K Number
K162862
Device Name
Raycast High Precision Lung Board Solution
Date Cleared
2016-11-09

(28 days)

Product Code
Regulation Number
892.5050
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The Raycast High Precision Lung Board Solution is a patient positioning device intended to be used for the positioning and re-positioning of patients undergoing or receiving a course of external beam radiation therapy for the treatment of cancer and other diseases. It is intended to be used by or under the direction of a licensed physician.
Device Description
The Raycast High Precision Lung Board is used to position the patient supine on the treatment couch with the arms lifted above the head. This will keep the arms outside of the treatment field, which is the thorax in this case. The Raycast High Precision Lung Board is attached to the treatment couch with a 2-vin indexing bar in order to reproduce the same position each day. The Raycast High Precision Lung Board should be fully supported by the treatment couch. Then the patient is asked to lie down on the couch with his head in a head support that is attached to the Raycast High Precision Lung Board. Once the patient is lying down, he can lift up his arms until the elbows rest against the 'wings' of the board and the hands can reach the T-shaped handgrip. The position of the T-shaped handgrip can be adjusted both in height and length according to the patient's anatomy. To adjust the height of the handgrip, pull the white knob on the side and move the grip pole up or down. To adjust the length of the handgrip, pull the white knob at the cranial side and slide the handgrip more caudally or cranially. Various head supports can be placed on the Raycast High Precision Lung Board depending on the physician's preference. The standard set-up will be with an Orfit Head Support, but it is also possible to use a Silverman or Timo Head Support which they might already have available in their department. Once the patient is set-up correctly, the arms should not be treatment field anymore, which is the thorax area in this case. This allows the physician to irradiate the thorax from various angles, including laterally without passing through the arms of the patient. The Raycast High Precision Lung Board itself will not be in the treatment field and as such will not be irradiated through.
More Information

Not Found

No
The device description focuses on mechanical positioning and adjustment mechanisms, with no mention of software, algorithms, or data processing that would indicate AI/ML. The performance studies are bench testing and MR safety, not related to algorithmic performance.

No
The document describes the device as a patient positioning device for radiation therapy, which supports the delivery of therapeutic treatment rather than being a therapeutic device itself.

No

This device is described as a "patient positioning device" intended for "positioning and re-positioning of patients" during radiation therapy. Its function is to hold the patient in a specific pose to keep body parts out of the radiation field, not to diagnose a condition.

No

The device description clearly details a physical patient positioning board with adjustable components (handgrip, head support) and mentions bench testing and MR safety studies, indicating it is a hardware device.

Based on the provided information, the Raycast High Precision Lung Board Solution is not an In Vitro Diagnostic (IVD) device.

Here's why:

  • IVD Definition: In Vitro Diagnostic devices are used to examine specimens (like blood, urine, or tissue) taken from the human body to provide information about a person's health. This is typically done outside of the body ("in vitro").
  • Device Function: The Raycast High Precision Lung Board Solution is a patient positioning device. Its purpose is to physically position a patient for external beam radiation therapy. It does not analyze any biological samples or provide diagnostic information based on such analysis.
  • Intended Use: The intended use clearly states it's for "positioning and re-positioning of patients undergoing or receiving a course of external beam radiation therapy". This is a therapeutic support function, not a diagnostic one.

Therefore, the Raycast High Precision Lung Board Solution falls under the category of a medical device used for patient support during treatment, not an IVD.

N/A

Intended Use / Indications for Use

The Raycast High Precision Lung Board Solution is a patient positioning device intended to be used for the positioning and re-positioning of patients undergoing or receiving a course of external beam radiation therapy for the treatment of cancer and other diseases. It is intended to be used by or under the direction of a licensed physician.

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

IYE

Device Description

The Raycast High Precision Lung Board is used to position the patient supine on the treatment couch with the arms lifted above the head. This will keep the arms outside of the treatment field, which is the thorax in this case. The Raycast High Precision Lung Board is attached to the treatment couch with a 2-vin indexing bar in order to reproduce the same position each day. The Raycast High Precision Lung Board should be fully supported by the treatment couch. Then the patient is asked to lie down on the couch with his head in a head support that is attached to the Raycast High Precision Lung Board. Once the patient is lying down, he can lift up his arms until the elbows rest against the 'wings' of the board and the hands can reach the T-shaped handgrip.

The position of the T-shaped handgrip can be adjusted both in height and length according to the patient's anatomy. To adjust the height of the handgrip, pull the white knob on the side and move the grip pole up or down. To adjust the length of the handgrip, pull the white knob at the cranial side and slide the handgrip more caudally or cranially. Various head supports can be placed on the Raycast High Precision Lung Board depending on the physician's preference. The standard set-up will be with an Orfit Head Support, but it is also possible to use a Silverman or Timo Head Support which they might already have available in their department.

Once the patient is set-up correctly, the arms should not be treatment field anymore, which is the thorax area in this case. This allows the physician to irradiate the thorax from various angles, including laterally without passing through the arms of the patient. The Raycast High Precision Lung Board itself will not be in the treatment field and as such will not be irradiated through.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

thorax area

Indicated Patient Age Range

Not Found

Intended User / Care Setting

licensed physician

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)

Bench testing was performed and includes a dosimetry test report for the device including device attenuation and water thickness, which have been validated to demonstrate SE to the predicate in safety and effectiveness.

Additional studies performed are the MR safety studies performed in order to demonstrate that the device tested as MR safe.

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.

K040773

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.

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Image /page/0/Picture/1 description: The image shows the logo for the U.S. Department of Health and Human Services. The logo is a circular seal with the words "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" around the perimeter. Inside the circle is an abstract symbol that resembles a stylized human figure.

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

November 9, 2016

Orfit Industries NV % Mr. Dave Yungvirt CEO Third Party Review Group, LLC The Old Station House 24 Lackawanna Place MILLBURN NJ 07041

Re: K162862

Trade/Device Name: Raycast High Precision Lung Board Solution Regulation Number: 21 CFR 892.5050 Regulation Name: Medical charged-particle radiation therapy system Regulatory Class: II Product Code: IYE Dated: October 13, 2016 Received: October 14, 2016

Dear Mr. Yungvirt:

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.

Michael O'Hara

For

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)

K162862

Device Name

Raycast High Precision Lung Board Solution

Indications for Use (Describe)

The Raycast High Precision Lung Board Solution is a patient positioning device intended to be used for the positioning and re-positioning of patients undergoing or receiving a course of external beam radiation therapy for the treatment of cancer and other diseases. It is intended to be used by or under the direction of a licensed physician.

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)Prescription Use (Part 21 CFR 801 Subpart D)Over-The-Counter Use (21 CFR 801 Subpart C)
Prescription Use (Part 21 CFR 801 Subpart D)
Over-The-Counter Use (21 CFR 801 Subpart C)

CONTINUE ON A SEPARATE PAGE IF NEEDED.

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DO NOT SEND YOUR COMPLETED FORM TO THE PRA STAFF EMAIL ADDRESS BELOW.

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510(k) Summary

This summary of 510(k) safety and effectiveness information is submitted in accordance with the requirements of SMDA 1990 and 21 CFR 807.92.

Date Prepared: October 10, 2016

Applicant Orfit Industries NV 9A Vosveld 2110 Wijnegem Belgium

Contact Person c/o Raymond Kelly 68 Southwoods Terrace Southbury, CT 06488 Phone: (203) 4007566

Alternate Contact Eddy Marivoet QA/RA Manager Orfit Industries NV 9A Vosveld 2110 Wijnegem Belgium Phone: +32 (0)3 326 20 26

Device Information
Trade Name:Raycast High Precision Lung Board Solution
Model Number:29115
Classification Name:accelerator, linear, medical
Review Panel:Radiology
Product Code:IYE
Device Class:Class II
Regulation:892.5050

Predicate Device Information K040773 Extended Butterfly Board, Bionix Development Corp.,

Intended Use/Indications for Use

The Raycast High Precision Lung Board is a patient positioning device intended to be used for the positioning and re-positioning of patients undergoing or receiving a course of external beam radiation therapy for the treatment of cancer and other diseases. It is intended to be used by or under the direction of a licensed physician.

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Principle of Operation

This product is a medical device used for positioning patients in radiation therapy. This system is used to position the arms over the head, for treating the thorax area.

Device Description

The Raycast High Precision Lung Board is used to position the patient supine on the treatment couch with the arms lifted above the head. This will keep the arms outside of the treatment field, which is the thorax in this case. The Raycast High Precision Lung Board is attached to the treatment couch with a 2-vin indexing bar in order to reproduce the same position each day. The Raycast High Precision Lung Board should be fully supported by the treatment couch. Then the patient is asked to lie down on the couch with his head in a head support that is attached to the Raycast High Precision Lung Board. Once the patient is lying down, he can lift up his arms until the elbows rest against the 'wings' of the board and the hands can reach the T-shaped handgrip.

The position of the T-shaped handgrip can be adjusted both in height and length according to the patient's anatomy. To adjust the height of the handgrip, pull the white knob on the side and move the grip pole up or down. To adjust the length of the handgrip, pull the white knob at the cranial side and slide the handgrip more caudally or cranially. Various head supports can be placed on the Raycast High Precision Lung Board depending on the physician's preference. The standard set-up will be with an Orfit Head Support, but it is also possible to use a Silverman or Timo Head Support which they might already have available in their department.

Once the patient is set-up correctly, the arms should not be treatment field anymore, which is the thorax area in this case. This allows the physician to irradiate the thorax from various angles, including laterally without passing through the arms of the patient. The Raycast High Precision Lung Board itself will not be in the treatment field and as such will not be irradiated through.

Accessories Description

There are no accessories marketed with the Raycast High Precision Lung Board.

Performance

No performance standards or special controls have been developed under Section 514 of the Federal Food, Drug, and Cosmetic Act ("FD&C Act") for the Raycast High Precision Lung Board. Bench testing was performed and includes a dosimetry test report for the device including device attenuation and water thickness, which have been validated to demonstrate SE to the predicate in safety and effectiveness.

Additional studies performed are the MR safety studies performed in order to demonstrate that the device tested as MR safe.

Substantial Equivalence

Equivalence was determined using a side by side tabular comparison between the predicate and proposed devices which included: Features. Intended Use. Labeling, Materials, Specifications, Performance Data, and Technological Aspects. The proposed device is substantially equivalent to the K040773 Bionix Extended Butterfly Board.

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SE Table of Attributes
Basic Unit
CharacteristicsPredicate K040773
Bionix Development Corp.,
Extended Butterfly BoardProposed Raycast
High Precision Lung BoardDifference
Indications for UseTo be used for the positioning and
repositioning of patients undergoing
or receiving a course of external
beam radiation therapy for the
treatment of cancer and other
diseases. It is intended to be used by
or under the direction of a licensed
physician.To be used for the positioning and
repositioning of patients
undergoing or receiving a course
of external beam radiation therapy
for the treatment of cancer and
other diseases. It is intended to be
used by or under the direction of a
licensed physician.None
Intended UseDesigned to be used for the
positioning and repositioning of
patients for receiving radiation
therapy.Designed to be used for the
positioning and repositioning of
patients for receiving radiation
therapy.None
PrescriptionRxRxNone
CFR892.5050892.5050None
Material Board
AssemblyAcrylicAcrylicNone
Material T Handle
Base and PostsPOM + NylonPOM + NylonNone, to the best of our knowledge the predicate device
accessories are made from the same POM and Nylon
materials as the subject device. No different questions of
safety or effectiveness are raised.
Material Flat
ScrewsNylonNylonNone, to the best of our knowledge the predicate device
accessories are made from the same POM and Nylon
materials as the subject device. No different questions of
safety or effectiveness are raised.
Material Socket
Head Cap Screws
and Knurled
ThumbscrewsNylonNoneProposed device does not have these screws; SE is not
affected since the proposed design does not require these
screws to be SE. No different questions of safety or
effectiveness are raised.
Basic Unit
CharacteristicsPredicate K040773
Bionix Development Corp.,
Extended Butterfly BoardProposed Raycast
High Precision Lung BoardDifference
Material Hand Grip
AssemblyVinylPOM + NylonBoth polymers are similar in grip characteristics. Both vinyl
and nylon are SE materials for the hand grip, the primary
difference between the materials is resistance to extreme
temperatures, not applicable to this device. No different
questions of safety or effectiveness are raised.
Material
Attachment PinsPOMPOMNone, to the best of our knowledge the predicate device
accessories are made from the same POM and Nylon
materials as the subject device. No different questions of
safety or effectiveness are raised.
Hand Grip SpringNonePolyamidePredicate device does not have this spring; SE is not
affected since the predicate design does not require this
spring to be SE. No different questions of safety or
effectiveness are raised.
FabricationMachined and ThermoformedMachined and ThermoformedNone
DesignHas elevated thermoformed "wings"
on either side to support the patient's
upper arms and facilitate patient
positioningHas elevated thermoformed
"wings" on either side to support
the patient's upper arms and
facilitate patient positioningNone
PositioningHandgrip included to help facilitate
patient positioning and repositioning.Handgrip included to help
facilitate patient positioning and
repositioning.None
Mounting HolesYesYesNone
Thickness0.31"0.31"None
LxWxH22.4" x 21.3" x 6.7"22.4" x 21.3" x 6.7"None
Cleaning/
Disinfection in
LabelingTo clean, wipe thoroughly with
water based antiseptic cleaner or
foam. Allow to dry before next
patient use. Notice: Do not use
alcohol based cleaners on this
productthis product can be cleaned and
disinfected by means of soapy
water or an isopropanol based
disinfectant, applied with a soft
clothMinor difference in way of describing the
cleaning/disinfection method, but the scope is the same, no
difference in SE.
Basic Unit
CharacteristicsPredicate K040773
Bionix Development Corp.,
Extended Butterfly BoardProposed Raycast
High Precision Lung BoardDifference
Weight6.24 lbs6.24 lbsNone
MR SafetyMR SafeSE for attenuation, MR Safety, and skin build up was
Attenuation/SBU~6MV (4.15%)extrapolated based on the performance testing on the
Skin Build UpUnknown~mmH2O/11mmproposed device, and the SE comparison of material,
fabrication method, thickness, and material
density/thickness between the proposed and predicate
device. The predicate device is made from similar non-
magnetic material which contains a similar attenuation
coefficient. It is fabricated using similar manufacturing
methods to a similar thickness. The dimensions and weight
are similar and the materials have similar density. The
amount of attenuation and skin build up is directly related to
the material properties, fabrication method, density, and
thickness. Therefore, the predicate device contains similar
inherent properties as the proposed device including
attenuation and skin build up and MR safety.
Differences/Conclusion: There are no significant differences between the proposed and predicate devices, no new patient contacting materials are being
introduced. Minor differences in the way labeling sections are described, some differences in the number of components included in the submission. The
proposed device labeling is written to be more descriptive than the predicate labeling which does not introduce different questions of safety or effectiveness
because the labeling is more clear. The proposed device contains less components compared to the predicate device, this does not introduce different questions
of safety or effectiveness because the device functions equivalently to the predicate and introduces less materials and components to the patient. The proposed
device is found to be SE to the predicate device.

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