K Number
K081066
Device Name
BRACHYTHERAPY SOURCE DEVICE, MODEL 9011
Date Cleared
2008-05-05

(20 days)

Product Code
Regulation Number
892.5730
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The Brachytherapy Source Device, with apparent activities between 0.19mCi and 1.01mCi, is indicated for permanent interstitial implantation of selected localized tumors which are of low to moderate radiosensitivity. They may be used either as primary treatment (such as for prostate cancer or unresectable tumors) or for treatment of residual disease after excision of the primary tumor. Seeds in this apparent activity range may be used to treat superficial, intra-abdominal, and intra-thoracic tumors. Tumors of the head, neck, lung, pancreas and prostate (early stages) are commonly treated. The Brachytherapy Source Device, with total apparent activities greater than 1.01mCi, is indicated for interstitial treatment of tumors which have the following characteristics; unresectable, localized, and moderate radiosensitivity. These seeds may be used for selected radiation applications as temporary implants. The Brachytherapy Source Device is indicated to treat residual tumors concurrent with or at the completion of other treatment modalities, such as external beam radiation therapy or chemotherapy. In addition, recurrent tumors may be implanted with seeds.
Device Description
The Brachytherapy Source Device, Model 9011, is a welded titanium capsule containing Iodine-125 adsorbed onto a silver rod.
More Information

No
The 510(k) summary describes a physical brachytherapy source device and its intended use. There is no mention of software, algorithms, image processing, or any terms related to AI or ML. The performance studies focus on physical characteristics and activity measurements, not algorithmic performance.

Yes.
The device is used for permanent interstitial implantation of selected localized tumors as a primary treatment or for residual disease after excision, indicating its therapeutic purpose in treating medical conditions.

No

The device is a Brachytherapy Source Device used for the treatment of tumors, not for diagnosing them. It is a therapeutic device that delivers radiation to localized tumors.

No

The device description clearly states it is a "welded titanium capsule containing Iodine-125 adsorbed onto a silver rod," which is a physical hardware component.

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

Here's why:

  • IVD Definition: In vitro diagnostics are tests performed on samples taken from the human body, such as blood, urine, or tissue, to detect diseases, conditions, or infections. They are used to provide information for diagnosis, monitoring, or screening.
  • Device Description and Intended Use: The description clearly states that this device is a "Brachytherapy Source Device" which is a "welded titanium capsule containing Iodine-125 adsorbed onto a silver rod." Its intended use is for "permanent interstitial implantation of selected localized tumors." This involves placing a radioactive source directly into the body to treat cancer.
  • Lack of Sample Analysis: There is no mention of this device analyzing any biological samples from a patient. Its function is to deliver radiation therapy.

Therefore, this device falls under the category of a therapeutic medical device, specifically a brachytherapy source, rather than an in vitro diagnostic device.

N/A

Intended Use / Indications for Use

The Brachytherapy Source Device, with apparent activities between 0.19mCi and 1.01mCi, is indicated for permanent interstitial implantation of selected localized tumors which are of low to moderate radiosensitivity. They may be used either as primary treatment (such as for prostate cancer or unresectable tumors) or for treatment of residual disease after excision of the primary tumor. Seeds in this apparent activity range may be used to treat superficial, intra-abdominal, and intra-thoracic tumors. Tumors of the head, neck, lung, pancreas and prostate (early stages) are commonly treated.

The Brachytherapy Source Device, with total apparent activities greater than 1.01mCi, is indicated for interstitial treatment of tumors which have the following characteristics; unresectable, localized, and moderate radiosensitivity. These seeds may be used for selected radiation applications as temporary implants.

The Brachytherapy Source Device is indicated to treat residual tumors concurrent with or at the completion of other treatment modalities, such as external beam radiation therapy or chemotherapy. In addition, recurrent tumors may be implanted with seeds.

Product codes

90-IWI, IWG, KXK

Device Description

The Brachytherapy Source Device, Model 9011, is a welded titanium capsule containing Iodine-125 adsorbed onto a silver rod.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

superficial, intra-abdominal, intra-thoracic tumors, head, neck, lung, pancreas, and prostate

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)

The Brachytherapy Source Device, Model 9011, has been tested according to ISO 2919 for sealed sources, (test report section E) and activity measurements have been obtained from NIST Report (Report of Air-Kerma rate measurements) (see section F). In addition, Prototype sources have been manufactured and assessed against predetermined criteria for Design Verification and Design Validation (Declaration of Conformity Attachment 1).

Key Metrics (Sensitivity, Specificity, PPV, NPV, etc.)

Not Found

Predicate Device(s)

K914281

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 892.5730 Radionuclide brachytherapy source.

(a)
Identification. A radionuclide brachytherapy source is a device that consists of a radionuclide which may be enclosed in a sealed container made of gold, titanium, stainless steel, or platinum and intended for medical purposes to be placed onto a body surface or into a body cavity or tissue as a source of nuclear radiation for therapy.(b)
Classification. Class II (special controls). A prostate seeding kit intended for use with a radionuclide brachytherapy source only is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 892.9.

0

K081066

MAY 15 2008

510(k) SUMMARY OF SAFETY AND EFFECTIVENESS

The following 510(k) Summary of Safety and Effectiveness is prepared and provided in accordance with the requirements of 21 CFR 807.92 as amended under the Safe Medical Devices Act of 1990 (SMDA).

Submitter's Information

Company Name:Medi-Physics, Inc DBA GE Healthcare
Address:101 Carnegie Center
Princeton, NJ 08540-6231
Contact Name:David Risley
Director, US Regulatory Co-ordination Group
Regulatory Affairs
Phone Number:609-514-6489

April 3, 2008 Summary Prepared Date:

Subject Device Information

Trade Name:Brachytherapy Source Device
Model:9011
Common Name:Radionuclide Brachytherapy Source
Class:II
Classification:21 CFR 892.5730Product Code: 90-IWI
Predicate DevicesLegally marketed devices to which equivalence is claimed.
1. Trade Name:OncoSeed™ (Iodine-125 seeds)
Common Name:Radionuclide Brachytherapy Source
Class:II
Classification:21 CFR 892.5730Product Code: 90-KXK
Cleared 510(k) No.:K914281, FDA Cleared on November 22, 1991
Submitted by:Medi-Physics Inc, dba GE Healthcare

. . . .

1

Description of Device

The Brachytherapy Source Device, Model 9011, is a welded titanium capsule containing Iodine-125 adsorbed onto a silver rod.

Intended Use

The Brachytherapy Source Device, with apparent activities between 0.19mCi and 1.01mCi, is indicated for permanent interstitial implantation of selected localized turnors which are of low to moderate radiosensitivity. They may be used either as primary treatment (such as for prostate cancer or unresectable tumors) or for treatment of residual disease after excision of the primary tumor. Seeds in this apparent activity range may be used to treat superficial, intra-abdominal, and intra thoracic tumors. Tumors of the head, neck, lung, pancreas, and prostate (early stages) are commonly treated.

The Brachytherapy Source Device, with total apparent activities greater than 1.01mCi, is indicated for interstitial treatment of tumors which have the following characteristics; unresectable, localized, and moderate radiosensitivity. These seeds may be used for selected radiation applications as temporary implants.

The Brachytherapy Source Device is indicated to treat residual turnors concurrent with or at the completion of other treatment modalities, such as external beam radiation therapy or chemotherapy. In addition, recurrent tumors may be implanted with seeds.

When comparing the Intended Use and Indications for Use of the predicate OncoSeed, Model 6711, device, the Intended Use and Indications for Use of the subject device, Brachytherapy Source Device, Model 9011, has not changed.

Technological Characteristics

The following modifications have been incorporated in the subject device -- Brachytherapy Source Device, Model 9011, when compared to predicate device, OncoSeed, Model 6711:

| Modified
Characteristics | Brachytherapy Source Device
Model 9011
(Subject Device) | OncoSeed, Model 6711
(Predicate Device) |
|-----------------------------|---------------------------------------------------------------|--------------------------------------------|
| Seeds | | |
| Regulatory Status | Subject Application | K914281 |
| Capsule Material | Titanium, type A-40 | Titanium, type A-40 |
| Capsule Length | 4.20 - 4.90mm (0.165 - 0.193in) | 4.20 - 4.90mm (0.165 - 0.193in |
| Capsule Wall
Thickness | 0.051 - 0.0635mm (0.002 -
0.0025in) | 0.051 - 0.0635mm (0.002 -
0.0025in) |
| Capsule Diameter | 0.48 - 0.67mm (0.019 - 0.026in) | 0.77-0.96mm (0.031 - 0.38in) |
| Carrier Substrate | 99.9% silver | 99.9% silver |
| Carrier Length | 2.74 - 2.85mm (0.108 - 0.112in) | 2.74-2.85mm (0.108 - 0.112in) |
| Carrier Diameter | 0.27 - 0.33mm (0.011 - 0.013in) | 0.48 - 0.53mm (0.019 - 0.021in) |
| Isotope | Iodine I-125 | Iodine I-125 |
| Sterilization | Not sterile (User Sterilized) | Not sterile (User sterilized) |

2

Changes have only been made to the diameter of the capsule and carrier substrate diameter. All other technological characteristics of the subject seed remain unchanged compared to the predicate OncoSeed, Model 6711, 510(k) #K914281.

Nonclinical Test Data

The Brachytherapy Source Device, Model 9011, has been tested according to ISO 2919 for sealed sources, (test report section E) and activity measurements have been obtained from NIST Report (Report of Air-Kerma rate measurements) (see section F). In addition, Prototype sources have been manufactured and assessed against predetermined criteria for Design Verification and Design Validation (Declaration of Conformity Attachment 1).

Conclusion:

Upon reviewing the safety and effectiveness information provided in this submission and comparing the intended use, indications for use, method of use, the non-clinical test data and other technological characteristics, it can be concluded that the subject seed is substantially equivalent to the predicate OncoSeed, Model 6711, cleared under 510(k) # K914281.

3

DEPARTMENT OF HEALTH & HUMAN SERVICES

Image /page/3/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 symbol resembling an eagle or bird in flight, composed of three curved lines.

Public Health Service

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

MAY 1 5 2008

Mr. David Risley Director, US Regulatory Co-ordination Group Medi-Physics, Inc. dba GE Healthcare 101 Carnegie Center PRINCETON NJ 08540

Re: K081066

Trade/Device Name: Brachytherapy Source Device, Model 9011 Regulation Number: 21 CFR 892.5730 Regulation Name: Radionuclide brachytherapy source Regulatory Class: II Product Code: IWG and KXK Dated: April 14, 2008 Received: April 17, 2008

Dear Mr. Risley:

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.

4

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 Center for Devices and Radiological Health's (CDRH's) Office of Compliance at one 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" (21CFR Part 807.97). For questions regarding postmarket surveillance, please contact CDRH's Office of Surveillance and Biometric's (OSB's) Division of Postmarket Surveillance at 240-276-3474. For questions regarding the reporting of device adverse events (Medical Device Reporting (MDR)), please contact the Division of Surveillance Systems at 240-276-3464. 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 (240) 276-3150 or at its Internet address http://www.fda.gov/cdrb/industry/support/index.html.

Sincerely yours,

Nancy Brogdon

Nancy C. Brogdon Director, Division of Reproductive. Abdominal, and Radiological Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

5

EXHIBIT-2

Indications for Use Form

Page 1 of 1

长081066 510(k) Number (if known): _

Device Name:

Brachytherapy Source Device, Model 9011

Indications For Use:

The Brachytherapy Source Device, with apparent activities between 0.19mCi and 1.01mCi, is indicated for permanent interstitial implantation of selected localized tumors which are of low to moderate radiosensitivity. They may be used either as primary treatment (such as for prostate cancer or unresectable tumors) or for treatment of residual disease after excision of the primary tumor. Seeds in this apparent activity range may be used to treat superficial, intra-abdominal, and intra-thoracic tumors. Tumors of the head, neck, lung, pancreas and prostate (early stages) are commonly treated.

The Brachytherapy Source Device, with total apparent activities greater than 1.01mCi, is indicated for interstitial treatment of tumors which have the following characteristics; unresectable, localized, and moderate radiosensitivity. These seeds may be used for selected radiation applications as temporary implants.

The Brachytherapy Source Device is indicated to treat residual tumors concurrent with or at the completion of other treatment modalities, such as external beam radiation therapy or chemotherapy. In addition, recurrent tumors may be implanted with seeds.

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

Concurrence of CDRH, Office of Device Evaluation (ODE)

(Division S Division of Reproductive, Abdominal and Radiological Devices 510(k) Number _

Prescription Use
(Per 21 CFR 801.109) √

OR

Over-The-Counter Use _