K Number
K171087
Device Name
AXON IR Heat Lamp
Date Cleared
2017-07-07

(86 days)

Product Code
Regulation Number
890.5500
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The AXON IR Heat Lamp System is intended to emit energy in the infrared spectrum to provide topical heating for the purpose of elevating tissue temperature for the temporary relief of minor muscle and joint pain and stiffness, minor arthritis pain, or muscle spasm; the temporary increase in local blood circulation; and / or the temporary relaxation of muscle.
Device Description
The AXON IR Heat Lamp System is intended for use as a therapeutic heat lamp. The System is a non-invasive device that emits light energy to the skinsurface of the human body for the purpose of causing the therapeutic elevation of tissue temperature. The AXON IR Heat Lamp System deliver invisible laser light beams at 810 and 915 nm wavelengths using gallium arsenide (GaAs) diode sources. The laser light beam is carried to the focusing lens on the handpiece probe by quartz optical fibers. The tissue to be treated is illuminated by a non-therapeutic green laser guide light with 3 mW of power. TThe System consists of 2 main hardware sub-systems: 1) the control console and 2) the treatment handpiece probe with its connecting cable. The control consoles are made of standard medical PVC material and are designed to be placed in the vicinity of the patient to be treated. The console houses the user interface, which is a pressure activated membrane and an LCD display. The treatment probes are made of standard medical grade PVC. The laser energy for heat treatment is delivered to the treatment probe via fiberoptic cables. The probes contain a protective lens at the aperture, which is made of qlass suitable for medical applications.
More Information

Not Found

No
The description focuses on the hardware components (laser diodes, fiber optics, control console, handpiece) and the physical mechanism of action (infrared heating). There is no mention of any software algorithms, data processing, or learning capabilities that would indicate the presence of AI or ML.

Yes
The intended use explicitly states the device is for "temporary relief of minor muscle and joint pain and stiffness, minor arthritis pain, or muscle spasm," aligning with the definition of a therapeutic device. The device description also labels it as a "therapeutic heat lamp."

No

The provided text clearly states the device's purpose is "to provide topical heating for the purpose of elevating tissue temperature for the temporary relief of minor muscle and joint pain and stiffness, minor arthritis pain, or muscle spasm; the temporary increase in local blood circulation; and/or the temporary relaxation of muscle." This describes a therapeutic function, not a diagnostic one. A diagnostic device would identify or characterize a disease or condition.

No

The device description explicitly details hardware components including a control console, treatment handpiece probe, connecting cable, laser sources, optical fibers, and a protective lens.

Based on the provided information, the AXON IR Heat Lamp System is not an IVD (In Vitro Diagnostic) device.

Here's why:

  • Intended Use: The intended use clearly states that the device is for providing topical heating to the human body for therapeutic purposes (pain relief, increased circulation, muscle relaxation). This is a therapeutic application, not a diagnostic one.
  • Device Description: The description details a system that emits infrared light to the skin surface to elevate tissue temperature. This is consistent with a therapeutic heat lamp, not a device used to examine specimens from the human body.
  • Lack of IVD Characteristics: There is no mention of the device being used to test or analyze samples (blood, urine, tissue, etc.) from the human body. IVD devices are specifically designed for this purpose to provide information about a person's health status.

In summary, the AXON IR Heat Lamp System is a therapeutic device that applies energy to the body, not a diagnostic device that analyzes samples from the body.

N/A

Intended Use / Indications for Use

The AXON IR Heat Lamp System is intended to emit energy in the infrared spectrum to provide topical heating for the purpose of elevating tissue temperature for the temporary relief of minor muscle and joint pain and stiffness, minor arthritis pain, or muscle spasm; the temporary increase in local blood circulation; and / or the temporary relaxation of muscle.

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

ILY

Device Description

The AXON IR Heat Lamp System is intended for use as a therapeutic heat lamp. The System is a non-invasive device that emits light energy to the skinsurface of the human body for the purpose of causing the therapeutic elevation of tissue temperature.

The AXON IR Heat Lamp System deliver invisible laser light beams at 810 and 915 nm wavelengths using gallium arsenide (GaAs) diode sources. The laser light beam is carried to the focusing lens on the handpiece probe by quartz optical fibers. The tissue to be treated is illuminated by a non-therapeutic green laser guide light with 3 mW of power. TThe System consists of 2 main hardware sub-systems: 1) the control console and 2) the treatment handpiece probe with its connecting cable.

The control consoles are made of standard medical PVC material and are designed to be placed in the vicinity of the patient to be treated. The console houses the user interface, which is a pressure activated membrane and an LCD display.

The treatment probes are made of standard medical grade PVC. The laser energy for heat treatment is delivered to the treatment probe via fiberoptic cables. The probes contain a protective lens at the aperture, which is made of qlass suitable for medical applications.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

back, ankle, leg, shoulder, neck, upper and/or low back

Indicated Patient Age Range

Not Found

Intended User / Care Setting

Not Found

Description of the training set, sample size, data source, and annotation protocol

Not Found

Description of the test set, sample size, data source, and annotation protocol

Not Found

Summary of Performance Studies (study type, sample size, AUC, MRMC, standalone performance, key results)

Study Type: Bench testing. The AXON IR Heat Lamp System can achieve therapeutic temperature range of 40 - 45 degrees centigrade. An increase in topical heating of the tissue level by at least 5 degrees centigrade was reached within one (1) minute. The therapeutic temperature range was maintained for the 10-minute testing time.
Sample Size: 3 subjects. 2 physical locations tested per subject.
Key Results:

  • The average ambient temperature at the beginning of the testing was approximately 22 degrees centigrade.
  • The pre-exposed topical skin temperature ranged from 30 to 32 degrees centigrade.
  • The topical temperature during exposure following brief stabilization time ranged from 40 to 45 degrees centigrade.
  • The average warm-up time for the devices was less than two minutes.
  • The average time to achieve therapeutic temperature (40 - 45 degrees centigrade) was less than 2 minutes.
  • The data demonstrate the system meets the generally accepted topical temperature range for therapeutic heat of 40-45 degrees centigrade during the recommended treatment time of 10 minutes.

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.

K132016, K101893, K120604

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

§ 890.5500 Infrared lamp.

(a)
Identification. An infrared lamp is a device intended for medical purposes that emits energy at infrared frequencies (approximately 700 nanometers to 50,000 nanometers) to provide topical heating.(b)
Classification. Class II (special controls). The device, when it is an infrared therapeutic heating lamp, is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 890.9.

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Image /page/0/Picture/2 description: The image shows the seal of the U.S. Department of Health & Human Services. The seal is circular and contains the text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" around the top half of the circle. In the center of the seal is a stylized image of three human profiles facing to the right, stacked on top of each other.

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

July 7, 2017

Crystal Medtech, LLC Nelson Marquina Manager, Regulatory Affairs 4704 Bavberry Street Schofield, Wisconsin 54476

Re: K171087

Trade/Device Name: AXON IR Heat Lamp Regulation Number: 21 CFR 890.5500 Regulation Name: Infrared Lamp Regulatory Class: Class II Product Code: ILY Dated: April 8, 2017 Received: April 12, 2017

Dear Nelson Marquina:

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 Actinclude 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

1

related adverse events) (21 CFR 803): good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820); and if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please 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,

Jennifer R. Stevenson -S3

For Binita S. Ashar, M.D., M.B.A., F.A.C.S. Director Division of Surgical Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

2

Indications for Use

510(k) Number (if known) K171087

Device Name AXON IR Heat Lamp

Indications for Use (Describe)

The AXON IR Heat Lamp System is intended to emit energy in the infrared spectrum to provide topical heating for the purpose of elevating tissue temperature for the temporary relief of minor muscle and joint pain and stiffness, minor arthritis pain, or muscle spasm; the temporary increase in local blood circulation; and / or the temporary relaxation of muscle.

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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3

008_510(k) Summary (as per 21 CFR 807.92)

GENERAL INFORMATION l.

Device Generic Name:

Trade Name:

AXON IR Heat Lamp System

| Device Classification: | Class II, Performance Standards
21CFR Part 890.5500 – Infrared Lamp |

------------------------------------------------------------------------------------------------

Product Code: ILY

Applicant Name and Address: Crystal MedTech, LLC 4704 Bayberry Street Schofield, WI 54476 USA Telephone: 715 / 843-0325

510(k) Number: Pending

II. Device Description

The AXON IR Heat Lamp System is intended for use as a therapeutic heat lamp. The System is a non-invasive device that emits light energy to the skinsurface of the human body for the purpose of causing the therapeutic elevation of tissue temperature.

The AXON IR Heat Lamp System deliver invisible laser light beams at 810 and 915 nm wavelengths using gallium arsenide (GaAs) diode sources. The laser light beam is carried to the focusing lens on the handpiece probe by quartz optical fibers. The tissue to be treated is illuminated by a non-therapeutic green laser guide light with 3 mW of power. TThe System consists of 2 main hardware sub-systems: 1) the control console and 2) the treatment handpiece probe with its connecting cable.

The control consoles are made of standard medical PVC material and are designed to be placed in the vicinity of the patient to be treated. The console houses the user interface, which is a pressure activated membrane and an LCD display.

4

The treatment probes are made of standard medical grade PVC. The laser energy for heat treatment is delivered to the treatment probe via fiberoptic cables. The probes contain a protective lens at the aperture, which is made of qlass suitable for medical applications.

lll. Indications For Use

The AXON IR Heat Lamp System is intended to emit energy in the infrared spectrum to provide topical heating for the purpose of elevating tissue temperature for the temporary relief of minor muscle and joint pain and stiffness, minor arthritis pain, or muscle spasm; the temporary increase in local blood circulation; and/or the temporary relaxation of muscle.

IV. Predicate Devices

The AXON IR Heat Lamp System is substantially equivalent to other therapeutic heat lamps that are currently in commercial distribution. These predicate devices include, but are not limited to:

    1. USA Laser Biotech Inc. LUMIX 3 Series Infrared Heat Lamp Therapy Systems (K132016),
    1. USA Laser Biotech Inc. NEXUS Series IR Heat Lamp System (K101893),
    1. ELTECH s.r.l. K-Laser Cube 1, K-Laser Cube 2, K-Laser Cube 3, K-Laser Cube 4 (K120604).

v. Summary of the Technical Characteristics of the AXON System as Related to the Referenced Predicate Devices

The AXON IR Heat Lamp System and the predicate devices are infrared lamps as defined in 21 CFR 890.5500. These devices utilize infrared and visible laser diodes to generate topical heating for the purpose of elevating tissue temperatures for temporary relief of muscle and joint pain.

VI. Testing

Testing of the AXON System includes electromagnetic compatibility, software validation and verification, functional performance testing, and electrical safety testing. The System is manufactured to comply with the following international standards:

5

| IEC 60601-1:2006 – Ed. 3 | Medical Electrical Equipment, Part 1:
General Requirements for Basic Safety
and Essential Performance |
|-------------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| IEC 60825-1:2014 - Ed. 2 | Safety of Laser Products - Part 1:
Classification of laser devices and
requirements |
| IEC 60601-1-2:2007 - Ed. 3 | Medical Electrical Equipment - Part 1-2:
Collateral Standard: Electromagnetic
disturbances - Requirements and tests |
| IEC 60601-1-6:2013 - Ed. 3.1 | Medical Electrical Equipment - Part 1-6:
Collateral Standard: Usability |
| IEC 60601-2-22:2012 - Ed. 3.1 | Medical Electrical Equipment - Part 2-22:
Particular requirements for basic and
essential performance of surgical,
cosmetic, therapeutic and diagnostic laser
equipment |
| IEC 63204:2006 | Software for Medical Devices: Software
life cycle processes |
| ISO 14971:2012 – Ed. 2 | Risk Management to Medical Devices |

VII. Conclusions

Pursuant to the testing and comparison to the predicate devices, the AXON IR Heat Lamp System have the same intended uses, with similar functional and performance characteristics. The AXON IR Heat Lamp System is designed to comply with applicable performance standards promulgated by the U.S. Food and Drug Administration. - These Systems perform as intended and do not raise any new safety or efficacy issues.

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CharacteristicAXON IR Heat LampLUMIX 3 Series IR Heat LampNEXUS Series IR Heat LampK-LASER CUBE 1, 2, 3, and 4 Heat Lamp
ManufacturerCrystal MedTech, LLCFisioline S.r.l.Wuhan Gigaa Laser Optronics Technology Co., Ltd.ELTECH S.r.l.
510k NumberPendingK132016K101893K120604
Power Supply115/230 VAC, 6.3A power supply, single phase115/230 VAC, 6.3A power supply, single phaseDC26V/4A. Use SINPRO MPU100-102 desktop power supply adapterDC12V SINPRO MPU100-106 desktop power supply adapter
Heat SourceGaAs diode and red guide beam diodeGaAs diode and red guide beam diodeGaAIAs diode and red guide beam diodeGaAIAs diode and red guide beam diode
Wavelengths (nm)810 and 915650, 810 and 910665, 810 and 980660, 800, 905, and 970
Power Range of Max. Output1 W to 20 W4.2 W to 8.2 W7 W to 60 W10 W to 20 W
Laser Classification4444
CFR Regulation Product Code21 CFR 890.5500 ILY21 CFR 890.5500 ILY21 CFR 890.5500 ILY21 CFR 890.5500 ILY
Clearance TypePrescriptionPrescriptionPrescriptionPrescription
Treatment ModePulsed / ContinuousPulsed / ContinuousPulsed / ContinuousPulsed / Continuous
Treatment TimesVariableVariableVariableVariable
Delivery SystemFiberoptic cable / handheld probeFiberoptic cable / handheld probeFiberoptic cable / handheld probeFiberoptic cable / handheld probe

Table 3. Technical Characteristics and Comparison Chart

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014_Non-Clinical Performance Data

AXON IR Heat Lamp System

The AXON IR Heat Lamp System can achieve therapeutic temperature range of 40 - 45 degrees centigrade as accepted by the FDA. An increase in topical heating of the tissue level by at least 5 degrees centigrade was reached within one (1) minute as demonstrated in the bench testing that was conducted. The therapeutic temperature range was maintained for the 10-minute testing time.

The average ambient temperature at the beginning of the testing was approximately 22 degrees centigrade. The temperatures versus time measurements were conducted on 3 subjects at 2 physical locations i.e., knee, ankle, shoulder, neck, upper and/or low back. On an average, the pre-exposed topical skin temperature ranged from 30 to 32 degrees centigrade.

The topical temperature during exposure following brief stabilization time ranged from 40 to 45 degrees centigrade. The average warm-up time for the devices was less than two minutes. The average time to achieve therapeutic temperature (40 - 45 degrees centigrade) was less than 2 minutes. These data demonstrate the System meets the generally accepted topical temperature range for therapeutic heat of 40 - 45 degrees centigrade during the recommended treatment time of 10 minutes. The results of these tests are summarized in Tables 4 to 6.

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Device:AXONSpacer: 6 cm Diam: 6 cmSpot: 28 cm²
Settings:AP 810 & 915 nm combined = 4.0 W
t = 600 s
Warming Time = 2 minutes
Subject:Gender: maleAge: 62Ethnicity: HispanicL1: backL2: ankle
Room Temperature: start = 22.2 °CRoom Temperature: end = 22.3 °C
Location1:Upper BackLocation2:Ankle
Time (min)Temp (°C)Time (min)Temp (°C)
initial31.0initial29.0
140.0140.0
241.0241.0
342.0341.0
442.0441.0
543.0542.0
643.0642.0
743.0742.0
844.0842.0
944.0943.0
1045.01043.0
Mean (active):42.7Mean (active):41.7
St. Dev.:1.49St. Dev.:0.95
Comments:

Table 4. Temperature versus Time for AXON IR Heat Lamp System: Subject 1

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Device:AXONSpacer: 6 cm Diam: 6 cmSpot: 28 cm²
Settings:AP 810 & 915 nm combined = 4.0 W
t = 600 s Warming Time = 2 minutes
Subject:Gender: female Age: 30Ethnicity: Black L1: legL2: ankle
Room Temperature: start = 23.1 °C
Room Temperature: end = 22.9 °C
Location1:LegLocation2: Ankle
Time (min)Temp (°C)Time (min) Temp (°C)
initial30.0initial 30.0
141.01 40.0
241.02 41.0
341.03 41.0
442.04 42.0
542.05 42.0
642.06 43.0
743.07 42.0
843.08 43.0
944.09 42.0
1043.010 43.0
Mean (active):42.2Mean (active): 41.9
St. Dev.:1.03St. Dev.: 0.99
Comments:

Table 5. Temperature versus Time for AXON IR Heat Lamp System: Subject 2

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Device:AXONSpacer: 6 cm Diam: 6 cmSpot: 28 cm²
Settings:AP 810 & 915 nm combined = 4.0 W
t = 600 s Warming Time = 2 minutes
Subject:Gender: female Age: 37Ethnicity: White L1: legL2: shoulder
Room Temperature: start = 21.8 °CRoom Temperature: end = 22.2 °C
Location1: LegLocation2: Shoulder
Time (min) Temp (°C)Time (min) Temp (°C)
initial 31.0initial 30.0
1 41.01 40.0
2 42.02 41.0
3 42.03 42.0
4 42.04 43.0
5 43.05 42.0
6 44.06 42.0
7 43.07 43.0
8 43.08 44.0
9 44.09 44.0
10 45.010 45.0
Mean (active): 42.9Mean (active): 42.6
St. Dev.: 1.20St. Dev.: 1.51
Comments:

Table 6. Temperature versus Time for AXON IR Heat Lamp System: Subject 3