Who is the manufacturer of Vitrea CT Brain Perfusion?

Vital Images, Inc. filed the 510(k) submission for Vitrea CT Brain Perfusion (K181247).

What is the FDA product code for Vitrea CT Brain Perfusion?

LLZ. It is classified under 21 CFR 892.2050 as a Class 2 device in the Radiology panel.

What is the regulatory pathway for Vitrea CT Brain Perfusion?

510(k) clearance (submission type: Traditional).

Who can help prepare an FDA 510(k) submission like Vitrea CT Brain Perfusion?

Innolitics — a medical-device software consultancy — provides regulatory and engineering support for FDA 510(k) submissions. See https://innolitics.com/services/510ks/ or contact https://innolitics.com/contact.

Vitrea CT Brain Perfusion

K181247 · Vital Images, Inc. · LLZ · Nov 20, 2018 · Radiology

Device Facts

Record ID	K181247
Device Name	Vitrea CT Brain Perfusion
Applicant	Vital Images, Inc.
Product Code	LLZ · Radiology
Decision Date	Nov 20, 2018
Decision	SESE
Submission Type	Traditional
Regulation	21 CFR 892.2050
Device Class	Class 2
Attributes	Software as a Medical Device

Intended Use

Vitrea CT Brain Perfusion is a non-invasive post-processing application designed to evaluate areas of brain perfusion. The software can calculate cerebral blood flow (CBF), cerebral blood volume (CBV), local bolus timing (i.e., delay of tissue response, time to peak), and mean transit time (MTT) from dynamic CT image data acquired after the injection of contrast media. The package also allows the calculation of regions of interest and mirrored regions, as well as the visual inspection of time density curves. Vitrea CT Brain Perfusion supports the physician in visualizing the apparent blood perfusion in brain tissue affected by acute stroke. Areas of decreased perfusion, as is observed in acute cerebral infarcts, appear as areas of changed signal intensity (lower for both CBF and CBV and higher for time to peak and MTT).

Device Story

Vitrea CT Brain Perfusion is a non-invasive post-processing software application used by clinicians to analyze dynamic CT image data acquired after contrast media injection. It transforms raw CT data into quantitative perfusion maps, including cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), and time to peak (TTP). The device utilizes a Bayesian algorithm—or optionally an SVD+ algorithm—to perform motion correction, curve fitting, and noise reduction. It generates 2D/3D perfusion maps, summary maps, and time-density curves. Used in clinical settings, the software assists physicians in visualizing perfusion deficits associated with acute stroke. By providing objective quantification of blood flow, the device supports clinical decision-making regarding stroke management and patient intervention.

Clinical Evidence

No clinical studies were required. Safety and effectiveness were supported by bench testing, software verification, and validation. External validation involved physician evaluation comparing the Bayesian algorithm to the predicate's SVD+ algorithm, concluding the subject device is as safe and effective as the predicate.

Technological Characteristics

Post-processing software for CT imaging. Features Bayesian and SVD+ perfusion algorithms. Supports DICOM 3.0 standards. Operates on standard radiological workstations. Includes automated motion correction, vessel removal, and midline detection. Complies with IEC 62304 (software lifecycle) and ISO 14971 (risk management).

Indications for Use

Indicated for patients with suspected compromised or abnormal cerebral blood flow. Intended for use by qualified healthcare professionals including radiologists, non-radiology specialists, physicians, and technologists.

Regulatory Classification

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.

Special Controls

*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).

Predicate Devices

Vitrea CT Brain Perfusion software (K121213)

Reference Devices

Olea Sphere V3.0 (K152602)

Related Devices

K201573 — Brain Perfusion (BP) application · Philips Medical Systems Nederland B.V. · Aug 17, 2021
K120637 — SYNAPSE 3D BRAIN PERFUSION · Fujifilm Medical System U.S.A., Inc. · May 8, 2012
K182716 — Brain Perfusion (BP) application · Philips Medical Systems Nederland B.V. · May 29, 2019
K231570 — StrokeViewer Perfusion · Nico-Lab B.V. · Dec 14, 2023
K072693 — CSNP-001A NEURO PACKAGE · Toshiba America Medical Systems, In.C · Nov 1, 2007

Submission Summary (Full Text)

{0}------------------------------------------------ Image /page/0/Picture/0 description: The image contains the logo of the U.S. Food and Drug Administration (FDA). On the left is the Department of Health & Human Services logo. To the right of that is the FDA logo, which is a blue square with the letters "FDA" in white. To the right of the blue square is the text "U.S. FOOD & DRUG ADMINISTRATION" in blue. November 20, 2018 Vital Images, Inc. Susan Atwood Principal Quality Engineer 5850 Opus Parkway, Suite 300 MINNETONKA, MN 55343-4414 Re: K181247 Trade/Device Name: Vitrea CT Brain Perfusion Regulation Number: 21 CFR 892.2050 Regulation Name: Picture Archiving And Communications System Regulatory Class: Class II Product Code: LLZ Dated: October 23, 2018 Received: October 24, 2018 Dear Susan Atwood: We have reviewed your Section 510(k) premarket notification of intent to market the device referenced above and have determined the device is substantially equivalent (for the indications for use stated in the enclosure) to legally marketed predicate devices marketed in interstate commerce prior to May 28, 1976, the enactment date of the Medical Device Amendments, or to devices that have been reclassified in accordance with the provisions of the Federal Food, Drug, and Cosmetic Act (Act) that do not require approval of a premarket approval application (PMA). You may, therefore, market the device, subject to the general controls provisions of the Act. Although this letter refers to your product as a device, please be aware that some cleared products may instead be combination products. The 510(k) Premarket Notification Database located at https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm identifies combination product submissions. The general controls provisions of the Act include requirements for annual registration, listing of devices, good manufacturing practice, labeling, and prohibitions against misbranding and adulteration. Please note: CDRH does not evaluate information related to contract liability warranties. We remind you, however, that device labeling must be truthful and not misleading. If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to additional controls. Existing major regulations affecting your device can be found in the Code of Federal Regulations, Title 21, Parts 800 to 898. In addition, FDA may publish further announcements concerning your device in the Federal Register. Please be advised that FDA's issuance of a substantial equivalence determination does not mean that FDA has made a determination that your device complies with other requirements of the Act or any Federal statutes and regulations administered by other Federal agencies. You must comply with all the Act's requirements, including, but not limited to: registration and listing (21 CFR Part 807); labeling (21 CFR Part {1}------------------------------------------------ 801); medical device reporting of medical device-related adverse events) (21 CFR 803) for devices or postmarketing safety reporting (21 CFR 4, Subpart B) for combination products (see https://www.fda.gov/CombinationProducts/GuidanceRegulatoryInformation/ucm597488.htm); good manufacturing practice requirements as set forth in the quality systems (OS) regulation (21 CFR Part 820) for devices or current good manufacturing practices (21 CFR 4, Subpart A) for combination products; and, if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR Part 807.97). For questions regarding the reporting of adverse events under the MDR regulation (21 CFR Part 803), please go to http://www.fda.gov/MedicalDevices/Safety/ReportaProblem/default.htm. For comprehensive regulatory information about mediation-emitting products, including information about labeling regulations, please see Device Advice (https://www.fda.gov/MedicalDevices/DeviceRegulationandGuidance/) and CDRH Learn (http://www.fda.gov/Training/CDRHLearn). 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 (http://www.fda.gov/DICE) for more information or contact DICE by email (DICE@fda.hhs.gov) or phone (1-800-638-2041 or 301-796-7100). Sincerely, Michael D. O'Hara For Robert A. Ochs. Ph.D. Director Division of Radiological Health Office of In Vitro Diagnostics and Radiological Health Center for Devices and Radiological Health Enclosure {2}------------------------------------------------ # Indications for Use 510(k) Number (if known) K181247 Device Name Vitrea CT Brain Perfusion #### Indications for Use (Describe) Vitrea CT Brain Perfusion is a non-invasive post-processing application designed to evaluate areas of brain perfusion. The software can calculate cerebral blood flow (CBF), cerebral blood volume (CBV), local bolus timing (i.e., delay of tissue response, time to peak), and mean transit time (MTT) from dynamic CT image data acquired after the injection of contrast media. The package also allows the calculation of regions of interest and mirrored regions, as well as the visual inspection of time density curves. Vitrea CT Brain Perfusion supports the physician in visualizing the apparent blood perfusion in brain tissue affected by acute stroke. Areas of decreased perfusion, as is observed in acute cerebral infarcts, appear as areas of changed signal intensity (lower for both CBF and CBV and higher for time to peak and MTT). | Type of Use (Select one or both, as applicable) | |-------------------------------------------------| |-------------------------------------------------| X Prescription Use (Part 21 CFR 801 Subpart D) Over-The-Counter Use (21 CFR 801 Subpart C) ## CONTINUE ON A SEPARATE PAGE IF NEEDED. This section applies only to requirements of the Paperwork Reduction Act of 1995. #### *DO NOT SEND YOUR COMPLETED FORM TO THE PRA STAFF EMAIL ADDRESS BELOW.* The burden time for this collection of information is estimated to average 79 hours per response, including the time to review instructions, search existing data sources, gather and maintain the data needed and complete and review the collection of information. Send comments regarding this burden estimate or any other aspect of this information collection, including suggestions for reducing this burden, to: > Department of Health and Human Services Food and Drug Administration Office of Chief Information Officer Paperwork Reduction Act (PRA) Staff PRAStaff@fda.hhs.gov "An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB number." {3}------------------------------------------------ Image /page/3/Picture/0 description: The image shows the word "VITAL" in a sans-serif font. The letters are black, except for the dot above the "i", which is red. The letters are evenly spaced and the word is centered. # 510K Summary This 510(k) summary is submitted in accordance with the requirements of 21 C.F.R. Part 807.92(c). | Basis for the Submission: | Vital Images, Inc. hereby submits this traditional 510(k) to provide a notification submission for proposed software changes in the already 510(k) cleared Vitrea CT Brain Perfusion software (K121213). | | |---------------------------------------------|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|----------------------------------------------------------------------------------------------------------------------------------------------------------------------| | Submitter: | Vital Images, Inc. 5850 Opus Parkway, Suite 300 Minnetonka, MN, 55343-4414, USA | | | Establishment Registration: | 2134213 | | | Contact Person: | Susan Atwood Principal Quality Engineer Phone: 952-487-9759 Fax: 952-487-9510 E-mail: satwood@vitalimages.com | Alternate Contact Person: Vince Swenson Sr. Director of Quality and Regulatory Phone: 952-487-9548 Fax: 952-487-9510 E-mail: vswenson@vitalimages.com | | 510(k) Type: | Traditional | | | Summary Date: | May 8, 2018 | | | Device Trade Name: | Vitrea CT Brain Perfusion | | | Device Common Name/ Regulatory Description: | Picture Archiving and Communications System | | | Device Classification Name: | System, Image Processing, Radiological | | | Regulation Number: | 21 CFR 892.2050 | | | Product Code: | LLZ | | | Regulatory Classification: | Class II | | | Device Panel: | Radiology | | {4}------------------------------------------------ Image /page/4/Picture/0 description: The image shows the word "VITAL" in black font. The "i" in "VITAL" has a red dot above it. The font is sans-serif and the letters are evenly spaced. ## Predicate Device | Predicate Device | Manufacturer | FDA 510(k) Number | |---------------------------------------|-----------------------------------------------------------------------------------|-------------------| | Vitrea CT Brain Perfusion software | Vital Images, Inc. 5850 Opus Parkway, Suite 300 Minnetonka, MN 55343 USA | K121213 | #### Reference Device | Reference Device | Manufacturer | FDA 510(k) Number | |------------------|-----------------------------------------------------------------------------------|-------------------| | Olea Sphere V3.0 | Olea Medical 93 Avenue Des Sorbiers, Zone Athelia Iv La Ciotat, FR 13600 | K152602 | ## Device Description Vitrea CT Brain Perfusion is a noninvasive post-processing software that calculates cerebral blood flow (CBF), cerebral blood volume (CBV), local bolus timing (i.e., delay of tissue response, time to peak), and mean transit time (MTT) from dynamic CT image data. It displays time density curves, perfusion characteristics in perfusion and summary maps, as well as regions of interest and mirrored regions. #### Intended Use / Indications for Use Vitrea CT Brain Perfusion is a non-invasive post-processing application designed to evaluate areas of brain perfusion. The software can calculate cerebral blood flow (CBF), cerebral blood volume (CBV), local bolus timing (i.e., delay of tissue response, time to peak), and mean transit time (MTT) from dynamic CT image data acquired after the injection of contrast media. The package also allows the calculation of regions of interest and mirrored regions, as well as the visual inspection of time density curves. Vitrea CT Brain Perfusion supports the physician in visualizing the apparent blood perfusion in brain tissue affected by acute stroke. Areas of decreased perfusion, as is observed in acute cerebral infarcts, appear as areas of changed signal intensity (lower for both CBF and CBV and higher for time to peak and MTT). ## Intended for Disease / Condition / Patient Population Vitrea CT Brain Perfusion is intended for patients with suspected compromised or abnormal cerebral blood flow. ## Key Changes from last 510k clearance K121213 The following list contains the key changes since the last 510k. These changes were made to enhance user experience and performance: - . Addition of Bayesian algorithm. - Enhancements to Region-of-Interest tools (ROI) tools. ● - Optimized layouts to include 4-up and 6-up views. . - Support for loading variable time scans for multi-series studies in 2D. ● - Support for Jog and Helical Shuttle Thin Slice Brain Perfusion datasets from Canon ● (formerly Toshiba) Aquilion Prime Scanners. - . Support for Thick Slice "Jog Shuttle" from Philips Scanners (2D Perfusion). - . Support of 2D perfusion for thick slice irregular helical Siemens & GE scans. Page: 009-2 (of 10) {5}------------------------------------------------ Image /page/5/Picture/0 description: The image shows the word "VITAL" in black font. The "i" in "VITAL" has a red dot above it. The font is simple and sans-serif. The letters are evenly spaced and the word is centered. - Increased the number of slices allowed per time series for GE & Siemens Helical Shuttle . Scans. - Support for DSA for Jog and Helical datasets. . - Enhancements to 4D thin slice to support axial and helical GE scans and helical Siemens scans. - . Addition of 3D Summary Map view ## Regulatory Comparison | | Subject Device | Predicate Device | Reference Device | | |---------------------|---------------------------------------------------------------|----------------------------------------------|----------------------------------------------|-------------------------------------------------------| | Characteristic | Vitrea CT Brain Perfusion with Bayesian Algorithm | Vitrea CT Brain Perfusion (K121213) | Olea Sphere V3.0 (K152602) | Comparison | | Classification Name | System, Image Processing, Radiological | System, Image Processing, Radiological | System, Image Processing, Radiological | Same | | Regulatory Number | 892.2050 | 892.2050 | 892.2050 | Same | | Product Code | LLZ | LLZ | LLZ | Same | | Classification | Class II | Class II | Class II | Same | | Review Panel | Radiology | Radiology | Radiology | Same | | Decision Date | Under Review | Nov. 02, 2012 | Mar. 03, 2016 | Predicate and reference devices are cleared. | ## Indications for Use Comparison with the Predicate Device | | Subject Device | Predicate Device | | |------------------------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|------------| | Criteria | Vitrea CT Brain Perfusion with Bayesian Algorithm | Vitrea CT Brain Perfusion (K121213) | Comparison | | Indications for Use | Vitrea CT Brain Perfusion is a non-invasive post-processing application designed to evaluate areas of brain perfusion. The software can calculate cerebral blood flow (CBF), cerebral blood volume (CBV), local bolus timing (i.e., delay of tissue response, time to peak), and mean transit time (MTT) from dynamic CT image data acquired after the injection of contrast media. The package also allows the calculation of regions of interest and mirrored regions, as well as the visual inspection of time density curves. Vitrea CT Brain | Vitrea CT Brain Perfusion is a non-invasive post-processing application designed to evaluate areas of brain perfusion. The software can calculate cerebral blood flow (CBF), cerebral blood volume (CBV), local bolus timing (i.e., delay of tissue response, time to peak), and mean transit time (MTT) from dynamic CT image data acquired after the injection of contrast media. The package also allows the calculation of regions of interest and mirrored regions, as well as the visual inspection of time density curves. Vitrea CT Brain | Same | {6}------------------------------------------------ | Criteria | Subject Device | Predicate Device | Comparison | |-----------------------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|------------| | | Vitrea CT Brain Perfusion with Bayesian Algorithm | Vitrea CT Brain Perfusion (K121213) | | | | Perfusion supports the physician in visualizing the apparent blood perfusion in brain tissue affected by acute stroke. Areas of decreased perfusion, as is observed in acute cerebral infarcts, appear as areas of changed signal intensity (lower for both CBF and CBV and higher for time to peak and MTT). | Perfusion supports the physician in visualizing the apparent blood perfusion in brain tissue affected by acute stroke. Areas of decreased perfusion, as is observed in acute cerebral infarcts, appear as areas of changed signal intensity (lower for both CBF and CBV and higher for time to peak and MTT). | | | Intended Users | Qualified healthcare professionals including, but not restricted to, radiologists, non- radiology specialists, physicians and technologists. | Qualified healthcare professionals including, but not restricted to, radiologists, non- radiology specialists, physicians and technologists. | Same | | Patient Population | Patients with suspected compromised or abnormal cerebral blood flow. | Patients with suspected compromised or abnormal cerebral blood flow. | Same | | Modality Support | CT | CT | Same | ## Similarities in Technology with the Predicate Device | | Subject Device | Predicate Device | | |------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|------------------------------------------------------------|----------------------------------------------|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------| | Software Functionality | Vitrea CT Brain Perfusion with Bayesian Algorithm | Vitrea CT Brain Perfusion (K121213) | Comparison | | Quantitative brain perfusion maps for: • Regional cerebral blood volume (rCBV) • Regional cerebral blood flow (rCBV) • Mean transit time (MTT) • Time to peak of tissue (TTP) • Delay of tissue response (Delay) | Yes | Yes | Same | | Display: • Region of interest (ROI) • Mirrored regions • Time density curves | Yes | Yes | Same | | | Subject Device | Predicate Device | | | Software Functionality | Vitrea CT Brain Perfusion with Bayesian Algorithm | Vitrea CT Brain Perfusion (K121213) | Comparison | | Display of Perfusion Maps in: MPR orientations • 2D • 3D | Yes | Yes | Same | | 4D-DSA (digital subtraction angiography) view for visualizing flow of contrast through the vessels | Yes | Yes | Same | | Perfusion maps in MPR orientations and 2D | Yes | Yes | Same | | Automatic motion correction and curve fitting | Yes | Yes | Same | | Region of interest (ROI) templates | Yes | Yes | Same | | Midline identification and display | Yes | Yes | Same | | Manual and automatic detection of artery and vein locations | Yes | Yes | Same | | Automatic calculation of quantitative brain perfusion results | Yes | Yes | Same | | Window leveling, edit mid-plane line, display mirrored ROIs, snapshots, time-series batch, movies for physician reporting | Yes | Yes | Same | | Report generation for the Brain Perfusion patient study | Yes | Yes | Same | | Perfusion measurement averages for multiple ROIs with ability to mirror an ROI from one hemisphere to the other | Yes | Yes | Same | | Window leveling, edit mid-plane line, display mirrored ROIs, snapshots, time-series batch, movies for physician reporting | Yes | Yes | Same | | Color coded Summary maps | Yes | Yes | Same | | | Subject Device | Predicate Device | | | Software Functionality | Vitrea CT Brain Perfusion with Bayesian Algorithm | Vitrea CT Brain Perfusion (K121213) | Comparison | | Bayesian Perfusion Algorithm | Yes | No | Subject device provides user with choice to use either the Bayesian algorithm or SVD+ algorithm. Predicate device can use the SVD+ algorithm. Note: The added Bayesian algorithm in the subject device is similar to the Bayesian algorithm in the reference device, Olea Sphere 3.0, which was cleared by the FDA under K152602. Therefore, this added algorithm does not raise different questions of safety and effectiveness. | {7}------------------------------------------------ {8}------------------------------------------------ Image /page/8/Picture/0 description: The image shows the word "VITAL" in a bold, sans-serif font. The letters are black, except for the dot above the "i", which is red. The word is horizontally oriented and appears to be a logo or brand name. ## Differences in Technology with the Predicate Device ## Similarities in Technology with the Reference Device | | Subject Device | Reference Device | | |-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|------------------------------------------------------------|-------------------------------|------------| | Software Functionality | Vitrea CT Brain Perfusion with Bayesian Algorithm | Olea Sphere V3.0 (K152602) | Comparison | | Bayesian Algorithm: The Bayesian estimation of the hemodynamical parameters integrates a model-based approach especially robust to image noise and fast analytical integration techniques to compute the posterior probabilities of the estimated blood flow, delay, MTT and time concentration curves (residue functions). | Yes | Yes | Same | | Motion correction | Yes | Yes | Same | | Automatic Arterial Input function and Vein Output function | Yes | Yes | Same | {9}------------------------------------------------ | | Subject Device | Reference Device | | |----------------------------------------------------------------|------------------------------------------------------------|-------------------------------|------------| | Software Functionality | Vitrea CT Brain Perfusion with Bayesian Algorithm | Olea Sphere V3.0 (K152602) | Comparison | | Automatic vessel removal | Yes | Yes | Same | | Automatic Brain Midline detection | Yes | Yes | Same | | Noise reduction is applied before the Bayesian computation. | Yes | Yes | Same | | Model based Bayesian estimation of perfusion parameters. | Yes | Yes | Same | | Delay insensitive method. | Yes | Yes | Same | # Summary of Non-Clinical Tests The changes to the Vitrea CT Brain Perfusion software were designed, developed, and tested according to written procedures that included risk management. Software verification testing was completed to ensure the new features operate according to defined requirements. The following design control measures were applied to the development of the Vitrea CT Brain Perfusion software: - . Risk Management - Requirements Reviews ● - Code Designs ● - Code Development Testing ● - Code Reviews ● - Design Reviews ● - Verification of the software - . Validation of the software # Risk Management Each risk pertaining to the modifications to the Vitrea CT Brain Perfusion software has been individually assessed to determine if the benefits outweigh the risk. Every risk has been reduced as low as possible and has been evaluated to have a probability of occurrence of harm of "Improbable." All risks for these modifications were collectively reviewed to determine if the benefits outweigh the risk. Based on Post Market information and because of the risk control measures included in these modifications, it is believed that the risk for these modifications as a whole are extremely low. Considering all risks against the benefits, it has been assessed that the benefits do outweigh the risks for these modifications. 009 510(k) Summary {10}------------------------------------------------ Image /page/10/Picture/0 description: The image shows the word "VITAL" in a bold, sans-serif font. The letters are black, except for the dot above the "i", which is red. The letters are evenly spaced and the word is centered. During the design review, the following conclusions were reached: - The medical benefits of the device outweigh the residual risk for each individual risk and ● all risks together - . All risks have been reduced as low as possible - . The overall residual risk for the software product is deemed acceptable # Verification The software verification team's primary goal was to assure that the software fully satisfies all expected system requirements and features. Test cases were executed against the system features, requirements and risk mitigations. Verification testing confirmed the software functions according to its requirements and all risk mitigations are functioning properly. # Validation The software validation team's primary qoal was to assure that the software conforms to user needs and intended use. The validation team conducted workflow testing that provided evidence that the system requirements and features were implemented properly to conform to the intended use. # Alqorithm Testing Algorithm testing was performed to validate the proper function of the Bayesian algorithms within Vitrea CT Brain Perfusion. The Vitrea CT Brain Perfusion Bavesian algorithm has passed all the verification and validation and is therefore considered validated and acceptable. # External Validation During the external validation of the Vitrea CT Brain Perfusion software, physicians evaluated if the Brain Perfusion with Bayesian algorithm (subject device) was substantially equivalent with the Brain Perfusion with SVD+ algorithm (K121213, predicate device). Based on the scores provided by the physicians, Vital concluded the Brain Perfusion with Bayesian algorithm is as safe and effective as the already cleared Brain Perfusion with SVD+ algorithm and fulfills its intended use. # Summary of Clinical Tests The subject of this 510(k) notification, Vitrea CT Brain Perfusion software, did not require clinical studies to support safety and effectiveness of the software. # Cyber and Information Security The Vitrea CT Brain Perfusion software follows internal documentation which includes information based on the FDA Guidance: Content of Premarket Submissions for Management of Cybersecurity in Medical Devices. Internal documentation covers the following: - 1. Hazard analysis, mitigations, and design considerations pertaining to intentional and unintentional cybersecurity risks associated with the device, including: - A specific list of all cybersecurity risks that were considered in the design of the . device; {11}------------------------------------------------ Image /page/11/Picture/0 description: The image shows the word "VITAL" in black letters. The "i" in "VITAL" has a red dot above it. The font is sans-serif and the letters are evenly spaced. - . A specific list and justification for all cybersecurity controls that were established for the device. - A traceability matrix that links the actual cybersecurity controls to the cybersecurity risks 2. that were considered; - 3. A summary describing the plan for providing validated software updates and patches as needed throughout the lifecycle of the medical device to continue to assure its safety and effectiveness. The FDA typically will not need to review or approve medical device software changes made solely to strengthen cybersecurity. - A summary describing controls that are in place to assure that the medical device 4. software will maintain its integrity (e.g. remain free of malware) from the point of origin to the point at which that device leaves the control of the manufacturer; and - 5. Device instructions for use and product specifications related to recommended cybersecurity controls appropriate for the intended use environment (e.g. anti-virus software, use of firewall). # Performance Standards The FDA has not established mandatory performance standards and no special controls exist for this device. General software verification and validation tests were conducted to confirm proper function of the device's features. | Standard No. | Standards Organization | Standard Title | Version | Date | |------------------------------------------------------------|---------------------------|-------------------------------------------------------------------------------------------|---------|------------| | PS 3.1- 3.20 (2016) (Recognition Number 12-300) | NEMA | Digital Imaging and Communications in Medicine (DICOM) Set (Radiology) | 3 | 06/27/2016 | | ISO 14971:2007 /(R)2010 (Recognition Number 5-70) | AAMI / ANSI / ISO | Medical Devices - Applications of Risk Management to Medical Devices | 2007 | 06/27/2016 | | IEC 62304:2006 (Recognition Number 13-32) | AAMI / ANSI / IEC | Medical Device Software - Software Life Cycle Processes (Software / Informatics) | 2006 | 08/20/2012 | The Vitrea CT Brain Perfusion software complies with the following voluntary recognized consensus standards: # Substantial Equivalence Analysis Conclusion Vital Images, Inc. believes the Vitrea CT Brain Perfusion software with Bayesian algorithm has a similar intended use, indications for use, principle of operation, and technological characteristics as the legally marketed, predicate device Vitrea CT Brain Perfusion with SVD+ algorithm (K121213). In addition, the Bayesian perfusion algorithm added to the Vitrea CT Brain Perfusion software is similar to the Bayesian perfusion algorithm in the reference device, Olea Sphere V3.0, which was cleared by the FDA under K152602. {12}------------------------------------------------ Image /page/12/Picture/0 description: The image shows the word "VITAL" in black letters. The "i" in "VITAL" has a red dot above it. The letters are bold and sans-serif. The background is white. Furthermore, the verification and validation testing performed demonstrates the subject device is as safe and effective as the predicate device and does not raise any different questions of safety and effectiveness. Therefore, Vital believes the enhancements in the Vitrea CT Brain Perfusion software do not alter the fundamental scientific technology, safety or intended use of the device. Each change was evaluated for the impact to the safety and effectiveness of the software. It was concluded that the changes do not raise any different questions of safety or effectiveness when used as labeled. The implemented design controls, risk management activities, labeling, and performed verification and validation tests demonstrate the safety and efficacy of the subject device. Based on the comparison information provided above, Vital Images, Inc. believes the subject device should be found substantially equivalent to the predicate device.