The specialty coils are indicated for use in conjunction with the MAGNETOM Aera 1.5T & MAGNETOM Skyra 3T MR Systems, Magnetic Resonance Diagnostic Devices (MRDD), that produce transverse, sagittal, coronal and oblique cross sectional images, and display the internal structure and/or function of the rody. These images, when interpreted by a trained physician, yield information that may assist in diagnosis.

Device Description

The specialty coils are intended to be used in conjunction with the MAGNETOM Aera 1.5T & MAGNETOM Skyra 3T MR Systems, Magnetic Resonance Diagnostic Devices. These coils will be used to present images which reflect the spatial distribution and the other physical parameters derived from the images may also be produced.

The specialty coils will include: Shoulder Large 16, Shoulder Small 16, Hand/Wrist 16 and Foot/ Ankle 16 for the existing MAGNETOM Aera 1.5T & MAGNETOM Skyra 3T MR Systems.

AI/ML Overview

Acceptance Criteria and Study for Specialty Coils for MAGNETOM Aera 1.5T & MAGNETOM Skyra 3T MR Systems

1. Table of Acceptance Criteria and Reported Device Performance

Acceptance Criterion	Reported Device Performance
Biocompatibility	Not applicable (no new materials used compared to predicate devices).
Signal to Noise Ratio (SNR)	Equivalent to predicate devices.
Image Uniformity	Equivalent to predicate devices.

2. Sample Size Used for the Test Set and Data Provenance

The document does not specify a separate "test set" in the context of an AI/ML device. Instead, it refers to laboratory testing performed to demonstrate substantial equivalence to predicate devices. The details of the sample size (number of MR systems tested, number of scans performed) are not explicitly provided.

Data provenance is also not detailed, but the tests were performed in a laboratory setting, likely by the manufacturer (Siemens Mindit Magnetic Resonance Ltd. in PR. China).

3. Number of Experts Used to Establish Ground Truth for the Test Set and Qualifications of Those Experts

Not applicable. This submission is for accessory coils for existing MR systems and focuses on engineering and performance criteria (SNR, image uniformity) rather than diagnostic accuracy that would require expert consensus on medical images. The "ground truth" here is objective physical measurements and comparisons to established performance of predicate devices.

4. Adjudication Method for the Test Set

Not applicable. See point 3 above.

5. If a Multi-Reader Multi-Case (MRMC) Comparative Effectiveness Study Was Done, and the Effect Size of How Much Human Readers Improve with AI vs. Without AI Assistance

Not applicable. This K103275 submission is for specialty coils for MR systems, not an AI/ML diagnostic device, and thus no MRMC study was conducted.

6. If a Standalone (i.e., algorithm only without human-in-the-loop performance) Was Done

Not applicable. This is not an AI/ML algorithm; it is a hardware component (MRI coils). The performance metrics (SNR, image uniformity) are intrinsic to the device's physical properties.

7. The Type of Ground Truth Used (Expert Consensus, Pathology, Outcomes Data, etc.)

The ground truth used for performance evaluation was based on objective engineering measurements of physical properties like Signal to Noise Ratio (SNR) and image uniformity. This was compared against the established performance benchmarks of the predicate devices.

8. The Sample Size for the Training Set

Not applicable. This is not an AI/ML device, and therefore no "training set" was used.

9. How the Ground Truth for the Training Set Was Established

Not applicable. See point 8 above.

Summary of the Study:

The study conducted to prove the device meets acceptance criteria was laboratory testing focusing on specific safety and performance parameters for the specialty coils. The primary goal was to demonstrate substantial equivalence to existing, legally marketed predicate devices.

The key performance parameters evaluated were:

Signal to Noise Ratio (SNR): Measured and compared to predicate devices. The reported outcome was "equivalent with the predicate devices."
Image Uniformity: Measured and compared to predicate devices. The reported outcome was "equivalent with the predicate devices."

Additionally, biocompatibility was considered, but no new tests were performed because no new materials were introduced compared to the predicate devices. The other general safety and performance parameters for MR diagnostic devices (Maximum Static Field, Rate of Change of Magnetic Field, RF Power Deposition, Acoustic Noise Level, Geometric Distortion, Slice Profile, Thickness and Gap, High Contrast Spatial Resolution) were deemed "unaffected by the modifications described within this notification."

The conclusion was that the technological differences of the new specialty coils did not raise any new questions pertaining to effectiveness compared to the predicate devices, thus supporting the claim of substantial equivalence.

Summary

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Section 5: 510(k) Summary

510(k) Summary ഗ

JAN 1 1 2011

This summary of 510(k) safety and effectiveness information is being submitted in accordance with the requirements of Safe Medical Device Act 1990 and 21 CFR & 807.92.

l. General Information

Establishment	Siemens Medical Solutions USA, Inc.51 Valley Stream ParkwayMalvern, PA 19355
---------------	--------------------------------------------------------------------------------------

Registration Number 2240869

Manufacturer Siemens Mindit Magnetic Resonance Ltd.

Siemens MRI Center, Gaoxin C. Ave. 2nd Hi-Tech Industrial Park, ShenZhen 518057, PR. China

Registration Number 3004754211

Contact

Alicia Bustos-Juergensen Technical Specialist, Regulatory Submissions 51 Valley Stream Parkway Malvern, PA 19355 Phone: (610) 448-4056 Fax: (610) 448-1787 E-mail address: alicia.bustos-juergensen@siemens.com

Device Name	Trade Name:	Specialty Coils for MAGNETOMAera 1.5T & MAGNETOM Skyra 3TMR Systems
	Classification Name:Device Class:Product Code:Classification Panel:	Coil, Magnetic Resonance SpecialtyClass II 21 CFR § 892.1000MOSRadiology

Performance Standards

None established under Section 514 the Food, Drug, and Cosmetic Act.

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ll. Safety and Effectiveness Information Supporting Substantial Equivalence.

Intended Use

Device Description

The specialty coils will include: Shoulder Large 16, Shoulder Small 16, Hand/Wrist 16 and Foot/ Ankle 16 for the existing MAGNETOM Aera 1.5T & MAGNETOM Skyra 3T MR Systems.

Substantial Equivalence

Siemens believes that, within the meaning of the Safe Medical Device Act of 1990, the MAGNETOM Aera 1.5T & MAGNETOM Skyra 3T Systems with specialty coils are substantially equivalent to the following cleared medical devices:

Predicate Device Name	FDA ClearanceNumber	FDA ClearanceDate
Siemens MAGNETOM ESSENZA 1.5 T(Focus Shoulder Array Coil)	K071925	Aug 14, 2007
Siemens MAGNETOM ESSENZA 1.5 T(Focus Shoulder Array Coil, Small,8-Channel Wrist Coil,8-Channel Foot-Ankle Coil)	K083166	Jan 13, 2009
Siemens MAGNETOM Verio 3T(Large 4-Channel Shoulder Array Coil,Small 4-Channel Shoulder Array Coil,8- Channel Wrist Coil,8-Channel Foot -Ankle Coil)	K072237	Oct 10, 2007

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General Safety and Effectiveness Concerns:

The following safety and performance parameters:

[Safety] -Maximum Static Field -Rate of Change of Magnetic Field -RF Power Deposition -Acoustic Noise Level

[Performance] -Geometric Distortion -Slice Profile, Thickness and Gap -High Contrast Spatial Resolution

Specified by the FDA Guidance document for MR Diagnostic Devices are unaffected by the modifications described within this notification.

The following parameters were considered for the new Specialty Coils:

(Safetvl -Biocompatibility

[Performance] -Signal to Noise Ratio -Image Uniformity

No new materials were used for the new specialty coils compared to their predicate devices. Therefore no new biocompatibility tests were performed. Signal to Noise Ratio (SNR) and image uniformity tests were performed for the new specialty coils and the results presented in this submission show that they are equivalent with the predicate devices.

Conclusion as to Substantial Equivalence

Laboratory testing was performed to support this claim of substantial equivalence and to show that the technological differences do not raise any new questions pertaining to effectiveness.

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Image /page/3/Picture/0 description: The image shows the logo for the Department of Health & Human Services USA. The logo consists of a stylized eagle with three lines representing its wings, and the text "DEPARTMENT OF HEALTH & HUMAN SERVICES USA" arranged in a circular pattern around the eagle. The text is in all caps and is written in a sans-serif font.

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

Ms. Alicia Bustos-Jeurgensen Regulatory Technical Specialist Siemens Medical Solutions USA. Inc. 51 Valley Stream Parkway MALVERN PA 19355

JAN 1 1 2011

Re: K103275

Trade/Device Name: Specialty Coils for MAGNETOM Aera 1.5T & MAGNETOM Skyra 3T MR Systems

Regulation Number: 21 CFR 892.1000 Regulation Name: Magnetic resonance diagnostic device Regulatory Class: II Product Code: MOS Dated: November 4, 2010 Received: November 5, 2010

Dear Ms. Bustos-Jeurgensen:

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. Insting of devices, good manufacturing practice, labeling, and prohibitions against misbranding 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 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 Parts 801 and 809); medical device 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 Viro 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/ReportalProblem/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.

signature

David G. Brown, Ph.D. 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 Statement 4

510(k) Number (if known) K103x275

03275

JAN 1 1 2011

Specialty Coils for MAGNETOM Aera 1.5T & MAGNETOM Device Name: Skyra 3T MR Systems

Indications for Use:

The specialty coils are indicated for use in conjunction with the MAGNETOM Aera 1.5T & MAGNETOM Skyra 3T Systems, magnetic resonance diagnostic devices (MRDD), which produce transverse, sagittal, coronal and oblique cross sectional images, and display the internal structure and/or function of the body.

These images, when interpreted by a trained physician, yield information that may assist in diagnosis.

The intended use of the Aera and Skyra Systems is not affected by the use of the new specialty coils.

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)

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

Division Sign-Off Office of In Vitro Diagnostic Device Evaluation and Safety

510(k) K163275

Siemens 510(k) Premarket Notification Specialty Coils for MAGNETOM Aera 1.5T & MAGNETOM Skyra 3T MR Systems

Regulation Number and Section

§ 892.1000 Magnetic resonance diagnostic device.

(a)
Identification. A magnetic resonance diagnostic device is intended for general diagnostic use to present images which reflect the spatial distribution and/or magnetic resonance spectra which reflect frequency and distribution of nuclei exhibiting nuclear magnetic resonance. Other physical parameters derived from the images and/or spectra may also be produced. The device includes hydrogen-1 (proton) imaging, sodium-23 imaging, hydrogen-1 spectroscopy, phosphorus-31 spectroscopy, and chemical shift imaging (preserving simultaneous frequency and spatial information).(b)
Classification. Class II (special controls). A magnetic resonance imaging disposable kit intended for use with a magnetic resonance diagnostic device only is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 892.9.