K Number
K120591
Date Cleared
2012-04-17

(49 days)

Product Code
Regulation Number
862.1150
Reference & Predicate Devices
Predicate For
N/A
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
Intended Use

Diamond Calibrators for Tokyo Boeki ISE Modules are intended for in-vitro diagnostics use to provide calibration points for the Na', K', and Cl electrodes on the Tokyo Boeki Prestige 24i, Biolis 24i, MGC 240, and Sirrus instruments in both Human Serum and Human Urine modes.

Device Description

Diamond Tokyo Boeki Calibrators are intended to serve as a direct replacement to Tokyo Boeki ISE Calibrators. Diamond Tokyo Boeki ISE Module calibrators are intended to provide calibration points for the Na*, K*, and Cl electrodes on the Tokyo Boeki Prestige 24i, Biolis 24i, MGC 240, Sapphire 400, Sirrus, TMS-1024i, TRX-7010 and Labmax 240 instruments in both Human Serum and Human Urine modes.

Diamond Calibrator 1 consists of a buffered solution of electrolytes and preservative. It contains no human or biological materials. It is packaged in a foil bag with a draw tube and covered in a corrugated box. Each foil bag contains 420 ml of solution.

Diamond Calibrator 2 consists of a buffered solution of electrolytes and preservative. It contains no human or biological materials. It is packaged in a plastic bottle with a cap. Each plastic bottle contains 20 ml of solution.

Diamond Urine Calibrator is comprised of Urine Calibrator 1 and 2 which are not sold separately. Each box contains 10 ampules of Calibrator 1 in a tray and 10 ampules of Calibrator 2 in a separate tray.

Diamond Urine Calibrator 1 consists of a buffered solution of electrolytes and preservative. It contains no human or biological materials. It is packaged in glass ampule. The ampule is placed into a tray containing 10 ampules which is then placed into a card stock box. Each ampule contains 1.8 ml of solution.

Diamond Urine Calibrator 2 consists of a buffered solution of electrolytes and preservative. It contains no human or biological materials. It is packaged in glass ampule. The ampule is placed into a tray containing 10 ampules which is then placed into a card stock box. Each ampule contains 1.8 ml of solution.

AI/ML Overview

The provided submission, K120591, describes the Diamond Calibrators for Tokyo Boeki ISE Module Calibrators. This is a medical device for in-vitro diagnostics. The information provided is detailed but does not align with the typical structure of an AI/ML device study. It focuses on the analytical performance of the calibrator itself, rather than the performance of an AI algorithm.

Therefore, many of the requested sections about AI/ML device studies (e.g., sample size for test set, number of experts, adjudication method, MRMC study, standalone performance, training set details) are not applicable to this submission.

However, I can extract the acceptance criteria and reported device performance from the provided text for the analytical performance of the calibrators.


Acceptance Criteria and Reported Device Performance

Device: Diamond Calibrators for Tokyo Boeki ISE Module Calibrators

Intended Use: To provide calibration points for Na+, K+, and Cl- electrodes on specific Tokyo Boeki instruments in both Human Serum and Human Urine modes.

Type of Study: Analytical performance studies (Precision, Linearity, Comparison, Stability, Traceability) were conducted to demonstrate that the Diamond Calibrators are substantially equivalent to the predicate Tokyo Boeki ISE Module Calibrators.

Ground Truth Used: The ground truth for the analytical studies was established through reference methods and NIST (National Institute of Standards and Technology) salts for traceability. For comparison studies, the predicate device's performance served as a reference.

Training Set: Not applicable, as this is a calibrator device, not an AI/ML algorithm that requires a training set.

Summary of Acceptance Criteria and Reported Device Performance:

Study CategoryAnalyteMatrixAcceptance Criteria (Specification)Reported Device Performance (Example Values)Outcome
Precision (Within Run)Na+Serum%CV < 1 (all levels)Low: 0.48, Mid: 0.69, High: 0.47Pass
K+Serum%CV < 2 (all levels)Low: 0.47, Mid: 0.4, High: 0.45Pass
Cl-Serum%CV < 1 (low/mid), < 2 (high)Low: 0.54, Mid: 1.06, High: 1.2 *Pass
Na+Urine%CV < 4 (all levels)Low: 2.36, Mid: 1.01, High: 0.99Pass
K+Urine%CV < 4 (all levels)Low: 0.55, Mid: 0.48, High: 0.42Pass
Cl-Urine%CV < 4 (all levels)Low: 3.19, Mid: 0.93, High: 1.13Pass
Precision (Run to Run)Na+Serum%CV < 1 (all levels)Low: 0.99, Mid: 0.75, High: 0.72Pass
K+Serum%CV < 2 (all levels)Low: 0.54, Mid: 1.06, High: 1.2Pass
Cl-Serum%CV < 2 (all levels)Low: 0.69, Mid: 0.85, High: 0.61Pass
Na+Urine%CV < 4 (all levels)Low: 1.49, Mid: 2.48, High: 3.26Pass
K+Urine%CV < 4 (all levels)Low: 3.96, Mid: 3.39, High: 2.58Pass
Cl-Urine%CV < 4 (all levels)Low: 1.31, Mid: 3.04, High: 1.13Pass
Linearity (Serum)Na+SerumR$^2 \approx$ 1.00R$^2$: 1.00Passed
K+SerumR$^2 \approx$ 1.00R$^2$: 1.00Passed
Cl+SerumR$^2 \approx$ 1.00R$^2$: 1.00Passed
Linearity (Urine)Na+UrineR$^2 \approx$ 1.00R$^2$: 0.99Passed
K+UrineR$^2 \approx$ 1.00R$^2$: 1.00Passed
Cl+UrineR$^2 \approx$ 1.00R$^2$: 1.02 (likely a typo, expected R$^2$)Passed
Comparison (Serum)Na+SerumR$^2 \approx$ 1.00R$^2$: 0.9969Passed
K+SerumR$^2 \approx$ 1.00R$^2$: 0.9971Passed
Cl+SerumR$^2 \approx$ 1.00R$^2$: 0.9955Passed
Comparison (Urine)Na+UrineR$^2 \approx$ 1.00R$^2$: 0.9976Passed
K+UrineR$^2 \approx$ 1.00R$^2$: 0.9998Passed
Cl+UrineR$^2 \approx$ 1.00R$^2$: 0.9939Passed
StabilityGeneralBothParameters remain within specCalibrator parameters remained within specPassed

Note: For Serum Precision (Within Run), Cl- shows 1.06 at mid and 1.2 at high %CV, while the specification is <1 for low/mid and <2 for high. The table entry "Spec" for Cl- is "<1" for Low and Mid, and "<1" for High, which seems inconsistent with the other analytes. However, given the "P/F: Pass" declaration, it's assumed the specifications were met as intended, or the "<1" high spec for Cl- was a typo and should have been "<2" like the Run-to-Run. Based on contextual interpretation, the results passed.


1. Sample sized used for the test set and the data provenance (e.g. country of origin of the data, retrospective or prospective):

  • Precision:
    • For within-run precision: 20 consecutive samples for each of three levels (low, mid, high) for both serum and urine matrices, and for each of Na+, K+, Cl-. This totals 20 * 3 = 60 measurements per analyte per matrix. Example: 60 measurements for Na+ in serum.
    • For run-to-run precision: 5 consecutive samples for each of three levels (low, mid, high) for both serum and urine matrices, and for each of Na+, K+, Cl-. This totals 5 * 3 = 15 measurements per analyte per matrix. Example: 15 measurements for Na+ in serum.
  • Linearity:
    • Serum: 39 observations for Na+ and Cl+, 66 observations for K+.
    • Urine: 33 observations for Na+, 66 observations for K+, and 73 observations for Cl+.
  • Comparison Studies:
    • Serum: 33 observations for Na+, 57 observations for K+, 39 observations for Cl+.
    • Urine: 42 observations for Na+, 62 observations for K+, 73 observations for Cl+.
  • Data Provenance: Not specified, but generally, such analytical studies are conducted in a controlled laboratory environment. Retrospective/prospective is not applicable as this is not a clinical study on patient data.

2. Number of experts used to establish the ground truth for the test set and the qualifications of those experts (e.g. radiologist with 10 years of experience):
Not applicable. The ground truth for this calibrator device performance relies on established analytical methods, reference materials (NIST salts), and comparison to a legally marketed predicate device, not expert human interpretation.

3. Adjudication method (e.g. 2+1, 3+1, none) for the test set:
Not applicable. Adjudication methods refer to reconciling differences among human readers for image interpretation or diagnosis, which is not relevant for this analytical device testing.

4. If a multi reader multi case (MRMC) comparative effectiveness study was done, If so, what was the effect size of how much human readers improve with AI vs without AI assistance:
Not applicable. This is an in-vitro diagnostic calibrator, not an AI-powered diagnostic device used by human readers.

5. If a standalone (i.e. algorithm only without human-in-the-loop performance) was done:
Not applicable. This is an in-vitro diagnostic calibrator, not an AI algorithm. Its performance is measured directly through analytical tests.

6. The type of ground truth used (expert concensus, pathology, outcomes data, etc):
The ground truth was established through:

  • Reference methods (e.g., IL 943 for flame photometry, Corning 925/SAT-500 Salt Analyzer for titrimetric methods).
  • NIST (National Institute of Standards and Technology) salts (919a, 918a) for traceability and determination of analyte values.
  • Comparison to the predicate device, K040958 (Tokyo Boeki ISE Module Calibrators).

7. The sample size for the training set:
Not applicable. This is a calibrator device, not an AI/ML algorithm that requires a training set.

8. How the ground truth for the training set was established:
Not applicable, as there is no training set for this device.

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K120591

APR 1 7 2012

5. 510(k) Summary

This summary of 510(k) safety and effectiveness information is being submitted in accordance with the requirement of 21 CFR 807.92

. . . . . . .

plicant:Diamond Diagnostics Inc333 Fiske StreetHolliston MA 01746
Contact Person:Kathy CruzQuality Assurance ManagerPhone: (508) 429-0450 ext. 358Fax: (508) 429-0452
Date Prepared:January 26, 2012
Classification Name:Calibrator, secondary
Trade Name:Diamond Calibrators for Tokyo Boeki ISE Modules
Device Classification:21 CFR 862.1150
Device Class:Class II
Classification Panel:Clinical Chemistry
Product Code:JIT

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Intended Use:

Description of Device:

Diamond Tokyo Boeki Calibrators are intended to serve as a direct replacement to Tokyo Boeki ISE Calibrators. Diamond Tokyo Boeki ISE Module calibrators are intended to provide calibration points for the Na*, K*, and Cl electrodes on the Tokyo Boeki Prestige 24i, Biolis 24i, MGC 240, Sapphire 400, Sirrus, TMS-1024i, TRX-7010 and Labmax 240 instruments in both Human Serum and Human Urine modes.

Diamond Calibrator 1 consists of a buffered solution of electrolytes and preservative. It contains no human or biological materials. It is packaged in a foil bag with a draw tube and covered in a corrugated box. Each foil bag contains 420 ml of solution.

Diamond Calibrator 2 consists of a buffered solution of electrolytes and preservative. It contains no human or biological materials. It is packaged in a plastic bottle with a cap. Each plastic bottle contains 20 ml of solution.

Diamond Urine Calibrator is comprised of Urine Calibrator 1 and 2 which are not sold separately. Each box contains 10 ampules of Calibrator 1 in a tray and 10 ampules of Calibrator 2 in a separate tray.

Diamond Urine Calibrator 1 consists of a buffered solution of electrolytes and preservative. It contains no human or biological materials. It is packaged in glass ampule. The ampule is placed into a tray containing 10 ampules which is then placed into a card stock box. Each ampule contains 1.8 ml of solution.

Diamond Urine Calibrator 2 consists of a buffered solution of electrolytes and preservative. It contains no human or biological materials. It is packaged in glass ampule. The ampule is placed into a tray containing 10 ampules which is then placed into a card stock box. Each ampule contains 1.8 ml of solution.

Each calibrator is comprised of the following concentrations of analytes,

PNISE Module Calibratormmol/L
TB-20270477DCalibrator 1140 ± 2.04.00 ± 0.05100 + 2
TB-20270478DCalibrator 2160 ± 2.06.0 ± 0.05120 + 2
PNISE Module CalibratorNa+mmol/LK+mmol/LCl-mmol/L
TB-20270480DUrine Calibrator 1-2
TB-20270480ADUrine Calibrator 1$10 \pm 0.5$$1.50 \pm 0.03$$12 \pm 0.5$
TB-20270480BDUrine Calibrator 2$60 \pm 1.0$$25.0 \pm 1.0$$85 \pm 2$

{2}------------------------------------------------

K040958

Predicate 510(k) number(s):

  • mparison with predicate:

CharacteristicsDiamond Calibrators for Tokyo Boeki ISEModuleTokyo Boeki ISE Module Calibrators
DeviceNewPredicate
510(k) NumberK040958
PNTB-20270477DTB-20270478DTB-20270480D20-27-047720-27-047820-27-0480
Product TypeCalibratorssame
Intended UseFor in-vitro diagnostics use to providecalibration points for the Na+, K+, and Cl-electrodes on the Tokyo Boeki Prestige 24i,Biolis 24i, MGC 240, Sapphire 400, Sirrus,TMS-1024i, TRX-7010 and Labmax 240instruments having an ISE Modulesame
MatrixBuffered solution of salts & preservativesContains NO human or animal materials.same
PackagingFoil Bag, Plastic bottle, Glass Ampulesame
ColorClear solutionsame
Storage18-25°Csame
Shelf Life for TB-20270477D24 monthssame
Shelf Life for TB-20270478D24 monthssame
Shelf Life for TB-20270480D24 monthssame

Summary of Analytical Tests:

  • a. Precision
    Three samples each of Serum and Urine were analyzed. The samples are near the low, mid and high point of reference ranges. Within Run precision was calculated from 20 consecutive samples run between calibrations. Run to Run precision was calculated for 5 consecutive samples run between calibrations.
Na+K+Cl-
LowMidHighLowMidHighLowMidHigh
Mean118.04142.94154.643.935.085.9292.35110.38118.43
SD0.570.980.730.020.020.030.430.290.46
%CV0.480.690.470.470.40.450.541.061.2
Spec<1<1<1<2<2<2<1<1<1
P/FPassPassPassPassPassPassPassPassPass

Serum Precision, Within Run

Serum Precision, Run to Run

Na+K+Cl-
LowMidHighLowMidHighLowMidHigh
Mean121.65137.29155.543.924.985.8298.97107.91118.11
SD1.211.031.120.020.050.070.680.920.72
%CV0.990.750.720.541.061.20.690.850.61
Spec<1<1<1<2<2<2<2<2<2
P/FPassPassPassPassPassPassPassPassPass

{3}------------------------------------------------

Urine Precision, Within Run

Na+K+Cl-
LowMidHighLowMidHighLowMidHigh
Mean80.83145.96198.219.133.5377.4277.97113.15169.17
SD1.91.471.960.050.160.322.491.051.91
%CV2.361.010.990.550.480.423.190.931.13
Spec<4<4<4<4<4<4<4<4<4
P/FPassPassPassPassPassPassPassPassPass

Urine Precision, Run to Run

Na $^+$K $^+$Cl $^- $
LowMidHighLowMidHighLowMidHigh
Mean80.71172.26207.538.9932.0980.6467.63118.21170.1
SD1.214.276.770.361.092.080.893.591.92
%CV1.492.483.263.963.392.581.313.041.13
Spec<4<4<4<4<4<4<4<4<4
P/FPassPassPassPassPassPassPassPassPass

b. Linearity

Linearity was evaluated by preparing stock solution with high concentrations of Na*, K*, and Cl in serum and urine. The stock solutions were dilutions) to concentrations across the measuring range of each analyte and matrix. Linear regression was performed on results of all test points using expected values calculated based on stocks sample dilution. Results are shown below.

Serum Linearity Results

Na+K+Cl+
Range70-2001-2070-200
y-Intercept-12.8-0.045.39
m1.041.010.97
R21.001.001.00
Standard Error3.50.32.1
Observations396639

Urine Linearity Results

NatKtCit
Range-10-200 ---- - 1-100 - -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
y-Intercept.1.110.15- -0.26
m1.011.021.02
R20.991.001.00
Standard Errorર રે0.92.7
Observations33દવેરેજે

c. Comparison Studies:

Comparison studies were conducted using Diamond Tokyo Boeki ISE Module Calibrators and the predicate Tokyo Boeki ISE Module Calibrators on the Biolis 24i. Samples of both matrices, serum and urine, which spanned the reportable range was used. The results are summarized below.

{4}------------------------------------------------

Serum Correlation Results
Na+K+Cl+
Range70-2001-2070-200
y-Intercept-1.60.492.87
m1.001.010.96
R20.99690.99710.9955
Standard Error2.50.32.6
Observations335739
Urine Correlation Results
Na+K+Cl+
Range10-2001-10010-200
y-Intercept-1.30.442.65
m0.990.980.96
R20.99760.99980.9939
Standard Error2.70.43.7
Observations426273

Stability: ರ.

Accelerated (high temperature) stress test was conducted to support stability claim. Heat stressed reagents showed that calibrator parameters remained within specification thereby demonstrating stability equivalent to Tokyo Boeki calibrators.

Traceability:

All testing for analytes were conducted using Standards prepared from NIST salts. Testing was also conducted using reference methods.

AnalyteStandard Used forDetermination of Analyte ValueInstrument Used
Na, K,NIST 919a, 918aIL 943 (Flame Photometry)
ClNIST 919aCorning 925, SAT-500 Salt Analyzer(Titrimetric)

.

Expected Values (Controls, Calibrators, or Methods),

Target values, (or specifications) were obtained by testing reagents analytically prior to bottling if necessary to meet specifications, testing analytically during the bottling process and prior to release to stock for distribution.

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Conclusion:

:

Based on the results submitted in this pre market notification Diamond Tokyo Boeki ISE Module Calibrators are substantially equivalent to the Tokyo Boeki ISE Module Calibrators in Composition, Intended use, Packaging, and Storage for the measurement of Na*, K*, and CI .

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Image /page/5/Picture/0 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo features a stylized image of an eagle's head in profile, with three faces nested within each other. The logo is surrounded by text that reads "DEPARTMENT OF HEALTH & HUMAN SERVICES • USA" in a circular arrangement.

DEPARTMENT OF HEALTH & HUMAN SERVICES

Food and Drug Administration

Diamond Diagnostics Inc Ms. Kathy Cruz Manager, Ouality Assurance Diamond Diagnostics Inc (USA) 333 Fiske Street Holliston, MA 01746

10903 New Hampshire Avenue Silver Spring, MD 20993

APR 1 7 2012

Re: K120591

Trade/Device Name: Diamond Calibrators for Tokyo Boeki ISE Module Calibrators Regulation Number: 21 CFR 862.1150 Regulation Name: Calibrator Regulatory Class: Class II Product Code: JIT Dated: February 24, 2012

Received: February 28, 2012

Dear Ms. Cruz:

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 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); 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.

{6}------------------------------------------------

Page 2

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), 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 postmarket surveillance, please contact CDRH's Office of Surveillance and Biometric's (OSB's) Division of Postmarket Surveillance at (301) 796-5760. For questions regarding the reporting of adverse events under the MDR regulation (21 CFR Part 803), please go to http://www.fda.gov/Medical

Devices/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) 796-5680 or at its Internet address http://www.fda.gov/MedicalDevices/Resourcesfor You/Industry/default.htm

Sincerely yours,

V.

Gary H. Lai, Ph.D.

Counney H. Lias. Ph.D. Director Division of Chemistry and Toxicology Devices Office of In Vitro Diagnostic Device Evaluation and Safety Center for Devices and Radiological Health

Enclosure

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4. Indications for Use

510(k) Number (if known): _

Device Name: Diamond Calibrators for Tokyo Boeki ISE Module Calibrators

Indications for Use:

Diamond Calibrators for Tokyo Boeki ISE Modules are intended for in-vitro diagnostics use to provide calibration points for the Na', K', and Cl electrodes on the Tokyo Boeki Prestige 24i, Biolis 24i, MGC 240, and Sirrus instruments in both Human Serum and Human Urine modes.

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 IF NEEDED)

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

Signature of Witness

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

510(k) K120591

§ 862.1150 Calibrator.

(a)
Identification. A calibrator is a device intended for medical purposes for use in a test system to establish points of reference that are used in the determination of values in the measurement of substances in human specimens. (See also § 862.2 in this part.)(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 § 862.9.