K Number
K081557
Device Name
PORTABLE SUPINE PATIENT SUPPORT AND CASSETTE HOLDER
Date Cleared
2008-09-10

(99 days)

Product Code
Regulation Number
892.1850
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The Portable Supine Patient Support and Cassette Holder is a supine support device intended to lay flat on a flat surface to hold and position a radiographis cassette, also to hold and position a patient for radiographic x-ray exposure. I intended for medical use. Indications for Usessupine support intended to lay flat on a surface to i hold and position radiographic cassette, also to hold and position patient for radiographic exposure for medical use.
Device Description
The Portable Supine Patient Support and Cassette Holder is a portable, nonionizing radiation device used for scoliosis radiography of the spine. The device consists of a head support, a rectangular cassette holder (94cm×40.5cm), which will hold the cassette, a foot support, and a removable cover top on top of the cassette holder.
More Information

The text does not contain any Reference Devices.

No
The device description and performance studies focus on the physical properties and function of a patient support and cassette holder, with no mention of software, algorithms, or AI/ML capabilities.

No
The device is described as a "supine support device" and "cassette holder" for radiographic x-ray exposure, designed to hold patients and cassettes. Its performance studies focus on radiotranslucency, which is important for imaging, not for treating a disease or condition.

No

This device is a patient support and cassette holder used during radiographic x-ray exposure. It does not perform diagnostic functions itself, but rather facilitates the imaging process from which a diagnosis might be made by a separate device or professional.

No

The device description clearly outlines physical components (head support, cassette holder, foot support, removable cover top) and performance studies related to material properties (radio translucency), indicating it is a hardware device.

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

Here's why:

  • IVD devices are used to examine specimens derived from the human body (like blood, urine, tissue) to provide information about a person's health. The intended use and device description clearly state that this device is used to support and position a patient and a radiographic cassette for X-ray exposure. It does not involve the analysis of biological specimens.
  • The device's function is purely mechanical and related to positioning for imaging. It facilitates the process of obtaining a radiographic image, but it does not perform any diagnostic test on a biological sample.

The device is a medical device used in conjunction with an X-ray machine and a radiographic cassette to aid in diagnostic imaging, but it is not an IVD itself.

N/A

Intended Use / Indications for Use

The Portable Supine Patient Support and Cassette Holder is a supine support device intended to lay flat on a flat surface to hold and position a radiographis cassette, also to hold and position a patient for radiographic x-ray exposure. I intended for medical use.

ludications for Usessupine support intended to lay flat on a surface to i hold and position radiographic cassette, also to hold and position patient for radiographic exposure for medical use.

Product codes

IXA

Device Description

The Portable Supine Patient Support and Cassette Holder is a portable, nonionizing radiation device used for scoliosis radiography of the spine. The device consists of a head support, a rectangular cassette holder (94cm×40.5cm), which will hold the cassette, a foot support, and a removable cover top on top of the cassette holder.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

spine

Indicated Patient Age Range

Not Found

Intended User / Care Setting

Children Hospitals, Regular Hospitals, Rehabilitation Institutions, Hospitals for Crippled Children, Orthopedic Clinics, Chiropractic Offices, and Spine/ Scolios 111, Clinics.

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 technical characteristics of the Portable Supine Patient Support and Cassette Holder would be the same as those for the predicate device for the cassette. However, the cover top the patient will be positioned on top of, for the radiograph exposure, is made of carbon fiber material. Singled layer of carbon fiber material (2.76mm) moets the radiotranslucency requirements of 21 CFR Ch. 1 1 1020.30 (n) Table 2 (2008) criteria for "Tabletop, movable, without articulated joints" as well as Tabletop, with radiolucent panel having one articulated joint" since it is not greater than 1.7mm Al equivalent. The data also indicates that a single layer does meet the radiotranslucency requirement as "Tabletop, stationary, 'without articulated joints" since it does not exceed 1.2 mm Al equivalent. Data attached for two samples of carbon fiber material.

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

Not Found

Predicate Device(s)

K980722

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 892.1850 Radiographic film cassette.

(a)
Identification. A radiographic film cassette is a device intended for use during diagnostic x-ray procedures to hold a radiographic film in close contact with an x-ray intensifying screen and to provide a light-proof enclosure for direct exposure of radiographic film.(b)
Classification. Class II (special controls). The device is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 892.9.

0

K081557

SEP 1 0 2008

1. Company Identification

JDDB Manufacturing, Inc. 446 W. 1280 Place Chicago, Illinois Tel: 816-914-4871-7413 Fax: 773-264-5751

2. Official Correspondent

Jacquin C. Youngblood-Johnson (Ms.) Post Office Box 277782 Riverdale, Illinois 60827-7782

3. Date of Submission

September 2, 2008

4. Device Trade Name

Portable Supine Patient Support and Cassette Holder

5. Common Name

Scoliosis Supine Cassette Holder

6. Classification

Radiographic film cassette, Class II per CFR 892.1850.

7. Applicable Standard

Voluntary standard to which the Portable Supine Patient Support and Cassetti Holder conforms is: ISO 4090:2001

8. Intended Use

The Portable Supine Patient Support and Cassette Holder is a supine support device intended to lay flat on a flat surface to hold and position a radiographis cassette, also to hold and position a patient for radiographic x-ray exposure. I intended for medical use.

1

9. Description of Device

The Portable Supine Patient Support and Cassette Holder is a portable, nonionizing radiation device used for scoliosis radiography of the spine. The device consists of a head support, a rectangular cassette holder (94cm×40.5cm), which will hold the cassette, a foot support, and a removable cover top on top of the cassette holder.

10. Substantial Equivalence to Predicate Device

The Portable Supine Patient Support and Cassette Holder is substantially equivalent to Trimax Radiographic Cassette; 510(K) number: K980722.

11. Technical Characteristics

The technical characteristics of the Portable Supine Patient Support and Cassette Holder would be the same as those for the predicate device for the cassette. However, the cover top the patient will be positioned on top of, for the radiograph exposure, is made of carbon fiber material. Singled layer of carbon fiber material (2.76mm) moets the radiotranslucency requirements of 21 CFR Ch. 1 1 1020.30 (n) Table 2 (2008) criteria for "Tabletop, movable, without articulated joints" as well as Tabletop, with radiolucent panel having one articulated joint" since it is not greater than 1.7mm Al equivalent. The data also indicates that a single layer does meet the radiotranslucency requirement as "Tabletop, stationary, 'without articulated joints" since it does not exceed 1.2 mm Al equivalent. Data attached for two samples of carbon fiber material. I onl made reference to one sample in this writing because of space.

12. Who Will Use Device

11

Children Hospitals, Regular Hospitals, Rehabilitation Institutions, Hospitals for Crippled Children, Orthopedic Clinics, Chiropractic Offices, and Spine/ Scolios 111, Clinics.

2

Logo

K & S Associates, Inc.
--------------------------

Image /page/2/Picture/1 description: The image shows a document with the text "Test #: D080514" and "Test Date 07-Mar-08" at the top. Below the text is a black and white image of what appears to be a mechanical device. The device has a cylindrical shape with various attachments and components. The image is somewhat blurry, making it difficult to discern the exact details of the device.

RADIO TRANSLUCENCY TEST

| Submitted By: | Jacquin Youngblooc-Johnson
JDDE Manufacturing, Inc.
446 West 128th Place
Chicago, IL | Received: | 06-Mar-08 |
|---------------|-----------------------------------------------------------------------------------------------|-----------|-----------|
| P.O. #: | 401555 | Report #: | 80579 |
| Sample: | Vanguard 4"X4" | | |
| Procedure: | GL7 | | |
| TEMPERATURE: | 19.4 °C | | |
| PRESSURE: | 745.7 mmHg | | |

This uskeratory is aparatited by the Amazon Association for Lesertify Accordition (Albination in Internet dellarmand in annovance will the laboratory's tarms of accracition uness stated othernse in this report.

The indicated sample matersiale word on the store and weeks for ther were start with wopen wopen wopen workers of series and le as allers to the The industral statists and 1902 to on the socked in two as a lot as the risk a for a fill and and work of the many of wa bear geningy The chargy of the belief the later in hartor of the masterners on swell assembly on the mail and the seems of the mail one first worker seeming the all-relob layer = 2 / family for microsoft claims = 1.000 x 11.1 meter = market = m =80 minter species by K65, bir =8,0 minuter spielle by K65, bir =1.0 ( - Ni radings were normalized in a la manastis normal massal minde. Ne bitkens of the birding on the massures "incentrial "incentrial" incomponise "Incentrial "Incontrise" in

this incharacted of the Section of the Magin Cess In one Society the Resort All Englisher to the messures inter hider hider hider hider hider hider hider hider hider hider h

r in purchitections of the mass will the directions is the combined uncertainly of the matsurement will a coreinge acco ol 2 195% confidence).

| Sample
Number | Thickness
(mm) | Transmission | Al eq.
(mm) | mm Al eq
mm |
|------------------|-------------------|--------------|----------------|----------------|
| ? | 2.76 | 0.884 | 0.39 | 0.142 |

The above data indicato that a single layer of the above samples the radiciranslucancy requirement of 21CFR Ch. 1, J, 1020.30(n) Table 2 (2006) criteria for "Tabletop, movable, 'without articulated joints'' as 'well as Tabletop, with radiolucent particulated foint" 'since it is not greater than 1.7 mm ' Al oquivation

The data also indicates that a single layer does meet the rediotranslucency requirement as a "Tabletop, stationary, "without articulated joints" since it does not exceed ? 2 mm Al equivalent.

| Measurement by | ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Annual Property of the
1 400 | Brau Ham |
|----------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|----------|
| | | |

Reviewed by
Larry Bryson
Larry G. Bryson, MS-CHS

le: FULL ILLUSTRATION THE

Bryson, MS ale Directo

PH-1-11

ਣ ਸ

Title: CA L 1 154-4 77 * V TRE F Title:

K & S Associates, Inc. 1926 Elm Tres Drive Nastruitie Tennassea 37270 Tall Frae 800-322-2325 Phone 615.883-2760 Fex 815-871-0856

PAGE 1 OF 1

3

1 27 7 37 8100 - 2310 1 1 12 718 ዮ እንደ

1

00027002

| | K & S Associates, Inc. | | Test #:
Test Date | D080614
07-Mar-08 |
|--|------------------------|-------------------------|----------------------|----------------------|
| | | RADIO-TRANSLUCENCY TEST | | |

Submitted By:Jacquin Youngblood-Johnson
JDDB Manufacturing, Inc.
446 West 128th Place
Chicago, IL
P.O. #:401658
Sample:JPI 6"X6"
Procedure:GL7
Received:06-Mar-08
Report #:80580
TEMPERATURE:19.4 °C
PRESSURE:745.7 mmHg

This Laboration in accredited by the American Association (A2LA) and the reasults shown in this report hels them detemined in accordance with the laboratory's torms of accredition unless stated offierwise it. this report.

The indicated sample named on the above date and were assess for their x ray alternation properties under conditions of riserth-រមួយ ព្រះពាទប្រ. The brany of the base characterized in ក្រោះ ចេចកា geomedy using fillers contined as Coloner 102 ki p hati-raine layer = 2.7 mm.Al.Jr.hum. The loaler used to: the measurements has a well understood appoter over e All readings ware carralized to the response of a life. The following table ists an liem number assigned by KBS, the inear blocked a neasured at . S . the fredon of the inzident beam that passed through the thickness of autorials which would alcor equal fraction of the same lo pass finough (A) aquivalence), and thatly, the ratio of Al equivalence is than thickings.

The overal uncertainly of the musertainty is the contined expended uncenturned of the moseument with a coverage factor at 7 (95% contidentia).

| Sample
NUMBOR | mm | and and the production of the larges of the course of the comments of the country of the country of the count
Thickness Transmission | Al eq.
(ITTPT) | min Al ag
100.00 | |
|------------------|------|-----------------------------------------------------------------------------------------------------------------------------------------|-------------------|--------------------------------------------------------------------------------------------------------------------------|-------------|
| A | 2.63 | 0.888 | 0.30 | The Court of the collection and could by is while to the four and the four and and a form of the Came of Carder
0.147 | 1.000:
I |

12-1-1-Раде:

The above data indicato that a single layer of the above samples the radiofrance troquirement of 21CFR Ch. 1, J. 1020.30(n) Tablo 2 (2006) criteria for "Tabletop, movable, 'without articulated joints" as well as Tabletop, with radiolucent panel fraving one articulated joint" 'since it is not greater than 1.7 mm ' Al equivalent.

The data also Indicates that a single ine meet the radiotransiacency requirement as a "Tabletop, stationary, "without articulated joints" since it does not exceed 1.2 mm Al equivalent.

Measurement byBrad Horn
Title:CALIBRATION TECH

| Reviewed by | Larry G. Boyeon, MS, CHP
Associate Director |
|-------------|------------------------------------------------|
| Title: | |

K & S Associates, Inc. 1926 Elm Free Drive Nashville, Tennasses 37270 Foll Free 800-522-2325 Phono 615-883-9780 Fax 675-871-0866

PAGE I OF 1

4

Image /page/4/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo features a stylized eagle with three tail feathers, representing the department's mission to protect the health of all Americans and provide essential human services. The eagle is encircled by the words "DEPARTMENT OF HEALTH & HUMAN SERVICES USA" in a circular arrangement.

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

SEP 1 0 2008

Ms. Jacquin C. Youngblood-Johnson President JPI America, Inc. 141 - A Central Avenue FARMINGDALE NY 11735

Re: K081557

Trade/Device Name: Portable Supine Patient Support and Cassette Holder Regulation Number: 21 CFR 892.1850 Regulation Name: Radiographic film cassette Regulatory Class: II Product Code: IXA Dated: May 22, 2008 Received: June 3, 2008

Dear Ms. Youngblood-Johnson:

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

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 one of the following numbers, based on the regulation number at the top of this letter:

21 CFR 876.xxx(Gastroenterology/Renal/Urology)240-276-0115
21 CFR 884.xxx(Obstetrics/Gynecology)240-276-0115
21 CFR 894.xxx(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 Biometrics' (OSB's) Division of Postmarket Surveillance at 240-276-3474. For questions regarding 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/cdrh/industry/support/index.html.

Sincerely vours.

hope M. Whang

Joyce M. Whang, Ph.D. Acting Director, Division of Reproductive, Abdominal, and Radiological Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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Image /page/6/Picture/2 description: The image shows the logo of the U.S. Food and Drug Administration (FDA) along with the Department of Health and Human Services logo. The FDA logo is on the left side of the image, and the Department of Health and Human Services logo is on the right side of the image. The text "U.S. Food and Drug Administration" is written in between the two logos. The logos and text are white and the background is black.

CENTER FOR DEVICES AND RADIOLOCICAL HEALTH

FDA Home Page | CDRH Home Page | Section | GDTH A Z Titles | Conta | CDf3

Indications for Use

510(k) Number (if known): K081557

Device Name: Portable Supine Patient Support and Cassette Holder

ludications for Usessupine support intended to lay flat on a surface to i hold and position radiographic cassette, also to hold and position patient for radiographic exposure for medical use.

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 OF NEEDED)

Arge Mht

(Division Sign-Off) Concurrence of CDRH, Office of Device Evaluation (ODE) Division of Reproductive, Abdominal and Radiological Devices K081557

510(k) Number _ http://www.fda.gov/cdrh/ode/indicate.html

8/29/2008