyrogenic, and is intended for single use only.

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Chemfort® 28-day 20 mm Vial Adaptor is a single use, sterile Closed System Transfer Device (CSTD) that mechanically prohibits the release of drugs, including antineoplastic and hazardous drugs, in vapor, aerosol or liquid form during preparation, reconstitution, compounding and administration, thus minimizing exposure of individuals, healthcare personnel, and the environment to hazardous drugs.

Chemfort® 28-day 20 mm Vial Adaptor prevents the introduction of microbial and airborne contaminants into the drug or fluid path for up to 28 days or 10 activations.

The Chemfort® Closed System Transfer Device (CSTD) is a system of components that allows the reconstitution of liquid or pre-dissolved powder drugs into infusion bags, flexible bottles or syringes. Single, partial or multiple vials can be used for each infusion solution container. The Chemfort® CSTD prevents contamination of the user or the environment by the drug through the use of elastomeric seals and an active carbon filter.

The components of the predicate Chemfort® CSTD system are:

• Vial Adaptor 20 mm with 13 mm Vial Converter
• Vial Adaptor 28 mm
• Vial Adaptor 32 mm
• Syringe Adaptor
• Syringe Adaptor Lock
• Luer Lock Adaptor
• Bag Adaptor SP

Each of the Chemfort® system components is available separately.

This submission introduces a new version of the 20mm Vial Adaptor to the Chemfort® CSTD system, called the Chemfort® 28-day 20 mm Vial Adaptor, as a range extension. This new Vial Adaptor differs from the predicate Vial Adaptor only with respect to the usage time limitation, which is extended from 7 to 28 days, but with the same limit of 10 activations. This change is reflected in the Indications for Use statement and the device labeling.

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