K Number
K132971
Device Name
MONACO
Date Cleared
2013-11-20

(58 days)

Product Code
Regulation Number
892.5050
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The Monaco system is used to make treatment plans for patients with prescriptions for external beam radiation therapy. The system calculates dose for photon and electron treatment plans and displays, on-screen and in hard-copy. two- or three-dimensional radiation dose distributions inside patients for given treatment plan set-ups. The Monaco product line is intended for use in radiation treatment planning. It uses generally accepted methods for: - contouring - image manipulation - simulation - image fusion - plan optimization - QA and plan review
Device Description
Monaco is a radiation treatment planning system that first received FDA clearance in 2007 (K071938). The modified system received clearance in 2009, when Volumetric Modulated Arc Therapy (VMAT) planning capability was added (K091179) and again when Dynamic Conformal Arc planning was added (K110730). The Monaco system accepts patient diagnostic imaging data and "source" dosimetry data from a linear accelerator. The system then permits the user to display and define (contour) the target volume to be treated and critical structures which must not receive above a certain level of radiation on these diagnostic images. Based on the prescribed dose, the user, a Dosimetrist or Medical Physicist, can create multiple treatment scenarios involving the number, position(s) and energy of radiation beams and the use of beam modifiers between the source of radiation and the patient to shape the beam. The Monaco system then produces a display of radiation dose distribution within the patient, indicating doses to the target volume and surrounding structures. The "best" plan satisfying the prescription is then selected, one that maximizes dose to the target volume while minimizing dose to surrounding healthy volumes.
More Information

Not Found

No
The document describes a radiation treatment planning system that uses established methods for dose calculation and plan optimization. There is no mention of AI, ML, or related concepts like neural networks or training data. The optimization process appears to be based on user-defined parameters and algorithms, not learned patterns.

No
The device is a radiation treatment planning system, which is used to calculate dose distributions for treatment plans. It does not directly provide therapy to patients.

No
The device is described as a "radiation treatment planning system" that calculates and displays radiation dose distributions for external beam radiation therapy. It uses diagnostic imaging data but does not itself provide a diagnosis. Its function is to plan treatment based on a prescription, not to diagnose a condition.

No

The device description explicitly states that the system accepts "source" dosimetry data from a linear accelerator, which is a hardware component. While the core function is software-based treatment planning, it relies on input from a physical medical device.

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

Here's why:

  • IVD Definition: In Vitro Diagnostic devices are used to examine specimens derived from the human body (like blood, urine, tissue) to provide information for diagnosis, monitoring, or screening.
  • Monaco's Function: The Monaco system is a radiation treatment planning system. Its purpose is to create treatment plans for patients receiving external beam radiation therapy. It uses patient diagnostic imaging data and linear accelerator data to calculate and display radiation dose distributions within the patient's body.
  • No Specimen Analysis: The system does not analyze any biological specimens from the patient. It works with imaging data and physical parameters related to the radiation source and the patient's anatomy.

Therefore, the Monaco system falls under the category of a medical device used for treatment planning, not an In Vitro Diagnostic device.

N/A

Intended Use / Indications for Use

The Monaco system is used to make treatment plans for patients with prescriptions for external beam radiation therapy. The system calculates dose for photon and electron treatment plans and displays, on-screen and in hard-copy. two- or three-dimensional radiation dose distributions inside patients for given treatment plan set-ups.

The Monaco product line is intended for use in radiation treatment planning. It uses generally accepted methods for:

  • · contouring
  • · image manipulation
  • · simulation
  • · image fusion
  • · plan optimization
  • · QA and plan review

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

MUJ

Device Description

Monaco is a radiation treatment planning system that first received FDA clearance in 2007 (K071938). The modified system received clearance in 2009, when Volumetric Modulated Arc Therapy (VMAT) planning capability was added (K091179) and again when Dynamic Conformal Arc planning was added (K110730). The Monaco system accepts patient diagnostic imaging data and "source" dosimetry data from a linear accelerator. The system then permits the user to display and define (contour) the target volume to be treated and critical structures which must not receive above a certain level of radiation on these diagnostic images.

Based on the prescribed dose, the user, a Dosimetrist or Medical Physicist, can create multiple treatment scenarios involving the number, position(s) and energy of radiation beams and the use of beam modifiers between the source of radiation and the patient to shape the beam. The Monaco system then produces a display of radiation dose distribution within the patient, indicating doses to the target volume and surrounding structures. The "best" plan satisfying the prescription is then selected, one that maximizes dose to the target volume while minimizing dose to surrounding healthy volumes.

Mentions image processing

Yes

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

Not Found

Indicated Patient Age Range

Not Found

Intended User / Care Setting

Dosimetrist or Medical Physicist
The system is used in a clinical setting for radiation treatment planning.

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

Validation testing involved simulated clinical workflows. and algorithm testing, described in detail in section 20, which validated the accuracy of dose calculation functions using a simulated clinical setup. The product was deemed fit for clinical use.

Summary of Performance Studies (study type, sample size, AUC, MRMC, standalone performance, key results)

Clinical trials were not performed as part of the development of this product. Clinical testing on patients is not advantageous in demonstrating substantial equivalence or safety and effectiveness of the device since testing can be performed such that no human subjects are exposed to risk. Validation testing involved simulated clinical workflows. and algorithm testing, described in detail in section 20, which validated the accuracy of dose calculation functions using a simulated clinical setup. The product was deemed fit for clinical use.

Verification tests were written and executed to ensure that the system is working as designed. Over 500 test procedures were executed, including tests to verify requirements for new product functionality, tests to ensure that risk mitigations function as intended, and regression tests to ensure continued safety and effectiveness of existing functionality. Monaco passed testing and was deemed safe and effective for its intended use.

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.

K110730, K080601, K102011, K121448

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

§ 892.5050 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.

0

NOV 2 0 2013

K13297/

September 20, 2013

Monaco RTP System Premarket Notification (510(k)) Summary of Safety and Effectiveness

INTRODUCTION

This document summarizes the safety and effectiveness information contained within the Monaco RTP System 510(k). The Summary of Safety and Effectiveness contains no confidential or trade secret information and is intended for full public disclosure and distribution.

PREMARKET NOTIFICATION INFORMATION

  • l . Product Information:

    • a. Product Trade Name
    • b. Release Version Number
    1. Classification Information:
    • a. Classification Name system
    • b. Common/Usual Name
    • Product Classification c.
    • d. Product Code
    • Reference e.
    • ﯾﺖ Review Panel
    1. Establishment Information:
    • a. Submitter
    • b. Submitter Address
  • Monaco Release 5.0
    Medical charged-particle radiation therapy

Radiation Treatment Planning Svstem Class II MUJ 21 CFR 892.5050 Radiology

IMPAC Medical Systems, Inc. 13723 Riverport Dr., Suite 100 Maryland Heights, MO 63043

  • c. Establishment Number
  • d. Contact
  • e. Contact Phone
  • ি Contact Fax

1937649 Kathryn Stinson, RA Specialist 314-993-0003

314-993-0075

1

24. 11. 15 PREDICATE DEVICE INFORMATION

The Monaco RTP System is substantially equivalent to the following devices that the Food and Drug Administration (FDA) has cleared for distribution and are currently being actively marketed in the United States. Monaco is substantially equivalent to these products in intended use and safety and effectiveness.

    1. Monaco RTP System IMPAC Medical Systems, Inc. K110730
    1. ERGO++ IMPAC Medical Systems, Inc. K080601
    1. Eclipse Treatment Planning System Varian Medical Systems, Inc. K102011
    1. Oncentra Nulcetron Corporation K121448

MONACO INTENDED USE/INDICATIONS FOR USE

The Monaco system is used to make treatment plans for patients with prescriptions for external beam radiation therapy. The system calculates dose for photon and electron treatment plans and displays, on-screen and in hard-copy. two- or three-dimensional radiation dose distributions inside patients for given treatment plan set-ups.

The Monaco product line is intended for use in radiation treatment planning. It uses generally accepted methods for:

  • · contouring
  • · image manipulation
  • · simulation
  • · image fusion
  • · plan optimization
  • · QA and plan review

2

: 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

DESCRIPTION OF THE PRODUCT

Monaco is a radiation treatment planning system that first received FDA clearance in 2007 (K071938). The modified system received clearance in 2009, when Volumetric Modulated Arc Therapy (VMAT) planning capability was added (K091179) and again when Dynamic Conformal Arc planning was added (K110730). The Monaco system accepts patient diagnostic imaging data and "source" dosimetry data from a linear accelerator. The system then permits the user to display and define (contour) the target volume to be treated and critical structures which must not receive above a certain level of radiation on these diagnostic images.

Based on the prescribed dose, the user, a Dosimetrist or Medical Physicist, can create multiple treatment scenarios involving the number, position(s) and energy of radiation beams and the use of beam modifiers between the source of radiation and the patient to shape the beam. The Monaco system then produces a display of radiation dose distribution within the patient, indicating doses to the target volume and surrounding structures. The "best" plan satisfying the prescription is then selected, one that maximizes dose to the target volume while minimizing dose to surrounding healthy volumes.

LEVEL OF CONCERN

Item 4b of Table 1 in the FDA Guidance document entitled, "Guidance for the Content of Premarket Submissions for Software Contained in Medical Devices asks, "Does the Software Device control the delivery of potentially harmful energy that could result in death or serious injury, such as radiation treatment systems ... " Monaco does not directly control the linear accelerator that delivers the radiation. Once completed, plans are reviewed and approved by qualified clinicians and may be subject to quality assurance practices before treatment actually takes place. There is no automatic link between the Monaco software and the linear accelerator. However, should a flaw in the treatment plan escape the notice of the qualified professionals using the Monaco system, serious injury or death could result. Therefore, we believe Monaco to be of major level of concern.

SUMMARY OF CLINICAL TESTING

Clinical trials were not performed as part of the development of this product. Clinical testing on patients is not advantageous in demonstrating substantial equivalence or safety and effectiveness of the device since testing can be performed such that no human subjects are exposed to risk. Validation testing involved simulated clinical workflows. and algorithm testing, described in detail in section 20, which validated the accuracy of dose calculation functions using a simulated clinical setup. The product was deemed fit for clinical use.

SUMMARY OF NON-CLINICAL TESTING

3

  • -- Verification tests were written and executed to ensure that the system is working as designed. Over 500 test procedures were executed, including tests to verify requirements for new product functionality, tests to ensure that risk mitigations function as intended, and regression tests to ensure continued safety and effectiveness of existing functionality. Monaco passed testing and was deemed safe and effective for its intended use.

4

| | Monaco w/new
features | Monaco
(K110730) | ERGO++
(K080601) | Eclipse TPS
(K102011) | Oncentra
(K121448) | |
|-----------------------------------------------------------------------------------------------------------------------------------|----------------------------------------------------------------------------------------------------------------|--------------------------------------------------------------------|---------------------------|------------------------------------------------------------------------------------------------------|-----------------------------------------------------------------------|---------|
| Intended Use and Indications for Use | | | | | | |
| Contouring | Yes | Yes | Yes | Yes | Yes | |
| Dose Calculation | Yes | Yes | Yes | Yes | Yes | |
| Plan Optimization | Yes | Yes | Yes | Yes | Yes | |
| Image Manipulation & Fusion | Yes | Yes | Yes | Yes | Yes | |
| CT Simulation | Yes | Yes | No | Yes | Yes | |
| QA/Plan Review | Yes | Yes | Yes | Yes | Yes | |
| Brachytherapy | No | No | No | Yes | Yes | |
| Technological Characteristics | | | | | | |
| Dose Calculation Algorithms | Monte Carlo
(electron &
photon),
Collapsed Cone
(photon), Pencil
Beam
(optimization
only) | Monte Carlo
(photon) &
Pencil Beam
(optimization
only) | Pencil Beam
(electron) | Pencil Beam,
Monte Carlo
(electron)
Acurus XB &
AAA (photon),
proton eye
algorithm | Monte Carlo
(electron), Collapsed
Cone (photon),
Pencil Beam | |
| Calculation and display of standard ized
uptake value for contouring on PET images | Yes | No | No | Yes | No | |
| Local Biological Measure Optimization | Yes | Yes | No | Yes | No | |
| MLC Support | Yes | Yes | Yes | Yes | Yes | |
| Support for Other Treatment Aids | Yes | No | Yes | Yes | Yes | |
| Support for Dynamic Delivery Methods | Yes | Yes | Yes | Yes | Yes | |
| Operating System | Windows | Windows | Linux | Windows | Windows | |
| DICOM RT Support | Yes | Yes | Yes | Yes | Yes | |
| Modalities Supported: Full RTP Workflow | Photon &
Electron | Photon Only | Photon Only | Electron,
Photon, Proton | Electron, Photon | |
| | | | | | | くことここで、 |
| Modalities Supported: Partial Workflow* | lectron, Photon
Proton | Photon, Protor
Electron, | N/A | Same as above | N/A | |
| Can be used for stereotactic treatment
planning | Yes | Yes | Yes | Yes | No | |
| Stereotactic Localization | No | No | Yes | Yes | No | |
| Support for Cone-Based Stereotactic | Yes | No | Yes | Yes | No | |
| . It is nessble to configure Manchoolity such as image fusion, contantine and simulation, not including MIRT optimization or dose | | | | | | |

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5

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6

Image /page/6/Picture/0 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo features the department's emblem, which is a stylized representation of a human figure embracing a globe. The emblem is accompanied by the text "DEPARTMENT OF HEALTH & HUMAN SERVICES USA" arranged in a circular fashion around the emblem. The logo is in black and white.

DEPARTMENT OF HEALTH & HUMAN SERVICES

Public Health Service

Food and Drug Administration 10903 New Hampshire Avenue Document Control Center - WO6 Silver Spring, MD 20993-0002

November 20, 2013

IMPAC Medical Systems, Inc. % Ms. Kathryn Stinson Regulatory Affairs Specialist 13723 Riverport Drive. Suite 100 MARYLAND HEIGHTS MO 63043

Re: K132971

Trade/Device Name: Monaco RTP System Regulation Number: 21 CFR 892.5050 Regulation Name: Medical charged-particle radiation therapy system Regulatory Class: II Product Code: MUJ Dated: September 20, 2013 Received: September 23, 2013

Dear Ms. Stinson:

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. Please note: CDRH does not evaluate information related to contract liability warranties. We remind you, however, that device labeling must be truthful and not misleading.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to additional controls. Existing major regulations affecting your device can be found in the Code of Federal Regulations, Title 21, Parts 800 to 898. 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 Part 801); medical device reporting (reporting of medical device-related adverse events) (21 CFR 803); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820): and if applicable. the electronic product radiation control provisions (Sections 531-542 of the Act): 21 CFR 1000-1050.

7

Page 2-Ms. Stinson

.. ·· ······

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please contact the Division of Small Manufacturers, International and Consumer Assistance at its tollfree number (800) 638 2041 or (301) 796-7100 or at its Internet address

http://www.fda.gov/MedicalDevices/ResourcesforYou/Industrv/default.htm. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR 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/Medicall.covices/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/MedicalDevices/Resourcesfor You/Industry/default.htm.

Sincerely yours,

michal D.

for

Janine M. Morris Director, Division of Radiological Health Office of In Vitro Diagnostics and Radiological Health Center for Devices and Radiological Health

Enclosure

8

Indications for Use

510(k) Number (if known): K 132971

Device Name: Monaco RTP System

Indications For Use:

The Monaco system is used to make treatment plans for patients with prescriptions for external beam radiation therapy. The system calculates dose for photon and electron treatment plans and displays. on-screen and in hard-copy: two- or three-dimensional radiation dose distributions inside patients for given treatment plan set-ups.

The Monaco product line is intended for use in radiation reading . It uses generally accepted methods for:

  • · contouring
  • · image manipulation
  • · simulation
  • · image fusion
  • · plan optimization
  • · QA and plan review

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

Over-The-Counter Use (21 CFR 807 Subpart C)

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

Concurrence of Center for Devices and Radiological Health (CDRH)

Michael D.'Hara

(Division Sign Off) Division of Radiological Health Office of In Vitro Diagnostic and Radiological HealthPage 1 of __1

510(k) ___K 132971