K Number
K100115
Device Name
XVI R4.5
Manufacturer
Date Cleared
2010-03-10

(54 days)

Product Code
Regulation Number
892.5050
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The Elekta X-Ray Volume Imaging system, XVI, is an electronic imaging device (EID), designed to be used with the Elekta range of medical linear accelerators and intended to be used as part of radiation therapy treatment process, as determined by a licensed medical practitioner. XVI, is intended to confirm patient positioning and support decision making in response to target displacement resulting from organ deformation and anatomical movement. Symmetry™ is a software option within XVI that can be used to acquire and display volumetric images of sequential phases of the breathing cycle for the evaluation of respiration induced motion, to assist in identification of appropriate target locations within anatomical structures in motion.
Device Description
This Traditional 510(k) describes modifications made to the XVI kilo-voltage imaging accessory of the Elekta range of digital linear accelerators. The primary reason for these enhancements is to improve the acquisition and utilization of kV images in facilitating the correction of patient position for anatomical changes or movement. The additional features are; Symmetry™ (4D VolumeView™) to evaluate respiration induced motion, 3D shaped region of interest for registration, dual registration for quantitative information regarding both the critical structures and target position, and 3D seed registration of implanted markers. Improvements have also been made to the operator interface, connectivity with other systems through DICOM and in the provision of licensable options to tailor individual features. The XVI system consists of a kV radiation source mounted onto the linac gantry drum and a kV radiation image detector.
More Information

No
The document describes image acquisition and processing for patient positioning and motion evaluation, but there is no mention of AI or ML algorithms being used for these tasks. The focus is on hardware modifications and software features for image display and registration.

No.
The device is described as an electronic imaging device (EID) intended to confirm patient positioning and support decision making in radiation therapy, which classifies it as a diagnostic imaging device rather than a therapeutic device.

No

The device is described as an electronic imaging device used as part of the radiation therapy treatment process to confirm patient positioning and support decision-making regarding target displacement, particularly for anatomical changes or movement. It assists in identifying appropriate target locations but does not diagnose a disease or condition itself.

No

The device description explicitly states that the XVI system consists of a kV radiation source and a kV radiation image detector, which are hardware components. While it includes software options like Symmetry™, the overall device is a system with both hardware and software.

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

Here's why:

  • Intended Use: The intended use clearly states that the device is an "electronic imaging device (EID)" used "as part of radiation therapy treatment process" to "confirm patient positioning and support decision making in response to target displacement". This describes a device used in vivo (within the living body) for imaging and treatment guidance, not in vitro (outside the body) for testing biological samples.
  • Device Description: The description details a system with a "kV radiation source" and a "kV radiation image detector" mounted on a linear accelerator. This is consistent with an imaging system used for medical imaging of the patient's body.
  • Lack of IVD Characteristics: There is no mention of analyzing biological samples (blood, urine, tissue, etc.), reagents, or any of the typical components or processes associated with in vitro diagnostics.

The device is clearly intended for medical imaging and guidance during radiation therapy, which falls under the category of medical devices used in vivo.

N/A

Intended Use / Indications for Use

The Elekta X-Ray Volume Imaging system, XVI, is an electronic imaging device (EID), designed to be used with the Elekta range of medical linear accelerators and intended to be used as part of radiation therapy treatment process, as determined by a licensed medical practitioner.

XVI, is intended to confirm patient positioning and support decision making in response to target displacement resulting from organ deformation and anatomical movement. Symmetry™ is a software option within XVI that can be used to acquire and display volumetric images of sequential phases of the breathing cycle for the evaluation of respiration induced motion, to assist in identification of appropriate target locations within anatomical structures in motion.

Product codes

IYE

Device Description

This Traditional 510(k) describes modifications made to the XVI kilo-voltage imaging accessory of the Elekta range of digital linear accelerators. The primary reason for these enhancements is to improve the acquisition and utilization of kV images in facilitating the correction of patient position for anatomical changes or movement. The additional features are; Symmetry™ (4D VolumeView™) to evaluate respiration induced motion, 3D shaped region of interest for registration, dual registration for quantitative information regarding both the critical structures and target position, and 3D seed registration of implanted markers. Improvements have also been made to the operator interface, connectivity with other systems through DICOM and in the provision of licensable options to tailor individual features.

The XVI system consists of a kV radiation source mounted onto the linac gantry drum and a kV radiation image detector. Incorporation of the kV imaging system onto the same structure as the treatment system allows high quality images of the patient anatomy to be acquired at the point of treatment and their content to be spatially related to the forthcoming MV treatment, as previously cleared under Control Number K051932.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

kV radiation

Anatomical Site

Not Found

Indicated Patient Age Range

Not Found

Intended User / Care Setting

Licensed medical practitioner / radiation therapy treatment process

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)

K051932

Reference Device(s)

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

§ 892.5050 Medical charged-particle radiation therapy system.

(a)
Identification. A medical charged-particle radiation therapy system is a device that produces by acceleration high energy charged particles (e.g., electrons and protons) intended for use in radiation therapy. This generic type of device may include signal analysis and display equipment, patient and equipment supports, treatment planning computer programs, component parts, and accessories.(b)
Classification. Class II. When intended for use as a quality control system, the film dosimetry system (film scanning system) included as an accessory to the device described in paragraph (a) of this section, is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 892.9.

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KLOO11S

510(k) SUMMARY

Date of preparation of summary: January 11th 2010

Submitted by:

MAR I 0 2010

| Submitted by: | Elekta Limited
Linac House, Fleming Way, Crawley, West Sussex
RH10 9RR, United Kingdom |
|----------------------|----------------------------------------------------------------------------------------------|
| Telephone: | +44 (0) 1293 654201 |
| Fax: | +44 (0) 1293 654260 |
| Contact name: | Mr Andrew Hedges |
| Trade Name: | XVI R4.5 |
| Common Name: | Elekta X-Ray Volume Imaging system, XVI |
| Classification Name: | Medical Linear Accelerator Accessory, 21 CFR 892.5050, IYE |

Predicate Device: Elekta Synergy® (K051932)

Product Description:

This Traditional 510(k) describes modifications made to the XVI kilo-voltage imaging accessory of the Elekta range of digital linear accelerators. The primary reason for these enhancements is to improve the acquisition and utilization of kV images in facilitating the correction of patient position for anatomical changes or movement. The additional features are; Symmetry™ (4D VolumeView™) to evaluate respiration induced motion, 3D shaped region of interest for registration, dual registration for quantitative information regarding both the critical structures and target position, and 3D seed registration of implanted markers. Improvements have also been made to the operator interface, connectivity with other systems through DICOM and in the provision of licensable options to tailor individual features.

Intended Use Statement:

The intended use for the device has been amended to incorporate an extended imaging functionality for the confirmation of target localization;

The Elekta X-Ray Volume Imaging system, XVI, is an electronic imaging device (EID), designed to be used with the Elekta range of medical linear accelerators and intended to be used as part of radiation therapy treatment process, as determined by a licensed medical practitioner

XVI, is intended to confirm patient positioning and support decision making in response to target displacement resulting from organ deformation and anatomical movement. Symmetry™ is a software option within XVI that can be used to acquire and display volumetric images of sequential phases of the breathing cycle for the evaluation of respiration induced motion, to assist in identification of appropriate target locations within anatomical structures in motion.

Summary of Technological Characteristics:

The XVI system consists of a kV radiation source mounted onto the linac gantry drum and a kV radiation image detector. Incorporation of the kV imaging system onto the same structure as the treatment system allows high quality images of the patient anatomy to be acquired at the point of treatment and their content to be spatially related to the forthcoming MV treatment, as previously cleared under Control Number K051932.

There has been no change made to the underlying technological characteristics of the product.

Substantial Equivalence

The functionality for the XVI R4.5 is equivalent to its predicate device XVI R3.5 as part of the Elekta Synergy (K051932) in safety and effectiveness. The fundamental technica! characteristics are the same as those of the predicate device and differences in operation are described in the comparison chart and discussion provided elsewhere in this 510(k) submission.

Elekta Ltd., Linac House, Fleming Way, Crawley, West Sussex RH10 9RR UK Tel:+44 (0)1293 544422 Fax:+44 (0)1293 654321 www.elekta.com Registered in England No. 3244454

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Image /page/1/Picture/0 description: The image shows the seal of the Department of Health & Human Services - USA. The seal is circular and contains the text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" around the perimeter. In the center of the seal is a stylized image of a caduceus, a symbol often associated with medicine and healthcare.

DEPARTMENT OF HEALTH & HUMAN SERVICES

Public Health Service

Food and Drug Administration 10903 New Hampshire Avenue Document Control Room – WO66-G609 Silver Spring, MD 20993-0002

Mr. Andrew Hedges Regulatory Affairs Engineer Elekta Limited Linac House, Fleming Way Crawley, West Sussex, RH10 9RR UNITED KINGDOM

MAR 1 0 2010

Re: K100115

Trade/Device Name: XVI Regulation Number: 21 CFR 892.5050 Regulation Name: Medical charged-particle radiation therapy system Regulatory Class: II Product Code: IYE · Dated: January 11, 2010

Received: January 15, 2010

Dear Mr. Hedges:

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 intreated commerce prior to May 28, 1976, the enactment date of the Medical Device Amendmants or to devices that have been reclassified in accordance with the provisions of the Fedral Forl, Or to 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 provisiopp 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 misburanting and adulteration.

If your device is classified (see above) into class II (Special Controls), it may be subject to such additional controls. Existing major regulations affecting your device can be found in Title 21, Code of Federal Regulations (CFR), Parts 800 to 895. 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 aft 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 Parts 801 and 809); medical device reporting (reporting of

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medical device-related adverse events) (21 CFR 803); and good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820). 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 Parts 801 and 809), please contact the Office of In Vitro Diagnostic Device Evaluation and Safety at (301) 796-5450. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR Part 807.97). For questions regarding the reporting of adverse events under the MDR regulation (21 CFR Part 803), please go to http://www.fda.gov/MedicalDevices/Safety/ReportaProblem/default.htm for the CDRH's Office of Surveillance and Biometrics/Division of Postmarket Surveillance.

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) 796-7100 or at its Internet address http://www.fda.gov/cdrh/industry/support/index.html.

. Sincerely yours,

Amelia J. P.

Donald J. St.Pierre Acting Director Division of Radiological Devices Office of In Vitro Diagnostic Device Evaluation and Safety Center for Devices and Radiological Health

Enclosure

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Indications for Use

510(k) Number (if known): K100115

Device Name: XVI

Indications for Use:

The Elekta X-Ray Volume Imaging system, XVI, is an electronic imaging device (EID), designed to be used with the Elekta range of medical linear accelerators and intended to be used as part of radiation therapy treatment process, as determined by a licensed medical practitioner.

XVI, is intended to confirm patient positioning and support decision making in response to target displacement resulting from organ deformation and anatomical movement. Symmetry™ is a software option within XVI that can be used to acquire and display volumetric images of sequential phases of the breathing cycle for the evaluation of respiration induced motion, to assist in identification of appropriate target locations within anatomical structures in motion.

Prescription Use YES (Part 21 CFR 801 Subpart D) AND/OR

Over-The-Counter Use NO (21 CFR 807 Subpart C)

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

Concurrence of CDRH, Office of In Vitro Diagnostic Devices (OIVD)

Joff

(Division Sign-Off)
Division of Radiological Devices
Office of In Vitro Diagnostic Device Evaluation and Safety

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