K Number
K121997
Device Name
IMRIS ONCOLOGY PACKAGE
Manufacturer
Date Cleared
2012-08-10

(32 days)

Product Code
Regulation Number
892.1000
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The IMRIS Oncology package uses the IMRISneuro family of Intra-operative MRI systems/Siemens MAGNETOM MR systems indicated for use as a diagnostic imaging device that produce transverse, sagittal, coronal and oblique cross sectional images, spectroscopic images and / or spectra, and that display the internal structure and / or function of the entire body, including, but not limited to head, neck, and pelvis regions. Depending on the region of interest, contrast agents may be used. These images and / or spectra when interpreted by a trained physician yield information that may assist in diagnosis. The IMRIS Oncology Package provides an additional patient tabletop for IMRIS MR systems /Siemens MAGNETOM that allows patients to be imaged on a flat surface. The flat patient surface enables IMRIS MR system/Siemens MAGNETOM to acquire images in patient positions similar to other modalities that also utilize a flat patient surface such as X-ray, CT, PET and radiation therapy. The IMRIS MR systems/Siemens MAGNETOM MR Systems with IMRIS Oncology Package may also be used with MR safe/MR conditional patient positioning and immobilization accessories to assist in obtaining consistent patient positions throughout multiple imaging sessions.
Device Description
The IMRIS Oncology Package provides an additional patient tabletop (MR SIMS table top) that can be used with IMRIS Neuro 1.5T / Siemens MAGNETOM 1.5T MRI scanners for radiation therapy planning. The MR SIMS table top allows patients to be imaged on a flat surface that matches the imaging patient position. The oncology package includes Head and Neck coil (HNC150) and Pelvic coil (PCC 150). Used in the IMRISneuro 1.5Tsystem/Siemens MAGNETOM 1.5 Tesla, it is indicated for use as a diagnostic imaging device to produce transverse, sagittal, coronal, and oblique images of the internal structures of the head, neck and pelvic regions. When interpreted by a trained physician, these images provide information that can be useful in determining a diagnosis. The IMRIS HNC150 and PCC150 coils can also be used as standard diagnostic head coils and pelvic coil respectively for diagnostic examinations. The Oncology package may be used with MR-conditional/ MR safe patient immobilization accessories to assist in consistent positions throughout multiple imaging sessions.
More Information

No
The summary describes a patient tabletop and coils for an existing MRI system, focusing on physical components and standard imaging capabilities. There is no mention of AI, ML, or advanced image processing beyond standard diagnostic imaging.

No.
The device is clearly indicated for use as a "diagnostic imaging device" and the information it provides "may assist in diagnosis." There is no mention of treating or preventing diseases.

Yes
The "Intended Use / Indications for Use" section explicitly states that the device is "indicated for use as a diagnostic imaging device".

No

The device description explicitly mentions physical components like a patient tabletop, head and neck coil, and pelvic coil, which are hardware. The performance studies also include testing of these physical components.

No, this device is not an IVD (In Vitro Diagnostic).

Here's why:

  • IVD Definition: In Vitro Diagnostic devices are used to examine specimens taken from the human body (like blood, urine, tissue) to provide information for diagnosis, monitoring, or screening.
  • Device Function: The IMRIS Oncology package and the associated MR systems are imaging devices. They produce images of the internal structure and function of the body in vivo (within the living body).
  • Intended Use: The intended use clearly states that the device is a "diagnostic imaging device" that produces images and/or spectra to assist in diagnosis when interpreted by a trained physician. This is consistent with medical imaging, not IVD testing.
  • Device Description: The description focuses on the physical components (tabletop, coils) and their use in acquiring MR images of the patient's body.
  • Performance Studies: The performance studies described are related to the safety and image quality of the MR system and its components, not the analysis of biological specimens.

The device is a medical imaging device used for diagnostic purposes, specifically in the context of radiation therapy planning. It does not perform tests on samples taken from the body.

N/A

Intended Use / Indications for Use

The IMRIS Oncology package uses the IMRISneuro family of Intra-operative MRI systems/Siemens MAGNETOM MR systems indicated for use as a diagnostic imaging device that produce transverse, sagittal, coronal and oblique cross sectional images, spectroscopic images and / or spectra, and that display the internal structure and / or function of the entire body, including, but not limited to head, neck, and pelvis regions. Depending on the region of interest, contrast agents may be used. These images and / or spectra when interpreted by a trained physician yield information that may assist in diagnosis.

The IMRIS Oncology Package provides an additional patient tabletop for IMRIS MR systems /Siemens MAGNETOM that allows patients to be imaged on a flat surface. The flat patient surface enables IMRIS MR system/Siemens MAGNETOM to acquire images in patient positions similar to other modalities that also utilize a flat patient surface such as X-ray, CT, PET and radiation therapy.

The IMRIS MR systems/Siemens MAGNETOM MR Systems with IMRIS Oncology Package may also be used with MR safe/MR conditional patient positioning and immobilization accessories to assist in obtaining consistent patient positions throughout multiple imaging sessions.

Product codes

LNH, MOS

Device Description

The IMRIS Oncology Package provides an additional patient tabletop (MR SIMS table top) that can be used with IMRIS Neuro 1.5T / Siemens MAGNETOM 1.5T MRI scanners for radiation therapy planning. The MR SIMS table top allows patients to be imaged on a flat surface that matches the imaging patient position. The oncology package includes Head and Neck coil (HNC150) and Pelvic coil (PCC 150). Used in the IMRISneuro 1.5Tsystem/Siemens MAGNETOM 1.5 Tesla, it is indicated for use as a diagnostic imaging device to produce transverse, sagittal, coronal, and oblique images of the internal structures of the head, neck and pelvic regions. When interpreted by a trained physician, these images provide information that can be useful in determining a diagnosis. The IMRIS HNC150 and PCC150 coils can also be used as standard diagnostic head coils and pelvic coil respectively for diagnostic examinations. The Oncology package may be used with MR-conditional/ MR safe patient immobilization accessories to assist in consistent positions throughout multiple imaging sessions.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Magnetic Resonance

Anatomical Site

Entire body, including, but not limited to head, neck, and pelvis regions.

Indicated Patient Age Range

Not Found

Intended User / Care Setting

Trained physician / Hospital Diagnostic room

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)

Design Verification and Validation Test (Bench Testing): The IMRIS Oncology Package passed tests including IEC 60601-1 compliance, IEC 60601-2-33 compliance, Clinical image comparison, MRI compatibility test (MR image artifacts test, MR heating test), Surface heating (normal and single fault conditions), Single fault condition unplugged (passive detuning test), Workflow, and Loading test. The Head and Neck coil (HNC150) and Pelvic coil (PCC 150) Image Non-Uniformity and SNR was measured and reported in accordance with NEMA MS 9-2008. The oncology package was tested for electrical, mechanical, and flammability hazards. The Oncology Package provided clinical images demonstrating clinical effectiveness. The coils were tested for MR image artifacts and surface heating. The HNC 150 and PCC 150 coils SNR and Image non-uniformity were tested according to NEMA standards. The tests outlined were executed with acceptable results. Performance data demonstrate safety and effectiveness.

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

Not Found

Predicate Device(s)

K102155

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 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.

0

K121997

IMRIS

AUG 1 0 2012

510(k) Summary for Oncology Package

510(k) SUMMARY FOR IMRIS ONCOLOGY PACKAGE

(As required by 21 CFR 807.92)

1. GENERAL INFORMATION Establishment: IMRIS Inc. Address: 100-1370 Sony Place Winnipeg, Manitoba Canada, R3T 1N5 3003807210 Registration Number: Mr. Sanjay Shah Contact Person: QA and Regulatory Engineer Email: sshah@imris.com Phone: 1-204-480-7070 Fax: 1-204-480-7071 Date of Summary July 23, 2012 Preparation: Device Name / Trade name IMRIS Oncology Package Classification Name: Magnetic resonance diagnostic device. Classification Panel: Radiology Classification (CFR section): 21 CFR 892.1000 Class: Class II Product Code: LNH

2. PREDICATE DEVICES

The IMRIS Oncology Package is substantially equivalent to the following predicate medical devices.

| NAME OF THE DEVICE | 510(K) NUMBER | DATE OF
CLEARANCE | MANUFACTURER |
|-------------------------------|---------------|----------------------|---------------------------|
| MR Radiation Oncology Options | K102155 | August 31, 2010 | GE Medical System,
LLC |

1

IMBIS

510(k) Summary for Oncology Package

3. DEVICE DESCRIPTION

The IMRIS Oncology Package provides an additional patient tabletop (MR SIMS table top) that can be used with IMRIS Neuro 1.5T / Siemens MAGNETOM 1.5T MRI scanners for radiation therapy planning. The MR SIMS table top allows patients to be imaged on a flat surface that matches the imaging patient position. The oncology package includes Head and Neck coil (HNC150) and Pelvic coil (PCC 150). Used in the IMRISneuro 1.5Tsystem/Siemens MAGNETOM 1.5 Tesla, it is indicated for use as a diagnostic imaging device to produce transverse, sagittal, coronal, and oblique images of the internal structures of the head, neck and pelvic regions. When interpreted by a trained physician, these images provide information that can be useful in determining a diagnosis. The IMRIS HNC150 and PCC150 coils can also be used as standard diagnostic head coils and pelvic coil respectively for diagnostic examinations. The Oncology package may be used with MR-conditional/ MR safe patient immobilization accessories to assist in consistent positions throughout multiple imaging sessions.

4. INDICATION FOR USE

The IMRIS Oncology package uses the IMRISneuro family of Intra-operative MRI systems /Siemens MAGNETOM MR systems indicated for use as a diagnostic imaging device that produce transverse, sagittal, coronal and oblique cross sectional images, spectroscopic images and / or spectra, and that display the internal structure and / or function of the entire body, including, but not limited to head, neck, and pelvis regions. Depending on the region of interest, contrast agents may be used. These images and / or spectra when interpreted by a trained physician vield information that may assist in diagnosis.

The IMRIS Oncology Package provides an additional patient tabletop for IMRIS MR systems /Siemens MAGNETOM that allows patients to be imaged on a flat surface. The flat patient surface enables IMRIS MR system/Siemens MAGNETOM to acquire images in patient positions similar to other modalities that also utilize a flat patient surface such as X-ray. CT, PET and radiation therapy.

The IMRIS MR systems/Siemens MAGNETOM MR systems with IMRIS Oncology Package may also be used with MR safe/MR conditional patient positioning and immobilization accessories to assist in obtaining consistent patient positions throughout multiple imaging sessions.

CharacteristicGE MR Radiation Oncology OptionsIMRIS Oncology Package
FDA 510(k) #K102155Current Submission
Manufactured
byGE Medical Systems, LLCIMRIS Inc.
Intended use
/Indications for
useThe MR Radiation Oncology Options
are a patient positioning package
intended for use with the GE wide bore
MR Scanners. The MR Radiation
Oncology Options when used with a
GE wide bore MR scanner is a whole
body magnetic resonance scanner
designed to support high resolution,The IMRIS Oncology package
uses the IMRISneuro family of
Intra-operative MRI
systems/Siemens MAGNETOM
MR systems indicated for use as
a diagnostic imaging device that
produce transverse, sagittal,
coronal and oblique cross
510(k) Summary for Oncology Package
high signal-to-noise ratio and short
scan times. The GE wide bore MR
scanners with MR Radiation Oncology
Options are indicated for use as a
diagnostic imaging device to provide
axial, sagittal, coronal, and oblique
images, spectroscopic images, and/or
spectra, dynamic images of the internal
structures and organs of the entire
body, including but not limited to head,
neck, TMJ, spine, breast, heart,
abdomen, pelvis joints, prostate, blood
vessels, and musculoskeletal regions
of the body. The images produced by
the GE wide bore scanners with MR
Radiation Oncology Options reflect the
spatial distribution of protons (hydrogen
nuclei) exhibiting magnetic resonance.
These images and/or spectra when
interpreted by a trained physician yield
information that may assist in
diagnosis.
The MR Radiation Oncology Options
include a removable patient table insert
for GE wide bore MR scanners that
allow patients to be imaged on a flat
surface. The flat patient surface allows
image acquisition in patient positions
similar to other modalities that also use
a flat patient surface such as X-Ray,
CT, PET, and radiation therapy.
The GE wide bore MR scanners with
the MR Radiation Oncology Options
may also be used with MR- compatible
patient positioning and immobilization
accessories to assist in obtaining
consistent patient positions throughout
multiple imaging sessions.sectional images, spectroscopic
images and / or spectra, and
that display the internal
structure and / or function of the
entire body, including, but not
limited to head, neck, and pelvis
regions. Depending on the
region of interest, contrast
agents may be used. These
images and / or spectra when
interpreted by a trained
physician yield information that
may assist in diagnosis.
The IMRIS Oncology Package
provides an additional patient
tabletop for IMRIS MR
systems/Siemens MAGNETOM
that allows patients to be
imaged on a flat surface. The
flat patient surface enables
IMRIS MR system/Siemens
MAGNETOM to acquire images
in patient positions similar to
other modalities that also utilize
a flat patient surface such as X-
ray, CT, PET and radiation
therapy.
The IMRIS MR
systems/Siemens MAGNETOM
MR systems with IMRIS
Oncology Package may also be
used with MR safe/MR
conditional patient positioning
and immobilization accessories
to assist in obtaining consistent
patient positions throughout
multiple imaging sessions.
Where usedHospital Diagnostic roomHospital Diagnostic room
Anatomical
sitesEntire body, including but not limited to
head, neck, TMJ, spine, breast, heart,
abdomen, pelvis joints, prostate, blood
vessels, and musculoskeletal regions
of the bodyEntire body, including, but not
limited to head, neck, and pelvis
regions

5. COMPARISION TO PREDICATE DEVICES

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K121997

.

:

3

K12/997

IMRIS

510(k) Summary for Oncology Package

  1. SUMMARY OF THE TECHNOLOGICAL CHARACTERISTICS OF THE DEVICE COMPARED TO THE PREDICATE DEVICE: (807.92 (A) (6))

.

| Characteristic | GE MR Radiation Oncology
Options | IMRIS Oncology Package | Comparison |
|--------------------------------------------------|------------------------------------------------------------------------------------|----------------------------------------------------------------|--------------------------------------------------|
| FDA 510(k) # | K102155 | Current Submission | |
| | MR-SIM table Top and S Frame mask adaptor | | |
| | MR radiation oncology
position insert | MR-SIM table top and S-
frame adaptor | |
| MRI system
Compatibility | GE 1.5T MRI scanners | Siemens MAGNETOM 1.5T
MRI systems IMRIS 1.5T
MRI systems | Same field
Strength
1.5Tesla |
| Surface | Flat Surface | Flat Surface | Same |
| | Mobile patient table top with
embedded high-density,
posterior RF coil array | Table top with cavity allows
mounting of posterior coils | Similar
design |
| Material | Fiber glass with foam core | Acetal | Different |
| MRI safety | MR compatible | MR safe | Same |
| S-Frame and mask
connecting with
table top | Yes | Yes | Same |
| IEC 60601-1
compliance | Yes | Yes | Same |
| Head and Neck Coil (HNC 150) | | | |
| | GE head and neck coil (6-
channel flex coil) | IMRIS Head and neck
coil (HNC150) | Comparison |
| MRI system
Compatibility | GE 1.5T MRI Scanners | Siemens 1.5T MRI
scanners
IMRIS 1.5T MRI system | Same field
strength -
1.5T MRI
Scanners |
| Coil Type | Receive-only six channel
phased array coil | Receive-only eighteen
channel phased array coil | Similar |
| RF Cable Interface | Interface Cable with
Insulated Cable Traps | Interface Cable with
Insulated Cable Traps | Same |
| Tune and Match | No tune, no match | No tune, no match | Same |
| Safety features | Active and Passive
Decoupling | Active and Passive
Decoupling | Same |
| | | RF Fuse | New |
| Coil Enclosure
Material and design | Vinyl coating closed cell
foam | Vinyl coating closed cell
foam | Same |

.

.

4

K121997

IMRIS

510(k) Summary for Oncology Package

CharacteristicGE MR Radiation Oncology OptionsIMRIS Oncology PackageComparison
FDA 510(k) #K102155Current Submission
FlexibleFlexibleSame
IEC 60601-1 ComplianceYesYesSame IEC
standards
Pelvic Coil (PCC 150)
GEM anterior array coil
GEM posterior array coilIMRIS Pelvic coil
(PCC150)Comparison
MRI system CompatibilityGE 1.5T MRI ScannersSiemens 1.5T MRI
Scanners
IMRIS 1.5T MRI systemSame field
strength -
1.5T MRI
Scanners
Coil TypeReceive-only up to 36
channel phased array coilReceive-only eleven
channel phased array coilSimilar
System connectionThe coil plugs into the MRI
SystemThe coil plugs into the MRI
SystemSame
RF Cable InterfaceInterface Cable with
Insulated Cable TrapsInterface Cable with
Insulated Cable TrapsSame
Tune and MatchNo tune, no matchNo tune, no matchSame
Safety featuresActive and Passive
DecouplingActive and Passive
DecouplingSame
RF FuseNew
Coil Enclosure
Material and designPlastic, Vinyl coated closed
cell foam
FlexiblePlastic, Vinyl coated
closed cell foam
FlexibleSame
IEC 60601-1
ComplianceYesYesSame

.

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Image /page/5/Picture/1 description: The image shows a sequence of handwritten digits and a letter. The sequence starts with the letter 'K', followed by the numbers '121997'. The numbers are written in a simple, slightly slanted style, and the overall impression is that of a quickly jotted down code or identifier.

IMRIS

510(k) Summary for Oncology Package

7. SUMMARY OF NON-CLINICAL DATA

Design Verification and Validation Test (Bench Testing)

The IMRIS Oncology Package passed the following tests and meets product specifications. IMRIS has performed a number of V&V tests. The main tests include

  • IEC 60601-1 compliance .
  • . IEC 60601-2-33 compliance
  • Clinical image comparison .
  • MRI compatibility test (MR image artifacts test, MR heating test), .
  • Surface heating (normal and single fault conditions) .
  • Single fault condition unplugged (passive detuning test) .
  • Workflow .
  • Loading test .
  • The Head and Neck coil (HNC150) and Pelvic coil (PCC 150) Image Non-Uniformity and . SNR was measured and is reported in accordance with NEMA MS 9-2008 Characterization of Special Purpose Coils for Diagnostic Resonance Images. The NEMA MS 9-2008 references the ALTERNATE MEASUREMENT PROCEDURE as described in NEMA MS 6-2008.

The oncology package is tested for electrical, mechanical, and flammability hazards. The IMRIS Oncology package complies with voluntary standards (IEC 60601-2-33, and UL 94). The Oncology Package provided clinical images which demonstrate the clinical effectiveness of the Oncology package. The HNC 150 and PCC 150 coils are tested for MR image artifacts and surface heating test. The HNC 150 and PCC 150 coils SNR and Image non-uniformity are tested according to NEMA standards. The tests outlined above have been executed with acceptable results. Performance data demonstrate safety and effectiveness of the IMRIS Oncology Package.

8. CONCLUSION

The IMRIS Oncology Package has the same intended use and indications for use as the predicate devices. Performance data demonstrate safety and effectiveness of the IMRIS Oncology Package with the new characteristics.

The IMRIS Oncology Package verification results and performance/safety standard results show that the device is safe and effective and substantially equivalent to the currently available predicate device, GE MR Radiation Oncology options.

6

Image /page/6/Picture/0 description: The image shows the logo for the U.S. Department of Health and Human Services. The logo consists of a circular seal with the words "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" arranged around the perimeter. Inside the circle is a stylized image of an eagle or other bird-like figure, with three curved lines representing its wings or body.

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

—AUG—1-0—2012—

Mr. Sanjay Shah QA and Regulatory Engineer IMRIS Inc. 100-1370 Sony Place WINNIPEG MANITOBA R3T 1N5 CANADA .

Re: K121997

Trade/Device Name: IMRIS Oncology Package Regulation Number: 21 CFR 892.1000 Regulation Name: Magnetic resonance diagnostic device Regulatory Class: II Product Code: LNH and MOS Dated: July 4, 2012 Received: July 9, 2012

Dear Mr. Shah:

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 class II (Special Controls), it may be subject to such 11 your dowled to the birting 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 r lease of actived and I Drimination that your device complies with other requirements of the Act that 1 Dr Has Intact a and regulations administered by other Federal agencies. You must or any I vatual 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

7

medical device-related adverse events) (21 CFR 803); and good manufacturing practice mourements 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 will anow you to oogin finding of substantial equivalence of your device to a legally marketed nothleation. THE FDTS imanly of tication 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-GFR-Parts 801-and If you desire specific advice of In Vitro Diagnostic Device Evaluation and Safety at (301) 796-5450. Also, please note the regulation entitled, "Misbranding by reference to premarket 5-150. Thise, productions are veganding the reporting 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 Tou may other bates generational 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

8

Indications for Use

| 510(k) Number (if known): |