Exhibit 4.6

FOURTH SUPPLEMENT AND AMENDMENT TO
THE SERIES D PREFERRED SHARE PURCHASE AGREEMENT DATED JUNE 26, 2014



THIS FOURTH SUPPLEMENT
AND AMENDMENT (the “Supplement”) is made as of June 10, 2015, by and between InSightec Ltd., a private
limited company organized and existing under the laws of Israel (the “Company”), York Global Finance II S.à
r.l., a limited liability company organized under the laws of Luxemburg (“York”), Shanghai GEOC Hengtong Investment
Limited Partnership, a limited liability partnership organized under the laws of the People’s Republic of China (“GEOC”),
Fortune China Limited, a company incorporated under the laws of the British Virgin Islands (“Fortune China”),
Meditech Advisors LLC, a limited liability company organized under the laws of Delaware (“MTA”), Mr. Maurice
R. Ferré (“Ferré”), Mr. Lawrence Platt (“Platt”), Mr. Kenneth G. Langone (“Langone”),
Mr. Michael P. Stansky (“Stansky”), CIH- InSightec Ltd. series, a series of Cranley
Investment Holdings, LLCa limited liability company organized under the laws of Delaware(“CIH”), Primatec Holdings S.A. a company organized under the laws of Panama (“Primatec”)
and Exigent Alternative Capital or any of its affiliates (“Exigent”), (each of York, GEOC, Fortune China, MTA,
Ferré, Platt, Langone, Stansky, CIH, Primatec and Exigent shall be referred to as a “Purchaser” and together
the “Purchasers”). The Company and the Purchasers collectively referred to hereinafter as the “Parties”,
and each, a “Party”.



| | WHEREAS | the Company, York, GEOC, Fortune China, MTA, Ferré and Platt are parties to certain Series
D Preferred Share Purchase Agreement, dated June 26, 2014, as amended on September 7, 2014, on December 15, 2014 and on February
10, 2015 (the “Agreement”);
| | ------- | -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

| | WHEREAS | under the Agreement, Elbit Medical Technologies Ltd. (“Elbit”) had the option
to purchase up to an additional 1,804,433 Series D Preferred Shares, at the Series D Purchase Price, exercisable until May 31,
2015, for an aggregate consideration of $3,500,000 (“Option”);
| | ------- | ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

| | WHEREAS | on May 21, 2015, Elbit notified the Company that it has elected not to exercise its Option and
to waive such right;
| | ------- | -------------------------------------------------------------------------------------------------------------------

| | WHEREAS | pursuant to the Agreement, in the event that Elbit elects to purchase the Subsequent Purchased
Shares for an aggregate consideration of lessthan $3,500,000, York will have the right to purchase any shortfall pursuant
to the terms of the Agreement (the “Shortfall Right”);
| | ------- | -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

| | WHEREAS | York wishes to assign its Shortfall Right to Langone, Stansky, CIH, Primatec and Exigent, as described
below; and
| | ------- | -----------------------------------------------------------------------------------------------------------------

| | WHEREAS | each of Langone, Stansky, CIH, Primatec and Exigent wishes to invest in the Company in exchange
for Series D Preferred Shares to be issued by the Company, subject to the terms and conditions set forth below;
| | ------- | ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------



1




NOW IT IS HEREBY AGREED as follows:

| | 1. | Interpretation and Preamble
| | -- | ---------------------------

1.1.The preamble of this Supplement shall be an integral part thereof.

1.2.In
this Supplement, unless specified otherwise, all terms shall have the meaning ascribed to them in the Agreement.

| | 2. | Amendments to the Agreement
| | -- | ---------------------------

2.1.  York
hereby assigns its Shortfall Right to Langone, Stansky, CIH, Primatec and Exigent in accordance with the investment amounts of
each investor specified in Schedule 1 attached to this Supplement. It is hereby clarified that Schedule 1 attached
to this Supplement replaces and supersedes Schedule 1 of the Agreement. York shall have no further rights or obligations
of any kind with respect to exercise (or non-exercise) of the Shortfall Right, provided however, that should any of the assignees
not exercise his Shortfall Right, such unexercised right shall revert to York and York shall be entitled to exercise the Shortfall
Right in no event later than June 15, 2015.

2.2.The definition of
"Subsequent Investor" in Section 2.1 of the Agreement shall be revised such that Langone, Stansky, CIH, Primatec and
Exigent shall be also considered as "Subsequent Investors" under the Agreement. The purchase and sale of the Subsequent
Purchased Shares pursuant to this Supplement shall take place remotely via the exchange of documents and signatures, at such time
and place as the Company and the applicable Subsequent Investors mutually agree upon orally or in writing and in no event later
than June 15, 2015.

2.3.
   It isagreed by the Parties that, by executing this Supplement, each of the Purchasers shall be considered a Purchaser
under the Agreement and a Party to the Agreement, as if it were an original signatory thereto subject to the amendments and modifications
to the Agreement contained herein.

| | 3. | Miscellaneous
| | -- | -------------

3.1.   All notices and communications to be given or made under this Agreement shall be in writing and delivered by hand-delivery,
registered first class mail (return receipt requested), facsimile, air courier guaranteeing overnight delivery or shall be by e-
mail, addressed as set forth on the signature pages hereof, or to such other Person or address as a Party may designate by notice.
All notices and other communications delivered in person or by courier service shall be deemed to have been delivered as of three
(3) Business Days after sending thereof, those delivered by email shall be deemed delivered on the following business day in the
jurisdiction of the relevant recipient, and all notices and other communications sent by registered mail (or air mail if the posting
is international) shall be deemed given seven (7) days after posting. Each such notice or other communication shall be deemed to
have been duly given or served on the date on which personally delivered, with receipt acknowledged, telecopied and confirmed by
telecopy answer back or receipt confirmed by return e mail from the recipient. Such notices and communications shall be sent to
the Company and the Purchaser at the following addresses:



2












if to theCompany:



Nahum Het 5

Tirat Carmel
Israel

Attention: Kobi
Vortman

Email: kobiv@insightec.com

Facsimile: 04-8131322



if to GEOC:



Suite 3601B-03,
The Center, No.989 Changle Road,

Xuhui District,
Shanghai, 200031, China

Attention: Perry
Xu

Email: xuhj@gocapital.com.cn

Facsimile: +86
21 54070220



If to Fortune
China:



2101, 21/F

Wanchai Commercial
Center

194-204 Johnston
Road, Wanchai, Hong Kong

Attention: Howard
Chu

Email: zhuhh@gocapital.com.cn

Facsimile: 852
26870103





If to York:



York Capital
Management

767 Fifth
Avenue

New York, NY 10153, U.S.A
Attention: General Counsel
Email: RSwanson@yorkcapital.com

Facsimile: +1
(212) 300-1301



If to MTA:

Meditech Advisors
LLC

11 Kiryat Hamada
St.

Jerusalem, Israel
91450



If to Mr.
Maurice R. Ferré:

521 S Mashta
Dr

Key Biscayne,
FL 33149, U.S.A



If to Mr.
Lawrence Platt:

1505 S.Glenville

Los Angeles,
CA 90035, U.S.A





If to Mr.
Michael P. Stansky:

36 Skyview Lane

Sudbury, MA
01776

Email: mpstansky@gmail.com





3










If to Mr.
Kenneth G. Langone:

375 Park Avenue

Suite 2205

New York, NY
10152

Tel: (212) 421-2500

Email: ken@invemed.com





If to CIH:

701 Brickell
Avenue, Suite 2100

Miami, FL 33131,
U.S.A

Email: AlbertoBeeck@gmail.com



If toPrimatec:



Edificio Centro
Magna Corp

Piso 5to. #
 502-A,

Avenida Ricardo
Arango y Calle manuel Icaza

Panamá,
República de Panamá

Email: ramc@ayucus.com





If to Focused
Holdings LP:

250 Park Ave,
7th floor

New York, NY
10177, U.S.A

Email: smann@exigentcap.com

3.2.This
Supplement may be executed by one or more of the parties to this Supplement on any number of separate counterparts and all of
said counterparts taken together shall be deemed to constitute one and the same instrument. Delivery of an executed counterpart
of a signature page of this Supplement by facsimile or electronic transmission shall be effective as delivery of a manually executed
counterpart of this Supplement.

3.3.Except as provided herein, all terms and conditions of the Agreement shall remain unchanged. In the event of any contradiction
between the provisions of this Supplement and the Agreement, the provisions of this Supplement shall prevail.



[Signature page
to follow]



4






IN WITNESS WHEREOF, the Parties
hereto have caused this Supplement to the Agreement to be duly executed and delivered as of the date first written above.



On behalf of Company:





|/s/ Kobi Vortman and Roni Karie                                                    
|-----------------------------------------------------------------------------------
|Insightec Ltd.
        Name: Kobi Vortman and Roni Karie
        Title: CEO and CFO







On behalf of GEOC:





|/s/                                                                                                                                      
|-----------------------------------------------------------------------------------------------------------------------------------------
|Shanghai GEOC Hengtong Investment
        Limited Partnership
        
        Name: ___________________
        
        Title: Director





On
behalf of Fortune China:





|/s/ Zhu Hepeng                                                                          
|----------------------------------------------------------------------------------------
|Fortune China Limited
        
        Name: Zhu Hepeng
        
        Title: Director





5










On behalf of York:





|/s/ John J. Fosina                                                                                           
|-------------------------------------------------------------------------------------------------------------
|York Global Finance II S.à
        r.l.
        
        Name: John J. Fosina
        
        Title: Manager



On behalf of MTA:



|/s/ Samuel Cubal                                                                    
|------------------------------------------------------------------------------------
|Meditech Advisors LLC
        
        Name: Samuel Cubal
        
        Title: MD



On behalf of Mr. Maurice R. Ferré:



|/s/ Maurice R. Ferre
|--------------------
|Maurice R. Ferré    



On behalf of Mr. Lawrence Platt:



|/s/ Lawrence Platt
|------------------
|Lawrence Platt    



On behalf of Mr. Kenneth G. Langone:



|/s/ Kenneth G. Langone
|----------------------
|Kenneth G. Langone    





6










On behalf of Mr. Michael P. Stansky:



|/s/ Micheal P Stansky
|---------------------
|Michael P. Stansky   



On behalf of CIH :



|/s/ Alberto Beck                                                                                                                                                 
|-----------------------------------------------------------------------------------------------------------------------------------------------------------------
|CIH- InSightec Ltd. series, a series
        of Cranley Investment Holdings, LLC
        
        
        Name: Mr. Alberto Beck
        
        Title:
Manager



On behalf of Primatec:



|/s/ Rene A. Morales                                                                                     
|--------------------------------------------------------------------------------------------------------
|Primatec Holdings S.A.
        
        
        Name: Rene A. Morales
        
        Title: President



On behalf of Exigent Alternative
Capital or any of its affiliates:



|/s/ Eliezer Brender                                 
|----------------------------------------------------
|Name: Eliezer Brender
        
        Title: Member



7






Schedule 1

INVESTORS & CLOSING PURCHASE PRICE



|Name                                                                     |  | Purchase Price (US$) |            |  | No. of Purchased Preferred D Shares |  
|------------------------------------------------------------------------ |  | -------------------- | ---------- |  | ----------------------------------- | -
|York Global Finance II S.À R.L                                           |  | $                    | 43,875,851 |  |                                     | $
|Shanghai GEOC Hengtong Investment Limited Partnership                    |  | $                    | 12,150,000 |  |                                     |  
|Fortune China Limited                                                    |  | $                    | 350,000    |  |                                     |  
|Meditech Advisors LLC                                                    |  | $                    | 1,584,149  |  |                                     |  
|Maurice R. Ferré                                                         |  | $                    | 1,000,000  |  |                                     |  
|Lawrence Platt                                                           |  | $                    | 40,000     |  |                                     |  
|Kenneth G. Langone                                                       |  | $                    | 500,000    |  |                                     |  
|Michael P. Stansky                                                       |  | $                    | 500,000    |  |                                     |  
|CIH- InSightec Ltd. series, a series of Cranley Investment Holdings, LLC |  | $                    | 1,000,000  |  |                                     |  
|Primatec Holdings S.A.                                                   |  | $                    | 1,000,000  |  |                                     |  
|Focused Holdings LP                                                      |  | $                    | 500,000    |  |                                     |  
|TOTAL                                                                    |  | $                    | 62,500,000 |  |                                     |