K Number
K111548
Device Name
WIRELESS/WIRED FDR D-EVO FLAT PANCEL DETECTOR SYSTEM MODEL DR-ID600 W/DR-ID611SE
Date Cleared
2011-08-30

(88 days)

Product Code
Regulation Number
892.1680
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The Wireless/Wired FDR D-EVO flat panel detector system is intended to capture for display radiographic images of human anatomy. It is intended for use in general projection radiographic applications wherever conventional film/screen or CR systems may be used. The FDR D-EVO is not intended for mammography, fluoroscopy, tomography, and angiography applications.
Device Description
The proposed device, DR-ID600 w/DR-ID611SE is a modified version of our currentlycleared predicate device, Wired FDR D-EVO flat panel detector system (DR-ID600 w/DR-ID601SE), K103596. The predicate device includes the 14x17" fat panel detector model DR-ID601SE using GOS (Gadolinium Oxysulfide) scintillator whereas the proposed device introduces the 14x17" flat panel detector model DR-ID611SE using a different scintillator material, Csl (Cesium lodide). FUJIFILM's unique Irradiated Side Sampling (ISS) design delivering high image quality, and wireless communication specifications remains unchanged in the proposed device. The proposed DR-ID600 w/DR-ID611SE is a portable digital detector system that acquires and digitizes x-ray exposures from standard radiographic systems, which is the same as our legally marketed predicate device, DR-ID600 w/DR-ID601SE. The proposed device is designed to be used in any environment that would typically use a radiographic cassette. It can be placed in a wall bucky for upright exams, a table bucky for recumbent exams, or removed from the bucky for non-grid exams. All of which are also the same as our legally marketed predicate device.
More Information

Not Found

No
The document describes a flat panel detector system for capturing radiographic images and focuses on hardware changes (scintillator material) and image quality comparisons, with no mention of AI or ML in the device description, intended use, or performance studies.

No
The device is a flat panel detector system intended to capture radiographic images for display, which is a diagnostic function, not a therapeutic one.

Yes

The device is intended to capture radiographic images of human anatomy for display, and a reader study explicitly states that images from the device were "deemed to be of diagnostic capability," indicating its role in providing information for diagnosis.

No

The device description explicitly states it is a "portable digital detector system" that "acquires and digitizes x-ray exposures," indicating it includes hardware components (the flat panel detector) in addition to any software.

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

Here's why:

  • Intended Use: The intended use clearly states that the system is for capturing and displaying radiographic images of human anatomy for general projection radiographic applications. This involves imaging the internal structures of the body using X-rays.
  • Device Description: The description details a flat panel detector system that acquires and digitizes X-ray exposures. This is a medical imaging device used for diagnostic purposes within the body.
  • Lack of IVD Characteristics: IVD devices are used to examine specimens (like blood, urine, tissue) outside the body to provide information about a person's health. The provided text does not mention any interaction with biological specimens or analysis performed outside the body.

Therefore, the device described is a medical imaging device, specifically an X-ray detector system, and not an In Vitro Diagnostic device.

N/A

Intended Use / Indications for Use

The Wireless/Wired FDR D-EVO flat panel detector system is intended to capture for display radiographic images of human anatomy. It is intended for use in general projection radiographic applications wherever conventional film/screen or CR systems may be used. The FDR D-EVO is not intended for mammography, fluoroscopy, tomography, and angiography applications.

Product codes (comma separated list FDA assigned to the subject device)

90 MQB

Device Description

The proposed device, DR-ID600 w/DR-ID611SE is a modified version of our currently-cleared predicate device, Wired FDR D-EVO flat panel detector system (DR-ID600 w/DR-ID601SE), K103596. The predicate device includes the 14x17" fat panel detector model DR-ID601SE using GOS (Gadolinium Oxysulfide) scintillator whereas the proposed device introduces the 14x17" flat panel detector model DR-ID611SE using a different scintillator material, Csl (Cesium Iodide).

FUJIFILM's unique Irradiated Side Sampling (ISS) design delivering high image quality, and wireless communication specifications remains unchanged in the proposed device.

The proposed DR-ID600 w/DR-ID611SE is a portable digital detector system that acquires and digitizes x-ray exposures from standard radiographic systems, which is the same as our legally marketed predicate device, DR-ID600 w/DR-ID601SE. The proposed device is designed to be used in any environment that would typically use a radiographic cassette. It can be placed in a wall bucky for upright exams, a table bucky for recumbent exams, or removed from the bucky for non-grid exams. All of which are also the same as our legally marketed predicate device.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

X-ray

Anatomical Site

human anatomy

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)

FUJIFILM performed an image quality reader study on 30 image pairs comparing the images obtained between the proposed CsI detector (DR-ID611SE) and our legally marketed GOS detector (DR-ID601SE). Three board-certified radiologists reviewed the images and all images were deemed to be of diagnostic capability. In addition, the consensus results of the three radiologists shows that the proposed device provides images of equivalent or better diagnostic capability to those of our cleared predicate device (K103596) by 93.3%. Test protocol summary and analysis results are enclosed in the submission.

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

Not Found

Predicate Device(s): If the device was cleared using the 510(k) pathway, identify the Predicate Device(s) K/DEN number used to claim substantial equivalence and list them here in a comma separated list exactly as they appear in the text. List the primary predicate first in the list.

K103596, K102012

Reference Device(s): Identify the Reference Device(s) K/DEN number and list them here in a comma separated list exactly as they appear in the text.

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

§ 892.1680 Stationary x-ray system.

(a)
Identification. A stationary x-ray system is a permanently installed diagnostic system intended to generate and control x-rays for examination of various anatomical regions. This generic type of device may include signal analysis and display equipment, patient and equipment supports, component parts, and accessories.(b)
Classification. Class II (special controls). A radiographic contrast tray or radiology diagnostic kit intended for use with a stationary x-ray system 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

KII1548

Image /page/0/Picture/1 description: The image shows the Fujifilm logo. The logo is in black and white and features the word "FUJIFILM" in large, bold letters. Below the main logo, there is the text "Fujifilm Medical Systems, USA" in a smaller font. The logo appears to be a company logo.

AUG 300 2011

510(k) Summary Wireless/Wired FDR D-EVO Flat Panel Detector System (DR-ID600 w/DR-ID611SE)

Date: June 1, 2011

Submitter's Information:

FUJIFILM Medical Systems U.S.A., Inc. 419 West Avenue Stamford, CT, 06902, USA

Contact Person:

Name:Katherine Y. Choi, RAC
Title:Regulatory Affairs Specialist
Telephone:(203) 602-3568
Facsimile:(203) 363-3950

Identification of the Proposed Device:

Proprietary/Trade Name:

Classification Name: Regulations Number: Product Codes: Device Class: Review Panel: Common Name:

Wireless/Wired FDR D-EVO Flat Panel Detector System (DR-ID600 w/DR-ID611SE) Solid State X-ray Imager (Flat Panel/Digital Imager) 21 CFR 892.1650 90 MQB Class II Radiology Flat Panel Digital Detector

1. INDICATIONS FOR USE

The Wireless/Wired FDR D-EVO flat panel detector system is intended to capture for display radiographic images of human anatomy. It is intended for use in general projection radiographic applications wherever conventional film/screen or CR systems may be used. The FDR D-EVO is not intended for mammography, fluoroscopy, tomography, and angiography applications.

ll. DEVICE DESCRIPTION

The proposed device, DR-ID600 w/DR-ID611SE is a modified version of our currentlycleared predicate device, Wired FDR D-EVO flat panel detector system (DR-ID600 w/DR-ID601SE), K103596. The predicate device includes the 14x17" fat panel detector model DR-ID601SE using GOS (Gadolinium Oxysulfide) scintillator whereas the proposed device introduces the 14x17" flat panel detector model DR-ID611SE using a different scintillator material, Csl (Cesium lodide).

1

Image /page/1/Picture/0 description: The image shows the logo for Fujifilm Medical Systems, USA. The word "FUJIFILM" is written in large, bold, black letters. Below the main logo, the words "Fujifilm Medical Systems, USA" are written in a smaller, sans-serif font, also in black.

FUJIFILM's unique Irradiated Side Sampling (ISS) design delivering high image quality, and wireless communication specifications remains unchanged in the proposed device.

The proposed DR-ID600 w/DR-ID611SE is a portable digital detector system that acquires and digitizes x-ray exposures from standard radiographic systems, which is the same as our legally marketed predicate device, DR-ID600 w/DR-ID601SE. The proposed device is designed to be used in any environment that would typically use a radiographic cassette. It can be placed in a wall bucky for upright exams, a table bucky for recumbent exams, or removed from the bucky for non-grid exams. All of which are also the same as our legally marketed predicate device.

1111. SUMMARY OF STUDIES

The proposed device, DR-ID600 w/DR-ID611SE successfully completed internal and international IEC testing requirements. In addition, the FDA Guidance for the Submission of 510(k)'s for Solid State X-ray Imaging Devices, issued on August 6, 1999 was followed to describe the detector characteristics.

FUJIFILM performed an image quality reader study on 30 image pairs comparing the images obtained between the proposed CsI detector (DR-ID611SE) and our legally marketed GOS detector (DR-ID601SE). Three board-certified radiologists reviewed the images and all images were deemed to be of diagnostic capability. In addition, the consensus results of the three radiologists shows that the proposed device provides images of equivalent or better diagnostic capability to those of our cleared predicate device (K103596) by 93.3%. Test protocol summary and analysis results are enclosed in the submission.

IV. SUBSTANTIAL EQUIVALENCE

The proposed device, DR-ID600 w/DR-ID611SE is substantially equivalent to the following legally marketed devices.

Legally Marketed Device510(k)#
Wireless/Wired FDR D-EVO flat panel detector system (DR-ID600 w/DR-ID601SE)K103596
Canon CXDI-70C WirelessK102012

The proposed DR-ID600 w/DR-ID611SE has the same Indications for Use and very similar functional and technical requirements as our currently-cleared predicate device, K103596. The proposed device's wireless communication specifications remain unchanged as K103596. In addition, the scintillator material used in the proposed device is the same material as the legally marketed device, K102012.

V. CONCLUSION

The proposed DR-ID600 w/DR-ID611SE is substantially equivalent to the legally marketed devices and conforms to applicable medical device safety standards.

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Image /page/2/Picture/0 description: The image is a black and white logo for the U.S. Department of Health & Human Services. The logo features a stylized eagle with its wings outstretched, symbolizing care and protection. The eagle is positioned within a circular border. The text "DEPARTMENT OF HEALTH & HUMAN SERVICES USA" is arranged around the upper portion of the circle.

Public Health Service

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

Ms. Katherine Y. Choi, RAC Regulatory Affairs Specialist Fuji Medical Systems U.S.A., Inc. 419 West Avenue STAMFORD CT 06902

AUG 23 2013

Re: K111548

Trade/Device Name: Wireless/Wired FDR D-EVO Flat Panel Detector System (DR-ID600 w/DR-ID611SE)

Regulation Number: 21 CFR 892.1680 Regulation Name: Stationary x-ray system Regulatory Class: II Product Code: MQB Dated: July 26, 2011 Received: July 27, 2011

Dear Ms. Choi:

This letter corrects our substantially equivalent letter of August 30, 2011.

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 I va may , and controls 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 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 (reporting of

3

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 requirents as set form in the quality of evice as described in your Section 510(k) premarket whit anow you to begin marketing your arrance of your device to a legally marketed nouncation. The FDA imania of successification 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 CFF Parts 801 and If you desire specific advice of In Vitro Diagnostic Device Evaluation and Safety at (301) 796-007), product 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

under the MDK regulation (27 CFR Pat 003), products go the fault.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 Tour may 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,

Janine M. Morris

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): KIII548

Device Name: Wired FDR D-EVO Flat Panel Detector System (DR-ID600 w/DR-ID611SE)

Indications for Use:

The Wireless:Wired FDR D-EVO flat panel detector system is intended to capture for display radiographic images of human analomy. It is intended for use in general projection radiographic applications wherever conventional film /screen or CR systems may be used. The FDR D-EVO is not intended for mammography, fluoroscopy, tomography, and angiography applications.

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 Device (OIVD)

Michael O'Kane

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

510K 111548

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