(23 days)
The intended use of the Tripter-X1 Duet Extracorporeal Shock Wave Lithotripter is the fragmentation of urinary tract stones (i.e. renal calyceal, renal pelvic, and upper ureteral stones).
The Duet is a transportable Electrohydraulic Extracorporeal Shock Wave Lithotripter, which consists of a Shock Wave Generator (SWAG), a Motorized Floating Treatment Table (MFT), and control means.
The provided document is a 510(k) premarket notification for a medical device called the "Tripter X-1 Compact Duet with Sonographic Localization Option." This document relates to a device for Extracorporeal Shock Wave Lithotripsy (ESWL), which is a non-invasive procedure used to break up kidney stones.
Here's an analysis of the requested information based on the provided text:
1. Table of Acceptance Criteria and Reported Device Performance
The submission states, "No clinical tests were performed." Therefore, there are no specific acceptance criteria or reported device performance metrics in this document. The device is cleared via a "special 510(k)" because it is considered a minor modification that does not change the fundamental technology or reduce safety and effectiveness compared to a predicate device.
2. Sample Size Used for the Test Set and Data Provenance
Not applicable. No clinical tests or test sets were used for this submission.
3. Number of Experts Used to Establish the Ground Truth for the Test Set and Qualifications of Those Experts
Not applicable. No clinical tests or test sets were used, so no ground truth establishment by experts was performed.
4. Adjudication Method for the Test Set
Not applicable. No clinical tests or test sets were used.
5. If a Multi-Reader Multi-Case (MRMC) Comparative Effectiveness Study Was Done, and the Effect Size of How Much Human Readers Improve with AI vs. Without AI Assistance
Not applicable. This device is not an AI-based diagnostic tool, and no MRMC studies were performed.
6. If a Standalone (i.e., algorithm only without human-in-the-loop performance) Was Done
Not applicable. This is not an algorithm-only device.
7. The Type of Ground Truth Used
Not applicable. No clinical tests were performed.
8. The Sample Size for the Training Set
Not applicable. This submission is for a physical medical device (lithotripter), not a machine learning algorithm requiring a training set.
9. How the Ground Truth for the Training Set Was Established
Not applicable. No training set was used.
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JUL - 7 2004
K04/582
Page 1 of 2
SECTION 6 -- 510(k) SUMMARY
[Submitted pursuant to 21 CFR 807.87(h)]
1. Submitter Information
| Submitter: | Direx Systems Corporation11 Mercer RoadNatick Business ParkNatick, MA 01760 |
|---|---|
| Telephone:Fax:Contact Person | (508) 651-0900(508) 651-8125Larisa GershteinQA Manager |
| Contact Person e-mail address: | lgershtein@direxusa.com |
| 2. Device | |
| Trade/Proprietary Name: | Tripter X-1 Compact Duet (to bemarketed as "Duet") w. SonographicLocalization Option |
| Common/Usual Name: | Extracorporeal Shock Wave Lithotripter(ESWL) |
| Classification Name/ Product code: | 78 LNS |
| Regulatory Class: | Class II |
| Regulation Number: | 21 CFR 876.5990 |
3. Predicate Devices
Tripter X1 Compact Duet: K023535 Tripter X1 Compact: K040470
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K041582
Page 2 of 2
4. Intended Use:
The intended use of the Tripter-X1 Duet Extracorporeal Shock Wave Lithotripter is the fragmentation of urinary tract stones (i.e. renal calyceal, renal pelvic, and upper ureteral stones).
5. Technological Characteristics:
This Duet includes a sonographic localization option that enables the use of ultrasound for positioning. The device has the same fundamental scientific technology and intended use as predicate devices.
6. Description
The Duet is a transportable Electrohydraulic Extracorporeal Shock Wave Lithotripter, which consists of a Shock Wave Generator (SWAG), a Motorized Floating Treatment Table (MFT), and control means.
7. Clinical Tests
No clinical tests were performed.
8. Conclusion
The Duet with the Sonographic Localization Option meets the requirements for a special 510(k) by the virtue of being a minor modification, which does not change the fundamental technology or reduce safety and effectiveness, of the Company's predicate device, the Tripter X-1 Compact Duet.
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f rod and Drug Administration 9200 Corporate Boulevard Reast ville 140 20450
JUL - 7 2004
Ms. Larisa Gershtein Manager of Quality Assurance DiREX Systems Corp. 11 Mercer Road NATICK MA 01760
Re: K041582
Trade/Device Name: Tripter –XI Compact Duct with Sonography Localization Option Regulation Number: 21 CFR §876.5990 Regulation Name: Extracorporeal shock wave lithotripter Regulatory Class: II Product Code: 78 LNS Dated: May 9, 2004 Received: June 14, 2004
Dear Ms. Gershtein:
We have reviewed your Section 510(k) premarket notification of intent to market the device We have reviewed your Section 3 ro(x) prematice is substantially equivalent (for the indications for use stated in the enclosure) to legally marketed predicate devices marketed in interstate for use stated in the enclosure) to regary manological Device Amendments, or to
commerce prior to May 28, 1976, the enactment date of the Federal Food Days commerce prior to May 28, 1776, the exactiance with the provisions of the Federal Food, Drug, devices that have been recassince in accordance with a premarket approval application (PMA). and Cosmetic Act (Act) that do not require approvince controls provisions of the Act. The You may, therefore, market the devros, subject to me go
general controls provisions of the Act include requirements for annual registration, listing of general controls provisions of the rice meralies commitment against misbranding and adulteration.
If your device is classified (see above) into cither class II (Special Controls) or class III (PMA), If your device is classified (SC above) and entines regulations affecting your device can be
it may be subject to additional controls. Existing major It may be subject to adultional controls. Bittle 31, Parts 800 to 898. In addition, FDA may found in the Code of rederal regarders.
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 Picase be advised that FDA 3 issuates of a secondics with other requirements of the Act that FDA has made a decemmation mac your intered by other Federal agencies. You must of any Pederal statues and regalations as themelers of the limited to: registration and listing comply with an the Act STEQuirements, metaling, no and manufacturing practice requirements as set
(21 CFR Part 807); labeling (21 CFR Part 801); good manufacturing de collect (21 CFR Part 807), labeling (21 CFR Part 820); and 1f applicable, the electronic
forth in the quality systems (QS) regulation (21 CFR Part 820); 2009; 1950 forth in the quality Systems (Qo) registeriors (25-542 of the Act); 21 CFR 1000-1050.
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This letter will allow you to begin marketing your device as described in your Section 510(k) This lefter will allow you to begin marketing of substantial equivalence of your device to a legally premarket nothication. The FDA momg or bassification 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 Part 801), please If you desire specific advice tor your decided on be and against on the regulation number at the top of the letter:
| 8xx.1xxx | (301) 594-4591 |
|---|---|
| 876.2xxx, 3xxx, 4xxx, 5xxx | (301) 594-4616 |
| 884.2xxx, 3xxx, 4xxx, 5xxx, 6xxx | (301) 594-4610 |
| 892.2xxx, 3xxx, 4xxx, 5xxx | (301) 594-4654 |
| Other | (301) 594-4692 |
Additionally, for questions on the promotion and advertising of your device, please contact the Additionally, for questions of the promotion and the regulation entitled, "Misbranding Othios of Compliance at (301) 574-1057. Fab., production of Coltain. Other general by relerence to premarket notification (DFCF it in a may be obtained from the Division of Small information on your responsionities and consumer Assistance at its toll-free number (800) 638-2041 or Manufacturers, International and Octoballity of/hearth.com/cdrh/dsma/dsmamain.html.
Sincerely yours,
Nancy C. Brogdon
Nancy C. Brogdon Director, Division of Reproductive, Abdominal and Radiological Devices Office of Device Evaluation Center for Devices and Radiological Health
Enclosure
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Image /page/4/Picture/0 description: The image shows the logo for "Direx Systems Corp.". The word "Direx" is in large, bold, black letters. Underneath "Direx" is a horizontal line, and below that is the text "Systems Corp." in smaller, black letters. The logo appears to be for a company in the systems or technology industry.
INTENDED USE STATEMENT
510(k) Number (if known):
04/582
Device Name:
Tripter-X1 Compact Duet
Intended Use:
The intended use of the Tripter-X1 Compact Duet Extracorporeal The Intended use of the fripter is the fragmentation of urinary tract stones Shock Wave Exholipter frenal pelvic, and upper ureteral stones).
(PLEASE DO NOT WRITE BELOW THIS LINE -CONTINUE ON ANOTHER PAGE IF NEEDED)
510(k) Number K041582
Prescription Use (Per 21 CFR § 801.109) OR
Over the Counter Use_
Nancy Brogdon
(Division Sign-Off) () (Division Sign on) of Reproductive, Abdominal, and Radiological Devices 510(k) Number.
11 Mercer Road ♦ Natick, Ma 01760 Phone: 1-888-TRIPTER ♦ Fax: 508-651-8125 ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4-1
§ 876.5990 Extracorporeal shock wave lithotripter.
(a)
Identification. An extracorporeal shock wave lithotripter is a device that focuses ultrasonic shock waves into the body to noninvasively fragment urinary calculi within the kidney or ureter. The primary components of the device are a shock wave generator, high voltage generator, control console, imaging/localization system, and patient table. Prior to treatment, the urinary stone is targeted using either an integral or stand-alone localization/imaging system. Shock waves are typically generated using electrostatic spark discharge (spark gap), electromagnetically repelled membranes, or piezoelectric crystal arrays, and focused onto the stone with either a specially designed reflector, dish, or acoustic lens. The shock waves are created under water within the shock wave generator, and are transferred to the patient's body using an appropriate acoustic interface. After the stone has been fragmented by the focused shock waves, the fragments pass out of the body with the patient's urine.(b)
Classification. Class II (special controls) (FDA guidance document: “Guidance for the Content of Premarket Notifications (510(k)'s) for Extracorporeal Shock Wave Lithotripters Indicated for the Fragmentation of Kidney and Ureteral Calculi.”)