K Number
K041918
Date Cleared
2004-10-15

(91 days)

Product Code
Regulation Number
870.2300
Reference & Predicate Devices
Predicate For
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
Intended Use

The Philips Medical Systems Integrated Patient Monitoring System (IPMS) is intended to monitor the heart rhythm and other vital signs for a patient undergoing an MRI procedure and to provide signals for synchronization for the MRI scanner.

Device Description

The Philips Medical Systems Integrated Patient Monitoring System (IPMS) is a significant modification of the Invivo Research Omni-Trak™ 3150/3155 Series Patient Monitoring System. This device has been integrated into the Philips Physiotrak patient gurney used with the Philips MRI System. The Philips Medical Systems Integrated Patient Monitoring System is intended to monitor the heart rhythm and other vital signs for a patient undergoing an MRI procedure and to provide signals for synchronization for the MRI scanner. The IPMS works on DC (battery) power supplies and monitors ECG, non-invasive blood pressure, SPO2, respiration and temperature. This information can be displayed either at the monitor or remotely. The monitor sounds an alarm if any monitored parameter falls outside the range indicated by the alarm limits. The alarm limits is programmable either manually or programmally based on the current value of the parameter(s). This monitoring system is MRI-compatible. It utilizes technology from the Invivo Research Omni-Trak™ 3150/3155 Series Patient Monitoring System and the Invivo Research Millennia Patient Monitor. The IPMS consists of three major component parts; the MCB (Patient Connector Box), MEB (Monitoring Electronics Box), and MDCU (Monitoring Display and Control Unit) which are integrated into the Phillips Physiotrak patient gurney.

AI/ML Overview

The provided text describes the acceptance criteria and a summary of performance testing for the Philips Medical Systems Integrated Patient Monitoring System (IPMS). However, it does not include a detailed study description with information like sample sizes for test and training sets, data provenance, number or qualifications of experts, adjudication methods, or MRMC comparative effectiveness studies. This document is a 510(k) summary, which typically focuses on demonstrating substantial equivalence to a predicate device rather than providing full clinical study details.

Here's the information that can be extracted from the provided text based on your request:

1. Table of Acceptance Criteria and Reported Device Performance

ParameterAcceptance Criteria / Specification (Stated)Reported Device Performance (Implied by "Validation and Verification Testing confirmed that this device operates as designed and intended")
ELECTRICAL AND MECHANICAL CHARACTERISTICS
Line Voltage115 VAC +/- 10%, 50/60 HzMeets specification
Power Sources AvailableAC Power, or internal battery power with remote chargerMeets specification
Power Consumption< 30 Volt-Amperes @ 120 VAC nominal (< 60 VA maximum during charging)Meets specification
BatteryLead-Acid Gel Cell (x4), Capacity > 8 hours with 4 batteriesMeets specification
Electrical SafetyPer EN 60601-1Meets specification
Electromagnetic CompatibilityPer EN 60601-1-2Meets specification
PERFORMANCE REQUIREMENTS
Heart Rate Monitor
Range/Resolution0 to 250 BPM / 1 BPMMeets specification
Rate Accuracy0.5% of reading, +/- 1BPMMeets specification
Defibrillator ProtectionAccepts and recovers from a defibrillator discharge up to 5 KVMeets specification
Non-Invasive Blood Pressure Monitoring
Auto Mode Set IntervalsOFF, 1, 2, 2.5, 3, 5, 10, 15, 20, 30, 45 Min, or 1,2, 4 HrsMeets specification
Pop-Off Pressure Level270 +/- 14 mmHgMeets specification
Cuff Inflation Time3 to 20 secondsMeets specification
Pulse Oximetry
Range0 to 100% saturationMeets specification
Accuracy< 3.0% (60% to 100%)Meets specification
Averaging Period3, 6, or 12 secondsMeets specification
Respiration Monitoring
Range4 to 150 RPMMeets specification
Resolution1 RPMMeets specification
Accuracy2% up to 60 RPM, 3.4% at 87 RPM, 5.6% at 142 RPMMeets specification
Temperature
Range20°C to 44°CMeets specification
Accuracy0.3°C (32°C to 44°C)Meets specification
Time Constant15 secondsMeets specification
MRI COMPATIBILITY
Maximum RF EmissionsMaximum -100dB RF noise at MRI Larmor FrequenciesMeets specification
MRI In Bore Materials UsedAll materials are non- magnetic, and do not produce proton-signal emissions during MRIMeets specification

2. Sample size used for the test set and the data provenance

  • Sample Size for Test Set: Not specified in the document. The document states "Validation and Verification Testing confirmed that this device operates as designed and intended," but does not provide details on the number of subjects or test cases.
  • Data Provenance (e.g., country of origin of the data, retrospective or prospective): Not specified.

3. Number of experts used to establish the ground truth for the test set and the qualifications of those experts

  • Not applicable/Not specified. This device is a physiological patient monitor, and its performance is typically evaluated against calibrated reference instruments or simulated physiological signals, not human expert interpretation.

4. Adjudication method (e.g., 2+1, 3+1, none) for the test set

  • Not applicable/Not specified.

5. If a multi-reader multi-case (MRMC) comparative effectiveness study was done, If so, what was the effect size of how much human readers improve with AI vs without AI assistance

  • Not applicable. This is not an AI-assisted diagnostic device. It's a physiological monitoring system.

6. If a standalone (i.e. algorithm only without human-in-the-loop performance) was done

  • Yes, performance testing as described in the "Summary of Performance Testing" table is inherently standalone device performance. The device's accuracy for various parameters (Heart Rate, NIBP, SpO2, Respiration, Temperature) is specified.

7. The type of ground truth used (expert consensus, pathology, outcomes data, etc.)

  • The ground truth would be based on calibrated reference standards and established physiological benchmarks. For example, heart rate accuracy would be compared against an ECG simulator or directly measured heart rate from a known source; blood pressure against a calibrated sphygmomanometer; SpO2 against a co-oximeter in controlled studies; temperature against a calibrated thermometer.

8. The sample size for the training set

  • Not applicable/Not specified. This device is not described as utilizing a machine learning algorithm that requires a training set in the conventional sense. Its design and performance are based on engineering principles and established physiological measurement techniques.

9. How the ground truth for the training set was established

  • Not applicable.

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OCT 1 5 2004

K041918
page 1 of 2

510(k) Summary of Safety and Effectiveness

Submitter Information:

Invivo Research Inc. 12601 Research Parkway Orlando, FL 32826 407-275-3220 Contact: Mr. Neil Battiste

Device Name

Integrated Patient Monitor System

Common Name

Multiparameter Patient Monitor

Classification NamesCodesReference
1. Monitor, Physiological PatientMWI870.2300
2. System, Measurement, Blood Pressure, Non InvasiveDXN870.1130
4. OximeterDQA870.2700
3. Monitor, Breathing FrequencyBZQ868.2375
5. Thermometer, Electronic, ClinicalFFL880.2910

Predicate Devices:

Invivo Research Omni-Trak™ 3150/3155 Series Patient Monitoring System.

510(k) Number: K002030

Device Classification Name: Monitor, Physiological Patient (w/o Arr. Detector or Alarms) Regulation Number: 870.2300, 74 MWI

Invivo Research Millennia 3500 Series Monitor
510(k) Number: K974581
Device Classification Name: Monitor, Cardiac (incl. cardiotachometer & rate alarm)
Regulation Number: 870.2300, 74 DRT

Device Description:

Device Describution:
The Philips Medical Systems Integrated Patient Monitoring System (IPMS) is a significant modification books book The Invivo Research Omni-Trak™ 3150/3155 Series Patient Monitoring System. This Mevice has been
of the Invivo Research Omni-Trak™ 3150/3155 Series Patient Monitoring System of the Invivo Rescaren Online France - 3150133131796 patient gurney used with the Philips MRI System.

The Philips Medical Systems Integrated Patient Monitoring System is intended to monitor the heart The I million and other vital signs for a patient undergoing an MRI procedure and to provide signals for rhythm and other vital signs for a patient andergoing an work on DC (battery) power supplies and monitors synchionization for the Mr. Sountion) blood pressure, SPO2, respiration and temperature. This information can be displayed either at the monitor or remotely.

The monitor sounds an alarm if any monitored parameter falls outside the range indicated by the The montor sounds an allanits. The alarm limits is programmable either manually or programmally based on the current value of the paraméter(s).

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Image /page/1/Picture/0 description: The image shows handwritten text. The text at the top reads "K04/1918". Below that, the text reads "page 2 of 2". The handwriting appears to be cursive.

IPMS Summary o tiveness, page 2 of 2

This monitoring system is MRI-compatible. It utilizes technology from the Invivo Research Omni-Trak™ 3150/3155 Scries Patient Monitoring System and the Invivo Research Millennia Patient Monitor. The IPMS consists of three major component parts; the MCB (Patient Connector Box), MEB (Monitoring Electronics Box), and MDCU (Monitoring Display and Control Unit) which are intograted into the Phillips Physiotrak patient gurney

Intended Use

The Philips Medical Systems Integrated Patient Monitoring System (IPMS) is intended to monitor the heart rhythm and other vital signs for a patient undergoing an MRI procedure and to provide signals for synchronization for the MRI scanner.

Summary of Performance Testing:

Validation and Verification Testing confirmed that this device operates as designed and intended:

ParameterSpecification
ELECTRICAL AND MECHANICAL CHARACTERISTICS
Line Voltage115 VAC +/- 10%, 50/60 Hz
Power Sources AvailableAC Power, or internal battery power with remote charger
Power Consumption< 30 Volt-Amperes @ 120 VAC nominal (< 60 VA maximum during charging)
BatteryLead-Acid Gel Cell (x4), Capacity > 8 hours with 4 batteries
Electrical SafetyPer EN 60601-1
Electromagnetic CompatibilityPer EN 60601-1-2
PERFORMANCE REQUIREMENTS
Heart Rate Monitor
Range/Resolution0 to 250 BPM / 1 BPM
Rate Accuracy0.5% of reading, +/- 1BPM
Defibrillator ProtectionAccepts and recovers from a defibrillator discharge up to 5 KV
Non-Invasive Blood Pressure Monitoring
Auto Mode Set IntervalsOFF, 1, 2, 2.5, 3, 5, 10, 15, 20, 30, 45 Min, or 1,2, 4 Hrs
Pop-Off Pressure Level270 +/- 14 mmHg
Cuff Inflation Time3 to 20 seconds
Pulse Oximetry
Range0 to 100% saturation
Accuracy< 3.0% (60% to 100%)
Averaging Period3, 6, or 12 seconds
Respiration Monitoring
Range4 to 150 RPM
Resolution1 RPM
Accuracy2% up to 60 RPM, 3.4% at 87 RPM, 5.6% at 142 RPM
Temperature
Range20°C to 44°C
Accuracy0.3°C (32°C to 44°C)
Time Constant15 seconds
MRI COMPATIBILITY
Maximum RF EmissionsMaximum -100dB RF noise at MRI Larmor Frequencies
MRI In Bore Materials UsedAll materials are non- magnetic, and do not produce proton-signal emissions during MRI

Conclusion

The Integrated Patient Monitoring System is safe, effective and substantially equivalent to the predicate ... t devices.

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Image /page/2/Picture/1 description: The image is a black and white seal for the Department of Health & Human Services - USA. The seal is circular with the text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" around the perimeter. In the center of the seal is an abstract image of an eagle.

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

OCT 1 5 2004

Invivo Research, Inc. c/o Mr. Neil Battiste Director of Regulatory Affairs 12601 Research Parkway Orlando, FL 32826

Re: K041918

Trade Name: Integrated Patient Monitor System (IPMS) Regulation Number: 21 CFR 870.2300 Regulation Name: Physiological Patient Monitor Regulatory Class: Class II (two) Product Code: MWI Dated: September 16, 2004 Received: September 20, 2004

Dear Mr. Battiste:

We have reviewed your Section 510(k) premarket notification of intent to market the device we nave reviewed your because the device is substantially equivalent (for the indications felerenced above und nave acterimes ally marketed predicate devices marketed in interstate for use stated in the encrosaly to regists the enactment date of the Medical Device Amendments, or to Commerce provision to May 20, 1978, the excordance with the provisions of the Federal Food, DINA devices that have occh receasined in assere approval of a premarket approval application (PMA). alle Cosmetic Act (1101) that do not requent app to the general controls provisions of the Act. The r ou may, mercebre, market the act include requirements for annual registration, listing of general controls provisions practice, labeling, and prohibitions against misbranding and adulteration.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it If your device is olasbirou (600 a00 ro) als. Existing major regulations affecting your device can may be subject to sach addrener sentlations, Title 21, Parts 800 to 898. In addition, FDA may publish further announcements concerning your device in the Federal Register.

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Page 2 – Mr. Neil Battiste

Please be advised that FDA's issuance of a substantial equivalence determination does not mean Please be advised that FDA s issuance of a backer complies with other requirements of the Act that TDA has made a decormmanon ana your stered by other Federal agencies. You must or any Federal statutes and regulations daminding, but not limited to: registration and issting (21 CFR Part 807); labeling (21 CFR Part 801); good manufacturing practice requirements as set as a CFK Part 807), labeling (21 CFR Part 820); and if applicable, the electronic a forum in the quality systems (Sections 531-542 of the Act); 21 CFR 1000-1050. product laulation control provisions (Section your device as described in your Section 510(k) I his letter will anow you to begin maneting your and equivalence of your device to a legally premarket nothleadon: The TDA miang of castification 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 for your ac 1100 %. 4646. Also, please note the regulation entitled, Coniact the Ories of Come of Come the notification" (21CFR Part 807.97) you may obtain. IMISURahuing of Icrerchee to premaisonsibilities under the Act may be obtained from the Other general mionmation on your responsional and Consumer Assistance at its toll-free number (800) 638-2041 or (301) 443-6597 or at its Internet address http://www.fda.gov/cdrh/dsma/dsmamain.html

Sincerely yours,

Bhimma for

Bram D. Zuckerman, M.D. Director Division of Cardiovascular Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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Indications for Use

510(k) Number (if known):

K04/1918

Device Name: Integrated Patient Monitoring System

Indications For Use:

The Philips Medical Systems Integrated Patient Monitoring System The I mips Medical Bystems and other vital seen rhythm and other vital signs (ITMS) is intended to moments
for a patient undergoing an MRI procedure and to provide signals for synchronization for the MRI scanner.

Prescription Use (Part 21 CFR 801 Subpart D) AND/OR ..

Over-The-Counter Use (21 CFR 801 Subpart C)

(PLEASE DO NOT WRITE BELOW THIS LINE-CONTINUE ON ANOTHER PAGE IF NEEDED)

Concurrence of CDRH, Office of Device Evaluation (ODE)

Blummen
(Division Sign-Off)

(Division sign-Om)
Division of Cardiovascular Devices
510(k) Number K041918

Page 2-1 Page 1 of

§ 870.2300 Cardiac monitor (including cardiotachometer and rate alarm).

(a)
Identification. A cardiac monitor (including cardiotachometer and rate alarm) is a device used to measure the heart rate from an analog signal produced by an electrocardiograph, vectorcardiograph, or blood pressure monitor. This device may sound an alarm when the heart rate falls outside preset upper and lower limits.(b)
Classification. Class II (performance standards).