K Number
K052633
Device Name
DUAL SHOT - CONTRAST DELIVERY SYSTEM
Date Cleared
2005-10-17

(21 days)

Product Code
Regulation Number
870.1650
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The Dual Shot – Contrast Delivery System is an intravascular injection system intended for the administration of ionic and non-ionic contrast media and saline used in conjunction with computed X-ray tomography (CT).
Device Description
DUAL SHOT - CONTRAST DELIVERY SYSTEM is an Angiographic injector that is used in conjunction with X-ray Computed tomography, and is intended for use by doctors, radiologic technologists and other licensed medical practitioners. This device is designed to correspond to the various injection methods of contrast media which were materialized with the appearance of multi-slice CT scanners. The DUAL SHOT has two driving parts to deliver contrast media and/or saline, one side is for 50mL, 100mL and 200mL, size syringes, and the other side for 50mL syringes capable for saline flush injection. Syringes are connected to the patient via an intravascular catheter. DUAL SHOT consists following components; Injector head, Console, Power Supply, Options (Hand Switch).
More Information

Not Found

No
The summary describes a mechanical contrast injection system and does not mention any AI or ML capabilities.

No
This device is for the administration of contrast media and saline used in conjunction with CT imaging; it does not treat a disease or condition.

No

The device is an injector system for administering contrast media and saline, which aids in imaging; it does not itself diagnose conditions.

No

The device description explicitly lists hardware components such as an injector head, console, and power supply, indicating it is a physical device, not software-only.

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

Here's why:

  • Intended Use: The intended use is for the administration of contrast media and saline into the patient's body (intravascular injection) for use with CT imaging. IVDs are used to examine specimens from the human body (like blood, urine, tissue) to provide information about a person's health.
  • Device Description: The description clearly states it's an "Angiographic injector" used to deliver substances into the patient.
  • Lack of IVD Characteristics: There is no mention of analyzing biological samples, reagents, or any other typical components or processes associated with in vitro diagnostics.

The device is a medical device used in conjunction with a diagnostic imaging modality (CT), but it is not performing the diagnostic test itself.

N/A

Intended Use / Indications for Use

The DUAL SHOT - CONTRAST DELIVERY SYSTEM is an intravascular injection system intended for the administration of ionic and non-ionic contrast media and saline used in conjunction with computed X-ray tomography (CT).
The Dual Shot – Contrast Delivery System is an intravascular injection system intended for the administration of ionic and not in intrarasonia injocan system interior in computed Your and non-ionic contrast media and saline used in conjunction with computed X-ray tomography (CT).

Product codes

DXT

Device Description

DUAL SHOT - CONTRAST DELIVERY SYSTEM is an Angiographic injector that is used in conjunction with X-ray Computed tomography, and is intended for use by doctors, radiologic technologists and other licensed medical practitioners. This device is designed to correspond to the various injection methods of contrast media which were materialized with the appearance of multi-slice CT scanners. The DUAL SHOT has two driving parts to deliver contrast media and/or saline, one side is for 50mL, 100mL and 200mL, size syringes, and the other side for 50mL syringes capable for saline flush injection. Syringes are connected to the patient via an intravascular catheter. DUAL SHOT consists following components;

Iniector head

Iniector head provides accurate, automatic delivery of contrast media by two electromechanically driven actuators. Sterile empty-syringes or pre-filled syringes can be set onto the Injector head. For the sterile empty-syringes, Injector head provides auto-return function to fill the svringe with contrast media or saline. Injector head is composed of operation indicator LED, switches for manual operation, start-switch to start infusion and stop-switch to stop infusion. Injector head detects injection conditions and transmits the Iniector head status information to the console.

Console

The console takes up very little space on a control desk, and consists of TFT LCD display and touch panel interface to set/display various injections set by an operator. The operator can set injection pressure, time, volume, flow rate and a patient examination region of interest.

Power Supply

The power supply is intended for placement on the floor around the console of a CT scanner. The power supply consists of a transformer and appliance inlet, as a provide power source to the injector head and console.

Options

Hand Switch is connected to the console and consists of start and stop switches to start/stop injection according to the protocols already set on the console. Hand Switch provides LEDs with an operator to display scan time and injection state.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

computed X-ray tomography (CT)

Anatomical Site

Not Found

Indicated Patient Age Range

Not Found

Intended User / Care Setting

doctors, radiologic technologists and other licensed medical practitioners.

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)

No performance standards have been established for Angiographic injectors under section 514 of the FD&C Act.
DUAL SHOT CONTRAST DELIVERY SYSTEM has been tested in conformance with the following recognized standards, and is substantially equivalent to the predicate device:
IEC60601-1 (1988) Medical Electrical Equipment, Part 1: General Requirements for Safety - This is the general standard for medical electrical equipment
IEC60601-1-1 (2000) Medical electrical equipment - Part 1-1: General requirements for safety - Collateral standard: Safety requirements for medical electrical systems
IEC60601-1-2 (2001) Medical electrical equipment - Part 1-2: General requirements for safety - Collateral standard: Electromagnetic compatibility -Requirements and tests
Medical electrical equipment - Part 1-4: General IEC60601-1-4 (1996) requirements for safety - Collateral Standard: Programmable electrical medical systems
ISO13485 (2003) Medical devices - Quality management systems - Requirements for regulatory purposes
ISO14971 (2000) Medical devices - Application of risk management to medical devices
Biocompatibility testing has not been performed since DUAL SHOT - CONTRAST DELIVERY SYSTEM does not include a sterile syringe.

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.

K023183, K033881

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

Not Found

§ 870.1650 Angiographic injector and syringe.

(a)
Identification. An angiographic injector and syringe is a device that consists of a syringe and a high-pressure injector which are used to inject contrast material into the heart, great vessels, and coronary arteries to study the heart and vessels by x-ray photography.(b)
Classification. Class II (special controls). The device, when it is a non-patient contacting balloon inflation syringe intended only to inflate/deflate balloon catheters and monitor pressure within the balloon, is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 870.9.

0

OCT 17 2005

510(k) SUMMARY NEMOTO KYORINDO DUAL SHOT - CONTRAST DELIVERY SYSTEM

DATE 510(k) SUMMARY PREPARED: July 26, 2005

OFFICIAL CONTACT:Toshio Kanetaka
Director of Technical Center
Nemoto Kyorindo CO., LTD.
2-12-4 Aoki Kawaguchi-shi
Saitama 332-0031, Japan
TEL: +81 48 250 3255
FAX: +81 48 250 3256

CLASSIFICATION NAME(S): Angiographic Injector with Syringe

DEVICE CLASSIFICATION: Class II

COMMON NAME:

PROPRIETARY NAME: DUAL SHOT - CONTRAST DELIVERY SYSTEM

Powered Injector with Syringe

PREDICATE DEVICE: Stellant CT Injector System from MEDRAD K023183

Stellant CT Injector System with Imaging System Interface Module from MEDRAD K033881

INTENDED USE: The DUAL SHOT - CONTRAST DELIVERY SYSTEM is an intravascular injection system intended for the administration of ionic and non-ionic contrast media and saline used in conjunction with computed X-ray tomography (CT).

DESCRIPTION OF DEVICE:

DUAL SHOT - CONTRAST DELIVERY SYSTEM is an Angiographic injector that is used in conjunction with X-ray Computed tomography, and is intended for use by doctors, radiologic technologists and other licensed medical practitioners. This device is designed to correspond to the various injection methods of contrast media which were materialized with the appearance of multi-slice CT scanners. The DUAL SHOT has two driving parts to deliver contrast media and/or saline, one side is for 50mL, 100mL and 200mL, size syringes, and the other side for 50mL syringes capable for saline flush injection. Syringes are connected to the patient via an intravascular catheter. DUAL SHOT consists following components;

1

Iniector head

Iniector head provides accurate, automatic delivery of contrast media by two electromechanically driven actuators. Sterile empty-syringes or pre-filled syringes can be set onto the Injector head. For the sterile empty-syringes, Injector head provides auto-return function to fill the svringe with contrast media or saline. Injector head is composed of operation indicator LED, switches for manual operation, start-switch to start infusion and stop-switch to stop infusion. Injector head detects injection conditions and transmits the Iniector head status information to the console.

। Console

The console takes up very little space on a control desk, and consists of TFT LCD display and touch panel interface to set/display various injections set by an operator. The operator can set injection pressure, time, volume, flow rate and a patient examination region of interest.

Power Supply ।

The power supply is intended for placement on the floor around the console of a CT scanner. The power supply consists of a transformer and appliance inlet, as a provide power source to the injector head and console.

  • Options ।
  • Hand Switch

Hand Switch is connected to the console and consists of start and stop switches to start/stop injection according to the protocols already set on the console. Hand Switch provides LEDs with an operator to display scan time and injection state.

SUBSTANTIAL EQUIVALENCE:

DUAL SHOT - CONTRAST DELIVERY SYSTEM maintains the same intended use as the predicate device. It is intended for the specific purpose of injecting contrast media and saline solution into a patient's vascular system to obtain diagnostic images in X-rav computed tomography (i.e. "CT").

DUAL SHOT - CONTRAST DELIVERY SYSTEM consists of three main components like the predicate device: a Iniector head, a Console, and a Power Supply. Both the DUAL SHOT and predicate device consist of the same or substantially equivalent materials and technology. They are motor driven, electromechanical devices that are controlled by software.

Below is a table that compares the predicate device to the proposed DUAL SHOT -CONTRAST DELIVERY SYSTEM.

2

| Feature | Proposed Device:
DUAL SHOT – CONTRAST
DELIVERY SYSTEM | Predicate Device:
Stellant CT Injector System
(K023183 and K033881) |
|-------------------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Intended Use | The DUAL SHOT CONTRAST DELIVERY SYSTEM is an intravascular injection system
intended for the administration of ionic and
non-ionic contrast media and saline used in
conjunction with computed x-ray tomography
(CT). | Intended to be used for the specific purpose of
injecting intravenous contrast media into
humans for diagnostic studies in computed
tomography (CT) applications. |
| Single or Dual Syringe
System | Dual syringe model | Single and dual syringe models |
| Information Display | Color LCD | Same |
| Programming Keys | Non-dedicated keys – software determined | Same |
| Touch screen | Yes | Same |
| Multi-Phase | 1-5 Phases per injection | 1-6 Phases per injection |
| Arming Modes | Single | Same |
| Protocol Storage
Capability | 125 protocols | 32 protocols |
| Hold capability | Until user operate. | 20 minutes max. |
| Scan Delay | 1 – 300 seconds | Same |
| Safety Stop Mechanism | Multi layered software stops with backup
monitoring. | Electrical stop with a software backup system |
| Syringe System | A-head: 200mL or 100mLsyringe
B-head: 50mL syringe | Dual syringe model: two 200mL syringe |
| Programmed Volume | A-head: 1 to 200mL or 1 to 100mL
(depending on syringe size)
B-head: 1 to 50mL | 1 to 200mL |
| Volume Remaining
Readout | Graphical and numeric on LCD | LED on injector head; graphical and numeric
on LCD |
| Fill Rate | Variable up to 10mL /sec | Same |
| Flow Rate | 0.1mL/sec to 10mL/sec | Same |
| Programmable
Pressure Limit | Settable from 10 to 300PSI | 325PSI default, user settable 50 to 300 PSI |
| Pause | Programmable – 1 sec to 300 seconds in 1 sec
increments | Programmable – 1 sec to 900 sec in 1sec
increments |
| Autofill | Fill rate 1.5mL/sec | Fill rate 4mL/sec |
| Retract Control | No | Yes (Automatic) |
| Remote Start Switch | Yes | Yes |
| Pressure Graph | Yes | Yes |
| Syringe Sensing | Yes | Yes |
| Autoload | No | Yes |
| Auto Dock/Retract/
Advance | No | Yes; user-selectable autodock and advance;
user-selectable auto-retract |
| Protocol Lock/ Remote
Arming | No | Yes |
| Remote Check for Air
(from Head) | No | Yes |
| Test Injection | Yes | Yes |

.

.

:

.

.

3

PERFORMANCE DATA:

No performance standards have been established for Angiographic injectors under section 514 of the FD&C Act.

DUAL SHOT CONTRAST DELIVERY SYSTEM has been tested in conformance with the following recognized standards, and is substantially equivalent to the predicate device:

IEC60601-1 (1988) Medical Electrical Equipment, Part 1: General Requirements for Safety - This is the general standard for medical electrical equipment IEC60601-1-1 (2000) Medical electrical equipment - Part 1-1: General requirements for safety - Collateral standard: Safety requirements for medical electrical systems

IEC60601-1-2 (2001) Medical electrical equipment - Part 1-2: General requirements for safety - Collateral standard: Electromagnetic compatibility -Requirements and tests

Medical electrical equipment - Part 1-4: General IEC60601-1-4 (1996) requirements for safety - Collateral Standard: Programmable electrical medical systems ISO13485 (2003) Medical devices - Quality management systems - Requirements for regulatory purposes

ISO14971 (2000) Medical devices - Application of risk management to medical devices

Biocompatibility testing has not been performed since DUAL SHOT - CONTRAST DELIVERY SYSTEM does not include a sterile syringe.

4

Image /page/4/Picture/1 description: The image shows the logo for the U.S. Department of Health and Human Services. The logo consists of a stylized eagle with three lines representing its body and wings. The text "DEPARTMENT OF HEALTH AND HUMAN SERVICES - USA" is arranged in a circular fashion around the eagle symbol.

Public Health Service

OCT 17 2005

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

Tuv Rheinland of North America, Inc. c/o Mr. Tamas Borsal Manager, Medical Division 12 Commerce Road Newton, CT 06470

Re: K052633

Dual Shot - Contrast Delivery System Regulation Number: 21 CFR 870.1650 Regulation Name: Angiographic Injector and Syringe Regulatory Class: II Product Code: DXT Dated: September 20, 2006 Received: September 26, 2005

Dear Mr. Borsal:

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.

5

Page 2 - Mr. Tamas Borsal

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. 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 (240) 276-0120. 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 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/industry/support/index.html.

Sincerely yours.

Dina R. Vichner

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

Enclosure

6

Attachment 1b Page 1 of 1

510(k) Number (if known)

: KC52633

Device Name

:Dual Shot - Contrast Delivery System

Indications For Use:

The Dual Shot – Contrast Delivery System is an intravascular injection system intended for the administration of ionic and not in intrarasonia injocan system interior in
computed Your and non-ionic contrast media and saline used in conjunction with computed X-ray tomography (CT).

(Please DO NOT WRITE BELOW THE LINE-CONTIUNUE ON ANOTHER PAGE IF NEEDED)

Concurrence of CDRH, Office of Device Evaluation (ODE)

Prescription Use OR (Per 21 CFR 801.109)

Over-The-Counter Use

(Optional Format 1-2-96)

R. Vclines

(Division Sign-On)
Division of Cardiovascular Devices

510(k) Number K052633