Molecular Flow Simulations is designed as a planning system for pre- and intra-operative planning of stereotactic or image-guided surgeries. It is specially designed to display anatomical images of a patient acquired with magnetic resonance (MR) or computed tomography (CT) scanners as well as images derived from diffusion tensor imaging (DTI) data acquired with MR. Molecular Flow Simulations is a dedicated tool for planning trajectories of intracranial catheters. Guidelines for the catheter placement, such as from catheter suppliers, can be visualized and displayed to support the surgeon in improving catheter placement planning. The guidelines, in combination with anatomical information, can be used to suggest areas that are compliant with the guidelines. Molecular Flow Simulations does not generate or create rules for the placement of intracranial catheters by any means. Molecular Flow Simulations uses MR-DTI and T2- weighted MR images to suggest likely volumes of fluid distribution.
Device Story
Software-only planning system for stereotactic/image-guided intracranial catheter surgery. Inputs: MR/CT anatomical images, MR-DTI data. Operation: displays patient anatomy; visualizes catheter placement guidelines; calculates/predicts 3D infusate distribution based on patient-specific data and mathematical modeling (including flux boundary conditions, capillary loss maps, and poroelastic expansion). Output: surgical plan with suggested catheter trajectories and fluid distribution volumes. Used in clinical settings by surgeons. Benefits: improves catheter placement accuracy; optimizes infusate distribution; identifies potential leakage pathways (e.g., sulci).
Clinical Evidence
Bench testing only. Validation included verification of functional specifications, data integrity, and user performance testing of the manual. Requirements Traceability Matrix (RTM) confirmed all requirements and risks were tested. No clinical data.
Technological Characteristics
Software-only application for standard PC/laptop or intranet access. Uses MR-DTI and T2-weighted MR imaging. Features 3D distribution simulation, flux boundary modeling, capillary loss maps, and poroelastic expansion modeling. Risk management per ISO 14971.
Indications for Use
Indicated for pre- and intra-operative planning of stereotactic or image-guided intracranial catheter placement surgeries. Uses MR and CT anatomical images and MR-DTI data to visualize catheter trajectories and suggest fluid distribution volumes.
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.
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December 3, 2021
Therataxis, LLC % Al Memmolo President, Convergent Clinical, Inc. 6648 Surf Crest St. Carlsbad, California 92011
Re: K201435
Trade/Device Name: Molecular Flow Simulations Regulation Number: 21 CFR 882.4560 Regulation Name: Stereotaxic Instrument Regulatory Class: Class II Product Code: HAW, QRI Dated: November 11, 2021 Received: November 15, 2021
Dear Al Memmolo:
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.
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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 (QS) 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 medical devices and radiation-emitting products, including information about labeling regulations, please see Device Advice (https://www.fda.gov/medicaldevices/device-advice-comprehensive-regulatory-assistance) and CDRH Learn (https://www.fda.gov/training-and-continuing-education/cdrh-learn). Additionally, you may contact the Division of Industry and Consumer Education (DICE) to ask a question about a specific regulatory topic. See the DICE website (https://www.fda.gov/medical-device-advice-comprehensive-regulatoryassistance/contact-us-division-industry-and-consumer-education-dice) for more information or contact DICE by email (DICE@fda.hhs.gov) or phone (1-800-638-2041 or 301-796-7100).
Sincerely,
Adam D. Pierce, Ph.D. Assistant Director DHT5A: Division of Neurosurgical, Neurointerventional and Neurodiagnostic Devices OHT5: Office of Neurological and Physical Medicine Devices Office of Product Evaluation and Quality Center for Devices and Radiological Health
Enclosure
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# Indications for Use
510(k) Number (if known) K201435
Device Name Molecular Flow Simulations
#### Indications for Use (Describe)
Molecular Flow Simulations is designed as a planning system for pre- and intra-operative planning of stereotactic or image-guided surgeries. It is specially designed to display anatomical images of a patient acquired with magnetic resonance (MR) or computed tomography (CT) scanners as well as images derived from diffusion tensor imaging (DTI) data acquired with MR. Molecular Flow Simulations is a dedicated tool for planning trajectories of intracranial catheters. Guidelines for the catheter placement, such as from catheter suppliers, can be visualized and displayed to support the surgeon in improving catheter placement planning. The guidelines, in combination with anatomical information, can be used to suggest areas that are compliant with the guidelines. Molecular Flow Simulations does not generate or create rules for the placement of intracranial catheters by any means. Molecular Flow Simulations uses MR-DTI and T2- weighted MR images to suggest likely volumes of fluid distribution.
The primary mode of action for Molecular Flow Simulations is a device for creating stereotactic or image-guided surgical plans, especially for the creation of plans for the placement of intracranial catheters.
Type of Use (Select one or both, as applicable)
| <span style="font-family: Arial, sans-serif;"> <span style="font-size: 10pt;">☑ Prescription Use (Part 21 CFR 801 Subpart D)</span> </span> |
|---------------------------------------------------------------------------------------------------------------------------------------------|
| <span style="font-family: Arial, sans-serif;"> <span style="font-size: 10pt;">☐ Over-The-Counter Use (21 CFR 801 Subpart C)</span> </span> |
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| A. Device Information: | 510(k) Summary |
|--------------------------------------------------|-----------------------------------------------------------------------------------------------------------------------------|
| Category | Comments |
| Sponsor: | Therataxis, LLC<br>Johns Hopkins Eastern Building Suite B305<br>1101 East 33rd Street Baltimore, MD 21208<br>(443) 451-7154 |
| Correspondent Contact<br>Information: | Al Memmolo<br>Convergent Clinical, Inc.<br>Carlsbad, CA 92011<br>Email: almemmolo@gmail.com |
| Device Common Name: | Planning System, Stereotaxic Instrument |
| Device Regulation & Name: | CFR 882.4560 Stereotaxic Instrument |
| Classification & Product Code:<br>510(k) Number: | Classification: Class II Product Code: HAW, QRI<br>K201435 |
| Device Proprietary Name: | Molecular Flow Simulations |
# Molecular Flow Simulations
## Predicate Device Information:
| Predicate Device: | iPlan Flow |
|----------------------------------------------------|----------------------------------------------------------|
| Predicate Device Manufacturer: | Brainlab AG |
| Predicate Device Common Name: | iPlan Flow |
| Predicate Device Premarket Notification # | K053164 |
| Predicate Device Classification & Name | Classification: Class II<br>Name: Stereotaxic Instrument |
| Predicate Device Classification<br>& Product Code: | Classification: Class II<br>Product Code: HAW |
## B. Date Summary Prepared
December 3, 2021
## C. Description of Device
Molecular Flow Simulations is a software tool running on a standard, standalone computer (PC or Laptop), or being accessible via the intranet connection, that can be used by surgeons for pre- or intraoperative planning of treatments based on stereotactic systems or image guided surgery systems. The system is a software-only medical device to be installed on common IT hardware.
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#### D. Indications for Use
Molecular Flow Simulations is designed as a planning system for pre- and intra-operative planning of stereotactic or image-guided surgeries. It is specially designed to display anatomical images of a patient acquired with magnetic resonance (MR) or computed tomography (CT) scanners as well as images derived from diffusion tensor imaging (DTI)-data acquired with MR. Molecular Flow Simulations is a dedicated tool for planning trajectories of intracranial catheters. Guidelines for the catheter placement, such as from catheter suppliers, can be visualized and displayed to support the surgeon in improving catheter placement planning. The guidelines, in combination with anatomical information, can be used to suggest areas that are compliant with the guidelines. Molecular Flow Simulations does not generate or create rules for the placement of intracranial catheters by any means. Molecular Flow Simulations uses MR-DTI and T2weighted MR images to suggest likely volumes of fluid distribution.
The primary mode of action for Molecular Flow Simulations is a device for creating stereotactic or imageguided surgical plans, especially for the creation of plans for the placement of intracranial catheters.
| Characteristic | Application Device:<br>Molecular Flow<br>Simulations<br>(K201435) | Predicate Device:<br>iPlan Flow<br>(K053164) | Impact on<br>Substantial<br>Equivalence |
|----------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-----------------------------------------|
| Company | Therataxis, LLC | Brainlab | - |
| Regulation<br>Number | 882.4560 | 882.4560 | Identical |
| Product Code | HAW | HAW | Identical |
| Intended Use | Molecular Flow Simulations<br>is designed as a planning<br>system for pre- and<br>intraoperative planning of<br>stereotactic or image guided<br>surgery treatments. It is<br>specially designed to display<br>anatomical images of a<br>patient acquired with MR<br>and/or CT as well as images<br>derived from DTI-data<br>acquired with Magnetic<br>Resonance Imaging (MRI). | iPlan Flow is designed as a<br>planning system for pre-<br>and intraoperative planning<br>of stereotactic or image<br>guided surgery treatments.<br>It is specially designed to<br>display anatomical images<br>of a patient acquired with<br>MR and/or CT as well as<br>images derived from DTI-data<br>acquired with<br>Magnetic Resonance<br>Imaging (MRI). | Equivalent |
| Indications for Use | Molecular Flow | iPlan Flow | K201435 |
| | Molecular Flow<br>Simulations is designed as<br>a planning system for pre-<br>and intra-operative<br>planning of stereotactic or<br>image-guided surgeries. It<br>is specially designed to<br>display anatomical images<br>of a patient acquired with<br>magnetic resonance (MR)<br>or computed tomography<br>(CT) scanners as well as<br>images derived from<br>diffusion tensor imaging<br>(DTI)-data acquired with<br>MR. Molecular Flow<br>Simulations is a dedicated<br>tool for planning<br>trajectories of intracranial<br>catheters. Guidelines for the<br>catheter placement, such as<br>from catheter suppliers, can<br>be visualized and displayed<br>to support the surgeon in<br>improving catheter<br>placement planning. The<br>guidelines, in combination<br>with anatomical<br>information, can be used to<br>suggest areas that are<br>compliant with the<br>guidelines. Molecular Flow<br>Simulations does not<br>generate or create rules for<br>the placement of<br>intracranial catheters by<br>any means. Molecular Flow<br>Simulations uses MR-DTI<br>and T2- weighted MR<br>images to suggest likely<br>volumes of fluid<br>distribution. | iPlan Flow is designed as a<br>planning system for pre-<br>and intraoperative planning<br>of stereotactic or image<br>guided surgery treatments.<br>It is specially designed to<br>display anatomical images<br>of a patient acquired with<br>MR and/or CT as well as<br>images derived from DTI-<br>data acquired with<br>Magnetic Resonance<br>Imaging (MRI). iPlan Flow<br>is a dedicated tool for<br>planning trajectories of<br>intra-cranial catheters.<br>Guidelines for the catheter<br>placement e.g. from<br>catheter suppliers can be<br>visualized and displayed to<br>support the surgeon in<br>improving catheter<br>placement planning. The<br>guidelines, in combination<br>with anatomical<br>information, can be used to<br>suggest areas that are<br>compliant with the<br>guidelines. iPlan Flow does<br>not generate or create rules<br>for the placement of<br>intracranial catheters by<br>any means. iPlan Flow uses<br>MR-DTI and T2- weighted<br>MR images to suggest<br>likely volumes of fluid<br>distribution. | Equivalent |
| | The primary mode of action<br>for Molecular Flow<br>Simulations is a device for<br>creating stereotactic or<br>image-guided surgical plans,<br>especially for the creation of<br>plans for the placement of<br>intracranial catheters. | The Primary mode of<br>action for iPlan Flow is a<br>device for creating<br>treatment plans for<br>stereotactic or image<br>guided surgical treatment,<br>especially for the creation<br>of plans for the placement<br>of intra-cranial catheters.<br>The treatment plans can be<br>used in conjunction with<br>other BrainLAB medical<br>devices such as<br>VectorVision for image<br>guided surgical treatment. | |
| | | | K201435, Pag |
| Technology | Molecular Flow<br>Simulations can be used<br>for the planning of<br>intracranial catheters, with<br>image guided surgery.<br>Guidelines for the exact<br>placement of intracranial<br>catheters can be<br>visualized. These<br>guidelines comprise the<br>minimal depth of the<br>catheter tip in the brain<br>tissue, the minimal<br>distance of the catheter tip<br>from intra-cranial surfaces<br>and the minimal distance<br>between different catheter<br>tips. The depth guideline<br>can be calculated from the<br>flow rate and the catheter<br>diameter and warnings<br>will be displayed if the<br>trajectory of a planned<br>catheter is likely to cross<br>an intra-cranial surface.<br>Molecular Flow<br>Simulations is able to<br>calculate a likely fluid<br>distribution from the<br>planned catheter positions<br>to support the physician in<br>his decision about<br>appropriate catheter<br>positions. These features<br>enable the surgeon to<br>better plan and place intra-<br>cranial catheters. | iPlan Flow can be used for<br>the planning of<br>intracranial catheters, with<br>image guided surgery.<br>Guidelines for the exact<br>placement of intracranial<br>catheters can be<br>visualized. These<br>guidelines comprise the<br>minimal depth of the<br>catheter tip in the brain<br>tissue, the minimal<br>distance of the catheter tip<br>from intra-cranial surfaces<br>and the minimal distance<br>between different catheter<br>tips. The depth guideline<br>can be calculated from the<br>flow rate and the catheter<br>diameter and warnings<br>will be displayed if the<br>trajectory of a planned<br>catheter is likely to cross<br>an intra-cranial surface.<br>iPlan Flow is able to<br>calculate a likely fluid<br>distribution from the<br>planned catheter positions<br>to support the physician<br>in his decision about<br>appropriate catheter<br>positions. These features<br>enable the surgeon to<br>better plan and place intra-<br>cranial catheters. | Technology is<br>identical. |
| Characteristic | Application Device:<br>Molecular Flow<br>Simulations<br>(K201435) | Predicate Device:<br>iPlan Flow<br>(K053164) | Impact on<br>Substantial<br>Equivalence |
| Features | Comprehensive Target<br>Planning: Automatically<br>defines margins around<br>the tumor. | Comprehensive Target<br>Planning: Automatically<br>defines margins around<br>the tumor. | |
| Features | Guided Entry Point<br>Planning: The sulcus<br>detection feature<br>automatically segments<br>cerebrospinal fluid spaces<br>as they are potential<br>leakage pathways. | Guided Entry Point<br>Planning: The sulcus<br>detection feature<br>automatically segments<br>cerebrospinal fluid spaces<br>as they are potential<br>leakage pathways. | Equivalent |
| | Guided Catheter<br>Planning: Catheter<br>planning guidelines<br>indicate potential<br>backflow and other drug<br>leakage pathways around<br>the catheter tip in order to<br>maximize infusate<br>distribution. | Guided Catheter<br>Planning: Catheter<br>planning guidelines<br>indicate potential<br>backflow and other drug<br>leakage pathways around<br>the catheter tip in order to<br>maximize infusate<br>distribution. | |
| | 3D Distribution<br>Simulation: The likely<br>distribution of infusate for<br>a given catheter position<br>is predicted in 3D based<br>on patient-specific<br>information and<br>mathematical modeling.<br>Flux boundary conditions<br>can be utilized. This more<br>accurately models CED<br>infusions, in which the<br>infusate is delivered at a<br>constant flow rate rather<br>than a constant pressure. | 3D Distribution<br>Simulation: The likely<br>distribution of infusate for<br>a given catheter position<br>is predicted in 3D based<br>on patient-specific<br>information and<br>mathematical modeling. | |
| | 3D capillary loss maps<br>from DCE, poroelastic<br>expansion of the<br>extracellular space, and<br>flux boundary modeling of<br>the infusion sources. | | |
#### E. Comparison of the Technological Characteristics
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#### F. Summary of Supporting Data
Several tests were performed, in concordance with Duke University, using synthetic, animal and human imaging. Therefore, Molecular Flow Simulations does not raise any new questions regarding safety and effectiveness.
### G. Discussion of Performance Testing
All necessary testing has been performed with Molecular Flow Simulations to assure substantial equivalence to the predicate device.
Summary of non-clinical tests:
Molecular Flow Simulations is a software application; therefore no electrical safety or electromagnetic testing was required.
Testing conducted to demonstrate software validation and substantial equivalence included:
- . Verification testing that product meets product performance and functional specifications.
- Verification that data submitted is stored properly to maintain data integrity (e.g. no loss of data or corruption).
- User performance testing to demonstrate adequate instructional utility of the User Manual. ●
The Requirements Traceability Matrix (RTM) provides a mapping between requirements, risks, test cases, and shows related test results. The RTM confirms that there was a test case authored and executed for all requirements and any applicable risks.
After extensive bench testing to performance requirements and criteria established in accordance with application of ISO 14971, risk analysis standard, no new issues of safety, performance, technology or intended use were identified.
## H. Conclusion
Upon reviewing the technical information provided in this submission and comparing intended use, principle of operation, performance data, and overall technological characteristics, Molecular Flow Simulations is determined to be substantially equivalent to the predicate device.
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Head to the search page and work through a few of these AI/ML fuzzy searches to build intuition: perivascular fat on CT · aortic valve calcification opportunistic screening on noncontrast CT · breast cancer prediction on digital pathology slides · autism detection · gestational age prediction · a hearing aid that can also detect a pulse · foundation model based analysis of ECG · large language models · penetration test. Watch how the relevance scores, intended use, and AI Performance tables tell you when results stop being meaningful.