K Number
K152361
Date Cleared
2016-01-14

(147 days)

Product Code
Regulation Number
870.1650
Reference & Predicate Devices
Predicate For
N/A
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
Intended Use

The OptiOne Single-Head Contrast Delivery System is a contrast delivery system and is designed to inject radiopaque contrast media into a patient's vascular system to obtain diagnostic images with computed tomography (i.e. "CT") equipment.

Device Description

The OptiOne Single-Head Contrast Delivery System (OptiOne) is intended to inject radiopaque contrast media into a patient's vascular system to obtain diagnostic images when used in conjunction with computed tomography equipment. Each injection is accomplished with a motor-driven syringe mechanism with microprocessor control of the flow rate, volume, pressure and timing. The OptiOne consists of the following key components: a Powerhead, a Console, and a Power Supply. The Power Supply delivers power to the Powerhead and Console. The Console provides remote control and programmability of the injection through a touch screen display system. The Powerhead contains the components to perform the actual injection such as motor control circuits, ball screw and syringe push ram.

AI/ML Overview

The provided document is a 510(k) summary for the Liebel-Flarsheim Company LLC's OptiOne Single-Head Contrast Delivery System. It details the device's characteristics and its comparison to a predicate device, focusing on demonstrating substantial equivalence.

However, the document does not contain the specific acceptance criteria, reported device performance data, detailed descriptions of studies (sample sizes, data provenance, expert ground truth, adjudication methods, MRMC studies, standalone performance), or information on the ground truth establishment for either test or training sets as requested in your prompt.

The document states: "Extensive verification and validation activities were performed to ensure the OptiOne Single-Head Contrast Delivery System design outputs met all design inputs and the customer requirements were successfully met. The testing confirms the OptiOne Single-Head Contrast Delivery System meets the required specifications." And, "The OptiOne Single-Head Contrast Delivery System was developed under the Liebel-Flarsheim Company LLC Design Control processes. The verification and validation activities ensure the OptiOne meets all customer requirements and product specifications."

This indicates that internal testing was conducted to verify that the device met its specifications, but the specifics of those tests, their results against acceptance criteria, or the methodology of the studies are not included in this publicly available summary.

Therefore, I cannot provide the requested information from the given text.

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Image /page/0/Picture/1 description: The image shows the logo for the United States Department of Health and Human Services. The logo features a stylized caduceus, which is a symbol of medicine and healing. The caduceus is composed of three human profiles facing to the right. The text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" is arranged in a circle around the caduceus.

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

January 14, 2016

Liebel-Flarsheim Company, LLC Craig Buehler Sr. Regulatory Affairs Specialist 2111 East Galbraith Rd Cincinnati, Ohio 45237

Re: K152361

Trade/Device Name: OptiOne Single-Head Contrast Delivery System Regulation Number: 21 CFR 870.1650 Regulation Name: Angiographic Injector And Syringe Regulatory Class: Class II Product Code: IZQ Dated: December 14, 2015 Received: December 15, 2015

Dear Craig Buehler:

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 devicerelated 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.

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If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please contact the Division of Industry and Consumer Education 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. 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 Industry and Consumer Education 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,

Kenneth J. Cavanaugh -S

for

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

Enclosure

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Indications for Use

510(k) Number (if known) K152361

Device Name

OptiOne Single-Head Contrast Delivery System

Indications for Use (Describe)

The OptiOne Single-Head Contrast Delivery System is a contrast delivery system and is designed to inject radiopaque contrast media into a patient's vascular system to obtain diagnostic images with computed tomography (i.e. "CT") equipment.

Type of Use (Select one or both, as applicable)
☑ Prescription Use (Part 21 CFR 801 Subpart D)☐ Over-The-Counter Use (21 CFR 801 Subpart C)

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Image /page/3/Picture/0 description: The image shows the logo for Mallinckrodt Pharmaceuticals. The logo consists of a geometric shape on the left, made up of overlapping cubes in shades of green, blue, and purple. To the right of the shape is the company name, "Mallinckrodt" in a bold, dark blue font, with the word "Pharmaceuticals" underneath in a lighter blue, smaller font.

Section 5: 510(k) Summary

I. SUBMITTER

Liebel-Flarsheim Company LLC 2111 East Galbraith Rd. Cincinnati. OH 45237 Establishment Number: 1518293

Contact:Mr. Craig Buehler
Title:Sr. Regulatory Affairs Specialist
Telephone:(314) 654-3188
Fax:(314) 654-3344
Date Prepared:19 August 2015

II. DEVICE

Name of Device: OptiOne Single-Head Contrast Delivery System Common or Usual Name: Power Injector Classification Name: Injector, Contrast Medium, Automatic (21 CFR 870.1650) Regulatory Class: II Product Code: IZQ

Model NumberDescription
847002Injector, OptiOne Base System
S8472OptiOne Single-Head Contrast Delivery System with Pedestal
S8473OptiOne Single-Head Contrast Delivery System with CeilingSuspension

III. PREDICATE DEVICE

OptiVantage DH Injector System with Enhanced Communication (K063503)

IV. DEVICE DESCRIPTION:

The OptiOne Single-Head Contrast Delivery System (OptiOne) is intended to inject radiopaque contrast media into a patient's vascular system to obtain diagnostic images when used in conjunction with computed tomography equipment. Each injection is accomplished with a motor-driven syringe mechanism with microprocessor control of the flow rate, volume, pressure and timing. The OptiOne consists of the following key components: a Powerhead, a Console, and a Power Supply. The Power

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Image /page/4/Picture/0 description: The image shows the Mallinckrodt Pharmaceuticals logo. The logo consists of a geometric shape on the left and the company name on the right. The geometric shape is made up of several overlapping cubes in shades of green, blue, and purple. The company name is written in a dark blue font, with the word "Mallinckrodt" on top and the word "Pharmaceuticals" below.

Supply delivers power to the Powerhead and Console. The Console provides remote control and programmability of the injection through a touch screen display system. The Powerhead contains the components to perform the actual injection such as motor control circuits, ball screw and syringe push ram.

The OptiOne is intended for use by doctors, radiology technologists and other licensed medical practitioners in a healthcare facility or hospital with computed tomography equipment.

The OptiOne incorporates the same materials as its predicate device and will not contact the patient under normal operation conditions.

V. INDICATIONS FOR USE

The OptiOne Single-Head Contrast Delivery System is a contrast delivery system and is designed to inject radiopaque contrast media into a patient's vascular system to obtain diagnostic images when used with computed tomography (i.e. "CT") equipment.

The OptiOne and the OptiVantage predicate device both have the same indication for use.

VI. COMPARISON OF TECHNOLOGICAL CHARACTERISTICS WITH THE PREDICATE DEVICE

The OptiOne Single-Head Contrast Delivery System (OptiOne) was developed using the predicate device, OptiVantage DH Injector System with Enhanced Communication (OptiVantage), as the basis for the injector design. Many of the same components and accessories found in and used with the OptiVantage are also found and used with the OptiOne. The main difference between the OptiOne and its predicate is the OptiVantage is a dual head injector and the OptiOne is a single head injector.

The OptiOne has the same technological characteristics as the predicate OptiVantage. These similarities and the differences reducing the powerhead from the predicate device's dual head to a single head are described in the table beginning on the next page.

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Image /page/5/Picture/0 description: The image shows the logo for Mallinckrodt Pharmaceuticals. The logo consists of a geometric design on the left, made up of overlapping cubes in shades of green, blue, and purple. To the right of the geometric design is the company name, "Mallinckrodt," in a bold, dark blue font, with the word "Pharmaceuticals" underneath in a smaller, lighter blue font.

FeatureOptiOne Single-Head ContrastDelivery SystemOptiVantage DH Injector Systemwith Enhanced Communication(K063503)
Indication for Useis a contrast delivery system and isdesigned to inject radiopaquecontrast media into a patient'svascular system to obtaindiagnostic images when used withcomputed tomography (i.e. "CT")equipment.Same
Number of Phases4 phases per protocol maximum6 phases per protocol maximum
Protocol Storage40 protocolsSame
Syringe Sizes125 mL, 100 mL, 75 mL, 50 mLpre-filled200 mL emptySame
Single or Dual SyringeModalitySingle Syringe CapabilitySingle and Dual Syringe Capability
Syringe Drive SystemElectromechanicalSame
Syringe Heater98° ± 6° F (37° ± 3° C) nominal.Maintains the temperature of pre-heated contrast (not intended toheat cold/room temperaturecontrast).Same
Auto Syringe Fill Rate7.0 mL/sTolerance: +/-5%Same
Manual Fill Rate2.0 - 15 mL/sTolerance: +/- 1 mL/sSame
Flow Rate0.1 - 10 mL/s adjustable inincrements of 0.1 mL/sTolerance: +/-0.05 mL/s for FlowRates less than 1 mL/s+/-5 % for Flow Rates 1 mL/s to10 mL/sSame
Peak Pressure LimitPounds per Square Inch (psi):50 - 325 adjustable in 5 psiincrementskPa: 345 – 2240 adjustable in34 kPa incrementsSame
FeatureOptiOne Single-Head ContrastDelivery SystemOptiVantage DH Injector Systemwith Enhanced Communication(K063503)
Remote StartUse of the remote hand switchallows the operator to performinjections from outside the area ofdirect radiation.Same
Scan Delay0 - 600 seconds adjustable inincrements of 1 secondSame
Phase Delay0 – 600 seconds adjustable inincrements of 1 second orpermanent pauseSame
Inject Delay0 - 600 seconds adjustable inincrements of 1 secondSame
OptiBolusYes - The OptiBolus feature isused to deliver an exponentiallydecaying flow rate injection thatoptimizes the contrast usage andprovides an extended period ofuniform enhancement of the areaof interest.Same
Universal Console12.25 W x 2.5 H x 8.5 D inches(311 W x 64 H x 216 D mm)5.8 lbs (2.6 kg)Same
Powerhead7 W x 6 H x 12.25 D inches(178 W x 152 H x 311 D mm)10.4 lbs (4.7 kg)12.5 W x 6 H x 8 D inches(318 W x 152 H x 203 D mm)14.5 lbs (6.57 kg)
Power Supply10 W x 4 H x 9 D inches(267 W x 102 H x 228 D mm)6 lbs (2.7 kg)Same
Post InjectionReadoutDisplayed on Powerhead andConsoleSame
OEM InterfaceAvailable Via Relays and OpticalCouplings / Serial (CAN)Same
Safety StopMechanismElectrical Stop When InjectionParameters are Out ofSpecificationSame
Volume RemainingDisplayDisplayed on Powerhead andConsoleSame
MaterialsPlastic and MetalSame Plastic and Metal
Target PopulationHumansSame
FeatureOptiOne Single-Head ContrastDelivery SystemOptiVantage DH Injector Systemwith Enhanced Communication(K063503)
Sterility (Syringe)Injectors are not sterile products,but syringes and disposables areprovided sterile.Same

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Image /page/6/Picture/0 description: The image shows the logo for Mallinckrodt Pharmaceuticals. The logo consists of a geometric shape made up of overlapping cubes in shades of green, blue, and purple. To the right of the geometric shape is the company name, "Mallinckrodt" in a bold, dark blue font, with the word "Pharmaceuticals" underneath in a lighter, thinner font.

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Image /page/7/Picture/0 description: The image shows the logo for Mallinckrodt Pharmaceuticals. On the left is a geometric design of overlapping cubes in shades of green, blue, and purple. To the right of the design is the company name, "Mallinckrodt" in large, bold, navy blue font, with the word "Pharmaceuticals" underneath in a smaller, lighter blue font.

VII. PERFORMANCE DATA

Extensive verification and validation activities were performed to ensure the OptiOne Single-Head Contrast Delivery System design outputs met all design inputs and the customer requirements were successfully met. The testing confirms the OptiOne Single-Head Contrast Delivery System meets the required specifications.

The OptiOne Single-Head Contrast Delivery System was also tested in conformance to the following recognized standards:

Standard
IEC ISO 14971 Second edition 2007-03-01 Application of Risk Management toMedical Devices
ISO 15223-1 Second Edition 2012-07-01 Medical Devices - Symbols to beUsed with Medical Device Labels, Labelling, and Information to be Supplied -Part 1
AAMI / ANSI ES60601-1:2005/(R)2012 and C1:2009/(R)2012 and,a2:2010/(r)2012 Medical Electrical Equipment -- Part 1: General Requirementsfor Basic Safety and Essential Performance
IEC 60601-1-2 Edition 4.0 2014-02 Medical Electrical Equipment - Part 1-2:General Requirements for Basic Safety and Essential Performance - CollateralStandard: Electromagnetic Disturbances - Requirements and Tests
IEC 60601-1-6 Edition 3.1 2013-10 Medical Electrical Equipment - Part 1-6:General Requirements for Basic Safety and Essential Performance - CollateralStandard: Usability
IEC 62304 First Edition 2006-05 Medical Device Software - Software LifeCycle Processes. (Software/Informatics)
IEC 62366 Edition 1.1 2014-01 Medical Devices - Application of UsabilityEngineering to Medical Devices. (General I)

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Image /page/8/Picture/0 description: The image shows the Mallinckrodt Pharmaceuticals logo. The logo consists of a geometric design on the left and the company name on the right. The geometric design is made up of overlapping cubes in shades of green, blue, and purple. The company name is written in a dark blue font, with "Mallinckrodt" on the top line and "Pharmaceuticals" on the bottom line.

VIII. CONCLUSIONS

The OptiOne Single-Head Contrast Delivery System was developed under the Liebel-Flarsheim Company LLC Design Control processes. The verification and validation activities ensure the OptiOne meets all customer requirements and product specifications. The OptiOne Single-Head Contrast Delivery System has the same intended use as its predicate. The powerhead and software was modified from the predicate device to reflect the clinical use of a single head contrast delivery system from a dual head injector. Based on the data contained in this submission, Liebel-Flarsheim Company LLC believes the OptiOne Single-Head Contrast Delivery System is substantially equivalent to its predicate.

§ 870.1650 Angiographic injector and syringe.

(a)
Identification. An angiographic injector and syringe is a device that consists of a syringe and a high-pressure injector which are used to inject contrast material into the heart, great vessels, and coronary arteries to study the heart and vessels by x-ray photography.(b)
Classification. Class II (special controls). The device, when it is a non-patient contacting balloon inflation syringe intended only to inflate/deflate balloon catheters and monitor pressure within the balloon, is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 870.9.