K Number
K133983
Device Name
INTRA. OX HANDHELD TISSUE OXIMETER
Manufacturer
Date Cleared
2014-09-12

(259 days)

Product Code
Regulation Number
870.2700
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The Intra.Ox™ Handheld Tissue Oximeter is intended to non-invasively estimate the percent oxygen saturation (StO2) in a volume of tissue. The Intra.Ox™ Handheld Tissue Oximeter is indicated for use in monitoring patients during circulatory or perfusion examinations.
Device Description
The ViOptix Intra.Ox™ Handheld Tissue Oximeter is a sterile, cordless, batterypowered device that non-invasively estimates the percent oxygen saturation (StO2) in a volume of tissue. The device uses spatially-resolved optical measurements at four wavelengths. The device performs measurements on the patient by direct physical contact to the patient's tissue and displays the StO2 estimate on the built-in screen. The ViOptix Intra.Ox™ Handheld Tissue Oximeter is a single-use disposable constructed from biocompatible materials that can tolerate bodily fluids and other liquids such as disinfectants and marking materials.
More Information

No
The summary describes a device that uses spatially-resolved optical measurements and standard signal processing to estimate tissue oxygen saturation. There is no mention of AI, ML, or related concepts in the device description, performance studies, or key metrics.

No.
The device is intended to monitor physiological parameters (specifically oxygen saturation) during examinations, not to treat a condition. While it provides diagnostic information, it does not perform a direct therapeutic action.

Yes

The device estimates the percent oxygen saturation (StO2) in a volume of tissue and is indicated for use in "monitoring patients during circulatory or perfusion examinations." This monitoring provides information about the patient's physiological state, which can be used to aid in diagnosis or management of conditions related to circulation or perfusion.

No

The device description explicitly states it is a "sterile, cordless, battery-powered device" that performs measurements through "direct physical contact to the patient's tissue" and has a "built-in screen," indicating it is a hardware device with integrated software, not a software-only device.

Based on the provided information, the Intra.Ox™ Handheld Tissue Oximeter is not an In Vitro Diagnostic (IVD) device.

Here's why:

  • IVD Definition: In Vitro Diagnostics are medical devices used to examine specimens derived from the human body (like blood, urine, or tissue samples) outside the body to provide information for diagnosis, monitoring, or screening.
  • Intra.Ox™ Function: The description clearly states that the Intra.Ox™ device "non-invasively estimates the percent oxygen saturation (StO2) in a volume of tissue" by "direct physical contact to the patient's tissue." This means it's performing measurements on the living patient, not on a sample taken from the patient.

Therefore, the Intra.Ox™ is a non-invasive medical device used for monitoring physiological parameters in vivo, not an in vitro diagnostic device.

N/A

Intended Use / Indications for Use

The Intra.Ox™ Handheld Tissue Oximeter is intended to non-invasively estimate the percent oxygen saturation (StO2) in a volume of tissue.

The Intra.Ox™ Handheld Tissue Oximeter is indicated for use in monitoring patients during circulatory or perfusion examinations.

Product codes

MUD

Device Description

The ViOptix Intra.Ox™ Handheld Tissue Oximeter is a sterile, cordless, battery-powered device that non-invasively estimates the percent oxygen saturation (StO2) in a volume of tissue. The device uses spatially-resolved optical measurements at four wavelengths. The device performs measurements on the patient by direct physical contact to the patient's tissue and displays the StO2 estimate on the built-in screen. The ViOptix Intra.Ox™ Handheld Tissue Oximeter is a single-use disposable constructed from biocompatible materials that can tolerate bodily fluids and other liquids such as disinfectants and marking materials.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Spectrophotometric oximetry

Anatomical Site

Not Found

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

Bench Tests:
The Intra.Ox™ devices were found to measure absorption coefficients with a high degree of correlation to actual absorption coefficients in liquid phantoms prepared with Intralipid and swine whole blood. The correlation coefficient was greater than 0.9 for each of the four wavelengths used in the devices.

The Intra.Ox™ devices were shown to agree well with the predicate device in StO2% measurements. Over three full-scale (complete oxygenation to complete deoxygenation) blood desaturations, three different Intra.Ox™ devices as compared to two T.Ox devices showed combined limits of agreement of +8.49 and -7.50 percentage points. The acceptance criterion required the limits of agreement to be less than ±10 percentage points. Therefore, the Intra.Ox™ is demonstrated to be substantially equivalent to the T.Ox in estimating StO2%.

Clinical Study:
Performance was determined by measuring tissue oxygen saturation (StO2) with both devices during transient ischemic events on healthy human volunteers that temporarily mimics compromised tissue. Data from 11 subjects, who were near-evenly distributed over age, gender, and skin color as determined by the Fitzpatrick skin type, were analyzed.

There was excellent agreement in shape of the ischemic events between the Intra.Ox™ and T.Ox devices. A direct comparison with paired data showed good agreement considering the physiological variances inherent between measurement sites.

The mean baseline value of 68% and mean desaturation dynamic range of 30 percentage points agrees well with literature-reported values of skin and muscle transient ischemia.

Importantly, the Intra.Ox™ and T.Ox measure similar ranges of StO2 values for both healthy and compromised tissue, thus validating substantial equivalence.

Key Metrics

Correlation coefficient was greater than 0.9 for absorbion coefficients.
Combined limits of agreement of +8.49 and -7.50 percentage points for StO2% measurements compared to predicate device.

Predicate Device(s)

K042657

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 870.2700 Oximeter.

(a)
Identification. An oximeter is a device used to transmit radiation at a known wavelength(s) through blood and to measure the blood oxygen saturation based on the amount of reflected or scattered radiation. It may be used alone or in conjunction with a fiberoptic oximeter catheter.(b)
Classification. Class II (performance standards).

0

Image /page/0/Picture/1 description: The image shows the seal of the Department of Health & Human Services - USA. The seal features the words "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" arranged in a circular pattern around a central graphic. The graphic depicts a stylized image of three human profiles facing right, with flowing lines suggesting movement or connection.

Public Health Service

Food and Drug Administration 10903 New Hampshire Avenue Document Control Center - WO66-G609 Silver Spring, MD 20993-002

September 12, 2014

Vioptix Inc. c/o Mr. Greg Holland Regulatory Specialist 3722 Ave. Sausalito Irvine, CA 92606 US

Re: K133983

Trade/Device Name: Intra. Ox Handheld Tissue Oximeter Regulation Number: 21 CFR 870.2700 Regulation Name: Oximeter, Tissue Saturation Regulatory Class: Class II Product Code: MUD Dated: August 5, 2014 Received: August 7, 2014

Dear Mr. Greg Holland:

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

1

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.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801). please go to http://www.fda.gov/AboutFDA/CentersOffices/CDRH/CDRHOffices/ucm115809.htm for the Center for Devices and Radiological Health's (CDRH's) Office of Compliance. 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/MedicalDevices/Safety/ReportaProblem/default.htmfor 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/ResourcesforYou/Industry/default.htm.

Sincerely yours,

Mitchell Stein

forBram D. Zuckerman, M.D. Director Division of Cardiovascular Devices Office of Device Evaluation Center for Devices and Radiological Health

2

K133983 Page 1 of 1

Indications for Use Statement

Indications for Use

510(k) Number (if known): ______________________

Device Name: Intra.Ox™ Handheld Tissue Oximeter

Indications for Use:

The Intra.Ox™ Handheld Tissue Oximeter is intended to non-invasively estimate the percent oxygen saturation (StO2) in a volume of tissue.

The Intra.Ox™ Handheld Tissue Oximeter is indicated for use in monitoring patients during circulatory or perfusion examinations.

Prescription Use _ X (Part 21 CFR 801 Subpart D) (21 CFR 801 Subpart C)

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

Concurrence of CDRH, Office of Device Evaluation (ODE)

Page 1 of 1

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510(k) Summary

Image /page/3/Picture/2 description: The image shows the logo for ViOptix. The logo consists of the word "ViOptix" in blue font, with the "V" and "i" in a larger, bolder font than the rest of the word. To the right of the word is a green checkmark symbol, with a green circle inside the top part of the checkmark.

47224 Mission Falls Court · Fremont, CA 94539 Office: (510)226-5860 · Fax: (510)226-5864

Submitter's NameViOptix, Inc.
Address47224 Mission Falls Ct., Fremont, CA 94539
Contact at ViOptixMark Lonsinger
Telephone510-360-7506
Fax510-226-5864
Emailinfo@vioptix.com
Date the Summary was prepared: December 20, 2013

Information regarding Application Correspondent:

Official CorrespondentGreg Holland
Address3722 Ave. Sausalito
Irvine, CA 92606
Telephone949-262-0411
Emailgreg@regulatoryspecialists.com

Information regarding the device classification:

Trade Name:Intra.Ox™ Handheld Tissue Oximeter
Common Name:Tissue Oximeter
Classification regulation:21 CFR 870.2700
Classification regulation name:Oximeter
Product code:MUD
Device Class:II

Information regarding the legally marketed device to which we are claiming equivalence [807.92(a)(3)]:

510(k) Reference # Device Name 510(k) Holder

K042657 ODISsey Tissue Oximeter ViOptix

Description of the Device:

The ViOptix Intra.Ox™ Handheld Tissue Oximeter is a sterile, cordless, batterypowered device that non-invasively estimates the percent oxygen saturation (StO2) in a volume of tissue. The device uses spatially-resolved optical

4

measurements at four wavelengths. The device performs measurements on the م patient by direct physical contact to the patient's tissue and displays the StO2 estimate on the built-in screen. The ViOptix Intra.Ox™ Handheld Tissue Oximeter is a single-use disposable constructed from biocompatible materials that can tolerate bodily fluids and other liquids such as disinfectants and marking materials.

Indications for Use:

The Intra.Ox™ Handheld Tissue Oximeter is intended to non-invasively estimate the percent oxygen saturation (StO2) in a volume of tissue.

The Intra.Ox™ Handheld Tissue Oximeter is indicated for use in monitoring patients during circulatory or perfusion examinations.

Intended Use:

The Intra.Ox™ Handheld Tissue Oximeter has the same intended use as the predicate, the T.Ox.

5

Technological Characteristics:

| Parameter | Subject Device:
Intra.OxTM | Predicate Device:
T.Ox (formerly known as
ODISsey) |
|------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| 510K number | This submission | K042657 |
| Manufacturer | ViOptix, Inc. | ViOptix, Inc. |
| Intended Use | | |
| Indications for Use | The Intra.OxTM Handheld
Tissue Oximeter is
intended to non-invasively
estimate the percent
oxygen saturation (StO2)
in a volume of tissue.

The Intra.OxTM Handheld
Tissue Oximeter is
indicated for use in
monitoring patients during
circulatory or perfusion
examinations. | The ViOptix ODISsey
Tissue Oximeter is
intended to non-invasively
estimate the percent
oxygen saturation (StO2) in
a volume of tissue. This is
performed in medical
environments including
physician offices, hospitals,
ambulatory care and
Emergency Medical
Services.

The ODISsey Tissue
Oximeter is indicated for
use in monitoring patients
during circulatory or
perfusion examinations of
skeletal muscle or when
there is a suspicion of
compromised circulation. |
| Measured
Parameters | Tissue oxygen saturation
(% StO2) | Tissue oxygen saturation
(% StO2) and trend graph |
| Operating Principle | Spectrophotometric
oximetry | Spectrophotometric
oximetry |
| Energy Delivered | Near-infrared light
Source: LED chips
Wavelengths: 760, 810,
850, 900 nm | Near-infrared light
Source: laser diodes
Wavelengths: 690, 830 nm |
| Single Patient Use? | Yes, integrated sensor
and control unit is single
patient use disposable. | Sensor is single patient
use disposable. Control
unit is reusable. |
| Power Source | Battery powered
Battery type: 4 Lithium AA
Battery voltage: 6 V total | Mains powered with
battery backup
Battery type: 3-cell Lithium
ion |
| Parameter | Subject Device:
Intra.Ox™ | Predicate Device:
T.Ox (formerly known as
ODISsey) |
| Measurement Range | 1-99% StO₂ | 1-99% StO₂ |

6

Performance Testing

Bench Tests

The Intra.Ox™ devices were found to measure absorption coefficients with a high degree of correlation to actual absorption coefficients in liquid phantoms prepared with Intralipid and swine whole blood. The correlation coefficient was greater than 0.9 for each of the four wavelengths used in the devices.

The Intra.Ox™ devices were shown to agree well with the predicate device in StO2% measurements. Over three full-scale (complete oxygenation to complete deoxygenation) blood desaturations, three different Intra.Ox™ devices as compared to two T.Ox devices showed combined limits of agreement of +8.49 and -7.50 percentage points. The acceptance criterion required the limits of agreement to be less than ±10 percentage points. Therefore, the Intra.Ox™ is demonstrated to be substantially equivalent to the T.Ox in estimating StO2%.

Clinical Study

Performance was determined by measuring tissue oxygen saturation (StO2) with both devices during transient ischemic events on healthy human volunteers that temporarily mimics compromised tissue. Data from 11 subjects, who were nearevenly distributed over age, gender, and skin color as determined by the Fitzpatrick skin type, were analyzed.

There was excellent agreement in shape of the ischemic events between the Intra. Ox™ and T.Ox devices. A direct comparison with paired data showed good agreement considering the physiological variances inherent between measurement sites.

The mean baseline value of 68% and mean desaturation dynamic range of 30 percentage points agrees well with literature-reported values of skin and muscle transient ischemia.

Importantly, the Intra.Ox™ and T.Ox measure similar ranges of StO2 values for both healthy and compromised tissue, thus validating substantial equivalence.

7

K133983 Page 5 of 5

Image /page/7/Figure/1 description: The image is a boxplot comparing Intra.Ox and T.Ox in healthy and compromised conditions. The y-axis represents StO2% ranging from 0 to 100. The boxplot shows the median, 25%-75% range, and 9%-91% range for each condition. The plot indicates that both Intra.Ox and T.Ox have higher StO2% values in healthy conditions compared to compromised conditions.

Conclusion

The Intra.Ox™ Handheld Tissue Oximeter has the predicate device identified above, has the same intended use as the predicate, has similar technology that does not raise new types of questions of safety or effectiveness, and performance data shows that this device provides reasonable assurance of safety and effectiveness to demonstrate substantial equivalence.