K Number
K134005
Device Name
MIROCAM CAPSULE ENDOSCOPE SYSTEM
Date Cleared
2014-07-09

(194 days)

Product Code
Regulation Number
876.1300
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The MiroCam® Capsule Endoscope System is intended for visualization of the small bowel mucosa. It may be used as a tool in the detection of abnormalities of the small bowel in adults and children from two years of age. The Suspected GI Bleeding Indicator (SGIB) is intended to mark frames of the video suspected of containing blood or red areas.
Device Description
The MroCam® Capsule Endoscope System is comprised of the following core components: - MiroCam® Capsule: MC1200-B - MiroCam® Receiver: MR1100 - Data Cable / Data Belt (Optional): MR1000-D / MR1000-D(S) or MR1000-D(M) or MR1000-D(L) - MroView™ Software: MroView™ U 3.0, MiroView™ RTV, MroView™ RTV-i The general usage workflow of the MiroCam® system is as follows, the MiroCam® capsule captures images of the Gl tract, which are sent via Human Body Communication to sensor pads which are affixed to the patient body. The sensor pads are connected to the receiver by the data cables. The image data is stored on the receiver for the duration of the patient procedure. After removing the receiver set from the patient body, the receiver is connected via USB to the Commercial PC and the image data is uploaded. Following upload, the physician (Gastroenterologist) reviews the patient image data for suspected abnormalities of the small bowel.
More Information

Not Found

No
The document describes image processing for a "Suspected GI Bleeding Indicator (SGIB)" but does not mention AI, ML, or any related terms. The performance studies focus on technical characteristics rather than algorithmic performance metrics typical of AI/ML.

No
The device is described as being for "visualization of the small bowel mucosa" and as a "tool in the detection of abnormalities," which are diagnostic rather than therapeutic functions.

Yes

The device is intended for "visualization of the small bowel mucosa" and "may be used as a tool in the detection of abnormalities of the small bowel". Detection of abnormalities is a diagnostic function.

No

The device description explicitly lists multiple hardware components (MiroCam® Capsule, MiroCam® Receiver, Data Cable / Data Belt) in addition to the software.

Based on the provided information, the MiroCam® Capsule Endoscope System is not an In Vitro Diagnostic (IVD).

Here's why:

  • IVDs are used to examine specimens derived from the human body. The MiroCam® system is used to visualize the small bowel mucosa inside the patient's body. It captures images directly from the gastrointestinal tract, not from a collected sample.
  • The intended use is visualization of the small bowel mucosa. This is an in-vivo imaging procedure, not an in-vitro diagnostic test.
  • The device description details components for capturing and processing images from within the body. This aligns with an in-vivo imaging system.

Therefore, the MiroCam® Capsule Endoscope System falls under the category of an in-vivo imaging device, not an IVD.

N/A

Intended Use / Indications for Use

The MiroCam® Capsule Endoscope System is intended for visualization of the small bowel mucosa. It may be used as a tool in the detection of abnormalities of the small bowel in adults and children from two years of age.

The Suspected GI Bleeding Indicator (SGIB) is intended to mark frames of the video suspected of containing blood or red areas.

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

NEZ

Device Description

The MroCam® Capsule Endoscope System is comprised of the following core components:

  • MiroCam® Capsule: MC1200-B -
  • -MiroCam® Receiver: MR1100
  • । Data Cable / Data Belt (Optional): MR1000-D / MR1000-D(S) or MR1000-D(M) or MR1000-D(L)
  • MroView™ Software: MroView™ U 3.0, MiroView™ RTV, MroView™ RTV-i -

The general usage workflow of the MiroCam® system is as follows, the MiroCam® capsule captures images of the Gl tract, which are sent via Human Body Communication to sensor pads which are affixed to the patient body. The sensor pads are connected to the receiver by the data cables. The image data is stored on the receiver for the duration of the patient procedure. After removing the receiver set from the patient body, the receiver is connected via USB to the Commercial PC and the image data is uploaded. Following upload, the physician (Gastroenterologist) reviews the patient image data for suspected abnormalities of the small bowel. The key system components are explained in detail below.

MroCam® Capsule

Functionally, the MroCam® capsule captures imaging via a CMOS imaging sensor for at least 12 hours at the rate of 3 images per second. Six white LEDs flash in concert with the imaging sensor. A sensor PCB links the imaging sensor to the two gold electrodes of the capsule, from which a weak current is emitted containing the image data via Human Body Communication technology. The weak current is then passed through the bodily tissue and fluid to be picked up by the sensor pads. Human Body Communications is uni-directional from the capsule to the sensor pads.

Physically, the capsule is 24.5mm in length, and 10.8mm in diameter. The exterior of the capsule is composed of biocompatible materials, capable of withstanding potential bite forces and exposure to fluids in the GI tract.

MroCam® Receiver

The image data from the capsule is saved to the MiroCam® Receiver via the sensor pads and data cables. The sensor pads are standard ECG type sensor pads (3M Red Dot), which are affixed to the patient's abdomen according to the location guide. The 9 sensor pads are attached to the 9 leads of the data cable is subsequently attached to the Receiver. The Receiver sits in a shoulder pouch, which is put on the patient for the duration of the procedure. A waist pouch is used to organize the data cables. The Receiver can store images for up to 12 hours. The three indicators on the Receiver are for battery status, initialization status of the receiver, and status of signal receipt from the capsule.

The dimensions of the receiver are 140mm in height, 85mm in width, and 40mm in length. The units weight 350grams with the battery, which is data cable. The battery is lithium ion, and is unique to the Receiver. The battery is rechargeable, and can be charged by placing in the battery charger provided with the Receiver. The receiver uses a storage flash for storing the images.

The MiroCam® Receiver has RTV (Real-Time View) function to view a capsule in the body in real time. There are the wire communication method to connect to a Commercial PC by USB cable and the wireless communication method to connect to i-Phone, i-Pad or i-Pod touch by Wifi.for RTV.

MiroView™ U 3.0

The MiroView™ U 3.0 helps the user to upload the image data from the Receiver and review the image data with displaying.

MiroView™ U 3.0 will be deployed as three types of software: MiroView™ Server, MiroView™ Operator and MiroView™ Client.

Server PC includes two types of S/W: MiroView™ Server and Operator.

MiroView™ Server and MiroView™ Operator will be deployed on a Server PC. MiroView™ Client S/W will be deployed on reviewer's PCs. 10 Client S/Ws will be able to connect to one Server PC via Network (LAN) at a time.

MiroView™ Server has functionalities: Data Storage, PACS connectivity.

MiroView™ Operator has functionalities: Receiver Management, Case Management and Account Management.

MiroView™ Client has functionalities: List Mode (Case Data Management), Review Mode (Video Display, Image Capture, Annotation Box, etc.), Report Mode (User Comment, Auto Disease Name Check, etc), Export Mode (JPG, AVI, MiroVlew™ file format)

MiroView™ U 3.0 provides some kinds of Modes and Views to help the user review patient video data quickly and conveniently; however, IntroMedic, Co., Ltd. recommends that the doctor review the patient video in the Normal Mode / Single View to prevent from a wrong diagnosis.

MiroView™ U 3.0 is a new version of MiroView™ U, which has new updated features from the MiroView™ U. The features are described below:

  • Changing SW architecture as a Windows Service (MiroView™ Server) -
  • Auto White Balance (MiroView™ Client) -
  • HDRi (MiroView™ Client) -
  • Image Warping (MiroView™ Client) -

Mentions image processing

Yes

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

CMOS imaging sensor

Anatomical Site

small bowel mucosa (of the GI tract)

Indicated Patient Age Range

adults and children from two years of age

Intended User / Care Setting

Physician (Gastroenterologist), in a clinical setting.

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)

The MiroCam® Capsule Endoscope System performance testing was done for the submission of predicate device but it was not included when Sensor Bench testing, Exposure Measurement testing, Minimum MTF Measurement testing, MTF Time testing, Distinguishable Contrast Value and Depth of View testing, Geometric distortion and Illumination Uniformity testing, Field of View testing, Color Reproduction testing, LED Spectrum Measurement testing, Testing intensity change during the shelf life period and Testing optical spectra of the light source at different time points during the battery life period was done. The results of this performance testing conclude that the material and technological characteristics have not diminished the safety and effectiveness of the IntroMedic Co., Ltd. MiroCam® Capsule Endoscope System device when compared to the predicate device.

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.

K123428, K140751

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

§ 876.1300 Ingestible telemetric gastrointestinal capsule imaging system.

(a)
Identification. An ingestible telemetric gastrointestinal capsule imaging system is used for visualization of the small bowel mucosa as an adjunctive tool in the detection of abnormalities of the small bowel. The device captures images of the small bowel with a wireless camera contained in a capsule. This device includes an ingestible capsule (containing a light source, camera, transmitter, and battery), an antenna array, a receiving/recording unit, a data storage device, computer software to process the images, and accessories.(b)
Classification. Class II (special controls). The special control is FDA's guidance, “Class II Special Controls Guidance Document: Ingestible Telemetric Gastrointestinal Capsule Imaging Systems; Final Guidance for Industry and FDA.”

0

5. 510(k) Summary

JUL 0 9 2014

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

1. Company and Correspondent making the submission

NameIntroMedic Co., Ltd.
AddressSuite 1104, E&C Venture Dream Tower 6-Cha, 197-28 Guro-
Dong, Guro-Gu, Seoul, 152-719 Korea
Telephone+82-2-801-9300
Fax+82-2-801-9330
ContactJinYoung Lee
Internethttp://www.intromedic.com

2. Device

Proprietary NameMiroCam® Capsule Endoscope System
Common NameCapsule Imaging System
Classification Name21 CFR 876.1300 (Product Code NEZ)

3. Predicate Device

ManufacturerIntroMedic Co., Ltd.
DeviceMiroCam® Capsule Endoscope System
510(K) NumberK123428
ManufacturerIntroMedic Co., Ltd.
DeviceMiroCam® Capsule Endoscope System

K140751 510(K) Number

1

4. Description

The MroCam® Capsule Endoscope System is comprised of the following core components:

  • MiroCam® Capsule: MC1200-B -
  • -MiroCam® Receiver: MR1100
  • । Data Cable / Data Belt (Optional): MR1000-D / MR1000-D(S) or MR1000-D(M) or MR1000-D(L)
  • MroView™ Software: MroView™ U 3.0, MiroView™ RTV, MroView™ RTV-i -

The general usage workflow of the MiroCam® system is as follows, the MiroCam® capsule captures images of the Gl tract, which are sent via Human Body Communication to sensor pads which are affixed to the patient body. The sensor pads are connected to the receiver by the data cables. The image data is stored on the receiver for the duration of the patient procedure. After removing the receiver set from the patient body, the receiver is connected via USB to the Commercial PC and the image data is uploaded. Following upload, the physician (Gastroenterologist) reviews the patient image data for suspected abnormalities of the small bowel. The key system components are explained in detail below.

MroCam® Capsule

Functionally, the MroCam® capsule captures imaging via a CMOS imaging sensor for at least 12 hours at the rate of 3 images per second. Six white LEDs flash in concert with the imaging sensor. A sensor PCB links the imaging sensor to the two gold electrodes of the capsule, from which a weak current is emitted containing the image data via Human Body Communication technology. The weak current is then passed through the bodily tissue and fluid to be picked up by the sensor pads. Human Body Communications is uni-directional from the capsule to the sensor pads.

Physically, the capsule is 24.5mm in length, and 10.8mm in diameter. The exterior of the capsule is composed of biocompatible materials, capable of withstanding potential bite forces and exposure to fluids in the GI tract.

MroCam® Receiver

The image data from the capsule is saved to the MroCam® Receiver via the sensor pads and data cables. The sensor pads are standard ECG type sensor pads (3M Red Dot), which are

2

affixed to the patient's abdomen according to the location guide. The 9 sensor pads are attached to the 9 leads of the data cable is subsequently attached to the Receiver. The Receiver sits in a shoulder pouch, which is put on the patient for the duration of the procedure. A waist pouch is used to organize the data cables. The Receiver can store images for up to 12 hours. The three indicators on the Receiver are for battery status, initialization status of the receiver, and status of signal receipt from the capsule.

The dimensions of the receiver are 140mm in height, 85mm in width, and 40mm in length. The units weight 350grams with the battery, which is data cable. The battery is lithium ion, and is unique to the Receiver. The battery is rechargeable, and can be charged by placing in the battery charger provided with the Receiver. The receiver uses a storage flash for storing the images.

The MiroCam® Receiver has RTV (Real-Time View) function to view a capsule in the body in real time. There are the wire communication method to connect to a Commercial PC by USB cable and the wireless communication method to connect to i-Phone, i-Pad or i-Pod touch by Wifi.for RTV.

MiroView™ U 3.0

The MiroView™ U 3.0 helps the user to upload the image data from the Receiver and review the image data with displaying.

MiroView™ U 3.0 will be deployed as three types of software: MiroView™ Server, MiroView™ Operator and MiroView™ Client.

Server PC includes two types of S/W: MiroView™ Server and Operator.

MiroView™ Server and MiroView™ Operator will be deployed on a Server PC. MiroView™ Client S/W will be deployed on reviewer's PCs. 10 Client S/Ws will be able to connect to one Server PC via Network (LAN) at a time.

MiroView™ Server has functionalities: Data Storage, PACS connectivity.

MiroView™ Operator has functionalities: Receiver Management, Case Management and Account Management.

3

MiroView™ Client has functionalities: List Mode (Case Data Management), Review Mode (Video Display, Image Capture, Annotation Box, etc.), Report Mode (User Comment, Auto Disease Name Check, etc), Export Mode (JPG, AVI, MiroVlew™ file format)

MiroView™ U 3.0 provides some kinds of Modes and Views to help the user review patient video data quickly and conveniently; however, IntroMedic, Co., Ltd. recommends that the doctor review the patient video in the Normal Mode / Single View to prevent from a wrong diagnosis.

MiroView™ U 3.0 is a new version of MiroView™ U, which has new updated features from the MiroView™ U. The features are described below:

  • Changing SW architecture as a Windows Service (MiroView™ Server) -
  • Auto White Balance (MiroView™ Client) -
  • HDRi (MiroView™ Client) -
  • Image Warping (MiroView™ Client) -

5. Indications for Use

The MiroCam® Capsule Endoscope System is intended for visualization of the small bowel mucosa. It may be used as a tool in the detection of abnormalities of the small bowel in adults and children from two years of age.

The Suspected GI Bleeding Indicator (SGIB) is intended to mark frames of the video suspected of containing blood or red areas.

6. Technological Characteristics and Substantial Equivalence

The characteristics of the IntroMedic Co., Ltd. MiroCam® Capsule Endoscope System are substantially equivalent to the following current legally marketed predicate devices based on indications for use, typical clinical use, and operational and fundamental technological characteristics

  • MiroCam® Capsule Endoscope System by IntroMedic Co., Ltd. K123428 .
  • MiroCam® Capsule Endoscope System by IntroMedic Co., Ltd. K140751

4

A detailed side-by-side comparison of the MiroCam® Capsule Endoscope System with the identified predicate device is provided in the substantial equivalence discussion in this premarket notification.

7. Performance Testing

The MiroCam® Capsule Endoscope System performance testing was done for the submission of predicate device but it was not included when Sensor Bench testing, Exposure Measurement testing, Minimum MTF Measurement testing, MTF Time testing, Distinguishable Contrast Value and Depth of View testing, Geometric distortion and Illumination Uniformity testing, Field of View testing, Color Reproduction testing, LED Spectrum Measurement testing, Testing intensity change during the shelf life period and Testing optical spectra of the light source at different time points during the battery life period was done. The results of this performance testing conclude that the material and technological characteristics have not diminished the safety and effectiveness of the IntroMedic Co., Ltd. MiroCam® Capsule Endoscope System device when compared to the predicate device.

8. Conclusion

Based on the similarities in indications for use, design, functional, and operational features as evaluated through clinical and non-clinical performance testing the IntroMedic Co., Ltd. MiroCam® Capsule Endoscope System has demonstrated substantial equivalence to the listed legally marketed predicate devices and any differences do not affect the product's safety or effectiveness.

5

Image /page/5/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo consists of a circular seal with the text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" around the perimeter. Inside the circle is a stylized symbol that resembles an abstract human figure with outstretched arms, with three horizontal lines extending from the figure's body.

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

July 9, 2014

IntroMedic Co., Ltd. Jinyoung Lee General Manager Suite 1104, E&C Venture Dream Tower 6-cha 197-28 Guro-dong, Guro-gu Seoul 152-719 Korea

K134005 Re:

Trade/Device Name: MiroCam® Capsule Endoscope System Regulation Number: 21 CFR8 876.1300 Regulation Name: Ingestible telemetric gastrointestinal capsule imaging system Regulatory Class: II Product Code: NEZ Dated: May 30, 2014 Received: June 2, 2014

Dear Jinyoung Lee,

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.

6

Page 2 - Jinyoung Lee

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 (OS) 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 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/Resourcesfor You/Industry/default.htm. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR Part 807.97). For questions regarding the reporting of adverse events under the MDR regulation (21 CFR Part 803), please go to

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 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,

Image /page/6/Picture/8 description: The image shows the name "Benjamin Fisher-S" in a bold, sans-serif font. The letters are black against a white background, creating a high contrast. The text appears to be a title or heading, possibly indicating a person's name or a company name. The letters "BFA" are in the middle of the name.

Benjamin R. Fisher, Ph.D. Director Division of Reproductive, Gastro-Renal, and Urological Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

7

4. Indications for Use

510(k) Number (if known): K134005

Device Name: MiroCam® Capsule Endoscope System

Indications for Use:

The MiroCam® Capsule Endoscope System is intended for visualization of the small bowel mucosa. It may be used as a tool in the detection of abnormalities of the small bowel in adults and children from two years of age.

The Suspected GI Bleeding Indicator (SGIB) is intended to mark frames of the video suspected of containing blood or red areas.

Prescription Use (Part 21 CFR 801 Subpart D)

AND/OR

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

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

Concurrence of CDRH, Office of Device Evaluation (ODE)

Benjamin R. Fisher -S 2014.07.09 17:58:46 -04'00'