visor2 system

K210109 · Eemagine Medical Imaging Solutions GmbH · HAW · Apr 8, 2022 · Neurology

Device Facts

Record IDK210109
Device Namevisor2 system
ApplicantEemagine Medical Imaging Solutions GmbH
Product CodeHAW · Neurology
Decision DateApr 8, 2022
DecisionSESE
Submission TypeTraditional
Regulation21 CFR 882.4560
Device ClassClass 2

Intended Use

visor2 is used to aid 3D navigation for positioning of Transcranial Magnetic Stimulation (TMS) coils over preselected brain regions based on data from MRI measurements or scalp landmarks and optional EMG recording in clinical procedures. The visor2 system is compatible with the following commercially available TMS coils of the following TMS companies: - Mag & More: PMD70-aCool Double coil Figure-8 (510575) - MagStim Company Ltd.: Double 70mm Remote Coil (3190-00 rev2), Double 70mm Air Film Coil (3910 00); - MagVenture A/S: Double 75mm (C-B60), Double Cooled 75mm (Cool-B65), Double 95mm (D-B80), Angulated Double Cooled 97mm (Cool-B70 rev2), Butterfly figure-8 (C-B70) - Neuronetics Inc.: NeuroStar coil The visor2 system must be operated by a trained physician and must not be used during surgical operations.

Device Story

3D navigation system for TMS coil positioning; inputs include MRI data, scalp landmarks, and optional EMG signals; uses optical stereotactic tracking (infrared camera and tracking tools) to register patient head and coil in 3D space; provides visual guidance on All-in-One touch display; operated by trained physicians in clinical/outpatient settings; aids accurate coil placement relative to anatomical/functional targets; benefits patient by ensuring precise stimulation delivery; does not perform stimulation itself.

Clinical Evidence

Bench testing only. No clinical data required. Performance validated via electrical safety (IEC 60601-1), EMC (IEC 60601-1-2), and system accuracy testing. Overall system accuracy demonstrated <4mm. EMG acquisition accuracy validated to 10% of parameters. Biocompatibility confirmed for patient-contacting pointer tool.

Technological Characteristics

Cart-based system with All-in-One PC; optical tracking via NDI infrared camera; tracking tools made of Polyurethane (PUR); connectivity via DICOM for MRI/fMRI import; optional EMG amplifier (eego EE-410); software-controlled navigation; electrical safety per IEC 60601-1; EMC per IEC 60601-1-2.

Indications for Use

Indicated for 3D navigation to aid positioning of TMS coils over preselected brain regions using MRI data or scalp landmarks, with optional EMG recording, in clinical procedures. For use by trained physicians; not for surgical use.

Regulatory Classification

Identification

A stereotaxic instrument is a device consisting of a rigid frame with a calibrated guide mechanism for precisely positioning probes or other devices within a patient's brain, spinal cord, or other part of the nervous system.

Predicate Devices

Reference Devices

Related Devices

Submission Summary (Full Text)

{0}------------------------------------------------ Image /page/0/Picture/0 description: The image shows the logo of the U.S. Food and Drug Administration (FDA). The logo consists of two parts: the Department of Health and Human Services logo on the left and the FDA logo on the right. The FDA logo features the letters "FDA" in a blue square, followed by the words "U.S. FOOD & DRUG ADMINISTRATION" in blue text. April 8, 2022 Eemagine Medical Imaging Solutions GmbH % Gary Syring Principal Consultant Quality & Regulatory Associates, LLC 800 Levanger Lane Stoughton, Wisconsin 53589 Re: K210109 Trade/Device Name: visor2 system Regulation Number: 21 CFR 882.4560 Regulation Name: Stereotaxic Instrument Regulatory Class: Class II Product Code: HAW, GWF, IKN, OBP Dated: March 9, 2022 Received: March 11, 2022 Dear Gary Syring: 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. 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You must comply with all the Act's {1}------------------------------------------------ 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 803) for devices or postmarketing safety reporting (21 CFR 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 (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 https://www.fda.gov/medical-device-safety/medical-device-reportingmdr-how-report-medical-device-problems. For comprehensive regulatory information about mediation-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). Sincerely, Pamela Scott Assistant Director DHT5B: Division of Neuromodulation and Physical Medicine Devices OHT5: Office of Neurological and Physical Medicine Devices Office of Product Evaluation and Quality Center for Devices and Radiological Health Enclosure {2}------------------------------------------------ 510(k) Number (if known) K210109 Device Name visor2 system Indications for Use (Describe) visor2 is used to aid 3D navigation for positioning of Transcranial Magnetic Stimulation (TMS) coils over preselected brain regions based on data from MRI measurements or scalp landmarks and optional EMG recording in clinical procedures. The visor2 system is compatible with the following commercially available TMS coils of the following TMS companies: - · Mag & More: PMD70-aCool Double coil Figure-8 (510575) - MagStim Company Ltd.: Double 70mm Remote Coil (3190-00 rev2), Double 70mm Air Film Coil (3910 00); - MagVenture A/S: Double 75mm (C-B60), Double Cooled 75mm (Cool-B65), Double 95mm (D-B80), Angulated Double Cooled 97mm (Cool-B70 rev2), Butterfly figure-8 (C-B70) - · Neuronetics Inc .: NeuroStar coil The visor2 system must be operated by a trained physician and must not be used during surgical operations. | Type of Use (Select one or both, as applicable) | | |---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|---------------------------------------------| | <div> <span> <svg height="12" width="12"> <rect fill="black" height="12" width="12" x="0" y="0"></rect> </svg> </span> Prescription Use (Part 21 CFR 801 Subpart D) </div> | Over-The-Counter Use (21 CFR 801 Subpart C) | CONTINUE ON A SEPARATE PAGE IF NEEDED. 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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 RAStaff@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 logo for eemagine medical imaging solutions. The word "eemagine" is written in gray, with the words "medical imaging solutions" written in a smaller font below it. To the right of the word "eemagine" are two blue circles with the letter "e" inside them. A blue line connects the two circles, resembling an EKG readout. eemagine Medical Imaging Solutions GmbH, Gubener Str. 47, D-10243 Berlin | 510(k) Summary | Date | |---------------------------------------------------------------------------------------------------------------------------------------------------------|-----------------------------------------------------------------------------------------------------------------------| | This summary is provided to support the 510(k) pre-market notification for the visor2<br>system. | Berlin | | Company Name: eemagine | Reference (eemagine):<br>e.g. contract ID | | Company Contact: Frank Zanow, Chief Executive Officer<br>eemagine Medical Imaging Solutions GmbH | | | Date Summary Prepared: April 8, 2022 | eemagine GmbH<br>Gubener Str.47<br>D-10243 Berlin<br>Tel. +49 30 29048404<br>Fax. +49 30 29048405<br>www.eemagine.com | | Trade Name: visor2 system | | | Common Name: Accessory to Repetitive Transcranial Magnetic Stimulation | | | Classification Name: Repetitive Transcranial Magnetic Stimulation System<br>21 CFR 882.4560, Product Code: HAW, Class II | | | Primary Predicate: K191422, Neural Navigator<br>Manufacturer: Soterix Medical, Inc., New York, NY 10001 | CEO/Geschäftsführer:<br>Ralf Hauffe, Ph.D. | | Reference Devices: K183376, HORIZON TMS Therapy System with Navigation<br>Manufacturer: Magstim Company Ltd., Whitland, GB Sa34 0hr | Registration: HRB 7128<br>VAT ID: DE201608185 | | K112881, Nexstim Navigational Brain Stimulation (NBS)<br>System 4, Nexstim NBS System 4 with NEXSPEECH®<br>Manufacturer: NEXSTIM OY, Helsinki, FI-00510 | Commerzbank Berlin<br>BIC Code CoBaDEBB120<br>IBAN | DE73120400000458888500 # Product Description The visor2 system is a 3D navigation system, supporting external/surface positioning of labeling identified commercially available Transcranial Magnetic Stimulation (TMS) coils based on the anatomical and functional areas for which use of the coil has been FDA cleared and as identified in cleared labeling for the coil. The visor2 system optionally records and processes electrophysiological signals to guide the user in the TMS coil placement. The visor2 system is compatible with TMS stimulators identified in the labeling that meet IEC 60601-1 and IEC 60601-1-2 electrical safety and EMC standards, a compatible optical tracking system, and further compatible accessories. Optionally, a compatible amplifier identified in the labeling may be applied for measuring electrophysiological signals. The visor2 system must be operated by a trained physician, and must not be used during surgical operations. The visor2 system consists of a cart, an All-in-One medical computer with touch interface, a mounting plate for an optional amplifier applied for EMG recording and a Tracking camera with mounting arm. There are two fundamental visor2 system variants: single or dual display. the second configuration is available with an additional touch display added next to the All-in-One computer. Both variants are identical with regard to hardware features. {4}------------------------------------------------ # Indications for Use visor2 is used to aid 3D navigation for positioning of Transcranial Magnetic Stimulation (TMS) coils over preselected brain regions based on data from MRI measurements or scalp landmarks and optional EMG recording in clinical procedures. The visor2 system is compatible with the following commercially available TMS coils of the following TMS companies: - · Mag & More: PMD70-aCool Double coil Figure-8 (510575) - MagStim Company Ltd.: Double 70mm Remote Coil (3190-00 rev2), Double 70mm Air Film Coil (3910 00); - MagVenture A/S: Double 75mm (C-B60), Double Cooled 75mm (Cool-B65), Double 95mm (D-B80), Angulated Double Cooled 97mm (Cool-B70 rev2), Butterfly figure-8 (C-B70) - · Neuronetics Inc.: NeuroStar coil The visor2 system must be operated by a trained physician and must not be used during surgical operations. | Substantial Equivalence Technical Characteristics | | | | | | 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| Feature | Subject Device<br>visor2 system | Primary<br>Predicate<br>Neural<br>Navigator<br>(K191422) | Reference<br>Device<br>HORIZON TMS<br>Therapy System<br>with Navigation<br>(K183376) | Reference<br>Device<br>Nexstim<br>Navigational<br>Brain<br>Stimulation<br>(NBS) System 4,<br>Nexstim NBS<br>System 4 with<br>NEXSPEECH®<br>(K112881) | Discussion of comparison | | Product Code,<br>Classification | HAW<br>(Subsequent:<br>GWF, IKN, OBP)<br>21 CFR<br>882.4560,<br>Class II | HAW<br>(Subsequent:<br>GWF, IKN, OBP)<br>21 CFR<br>882.4560,<br>Class II | OBP, HAW, IKN<br>21 CFR<br>882.5805,<br>Class II | GWF, HAW,<br>IKN<br>21 CFR<br>882.1870,<br>Class II | Classification of Subject Device,<br>Primary Predicate and Reference<br>Device matches.<br>The Subject Device is an<br>accessory to TMS therapy<br>systems, providing location for<br>the TMS coil. | | Intended use | As an accessory<br>to TMS systems,<br>provide<br>navigation,<br>location support<br>for placement of<br>the TMS coil on<br>the skull in<br>relation to a prior<br>acquired MRI<br>image. | A<br>neuronavigation<br>system indicated<br>for accurate<br>positioning of the<br>treatment coil of<br>the CloudTMS<br>Therapy System<br>with respect to<br>target brain<br>regions based on<br>data obtained<br>from MRI<br>measurements. | A repetitive<br>transcranial<br>magnetic<br>stimulation<br>system that<br>delivers<br>transcranial<br>repetitive pulsed<br>magnetic fields of<br>sufficient<br>magnitude to<br>induce neural<br>action potentials<br>in the prefrontal<br>cortex to treat the<br>symptoms of<br>major depressive | Non-invasive<br>mapping of the<br>primary motor<br>cortex of the<br>brain to its<br>cortical gyrus.<br>The NBS System<br>provides<br>information that<br>may be used in<br>the assessment of<br>the primary motor<br>cortex for pre-<br>procedural<br>planning. | The intended use of Subject<br>Device, Primary Predicate and<br>both Reference Devices match<br>fully with regards to all aspects<br>related to effectiveness and safety<br>(navigation of a TMS coil relative<br>to MRI and/or scalp<br>landmarks/targets).<br>As accessory to the TMS system,<br>the device under review provides<br>TMS coil location support.<br>The device under review provides<br>a locating feature to TMS<br>systems. The device under review<br>is an optional accessory to | | Substantial Equivalence Technical Characteristics | | | | | | | Feature | Subject Device<br>visor2 system | Primary<br>Predicate<br>Neural<br>Navigator<br>(K191422) | Reference<br>Device<br>HORIZON TMS<br>Therapy System<br>with Navigation<br>(K183376) | Reference<br>Device<br>Nexstim<br>Navigational<br>Brain<br>Stimulation<br>(NBS) System 4,<br>Nexstim NBS<br>System 4 with<br>NEXSPEECH®<br>(K112881) | Discussion of comparison | | Indications<br>for Use | visor2 is used to<br>aid 3D navigation<br>for positioning of<br>Transcranial<br>Magnetic<br>Stimulation<br>(TMS) coils over<br>preselected brain<br>regions based on<br>data from MRI<br>measurements or<br>scalp landmarks<br>and optional<br>EMG recording<br>in or clinical<br>procedures. The<br>visor2 system is<br>compatible with<br>the following<br>commercially<br>available TMS<br>coils of the<br>following TMS<br>companies:<br>Mag & More:<br>PMD70-aCool<br>Double coil<br>MagStim<br>Company Ltd.:<br>Double 70mm<br>Remote Coil<br>(3190-00 rev2),<br>Double 70mm<br>Air Film<br>(3910-00)<br>MagVenture A/S:<br>Double 75mm<br>(C-B60), Double<br>Cooled 75mm<br>(Cool-B65), | The Neural<br>Navigator is a<br>neuronavigation<br>system indicated<br>for accurate<br>positioning of the<br>treatment coil of<br>the CloudTMS<br>Therapy System<br>with respect to<br>target brain<br>regions based on<br>data obtained<br>from MRI<br>measurements.<br>Specifically, the<br>Neural Navigator<br>is indicated for<br>use with the<br>following<br>CloudTMS<br>Therapy System<br>coils<br>manufactured by<br>Neurosoft Ltd:<br>AFEC-02-100<br>and<br>AFEC-02-100-C. | HORIZON® is<br>indicated for the<br>treatment of<br>Major Depressive<br>Disorder in adult<br>patients who have<br>failed to achieve<br>satisfactory<br>improvement<br>from prior<br>antidepressant<br>medication in the<br>current episode. | The Nexstim<br>Navigated Brain<br>Stimulation<br>System (NBS<br>System) 4 is<br>indicated for non-<br>invasive mapping<br>of the primary<br>motor cortex of<br>the brain to its<br>cortical gyrus.<br>The NBS System<br>4 provides<br>information that<br>may be used in<br>the assessment of<br>the primary motor<br>cortex for<br>preprocedural<br>planning.<br>Nexstim<br>NEXSPEECH,<br>when used<br>together with the<br>Nexstim NBS<br>System 4, is<br>indicated for<br>noninvasive<br>localization of<br>cortical areas that<br>do not contain<br>essential speech<br>function. Nexstim<br>NEXSPEECH<br>provides<br>information that<br>may be used in<br>pre-surgical<br>planning in<br>patients<br>undergoing brain<br>surgery.<br>Intraoperatively,<br>the localization<br>information<br>provided by | The indication of use of Subject<br>Device, Primary Predicate and<br>both Reference Devices match<br>fully with regard to all aspects<br>related to effectiveness and safety<br>(navigation of a TMS coil relative<br>to MRI and/or scalp<br>landmarks/targets). The Subject<br>Device is more flexible with<br>regard to supported coils than any<br>of the Reference and Predicate<br>system.<br>As accessory to the TMS system,<br>the device under review provides<br>TMS coil location support.<br>The visor2 system under review is<br>an optional accessory to support<br>locating/navigating TMS coil<br>feature to existing TMS systems<br>for their intended use.<br>Note:<br>The reference device K183376<br>HORIZON TMS Therapy System<br>with Navigation includes a<br>StimGuide feature to support<br>TMS coil location/navigation.<br>The StimGuide feature is a sub<br>licensed variation of the visor2<br>system, was reviewed in the<br>Horizon TMS Therapy System<br>with Navigation, K183376, to<br>support TMS coil location. | | Substantial Equivalence Technical Characteristics | | | | | | | Feature | Subject Device<br>visor2 system | Primary<br>Predicate<br>Neural<br>Navigator<br>(K191422) | Reference<br>Device<br>HORIZON TMS<br>Therapy System<br>with Navigation<br>(K183376) | Reference<br>Device<br>Nexstim<br>Navigational<br>Brain<br>Stimulation<br>(NBS) System 4,<br>Nexstim NBS<br>System 4 with<br>NEXSPEECH®<br>(K112881) | Discussion of comparison | | | Double 95mm<br>(D-B80),<br>Angulated<br>Double Cooled<br>97mm<br>(Cool-B70 rev2),<br>Butterfly figure-8<br>(C-B70)<br>Neuronetics Inc.:<br>NeuroStar coil<br>The visor2<br>system must be<br>operated by a<br>trained physician<br>and must not be<br>used during<br>surgical<br>operations. | | | NEXSPEECH® is<br>intended to be<br>verified by direct<br>cortical<br>stimulation.<br>The Nexstim<br>NBS System 4<br>and NBS System<br>4 with<br>NEXSPEECH®<br>are not intended<br>to be used during<br>a surgical<br>procedure. The<br>Nexstim NBS<br>System 4 and<br>NBS System 4<br>with<br>NEXSPEECH®<br>are intended to be<br>used by trained<br>clinical<br>professionals. | | | TMS Coil<br>Position<br>Principle | Based on<br>anatomy (MRI<br>picture) and<br>indirect targeting<br>of treatment<br>target through<br>measured<br>distance and<br>direction using<br>optical<br>stereotactic<br>navigation. | Based on<br>Anatomy (MRI<br>picture) and<br>electro-magnetic<br>field navigation. | Indirect targeting<br>of treatment<br>target through<br>measured<br>distance and<br>direction using<br>optical<br>stereotactic<br>navigation and<br>anatomy. | Based on<br>Anatomy (MRI<br>picture) and<br>optical<br>stereotactic<br>navigation. | All devices support the<br>location/navigation of the TMS<br>coil. The reference device<br>K183376 HORIZON TMS<br>Therapy System with Navigation<br>includes a StimGuide feature to<br>support TMS coil<br>location/navigation uses the same<br>methodology as the visor2 system<br>under review.<br>The StimGuide feature is a sub<br>licensed variation of the visor2<br>system.<br>Subject Device, Primary Predicate<br>and both Reference Devices all<br>use the same or equivalent<br>position principle registering the<br>physical head/scalp and a coil via<br>tracker tools tracked by a stereo<br>infrared camera 3D tracking<br>system or in case of the Primary<br>Predicate Device electro-magnetic<br>field tracking. Electro-magnetic | | Substantial Equivalence Technical Characteristics | | | | | | | Feature | Subject Device<br>visor2 system | Primary<br>Predicate<br>Neural<br>Navigator<br>(K191422) | Reference<br>Device<br>HORIZON TMS<br>Therapy System<br>with Navigation<br>(K183376) | Reference<br>Device<br>Nexstim<br>Navigational<br>Brain<br>Stimulation<br>(NBS) System 4,<br>Nexstim NBS<br>System 4 with<br>NEXSPEECH®<br>(K112881) | Discussion of comparison | | Fundamental | Infrared locators<br>and 3D tracking | Electro-magnetic<br>field tracking | Infrared locators<br>and 3D tracking | Infrared locators<br>and camera | field tracking and optical field<br>tracking are both relying on<br>identifying the position of tools in<br>3D space. Optical tracking is in<br>general more precise as it relies<br>on shorter wavelength than<br>electrical tracking. All devices<br>define targets either via<br>landmarks in a co-registered MRI<br>image (same principle in all<br>systems using nasion-ear<br>landmarks) or directly on the<br>scalp. Further, all devices define a<br>point that represents the centre<br>position of the coil for navigation.<br>This is either referred to as a<br>geometrical centre of the coil<br>defining the maximum of the field<br>simply by geometry of the coil or<br>referring to the electrical field<br>maximum by design for any<br>treatment coil including tilted<br>designs. This point is at the<br>geometric centre of the coil and as<br>close as possible to the scalp<br>surface. The display of any<br>modelled induced electrical field<br>in the head tissue does not impact<br>the accuracy of the stimulus<br>delivered relative to the target but<br>only illustrates the field<br>distribution of a TMS stimulus<br>induced in head tissue. The<br>Primary Predicate device as well<br>as the Subject Device and the<br>Horizon Reference device rely on<br>geometry directly for the defining<br>the stimulation centre point while<br>reference K112881 calculates an<br>E-field for this purpose. With<br>regard to effectiveness and safety<br>all devices follow the same<br>working principle and perform<br>with identical effectiveness. The<br>Subject Device does not impose<br>any new or additional safety risks.<br>Comparison and discussion for | | Substantial Equivalence Technical Characteristics | | | | | | | Feature | Subject Device<br>visor2 system | Primary<br>Predicate<br>Neural<br>Navigator<br>(K191422) | Reference<br>Device<br>HORIZON TMS<br>Therapy System<br>with Navigation<br>(K183376) | Reference<br>Device<br>Nexstim<br>Navigational<br>Brain<br>Stimulation<br>(NBS) System 4,<br>Nexstim NBS<br>System 4 with<br>NEXSPEECH®<br>(K112881)…
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