K Number
K091985
Device Name
UNIVERSAL PHYSIOLOGICAL MEASUREMENT MODULE
Date Cleared
2009-07-24

(22 days)

Product Code
Regulation Number
870.2300
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The Universal Physiological Measurement Module is intended for use on patients requiring Rwave synchronization and timed imaging studies. Applications include: gamma cameras, TMR/PMR, multislice CT, PET/CT, and SPECT/CT. The UPMM is responsible for detecting the patient's heart waveform and producing a synchronized pulse that is used to trigger a device.
Device Description
Universal Physiological Measurement Module (UPMM)
More Information

Not Found

Not Found

No
The summary describes a device for detecting heart waveforms and producing a synchronized pulse, which is a signal processing task, not explicitly mentioning or implying the use of AI/ML. The "Mentions AI, DNN, or ML" field is also explicitly marked as "Not Found".

No
The device is described as a measurement module that detects a patient's heart waveform and produces a synchronized pulse to trigger other devices, rather than directly providing a therapeutic effect to the patient.

No
Explanation: The device is described as a "Universal Physiological Measurement Module" that "detects the patient's heart waveform and produces a synchronized pulse that is used to trigger a device." This functionality is for synchronization (e.g., for imaging studies), not for diagnosing a medical condition.

No

The description states the device is responsible for "detecting the patient's heart waveform and producing a synchronized pulse that is used to trigger a device." This strongly implies the need for hardware to interface with the patient (to detect the waveform) and to produce the synchronized pulse. A software-only device would typically process data received from a separate hardware component or system, not directly interact with the patient's physiology in this manner.

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

Here's why:

  • Intended Use: The intended use describes the device as being used on patients to detect their heart waveform and produce a synchronized pulse for triggering imaging devices. This is a direct interaction with the patient's physiological signals, not the analysis of samples taken from the patient (like blood, urine, or tissue).
  • Device Description: The description refers to a "Universal Physiological Measurement Module," which aligns with measuring physiological signals from a living being.
  • Lack of IVD Characteristics: There is no mention of analyzing samples, reagents, or any of the typical components or processes associated with in vitro diagnostics.

Therefore, the device described is a physiological monitoring and synchronization device used in conjunction with medical imaging equipment, not an in vitro diagnostic device.

N/A

Intended Use / Indications for Use

The Universal Physiological Measurement Module is intended for use on patients requiring Rwave synchronization and timed imaging studies. Applications include: gamma cameras, TMR/PMR, multislice CT, PET/CT, and SPECT/CT.

The UPMM is responsible for detecting the patient's heart waveform and producing a synchronized pulse that is used to trigger a device.

Product codes

DRT

Device Description

Not Found

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

Not Found

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

Not Found

Key Metrics

Not Found

Predicate Device(s)

Not Found

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 870.2300 Cardiac monitor (including cardiotachometer and rate alarm).

(a)
Identification. A cardiac monitor (including cardiotachometer and rate alarm) is a device used to measure the heart rate from an analog signal produced by an electrocardiograph, vectorcardiograph, or blood pressure monitor. This device may sound an alarm when the heart rate falls outside preset upper and lower limits.(b)
Classification. Class II (performance standards).

0

Image /page/0/Picture/0 description: The image shows the logo for the U.S. Department of Health and Human Services. The logo features a stylized eagle with its wings spread, and the text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" is arranged in a circular pattern around the eagle. The eagle is black, and the text is also black. The logo is simple and recognizable.

DEPARTMENT OF HEALTH & HUMAN SERVICES

Public Health Service

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

JUL 2 4 2009

Ivy Biomedical Systems, Inc. c/o Mr. Dick Listro Director of Regulatory 11 Business Park Dr. Branford, CT 06405

Re: K091985

Universal Physiological Measurement Module (UPMM) Regulation Number: 21 CFR 870.2300 Regulation Name: Cardiac Monitor (including cardiotachometer and rate alarm) Regulatory Class: Class II (two) Product Code: DRT Dated: July 06, 2009 Received: July 02, 2009

Dear Mr. Listro:

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.

1

Page 2 - Mr. Dick Listro

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 (240) 276-3150 or at its Internet address http://www.fda.gov/cdrh/industry/support/index.html.

Sincerely yours,

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

Enclosure

2

K091985

Indications for Use Statement

510(k) Number (if known):

Device Name: Universal Physiological Measurement Module (UPMM)

Indications for Use:

The Universal Physiological Measurement Module is intended for use on patients requiring Rwave synchronization and timed imaging studies. Applications include: gamma cameras, TMR/PMR, multislice CT, PET/CT, and SPECT/CT.

The UPMM is responsible for detecting the patient's heart waveform and producing a synchronized pulse that is used to trigger a device.

Prescription Use ਮ (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

IF NEEDED)

Concurrence of CDRH, Office of Device Evaluation (ODE)

(Division Sign-Off)
2/23/09

rdiovascular Devices 510fk) Ni

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