K Number
K041949
Device Name
ALLURA XPER FD10
Date Cleared
2004-07-30

(10 days)

Product Code
Regulation Number
892.1600
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The Allura Xper FD10 is intended for use in cardiovascular and vascular x-ray imaging applications, including diagnostic, interventional procedures (such as PTCA and stent placement and atherectomies), pacemaker implantations and electrophysiology. It is compatible with specified magnetic navigation systems.
Device Description
The Allura Xper FD10 is a stationary angiographic X-ray imaging system with a solid state x-ray imaging device for cardiovascular and vascular diagnostic and interventional procedures. The monoplane system can be configured as either a floor or a ceiling suspended G-arm frontal stand.
More Information

Not Found

No
The summary does not mention AI, ML, or any related terms, and the device description focuses on the hardware and basic imaging capabilities.

No.
The device is an imaging system used for diagnosis and guiding interventions, not for therapy itself.

Yes
The "Intended Use / Indications for Use" and "Device Description" sections explicitly state that the device is intended for "diagnostic" procedures.

No

The device description clearly states it is a "stationary angiographic X-ray imaging system with a solid state x-ray imaging device," indicating it is a hardware system, not software only.

Based on the provided information, the Allura Xper FD10 is not an IVD (In Vitro Diagnostic) device.

Here's why:

  • Intended Use: The intended use clearly states that the device is for "cardiovascular and vascular x-ray imaging applications, including diagnostic, interventional procedures...". This describes a device used for imaging the inside of the body, not for testing samples taken from the body (like blood, urine, or tissue).
  • Device Description: The description confirms it's an "angiographic X-ray imaging system" used for "cardiovascular and vascular diagnostic and interventional procedures." This further reinforces its use for in-vivo imaging.
  • IVD Definition: IVD devices are used to examine specimens derived from the human body to provide information for diagnostic, monitoring, or compatibility purposes. The Allura Xper FD10 does not perform this function.

Therefore, the Allura Xper FD10 is an imaging device used for diagnostic and interventional procedures, not an IVD.

N/A

Intended Use / Indications for Use

The Allura Xper FD10 is intended for use in cardiovascular and vascular x-ray imaging applications, including diagnostic, interventional procedures (such as PTCA and stent placement and atherectomies), pacemaker implantations and electrophysiology. It is compatible with specified magnetic navigation systems.

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

90KPR, 90IZI

Device Description

The Allura Xper FD10 is a stationary angiographic X-ray imaging system with a solid state x-ray imaging device for cardiovascular and vascular diagnostic and interventional procedures. The monoplane system can be configured as either a floor or a ceiling suspended G-arm frontal stand.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

X-ray

Anatomical Site

Cardiovascular and vascular

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)

Not Found

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.

K031333

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

§ 892.1600 Angiographic x-ray system.

(a)
Identification. An angiographic x-ray system is a device intended for radiologic visualization of the heart, blood vessels, or lymphatic system during or after injection of a contrast medium. This generic type of device may include signal analysis and display equipment, patient and equipment supports, component parts, and accessories.(b)
Classification. Class II.

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Image /page/0/Picture/1 description: The image shows the word "PHILIPS" in a bold, sans-serif font. Below the word "PHILIPS" is the text "K041949" in a smaller font. The text is black and the background is white. The image appears to be a logo or label.

JUL 3 0 2004

510(k) Summary

The following information is being submitted in accordance with the requirements of 21CFR 807.92.

Company Name:Philips Medical Systems North America Company
Address:22100 Bothell Everett Highway
P.O.Box 3003
Bothell, WA 98041-3003, USA
Registration No.:1217116
Contact Person:
Telephone No.:Lynn Harmer
(425) 487-7312
Date Prepared:July 12, 2004
Device (Trade) Name:Allura Xper FD10
Classification Names:Stationary X-ray system,
21CFR892.1680, Class II (code 90KPR)
Angiographic X-ray system,
21CFR892.1600, Class II (code 90IZI)

Predicate Device:

The Allura Xper FD10 is substantially equivalent to the Integris Allura Flat Detector release 1.2. both manufactured by Philips Medical Systems Nederland B.V. The Philips Integris Allura Flat Detector release 1.2 received a 510(k) substantially equivalent determination in K031333 on May 13th, 2003.

Device description:

The Allura Xper FD10 is a stationary angiographic X-ray imaging system with a solid state x-ray imaging device for cardiovascular and vascular diagnostic and interventional procedures. The monoplane system can be configured as either a floor or a ceiling suspended G-arm frontal stand.

Intended use:

The Allura Xper FD10 is intended for use in cardiovascular and vascular x-ray imaging applications, including diagnostic, interventional procedures (such as PTCA and stent placement and atherectomies), pacemaker implantations and electrophysiology. It is compatible with specified magnetic navigation systems.

1

Image /page/1/Picture/0 description: The image shows a logo for Philips. The logo is a shield shape with the word "PHILIPS" at the top. Inside the shield is a globe with a wavy line across the middle. There are four stars around the globe.

General Safety and Effectiveness information:

The device and its labeling will comply with the applicable requirements of:

  • Title 21 Code of Federal Regulations, Subchapter J Radiological Health, parts . 1010, 1020.30, 1020.32 & 1040.10.
  • . Underwriters Laboratories standard for Safety UL60601-1 and be classified by Underwriters Laboratories (UL).
  • ACR/NEMA DICOM digital imaging communication standard. .

Conclusion:

The Allura Xper FD10 does not introduce any new indications for use, nor does the use of the device result in any new potential hazard. Philips Medical Systems Nederland B.V. considers the Allura Xper FD10 to be substantially equivalent with the predicate device.

2

Image /page/2/Picture/1 description: The image shows a circular seal or emblem. The seal features a stylized depiction of an eagle or bird-like figure with three curved lines representing its wings or feathers. Encircling the bird is text, which appears to be part of the seal's official designation. The text is in a circular arrangement around the bird.

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

JUL 3 0 2004

Ms. Lynn Harmer Manager, Regulatory Submissions Philips Medical Systems North America Company 22100 Bothell Everett Highway P.O. Box 3003 BOTHELL WA 98041-3003, USA Re: K041949

Trade/Device Name: Allura Xper FD10 Regulation Number: 21 CFR 892.1600 Regulation Name: Angiographic x-ray system Regulatory Class: II Product Code: 90 IZI Dated: July 16, 2004 Received: July 20, 2004

Dear Ms. Harmer:

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 either class II (Special Controls) or class III (PMA), it may be subject to such 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.

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 Part 801); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820); and if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

3

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 Part 801), please contact the Office of Compliance at one of the following numbers, based 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) 594-4616
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 Office of Compliance at (301) 594-4639. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97) you may obtain. Other general information on your responsibilities under the Act may be obtained from the Division of Small Manufacturers, International 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,

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

4

Indications for Use

510(k) Number (if known): ____ Allura Xper FD10 Device Name: Indications for Use:

The Allura Xper FD10 is intended for cardiovascular and vascular x-ray imaging applications, including diagnostic, interventional procedures (such as PTCA, stent placement and atherectomies), pacemaker implantations and electrophysiology. It is compatible with specified magnetic navigation systems.

Prescription Use __ yes (Part 21 CFR 801 Subpart D)

AND/OR

Over-The-Counter Use _ No_ (21 CFR 807 Subpart C)

(PLEASE DO NOT WRITE BELOW THIS LINE-CONTINUE ON ANOTHER

PAGE OF NEEDED)

Concurrence of CDRH, Office of Device Evaluation (ODE)

Nancy C. hogdon

(Division Sign-Off)
Division of Reproductive, Abdominal,
and Radiological Devices
510(k) Number K041949

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