K Number
K022565
Device Name
TELSTAR BIPLANE DIGITAL IMAGING SYSTEM [TIS] MODEL 030-000915
Manufacturer
Date Cleared
2002-10-08

(67 days)

Product Code
Regulation Number
892.1650
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The Telstar™ Biplane Digital Imaging System provides the utility of fluoroscopic imaging of vascular systems for applications including vascular angiography and electrophysiology (EP) studies. This xray system may be used stand-alone, or in conjunction with an associated Stereotaxis Magnetic Navigation System.
Device Description
The Telstar™ Biplane Digital Imaging System [TIS] is a digital fluoroscopic system providing bi-plane fluoroscopic clinical images of both patients and medical devices during conventional and magnetic procedures.
More Information

Not Found

No
The summary does not mention AI, ML, or any related terms, and the device description focuses on standard digital fluoroscopic imaging.

No.
The device is described as an imaging system used for diagnosis (fluoroscopic imaging of vascular systems) rather than for direct treatment or therapy.

Yes
The device provides fluoroscopic imaging of vascular systems for applications like vascular angiography and electrophysiology (EP) studies. These are procedures used to visualize internal structures and processes within the body to diagnose medical conditions.

No

The device description explicitly states it is a "digital fluoroscopic system" and an "xray system," indicating it includes hardware components for image acquisition (fluoroscopy).

Based on the provided information, this device is not an IVD (In Vitro Diagnostic).

Here's why:

  • Intended Use: The intended use clearly states that the system provides "fluoroscopic imaging of vascular systems" and is used for "vascular angiography and electrophysiology (EP) studies." This involves imaging the inside of the body using X-rays, which is an in vivo (within the living body) procedure.
  • Device Description: The description reinforces this by stating it's a "digital fluoroscopic system providing bi-plane fluoroscopic clinical images of both patients and medical devices during conventional and magnetic procedures." Again, this describes imaging within the body.
  • IVD Definition: In Vitro Diagnostics (IVDs) are medical devices that are used to examine specimens taken from the human body, such as blood, urine, or tissue, to provide information for diagnosis, monitoring, or screening. This device does not process or analyze such specimens.

Therefore, the Telstar™ Biplane Digital Imaging System is an in vivo imaging device, not an IVD.

N/A

Intended Use / Indications for Use

The Telstar™ Biplane Digital Imaging System provides the utility of fluoroscopic imaging of vascular systems for applications including vascular angiography and electrophysiology (EP) studies. This xray system may be used stand-alone, or in conjunction with an associated Stereotaxis Magnetic Navigation System.

Product codes (comma separated list FDA assigned to the subject device)

JAA

Device Description

The Telstar™ Biplane Digital Imaging System [TIS] is a digital fluoroscopic system providing bi-plane fluoroscopic clinical images of both patients and medical devices during conventional and magnetic procedures.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Fluoroscopic X-ray

Anatomical Site

Vascular systems

Indicated Patient Age Range

Not Found

Intended User / Care Setting

Not Found

Description of the training set, sample size, data source, and annotation protocol

Not Found

Description of the test set, sample size, data source, and annotation protocol

Not Found

Summary of Performance Studies (study type, sample size, AUC, MRMC, standalone performance, key results)

Physical testing: The TIS is designed and tested in compliance with the requirements of 21 CFR §1020.32 (Fluoroscopic Equipment).
Preclinical animal performance data: Preclinical performance data were provided in K013484. No new studies were required or necessary to support the modifications.
Clinical performance data: Clinical performance data were provided in K013484. No new studies were required or necessary to support the modifications.

Key Metrics (Sensitivity, Specificity, PPV, NPV, etc.)

Not Found

Predicate Device(s): If the device was cleared using the 510(k) pathway, identify the Predicate Device(s) K/DEN number used to claim substantial equivalence and list them here in a comma separated list exactly as they appear in the text. List the primary predicate first in the list.

K013484

Reference Device(s): Identify the Reference Device(s) K/DEN number and list them here in a comma separated list exactly as they appear in the text.

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information for the subject device only (e.g. presence / absence, what scope was granted / cleared under the PCCP, any restrictions, etc).

Not Found

§ 892.1650 Image-intensified fluoroscopic x-ray system.

(a)
Identification. An image-intensified fluoroscopic x-ray system is a device intended to visualize anatomical structures by converting a pattern of x-radiation into a visible image through electronic amplification. This generic type of device may include signal analysis and display equipment, patient and equipment supports, component parts, and accessories.(b)
Classification. Class II (special controls). An anthrogram tray or radiology dental tray intended for use with an image-intensified fluoroscopic x-ray system only is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 892.9. In addition, when intended as an accessory to the device described in paragraph (a) of this section, the fluoroscopic compression device is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 892.9.

0

Appendix 1: 510(k) Summary of Safety and Effectiveness OCT 0 8 2002 KO22565

StatementInformation supporting claims of substantial equivalence, as defined under the Federal Food, Drug and Cosmetic Act, respecting safety and effectiveness is summarized below. For the convenience of the Reviewer, this summary is formatted in accordance with the Agency's final rule "...510(k) Summaries and 510(k) Statements..." (21 CFR §807) and can be used to provide a substantial equivalence summary to anyone requesting it from the Agency.
Device descriptionThe Telstar™ Biplane Digital Imaging System [TIS] is a digital fluoroscopic system providing bi-plane fluoroscopic clinical images of both patients and medical devices during conventional and magnetic procedures.
Intended useProvides the utility of fluoroscopic imaging of vascular systems for applications including vascular angiography and electrophysiology (EP) studies. This x-ray system may be used stand-alone, or in conjunction with an associated Stereotaxis Magnetic Navigation System.
Substantial equivalenceThe TIS is a modification of the Telstar™ Biplane Digital Imaging System originally cleared under K013484. The modifications described herein do not affect the intended use of the device or alter the fundamental scientific technology associated with the device.
Technological characteristicsThe TIS provides visualization through standard fluoroscopy.

Continued on next page

1

Appendix 1: 510(k) Summary of Safety and Effectiveness, Continued

Device comparisons - ImagingThe following clarifies the modifications to the Telstar Biplane Digital Imaging System cleared under K013484.
Device CharacteristicsCurrent TIS
(K013484)Modified TIS
ImagingFluoroscopicFluoroscopic
Pulsed fluoro7.5, 15, 30 pulses/sec7.5, 15, 30 pulses/sec
Pulsed cardiac15, 30 pulses/sec15, 30 pulses/sec
X-ray tube assemblyRotating anodeRotating anode
Image intensifierYesYes
MonitorQuad 15"Quad 15"
Operating modesFast Scan Fluoro (2x2 binning) onlyFast Scan Fluoro and Low Noise, High Sensitivity Fluoro (2x4 binning)
Frame rateSameSame
Physical testingThe TIS is designed and tested in compliance with the requirements of 21 CFR §1020.32 (Fluoroscopic Equipment).
Preclinical animal performance dataPreclinical performance data were provided in K013484. No new studies were required or necessary to support the modifications.
Clinical performance dataClinical performance data were provided in K013484. No new studies were required or necessary to support the modifications.

The information herein is considered CONFIDENTIAL to STEREOTAXIS, Inc. in accordance with the provisions and expectations of 21 CFR §20.61, 21 CFR §812.38, and 21 CFR §814.9.

2

Special 510(k): Telstar Biplane Digital Imaging System Stereotaxis, Inc.

Appendix 1: 510(k) Summary of Safety and Effectiveness, Continued

Contact Peter A. Takes, Ph.D., RAC Director, Clinical & Regulatory Affairs Stereotaxis, Inc. 4041 Forest Park Avenue St. Louis, Missouri 63108 Ph. 314-615-6964 Fax 314-615-6912

August 1, 2002 Date

3

DEPARTMENT OF HEALTH & HUMAN SERVICES

Public Health Service

Food and Drug Administration 10903 New Hampshire Avenue Document Control Room - WO66-G609 Silver Spring, MD 20993-0002

Peter A. Takes, Ph.D., RAC Director, Clinical & Regulatory Affairs Stereotaxis, Inc. 4041 Forest Park Avenue ST LOUIS MO 63108

AUG 2 0 2013

Re: K022565

Trade/Device Name: Telstar Biplane Digital Imaging System Regulation Number: 21 CFR 892.1650 Regulation Name: Image-intensified fluoroscopic x-ray system Regulatory Class: II Product Code: JAA Dated: September 6, 2002 Received: September 9, 2002

Dear Dr. Takes:

This letter corrects our substantially equivalent letter of October 8. 2002.

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. 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.

If your device is classified (see above) into class II (Special Controls), it may be subject to such additional controls. Existing major regulations affecting your device can be found in Title 21, Code of Federal Regulations (CFR). Parts 800 to 895. 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 Parts 801 and 809); medical device reporting (reporting of

4

medical device-related adverse events) (21 CFR 803); and good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820). This letter will allow you to begin marketing your device as described in your Section 510(k) premarket notification. The FDA finding of substantial equivalence of your device to a legally marketed predicate device results in a classification for your device and thus, permits your device to proceed to the market.

If you desire specific advice for your device on our labeling regulation (21 CFR Parts 801 and 809), please contact the Office of In Vitro Diagnostic Device Evaluation and Safety at (301) 796-5450. 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 the CDRH's Office of Surveillance and Biometrics/Division of Postmarket Surveillance.

You may obtain other general information on your responsibilities under the Act from the Division of Small Manufacturers, International and Consumer Assistance at its toll-free number (800) 638-2041 or (301) 796-7100 or at its Internet address http://www.fda.gov/cdrh/industry/support/index.html.

Sincerely Yours,

Janine M. Morris

Acting Director Division of Radiological Devices Office of In Vitro Diagnostic Device Evaluation and Safety Center for Devices and Radiological Health

Enclosure

5

Special 510(k): Telstar Biplane Digital Imaging System Stereotaxis, Inc. ·

August 1, 2002 Page 30

Appendix 2: Statement of Intended Use

Statement

Indications for Use Statement:

510(k) Number: K

Device Name: Telstar™ Biplane Digital Imaging System [TIS]

Indications for Use: The Telstar™ Biplane Digital Imaging System provides the utility of fluoroscopic imaging of vascular systems for applications including vascular angiography and electrophysiology (EP) studies. This xray system may be used stand-alone, or in conjunction with an associated Stereotaxis Magnetic Navigation System.

Prescription Use

Varid a. Seymon

(Division Sign-Off) Division of Reproductive, a and Radiological Device 510(k) Number

The information herein is considered CONFIDENTIAL to STEREOTAXIS, Inc. in accordance with the provisions and expectations of 21 CFR §20.61, 21 CFR §812.38, and 21 CFR §814.9.