K Number
K162573
Date Cleared
2016-11-04

(50 days)

Product Code
Regulation Number
892.5730
Reference & Predicate Devices
Predicate For
N/A
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
Intended Use

Source Production & Equipment Co., Inc. Model M14 192Iridium Brachytherapy Source, with individual activity up to 12 Ci, is indicated for temporary interstital, intraluminal, intraoperative or surface application to treat selected localized tumors. This source can be used as primary treatment for a variety of anatomical sites commonly treated with high dose rate brachytherapy, including the cervix, vagina, endometrium, rectum, esophagus, bronchus, head and neck, bile duct, brain, skin, prostate, lung, pancreas, and breast and for treatment of sarcomas and for intraoperative radiation therapy. This source may be used concurrently with or following treatment with external beam radiation therapy.

The source is designed for use in medical brachytherapy applications and may only be used in conjunction with the Elekta/Nucletron V2/V3 Afterloaders.

The intended use of the Source Production & Equipment Co., Inc. Model M14 194ridium Brachytherapy Source is for the treatment of cancer by temporary interstitial, intracavitary, intraluminal, intraoperative or surface irradiation.

Device Description

Source Production & Equipment Co., Inc. Model M14 194ridium Brachytherapy Source is a singly-encapsulated 192 ridium Brachytherapy Source. It consists of a stainless steel capsule containing a solid radioactive 1921ridium pellet is sealed in a stainless steel capsule that is attached to a cable to permit manipulation by the remote afterloading system.

The source consists of a solid 192Iridium pellet (0.6 mm dia x 3.5 mm long) singly encapsulated in stainless steel (0.9 mm dia x 4.8 mm long) and welded to a 7x7 stranded stainless steel cable (0.9 mm dia x 2022 mm long).

AI/ML Overview

The provided text is a 510(k) Premarket Notification for a medical device: the Source Production & Equipment Co., Inc. Model M14 192Iridium Brachytherapy Source. This type of FDA submission focuses on demonstrating substantial equivalence to a previously legally marketed predicate device, rather than proving stand-alone safety and effectiveness through extensive clinical trials as would be required for a novel, high-risk device.

Therefore, the document does not contain the information requested regarding acceptance criteria and study details for AI/ML-based medical devices (e.g., acceptance criteria tables, sample sizes for test sets, data provenance, expert ground truth establishment, MRMC studies, standalone algorithm performance, or training set details).

The information provided describes:

  • The device description (a singly-encapsulated 192Iridium Brachytherapy Source).
  • Its intended use (treatment of cancer via temporary interstitial, intracavitary, intraluminal, intraoperative, or surface irradiation).
  • Its technological characteristics in comparison to a predicate device (SPEC Model M15).
  • Nonclinical tests performed to demonstrate equivalence:
    • Physical Testing: Subjected to ANSI N43.6 and ISO 2019 standards, meeting Class C53211 requirements (equivalent to predicate).
    • Tensile Testing: Prototype sources subjected to tensile loads and fatigue tests exceeding maximum forces applicable by the afterloader (demonstrating sufficient strength, equivalent or better than predicate).
    • Operational Testing: Prototype successfully navigated curved pathways and endured over 50,000 exposure/retract cycles in an afterloader without failure (equivalent to predicate).
    • Dosimetry: Dose distribution calculated by Monte Carlo simulation in accordance with AAPM and ESTRO recommendations (equivalent to predicate).
  • Clinical Tests: Stated as "Not Applicable," which is common for substantial equivalence claims where nonclinical data are deemed sufficient.

In summary, the document demonstrates that the new device is functionally identical to a previously cleared device for its intended use, based on nonclinical performance data that meets established industry standards. It does not present data related to acceptance criteria or studies as typically described for AI/ML-driven diagnostics where performance metrics like sensitivity, specificity, or reader improvement are key.

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Image /page/0/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 image of three human profiles facing to the right, stacked on top of each other, with flowing lines beneath them.

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

November 4, 2016

Source Production & Equipment Co., Inc. % Ms. Kelley Richardt Regulatory and Quality Manager 113 Teal Street SAINT ROSE LA 70087

Re: K162573

Trade/Device Name: Source Production & Equipment Co., Inc. Model M14 122Tridium Brachytherapy Source

Regulation Number: 21 CFR 892.5730 Regulation Name: Radionuclide brachytherapy source Regulatory Class: II Product Code: KXK Dated: September 14, 2016 Received: September 19, 2016

Dear Ms. Richardt:

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.

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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/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 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.

Robert Oels

Robert Ochs, Ph.D. Director Division of Radiological Health Office of In Vitro Diagnostics and Radiological Health Center for Devices and Radiological Health

Enclosure

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Indications for Use

510(k) Number (if known)

K162573

Device Name

Device Name: Source Production & Equipment Co., Inc. Model M14 192Iridium Brachytherapy Source

Indications for Use (Describe)

Source Production & Equipment Co., Inc. Model M14 192Iridium Brachytherapy Source, with individual activity up to 12 Ci, is indicated for temporary interstital, intraluminal, intraoperative or surface application to treat selected localized tumors. This source can be used as primary treatment for a variety of anatomical sites commonly treated with high dose rate brachytherapy, including the cervix, vagina, endometrium, rectum, esophagus, bronchus, head and neck, bile duct, brain, skin, prostate, lung, pancreas, and breast and for treatment of sarcomas and for intraoperative radiation therapy. This source may be used concurrently with or following treatment with external beam radiation therapy.

The source is designed for use in medical brachytherapy applications and may only be used in conjunction with the Elekta/Nucletron V2/V3 Afterloaders.

Type of Use (Select one or both, as applicable)
---------------------------------------------------

|X | 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 word "spec" in a stylized font. The letters are outlined in black and filled with white. To the right of the word is a radiation symbol, also in black.

Section 5 510(k) Summary

Section 807.92(a)

Submitter Source Production & Equipment Co., Inc. Tel: 504.464.9471 (1) 113 Teal Street 504.467.7685 Fax: St. Rose, LA 70087 Establishment Registration No.: 1000437833 Contact Person: John J. Munro III Vice President e-mail: johnm@spec150.com

  • (2) Device Name:
Classification Name:Radionuclide Brachytherapy Source (892.5730) (90 KXK)
Common or Usual Name:Brachytherapy Source Assembly
Proprietary Name:Source Production & Equipment Co., Inc. Model M14 192 Iridium Brachytherapy Source
  • (3) Legally Marketed Predicate Device:
    Source Production & Equipment Co., Inc. Model M15, cleared under 510(k) number K132969 dated 02 January 2014

  • Description of Source Production & Equipment Co., Inc. Model M14 192 ridium (4) Brachytherapy Source:
    Source Production & Equipment Co., Inc. Model M14 194ridium Brachytherapy Source is a singly-encapsulated 192 ridium Brachytherapy Source. It consists of a stainless steel capsule containing a solid radioactive 1921ridium pellet is sealed in a stainless steel capsule that is attached to a cable to permit manipulation by the remote afterloading system.

  • (5) Intended Use
    The intended use of the Source Production & Equipment Co., Inc. Model M14 194ridium Brachytherapy Source is for the treatment of cancer by temporary interstitial, intracavitary, intraluminal, intraoperative or surface irradiation.

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Image /page/4/Picture/0 description: The image shows the word "spec" in a stylized font, with a radiation symbol to the right of the letter "c". The letters are outlined in black, giving them a hollow appearance. The radiation symbol consists of a central circle with three blades extending outward, also outlined in black.

  • (6) Technological Characteristics:
    Source Production & Equipment Co., Inc. Model M14 192ridium Brachytherapy Source is similar to the predicate high dose rate brachytherapy source that utilizes photons from 192 Iridium.
TechnologicalCharacteristicSource Production & Equipment Co.,Inc. Model M14 192IridiumBrachytherapy SourceSource Production & Equipment Co.,Inc. (SPEC) M15 192Iridium High DoseRate Brachytherapy Source
DesignThe source consists of a solid 192Iridiumpellet (0.6 mm dia x 3.5 mm long) singlyencapsulated in stainless steel (0.9 mmdia x 4.8 mm long) and welded to a 7x7stranded stainless steel cable (0.9 mm diax 2022 mm long).The source consists of a solid 192Iridiumpellet (0.6 mm dia x 3.5 mm long) singlyencapsulated in stainless steel (1.1 mmdia x 4.8 mm long) and welded to a 7x7stranded stainless steel cable (1.1 mm diax 2000 mm long).
MaterialsRadionuclideEncapsulation192IridiumStainless Steel192IridiumStainless Steel
CableStainless SteelStainless Steel
PerformanceDosimetry (TG43)Dose Rate Const ( $\lambda$ )Anisotropy ( $\phi_{av}$ ):1.11 cGy h-1 U-10.971.11 cGy h-1 U-10.97
SterilityThis source assembly never directlycontacts the patient; sterility is notrequired.This source assembly never directlycontacts the patient; sterility is notrequired.
BiocompatibilityThis source assembly never directlycontacts the patient; biocompatibilityassessment is not applicable. Theoutside of the entire assembly isfabricated from stainless steel, which is abiocompatible material.This source assembly never directlycontacts the patient; biocompatibilityassessment is not applicable. Theoutside of the entire assembly isfabricated from stainless steel, which is abiocompatible material.
Mechanical SafetyANSI N43.6 Class C53211Applied for Louisiana RegistrationANSI N43.6 Class C53211Louisiana Sealed Source RegistrationLA-0612-S-117-S
Chemical SafetyThis source assembly never directlycontacts the patient; chemical safetyassessment is not applicable. Theoutside of the entire assembly isfabricated from stainless steel, which iswill not chemically react with body tissue.This source assembly never directlycontacts the patient; chemical safetyassessment is not applicable. Theoutside of the entire assembly isfabricated from stainless steel, which iswill not chemically react with body tissue.
Energy Delivered192Iridium (half-life: 73.81 days) whichdecays by beta emission and electroncapture with the emission of characteristicphotons and electrons. The betas andelectrons are absorbed by the stainlesssteel wall of the source capsule. Theprincipal photon emissions are 67 keV x-rays and 201, 311, 467, and 603 keV192Iridium (half-life: 73.81 days) whichdecays by beta emission and electroncapture with the emission of characteristicphotons and electrons. The betas andelectrons are absorbed by the stainlesssteel wall of the source capsule. Theprincipal photon emissions are 67 keV x-rays and 201, 311, 467, and 603 keV
Compatibility withEnvironment andOther Devices192Iridium is a radioactive material andshould be strictly controlled.The source should only be used followingthe conditions and limitations specified bythe licensing authority (NRC or AgreementState).The source should be stored in a shieldedcontainer, either the remote afterloaderwith which it is used or the transportcontainer in which it is delivered.If any source cannot be accounted for, theloss should be reported to the federal orstate licensing agency.Store at normal room temperature.When disposal is indicated, radioactivematerial should be transferred to anauthorized recipient, typically the sourcesupplier. Radioactive material shouldnever be disposed of in normal waste.192Iridium is a radioactive material andshould be strictly controlled.The source should only be used followingthe conditions and limitations specified bythe licensing authority (NRC or AgreementState).The source should be stored in a shieldedcontainer, either the remote afterloaderwith which it is used or the transportcontainer in which it is delivered.If any source cannot be accounted for, theloss should be reported to the federal orstate licensing agency.Store at normal room temperature.When disposal is indicated, radioactivematerial should be transferred to anauthorized recipient, typically the sourcesupplier. Radioactive material shouldnever be disposed of in normal waste.
Where UsedThis source should only be used within aproperly shielded enclosure designed tomaintain radiation dose rates outside theenclosure within regulatory limits.This source should only be used within aproperly shielded enclosure designed tomaintain radiation dose rates outside theenclosure within regulatory limits.
Standards MetMechanicalDosimetryANSI N43.6AAPM TG-43ANSI N43.6AAPM TG-43
Electrical SafetyNot ApplicableNot Applicable
Thermal SafetyNot ApplicableNot Applicable
Radiation SafetyThis 192Iridium source is radioactive, andappropriate precautions must be takenduring handling to minimize radiationexposure to personnel. Personnelmonitoring is required.This source should only be used within aproperly shielded enclosure designed tomaintain radiation dose rates outside theenclosure within regulatory limits.In circumstances where emergencyoperations must be performed withinprotective barriers, the operator shoulduse proper applicators, maintain safeworking distances and work as rapidly assafely possible to minimize radiationexposureThis 192Iridium source is radioactive, andappropriate precautions must be takenduring handling to minimize radiationexposure to personnel. Personnelmonitoring is required.This source should only be used within aproperly shielded enclosure designed tomaintain radiation dose rates outside theenclosure within regulatory limits.In circumstances where emergencyoperations must be performed withinprotective barriers, the operator shoulduse proper applicators, maintain safeworking distances and work as rapidly assafely possible to minimize radiationexposure

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Image /page/5/Picture/0 description: The image shows the word "spec" in a stylized font. To the right of the word is a radiation symbol. The word is outlined in black, and the radiation symbol is solid black. The image is simple and clear.

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Image /page/6/Picture/0 description: The image shows the word "spec" in a stylized font. The letters are outlined in black and filled with white. To the right of the "c" is a radiation symbol. The symbol is black and consists of a small circle in the center with three curved shapes radiating outwards.

Section 807.92(b)

Nonclinical Tests (1)

Physical Testing

The Source Production & Equipment Co., Inc. Model M14 194ridium Brachytherapy Source has been subjected to the tests specified in American National Standard (ANSI) N43.6 and International Organization for Standardization (ISO) Standard 2019, as referenced in the FDA "Guidance for the Submission of Premarket Notifications for Photon-Emitting Brachytherapy Sources" dated 2 August 2000.

Prototype sources were subjected to the tests specified in ANSI N43.6-2007 and ISO 2919-2012 and have equaled or exceeded the requirements corresponding to a classification of C53211, which is the requirement for brachytherapy sources. This is equivalent to the physical testing of the predicate device.

Tensile Testing

The ultimate criteria for these categories of weld is to have sufficient tensile strength for the application. As described in Registry of Radioactive Sealed Sources and Devices Safety Evaluation of Source No. MD-0497-S-107-S, all welded connections of the sources used in the Elekta/Nucletron V2/V3 Series High Dose Rate (HDR) are mechanically tested by a pull test of 15 N of force. We have conservatively interpreted this value to be the maximum force that the afterloader can apply to the source assembly. We believe this is conservative because if the afterloader could apply a greater force than this, Nucletron would have applied a greater tensile test requirement. In all likelihood, the maximum force that can be applied to the source assembly would be less than this value. Therefore, under this interpretation, we have adopted a production tensile test requirement that is 2.5 times this specified force or 37.5 Newtons (8.4 lbs).

Prototype sources were subjected to a series of tensile fatigue tests consisting of:

  • a tensile load in excess of 45 N (10 lb). which is more than 2.5 times the . maximum force than can be applied to the cable by the Elekta/Nucletron V2/V3 Series HDR Afterloader
  • ten sequential applications of a tensile load of in excess of 22 N (5 lbs) which is . more than the maximum load that can be applied by the Elekta/Nucletron V2/V3 Series HDR Afterloader, and then
  • a tensile load in excess of 45 N (10 lb). which is more than 2.5 times the . maximum force than can be applied to the cable by the Elekta/Nucletron V2/V3 Series HDR Afterloader
  • and finally a tensile load to failure of each of the welds of the source assembly, . where the minimum failure load was 138 N (31 lb) which is more than 9 times the maximum force that can be applied by the Elekta/Nucletron V2/V3 Series HDR Afterloader.

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It is concluded that the tensile strength of this source assemble is sufficient for its intended application. This is equivalent to or better than the tensile testing of the predicate device.

Operational Testing

A prototype source assembly was subjected to a curved pathway performance test consisting of driving the source cable through a series of "S" and "U" curves with a variety of radii which simulate the various pathways of applicators used with the Elekta/Nucletron V2/V3 Series HDR Afterloader. The source capsule and cable successfully negotiated all of these pathways. There was no damage to the M14 source assembly.

Subsequently, the same source assembly was subjected to an endurance performance test in an Elekta/Nucletron V2/V3 Series HDR Afterloader, where the source assembly performed more than 50.000 exposure/retract cvcles. As a result of these tests, there was no failure of the source cable, the source capsule or the connection of the source capsule to the source cable.

This is equivalent to the physical testing of the predicate device.

Dosimetry

The dose distribution around the Source Production & Equipment Co., Inc. Model M14 192 ridium Brachytherapy Source was calculated by Monte Carlo simulation in accordance with the recommendations of the American Association of Physicists in Medicine and the European Society for Therapeutic Radiation Oncology. 1 This is equivalent to the dosimetry of the predicate device.

  • (2) Clinical Tests
    Not Applicable

  • (3) Conclusions
    The results of the nonclinical physical, tensile, operational tests and the dosimetric analysis, demonstrate that the Source Production & Equipment Co., Inc. Model M14 192 ridium Brachytherapy Source is as safe, as effective, and performs as well or better than the legally marketed predicate device, SPEC Model M15 High Dose Rate Brachytherapy Source.

1 Perez-Calatayud J, Ballester F, Das RK, Dewerd LA, Ibbott GS, Meigooni AS, Ouhib Z, Rivard MJ, Sloboda RS, Williamson JF, Dose calculation for photon-emitting brachytherapy sources with average energy higher than 50 keV: report of the AAPM and ESTRO, Med Phys. 2012 May;39(5):2904-29

§ 892.5730 Radionuclide brachytherapy source.

(a)
Identification. A radionuclide brachytherapy source is a device that consists of a radionuclide which may be enclosed in a sealed container made of gold, titanium, stainless steel, or platinum and intended for medical purposes to be placed onto a body surface or into a body cavity or tissue as a source of nuclear radiation for therapy.(b)
Classification. Class II (special controls). A prostate seeding kit intended for use with a radionuclide brachytherapy source only is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 892.9.