K Number
K050509
Device Name
LSO PET/CT HIREZ SERIES, MODELS 2I, 6I, 16I, 64I
Date Cleared
2005-03-25

(24 days)

Product Code
Regulation Number
892.1200
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The CPS LSO PET/CT HiRez Series Scanners are combined positron emission tomography (PET) and X-ray computed tomography (CT) scannesr. The LSO PET/CT scanner is intended to be utilized by appropriately trained health care professionals to 1) image and measure the distribution of injected positron emitting radiopharmaceuticals in humans for the purpose of determining various metabolic (molecular) and physiologic functions within the human body, and 2) to produce cross-sectional images of the body by computer reconstruction of x-ray prounds sion data from either the same axial plane taken at different angles or spiral planes* taken at different angles. The PET and the CT functions of this system can also be used in combination to provide high resolution, noise free CT attenuation correction maps for PET images and, additionally, utilized to produce fused CT and PET images, providing detailed anatomic and metabolic function information in a single image. (*spiral planes: the axial planes resulted from the continuous rotation of detectors and x-ray tube and the simultaneous translation of the patient.)
Device Description
The CPS LSO PET/CT Hi-Rez series of scanners are combined Positron Emission Tomography and X-Ray Computed Tomography scanners. These systems are designed for whole-body oncology, neurology and cardiology syotome are a signiture registration and fusion of high-resolution metabolic and anatomic information from the two major components of each system, the and anatomic informanner and the Siemens Somatom CT (either Emotion or Sensation depending on the specific model). The combined PET/CT scanner is intended for use as a clinical, whole-body oncology machine with high-end spiral CT and PET performance. The CT oncology maonine mans, quiet attenuation correction for PET studies as well as oomponont provided farmer through fused PET and CT images. In addition, the PET / CT system maintains independent functionality of the PET and CT scanning systems, allowing for most standard stand-alone CT and PET clinical diagnostic protocols to be available as well. Changes incorporated in this system are the result of a cost reduction effort Changes incorporated in this System are the roomtry to be modified easily. combined with changes that allow the "look" of the gantry to be interest Combined with chunges that and rain and and acturability and Adultional changes were intorporation to inipes were . These changes were serviceability as well as to deal with parts obsolescence. (RUC) The City Serviceability as well as to deal with parts esset Handling System (PHS). The CT limited to the PET gantry as well as the Patient Handling System (PHS). The CT illined to the F LT gamry as well as the reviously commercially available systems.
More Information

Not Found

No
The document describes a combined PET/CT scanner and its intended use, device description, and changes made for cost reduction and serviceability. There is no mention of AI or ML in the provided text.

No.
The device is used for imaging and diagnostic purposes to determine various metabolic and physiologic functions, not for treating diseases or conditions.

Yes

Explanation: The "Intended Use / Indications for Use" section states that the device is used "for the purpose of determining various metabolic (molecular) and physiologic functions within the human body" and to "produce cross-sectional images of the body." This information is used by trained healthcare professionals to diagnose conditions. Additionally, the "Device Description" states that the system "is intended for use as a clinical, whole-body oncology machine" and maintains "independent functionality of the PET and CT scanning systems, allowing for most standard stand-alone CT and PET clinical diagnostic protocols to be available." These uses are explicitly diagnostic in nature.

No

The device description clearly states it is a combined PET and CT scanner, which are hardware devices. The changes mentioned are related to the physical gantry and patient handling system, further indicating it is a hardware device.

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

Here's why:

  • IVDs analyze samples taken from the human body (like blood, urine, tissue). The description clearly states that this device images and measures the distribution of injected radiopharmaceuticals within the human body and produces cross-sectional images of the body using X-rays. This is an in vivo (within the living body) diagnostic process, not in vitro (in glass or outside the living body).
  • The intended use and device description focus on imaging and anatomical/metabolic function within the patient. There is no mention of analyzing biological samples.

Therefore, the CPS LSO PET/CT HiRez Series Scanners are diagnostic imaging devices, not IVDs.

N/A

Intended Use / Indications for Use

The CPS LSO PET/CT HiRez Series Scanners are combined positron emission tomography (PET) and X-ray computed tomography (CT) scannesr. The LSO PET/CT scanner is intended to be utilized by appropriately trained health care professionals to 1) image and measure the distribution of injected positron emitting radiopharmaceuticals in humans for the purpose of determining various metabolic (molecular) and physiologic functions within the human body, and 2) to produce cross-sectional images of the body by computer reconstruction of x-ray prounds sion data from either the same axial plane taken at different angles or spiral planes* taken at different angles.

The PET and the CT functions of this system can also be used in combination to provide high resolution, noise free CT attenuation correction maps for PET images and, additionally, utilized to produce fused CT and PET images, providing detailed anatomic and metabolic function information in a single image.

(*spiral planes: the axial planes resulted from the continuous rotation of detectors and x-ray tube and the simultaneous translation of the patient.)

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

KPS, JAK

Device Description

The CPS LSO PET/CT Hi-Rez series of scanners are combined Positron Emission Tomography and X-Ray Computed Tomography scanners. These systems are designed for whole-body oncology, neurology and cardiology syotome are a signiture registration and fusion of high-resolution metabolic and anatomic information from the two major components of each system, the and anatomic informanner and the Siemens Somatom CT (either Emotion or Sensation depending on the specific model).

The combined PET/CT scanner is intended for use as a clinical, whole-body oncology machine with high-end spiral CT and PET performance. The CT oncology maonine mans, quiet attenuation correction for PET studies as well as oomponont provided farmer through fused PET and CT images. In addition, the PET / CT system maintains independent functionality of the PET and CT scanning systems, allowing for most standard stand-alone CT and PET clinical diagnostic protocols to be available as well.

Changes incorporated in this system are the result of a cost reduction effort Changes incorporated in this System are the roomtry to be modified easily.
combined with changes that allow the "look" of the gantry to be interest Combined with chunges that and rain and and acturability and Adultional changes were intorporation to inipes were . These changes were
serviceability as well as to deal with parts obsolescence. (RUC) The City Serviceability as well as to deal with parts esset Handling System (PHS). The CT
limited to the PET gantry as well as the Patient Handling System (PHS). The CT illined to the F LT gamry as well as the reviously commercially available systems.

Mentions image processing

Yes

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Positron Emission Tomography (PET), X-Ray Computed Tomography (CT)

Anatomical Site

whole-body

Indicated Patient Age Range

Not Found

Intended User / Care Setting

appropriately trained health care professionals

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.

K033431, K042467

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

§ 892.1200 Emission computed tomography system.

(a)
Identification. An emission computed tomography system is a device intended to detect the location and distribution of gamma ray- and positron-emitting radionuclides in the body and produce cross-sectional images through computer reconstruction of the data. This generic type of device may include signal analysis and display equipment, patient and equipment supports, radionuclide anatomical markers, component parts, and accessories.(b)
Classification. Class II.

0

K050509

MAR 2 5 2005

510(K) SUMMARY

(As required by 21 CFR 807.87(h))

ldentification of Submitter

Submitter:

M. Alaine Medio, RAC Senior Regulatory Affairs Specialist CTI Molecular Imaging, Inc. 810 Innovation Drive Knoxville, TN 37932 (865)218-2703 (865)218-3019

Telephone Number: Fax Number: Date of Submission:

Identification of the Product

Device Proprietary Name:LSO PET/CT HiRez Series
Common Name:Combination Positron Emission Tomography
(PET) and Computed Tomography (CT)
Systems
Classification Name:Emission Computed Tomography System
per 21 CFR 892.1200

Marketed Devices to which Equivalence is Claimed

DeviceManufacturer510(k) Number
LSO PET/CT HiRez and
HiRez16CTI PET Systems (CPS)K033431
LSO PET/CT HiRez 64CTI PET Systems (CPS)K042467

Device Description:

The CPS LSO PET/CT Hi-Rez series of scanners are combined Positron Emission Tomography and X-Ray Computed Tomography scanners. These systems are designed for whole-body oncology, neurology and cardiology syotome are a signiture registration and fusion of high-resolution metabolic and anatomic information from the two major components of each system, the and anatomic informanner and the Siemens Somatom CT (either Emotion or Sensation depending on the specific model).

The combined PET/CT scanner is intended for use as a clinical, whole-body oncology machine with high-end spiral CT and PET performance. The CT oncology maonine mans, quiet attenuation correction for PET studies as well as oomponont provided farmer through fused PET and CT images. In addition, the PET / CT system maintains independent functionality of the PET and CT scanning systems, allowing for most standard stand-alone CT and PET clinical diagnostic protocols to be available as well.

1

Changes incorporated in this system are the result of a cost reduction effort Changes incorporated in this System are the roomtry to be modified easily.
combined with changes that allow the "look" of the gantry to be interest Combined with chunges that and rain and and acturability and Adultional changes were intorporation to inipes were . These changes were
serviceability as well as to deal with parts obsolescence. (RUC) The City Serviceability as well as to deal with parts esset Handling System (PHS). The CT
limited to the PET gantry as well as the Patient Handling System (PHS). The CT illined to the F LT gamry as well as the reviously commercially available systems.

Indications for Use:

The CPS LSO PET/CT HiRez Series Scanners are combined positron emission The CF S EOO F ETOT Hillson omputed tomography (CT) scannesr. The LSO tomography \r ET/ and X fay oompatible to hegopriately trained health care PET/CT scannel 13 intended to be atlines and measure the distribution of injected positron professionals to 1) image and mound on the purpose of determining various emiling radiophumabodicale in hysiologic functions within the human body, and 2) to metabolic (moleculur) and physiologie landy by computer reconstruction of x-ray produce cross-sectional images of the same axial plane taken at different angles or spiral planes* taken at different angles.

The PET and the CT functions of this system can also be used in combination to The FET and the OT fanstions of this of this cystems maps for PET images and, additionally, utilized to produce fused CT and PET images, images and, adultionally, and metabolic function information in a single image.

(*spiral planes: the axial planes resulted from the continuous rotation of ( Spiral planes. The uxia, pnd the simultaneous translation of the patient.)

2

Image /page/2/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo consists of a circular seal with the words "DEPARTMENT OF HEALTH & HUMAN SERVICES • USA" arranged around the perimeter. Inside the circle is an abstract image of an eagle or other bird-like figure, with three stylized lines forming the body and wings.

Public Health Service

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

MAR 2 5 2005

Ms. M. Alaine Medio, RAC Senior Regulatory Affairs Specialist CTI PET Systems, Inc. 810 Innovation Drive KNOXVILLE TN 37932

Re: K050509 Trade/Device Name: LSO PET/CT HiRez Series Regulation Number: 21 CFR 892.1200 Regulation Name: Emission computed tomography system Regulation Number: 21 CFR 892.1750 Regulation Name: Computed tomography x-ray system Regulatory Class: II Product Code: KPS and JAK Dated: February 28, 2005 Received: March 1, 2005

Dear Ms. Medio:

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 (Premarket Approval), 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 (OS) 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) I his ictief with anow you to begin maneeing your and equivalence of your device to a legally premarket notification: "The PDF mainly of oassification 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 11 you desire specific acvice for your de room of the following numbers, based on the regulation number at the top of this letter:

21 CFR 876.xxxx(Gastroenterology/Renal/Urology)240-276-0115
21 CFR 884.xxxx(Obstetrics/Gynecology)240-276-0115
21 CFR 892.xxxx(Radiology)240-276-0120
Other240-276-0100

Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR Also, prease note the regulation entirely information on your responsibilities under the Act from the 807.77). I ou may ootain other generer Assistance at its toll-free number (800) 638-2041 or (301) 443-6597 or at its Internet address http://www.fda.gov/cdrh/industry/support/index.html.

Sincerely yours,

Nancy C. Hodgdon

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 FORM

Page / of /

510(k) Number (if known):

K050509

LSO PET/CT HiRez Series Device Name:

Indications for Use:

The CPS LSO PET/CT HiRez Series Scanners are combined positron emission tomography (PET) and X-ray computed tomography (CT) scannesr. The LSO PET/CT scanner is intended to be utilized by appropriately trained health care professionals to 1) image and measure the distribution of injected positron emitting radiopharmaceuticals in humans for the purpose of determining various metabolic (molecular) and physiologic functions within the human body, and 2) to produce cross-sectional images of the body by computer reconstruction of x-ray prounds sion data from either the same axial plane taken at different angles or spiral planes* taken at different angles.

The PET and the CT functions of this system can also be used in combination to provide high resolution, noise free CT attenuation correction maps for PET images and, additionally, utilized to produce fused CT and PET images, providing detailed anatomic and metabolic function information in a single image.

(*spiral planes: the axial planes resulted from the continuous rotation of detectors and x-ray tube and the simultaneous translation of the patient.)

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

Concurrence of CDRH, Office of Device Evaluation (ODE)

Prescription Use (Per 21 CFR 801.109)

OR

Over the Counter Use - -

(Optional Format 1-2-96)

Nancy L. Brogdon

Division Sian-Off Division of Reproductive. A and Radiological Devices 510(k) Number .

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