K Number
K171102
Device Name
Ives MR Conditional Cup Electrode
Manufacturer
Date Cleared
2017-12-21

(252 days)

Product Code
Regulation Number
882.1320
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The Ives MR Conditional Cup Electrodes are intended for use in the general recording and monitoring of the electroencephalography (EEG), evoked potential (EP) as well as ground and reference related to the EEG and EP recording. The Cup Electrodes are intended to be left in place during MR imaging at 1.5T and 3T as well as during CT scanning. The extension cable must be disconnected from the Ives MR Conditional Cup Electrodes before scanning and MUST remain disconnected throughout the entire MR scan. EEG or EP should not be recorded throughout the entire the CT and MR imaging.
Device Description
The cutaneous surface electrode (CPE) are electrodes that are all applied to the surface of the patient's skin, they are non-invasive. These electrodes are used for the recording of electroencephalography (EEG), evoked potential (EP) as well as the ground and reference associated with the recording. They consist of a disc or cup made from a variety of materials, which include, conductive plastic and Ag-Ag/Cl, materials that have long been used for this intended purpose throughout the industry and compatible to the MR environment. The conductive cup electrode is permanently connected to a PVC insulated copper lead wire varying in length from 6" to 9". This joint is then covered in a heatshrink tube to provide a strain relief. The lead wires are staggered in length (6" to 9") and terminate in a small mass connector that conforms to DIN 42-802 for electrical safety. A blue sponge is provided to locate the lead wire termination off of the scalp and at the top of the patient's head. To permit EEG monitoring, this small mass connector mates with a harness system as per K062880 (an Ives EEG Solutions 510K describing a Subdermal Wire Electrode System) which connects to the EEG recording instrument using molded "touch-proof" connectors which also conform to DIN 42-802. The Harness is disconnected for imaging. The electrode lead length is as short as possible to connect directly with the 10-20 EEG scalp site. This prevents coiling of the lead wires and as short as possible lead length to reduce or eliminate the RF heating antenna effect during MR scanning sequences. Electrode and lead materials are selected to avoid use of any magnetic ferrous metals.
More Information

No
The device description and intended use focus on the physical characteristics and MR compatibility of the electrodes for recording EEG/EP signals, with no mention of AI or ML for signal processing or interpretation.

No.
The device is described as electrodes for recording and monitoring electroencephalography (EEG) and evoked potential (EP), which are diagnostic tools. There is no indication of it providing any treatment or therapy.

Yes

Explanation: The device is used for "general recording and monitoring of the electroencephalography (EEG), evoked potential (EP)" which are diagnostic procedures to assess brain activity and nerve responses.

No

The device description clearly details physical components like electrodes, lead wires, connectors, and a sponge, indicating it is a hardware device.

Based on the provided information, this device is not an In Vitro Diagnostic (IVD).

Here's why:

  • Intended Use: The intended use is for the recording and monitoring of electrophysiological signals (EEG and EP) from the patient's skin surface. This is a direct measurement of physiological activity within the body.
  • Device Description: The device is a surface electrode designed to be applied to the skin to pick up electrical signals.
  • Lack of In Vitro Activity: IVD devices are used to examine specimens taken from the human body (like blood, urine, tissue) in vitro (outside the body) to provide information about a physiological state, health, or disease. This device does not process or analyze samples taken from the body. It directly interacts with the patient's body to acquire signals.

Therefore, the Ives MR Conditional Cup Electrodes fall under the category of a medical device used for physiological monitoring, not an In Vitro Diagnostic device.

N/A

Intended Use / Indications for Use

The Ives MR Conditional Cup Electrodes are intended for use in the general recording and monitoring of the electroencephalography (EEG), evoked potential (EP) as well as ground and reference related to the EEG and EP recording.

The Cup Electrodes are intended to be left in place during MR imaging at 1.5T and 3T as well as during CT scanning.

The extension cable must be disconnected from the Ives MR Conditional Cup Electrodes before scanning and MUST remain disconnected throughout the entire MR scan. EEG or EP should not be recorded throughout the entire the CT and MR imaging.

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

GXY

Device Description

The cutaneous surface electrode (CPE) are electrodes that are all applied to the surface of the patient's skin, they are non-invasive. These electrodes are used for the recording of electroencephalography (EEG), evoked potential (EP) as well as the ground and reference associated with the recording. They consist of a disc or cup made from a variety of materials, which include, conductive plastic and Ag-Ag/Cl, materials that have long been used for this intended purpose throughout the industry and compatible to the MR environment. The conductive cup electrode is permanently connected to a PVC insulated copper lead wire varying in length from 6" to 9". This joint is then covered in a heatshrink tube to provide a strain relief. The lead wires are staggered in length (6" to 9") and terminate in a small mass connector that conforms to DIN 42-802 for electrical safety. A blue sponge is provided to locate the lead wire termination off of the scalp and at the top of the patient's head. To permit EEG monitoring, this small mass connector mates with a harness system as per K062880 (an Ives EEG Solutions 510K describing a Subdermal Wire Electrode System) which connects to the EEG recording instrument using molded "touch-proof" connectors which also conform to DIN 42-802. The Harness is disconnected for imaging. The electrode lead length is as short as possible to connect directly with the 10-20 EEG scalp site. This prevents coiling of the lead wires and as short as possible lead length to reduce or eliminate the RF heating antenna effect during MR scanning sequences. Electrode and lead materials are selected to avoid use of any magnetic ferrous metals.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

MR imaging, CT scanning

Anatomical Site

Surface, scalp, skin

Indicated Patient Age Range

Adult, >21

Intended User / Care Setting

EEG Technologist
Hospital, ICU, inpatient

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)

Non-clinical testing has demonstrated that the Ives MR Conditional Cup Electrodes is MR Conditional and can safely remain on the patient during an MR scan under the following conditions:

  • Static magnetic fields strength of 1.5 T and 3.0 T
  • Maximum spatial gradient magnetic fields of 2,000 gauss/cm (20T/m) or less
  • Transmit body and head coil, quadrature driven
  • Maximum MR System reported whole-body averaged specific absorption rate (SAR) of 2 W/kg and whole-head averaged SAR of 3.2 W/kg
  • The extension cable must be disconnected from the Ives MR Conditional Cup Electrodes before scanning and must remain disconnected throughout the entire MR scan.

Under the scan conditions defined above, the Ives MR Conditional Cup Electrodes is expected to produce a maximum temperature rise of less than 5℃ after 15 minutes of continuous scanning.

In clinical testing, the image artifact caused by the device extends approximately 3 mm from the Ives MR Conditional Cup Electrodes when imaged with a gradient echo pulse sequence in a 1.5 T and 3.0 T MRI system.

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.

K071118, K130287, K122376

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.

K062880

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

§ 882.1320 Cutaneous electrode.

(a)
Identification. A cutaneous electrode is an electrode that is applied directly to a patient's skin either to record physiological signals (e.g., the electroencephalogram) or to apply electrical stimulation.(b)
Classification. Class II (performance standards).

0

Image /page/0/Picture/0 description: The image contains the logos of the Department of Health & Human Services and the Food and Drug Administration (FDA). The Department of Health & Human Services logo is on the left, and the FDA logo is on the right. The FDA logo includes the letters "FDA" in a blue square, followed by the words "U.S. Food & Drug Administration" in blue text.

December 21, 2017

Ives EGG Solutions John Ives Design Engineer 25 Storey Avenue, #118 Newburyport, Massachusetts 01950

Re: K171102

Trade/Device Name: Ives MR Conditional Cup Electrode Regulation Number: 21 CFR 882.1320 Regulation Name: Cutaneous Electrode Regulatory Class: Class II Product Code: GXY Dated: Not Dated Received: November 29, 2017

Dear John Ives:

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 of medical device-related adverse events) (21 CFR 803); good

1

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.

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.

For comprehensive regulatory information about medical devices and radiation-emitting products, including information about labeling regulations, please see Device Advice (https://www.fda.gov/MedicalDevices/DeviceRegulationandGuidance/) and CDRH Learn (http://www.fda.gov/Training/CDRHLearn). Additionally, you may contact the Division of Industry and Consumer Education (DICE) to ask a question about a specific regulatory topic. See the DICE website (http://www.fda.gov/DICE) for more information or contact DICE by email (DICE@fda.hhs.gov) or phone (1-800-638-2041 or 301-796-7100).

Sincerely.

Vivek J. Pinto -S

for Carlos L. Peña, PhD, MS Director Division of Neurological and Physical Medicine Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

2

Indications for Use

510(k) Number (if known) K171102

Device Name Ives MR Conditional Cup Electrode

Indications for Use (Describe)

The Ives MR Conditional Cup Electrodes are intended for use in the general recording and monitoring of the electroencephalography (EEG), evoked potential (EP) as well as ground and reference related to the EEG and EP recording.

The Cup Electrodes are intended to be left in place during MR imaging at 1.5T and 3T as well as during CT scanning.

The extension cable must be disconnected from the Ives MR Conditional Cup Electrodes before scanning and MUST remain disconnected throughout the entire MR scan. EEG or EP should not be recorded throughout the entire the CT and MR imaging.

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)

CONTINUE ON A SEPARATE PAGE IF NEEDED.

This section applies only to requirements of the Paperwork Reduction Act of 1995.

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

The burden time for this collection of information is estimated to average 79 hours per response, including the time to review instructions, search existing data sources, gather and maintain the data needed and complete and review the collection of information. Send comments regarding this burden estimate or any other aspect of this information collection, including suggestions for reducing this burden, to:

Department of Health and Human Services Food and Drug Administration Office of Chief Information Officer Paperwork Reduction Act (PRA) Staff PRAStaff(@fda.hhs.gov

"An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB number."

3

010_510(k) Summary

Ives MR Conditional Cup Electrode (K171102)

Company Name:Ives EEG Solutions, Inc.
Contact:Mr. John Ives
Phone:978-358-8006
Fax:978-358-7825
Email:johnrives@gmail.com
Summary Date:December 8, 2017
Trade Name:Ives MR Conditional Cup Electrode
Model Number:CPE (Conductive Plastic Electrode)
Common Name:Surface Electrode, Cutaneous electrode
Classification Name:21 CFR 882.1350, Cutaneous Electrode GXY
Main Predicate Device:510(k) Number:
Manufacture:
Trade Name:
Product Code:K071118
Ives EEG Solutions, LLC
EEG Surface Electrode System
GXY
Other Predicate Devices:510(k) Number:
Manufacture:
Name:
Product Code:K130287
Rythmlink International, LLC Trade
MR Conditional Cup Electrode, MR Conditional Webb Electrode
GXY
Other Predicate Devices:510(k) Number:
Manufacture:
Name:
Product Code:K122376
TruScan® Surface Electrodes
TruScan® Surface Electrodes
GXY

Description of Electrodes:

The cutaneous surface electrode (CPE) are electrodes that are all applied to the surface of the patient's skin, they are non-invasive. These electrodes are used for the recording of electroencephalography (EEG), evoked potential (EP) as well as the ground and reference associated with the recording. They consist of a disc or cup made from a variety of materials, which include, conductive plastic and Ag-Ag/Cl, materials that have long been used for this intended purpose throughout the industry and compatible to the MR environment. The conductive cup electrode is permanently connected to a PVC insulated copper lead wire varying in length from 6" to 9". This joint is then covered in a heatshrink tube to provide a strain relief. The lead wires are staggered in length (6" to 9") and terminate in a small mass connector that conforms to DIN 42-802 for electrical safety. A blue sponge is provided to locate the lead wire termination off of the scalp and

4

010 4 510(k) Summary

at the top of the patient's head. To permit EEG monitoring, this small mass connector mates with a harness system as per K062880 (an Ives EEG Solutions 510K describing a Subdermal Wire Electrode System) which connects to the EEG recording instrument using molded "touch-proof" connectors which also conform to DIN 42-802. The Harness is disconnected for imaging. The electrode lead length is as short as possible to connect directly with the 10-20 EEG scalp site. This prevents coiling of the lead wires and as short as possible lead length to reduce or eliminate the RF heating antenna effect during MR scanning sequences. Electrode and lead materials are selected to avoid use of any magnetic ferrous metals.

Indications for Use

The Ives MR Conditional Cup Electrodes are intended for use in the general recording and monitoring of the electroencephalography (EEG), evoked potential (EP) as well as ground and reference related to the EEG and EP recording.

The Cup Electrodes are intended to be left in place during MR imaging at 1.5T and 3T as well as during CT scanning.

The extension cable must be disconnected from the Ives MR Conditional Cup Electrodes before scanning and MUST remain disconnected throughout the entire MR scan. EEG or EP should not be recorded throughout the entire the CT and MR imaging.

Substantial Equivalent to Predicate Devices

| | Ives Surface EEG
Electrodes Model:
GCE
SCE, SCES CPES | Rhythmlink International
Model: Cup Electrode | TruScan® Surface
Electrodes |
|-------------|----------------------------------------------------------------|--------------------------------------------------|--------------------------------|
| 510K number | K171102 | K130287 | K122376 |

5

010_4 510(k) Summary

IFUThe Ives MR ConditionalThe MR Conditional Cup andThe PMT® TruScan®
Cup Electrodes areWebb Electrodes are intendedSurface Electrodes are
intended for use in thefor use in the recording of theindicated for cutaneous
general recording andElectroencephalogram (EEG),use in the general
monitoring of thethe evoked potential (EP), or asrecording and monitoring
electroencephalographya ground and reference in anof the
(EEG), evoked potentialEEG or EP recording. ThisElectroencephalograph
(EP) as well as ground anddevice is non-sterile for Single(EEG) and Evoked
reference related to thePatient Use Only and mayPotential (EP).
EEG and EP recording.remain on the patient in a MRIThe PMT® TruScan®
environment under specificSurface Electrodes are CT
The Cup Electrodes areconditions.compatible and MR
intended to be left in placeConditional under the
during MR imaging atfollowing conditions:
1.5T and 3T as well as* Static magnetic field
during CT scanning.strength of 1.5-T only
* Maximum spatial
The extension cable mustgradient magnetic field of
be disconnected from the5,000 Gauss/cm (5OT/in)
Ives MR Conditional Cupor less
Electrodes before* The connector hub must
scanning and MUSTbe placed near the center
remain disconnectedMR system's bore, and
throughout the entire MRmust be at least 20-cm
scan. EEG or EP shouldfrom the wall of the MR
not be recordedsystem's bore at all times.
throughout the entire the* The extension cable
CT and MR imaging.must be disconnected from
the PMT TruScan Surface
Electrode before scanning
and MUST remain
disconnected throughout
the entire MR scan.
* Normal Operating Mode
of operation for the MR
system with a maximum
whole body averaged
specific absorption rate
(SAR) of 2.0-W/kg for 15
minutes of scanning (i.e.,
per pulse sequence)
Classification
Product CodeGXYGXYGXYIndications For
UseRecording of the
EEG, EP, GND, REFRecording of the EEG,
EP, GND, REFRecording of the
EEG, EP, GND,Target
PopulationAdultAdultAdultAge Range>21>21>21

6

010_4 510(k) Summary
Length oftemporarytemporarytemporary
Recording
SupervisionEEG TechnologistEEG TechnologistEEG Technologist
Size of electrode1cm1cm1cm
DesignCup electrode withCup electrode with hole for gelCup electrode with hole
hole for gelfor gel
MaterialsABS molded plasticABS molded plastic with Ag-Silver/silver chloride
with Ag- Ag/ClAg/Cl coating
Lead DesignTinseled copper wireCopper wire with Vinyl (PVC)Nichrome
with silver coat withinsulation
Lead LengthTested at 6" to 11" asTested at 3.9" but marketed atTested and marketed at
See below 1:well as marketed9.5"9"
PerformanceHigh quality EEGHigh quality EEG
BiocompatibilityLong HistoryLong History-
MechanicalIdealIdeal
Safety
Chemical SafetyOKOK
Anatomical SitesSurface, scalp, skinSurface, scalp, skinSurface, scalp, skin
Human FactorsEasily Placed byEasily Placed by traditionalEasily Placed by
traditional meansmeanstraditional means
Energy UsedRecord EEGRecord EEG Biopotential OnlyRecord EEG Biopotential
and/or DeliveredBiopotential OnlyOnly
CompatibilityConnects to anyConnects to any StandardConnects to any Standard
Standard RecordingRecording DeviceRecording Device
Interconnection48" lead connects48" lead connects from EEG48" lead connects from
between electrode from EEG electrode toelectrode to standard 1.5mmEEG electrode to
lead andstandard 1.5mm Safe-Safe-Lead ("Touch-Proof")standard 1.5mm
ConnectionNO other connectionNO other connection to
during imagingto electrode set duringelectrode set during imaging
Where UsedHospital, ICU,Hospital, ICU, inpatient
inpatient
PackagingNon-sterile in plasticNon-sterile in plastic bagNon-sterile, sealed in PE
bagpouch
Electrical SafetyConnects with Safe-Connects with Safe-Lead1.5mm
LeadBrass/Polypropylene IEC
60601-1 subclause
56.3(c) compliant
Static MRI field1.5T and 3T1.5T and 3T1.5T only
strength tested
ConnectorLocated at top of headNot specifiedMust be at least 20cm
placementusing supplied sponge,from the wall of the MR
thus near center ofbore at all times
Maximum SAR3.2W/KgNot specified2.0W/Kg

7

010_4 510(k) Summary DIFFERENCE RATIONALE:

There are essentially no major differences between our device and the predicate device except as noted below.

1: There is a significant lead length difference between Rhythmlink as tested and Ives as tested (3.9" vs. 6"-11"); however, as marketed the difference is 9.5" vs. 6" to 11"). Testing showed that the leads connected to the subject device supported the safe and effective use of the device for the indications for use stated. Ives EEG Solutions found that the EEG technologist needs at least 6" to allow easy application of the electrode and also to allow for staggered lead lengths to extend from the 10-20 site to the connector at the top of the head, thus the longest lead is 11".

Non-Clinical Testing

Non-clinical testing has demonstrated that the Ives MR Conditional Cup Electrodes is MR Conditional and can safely remain on the patient during an MR scan under the following conditions:

  • Static magnetic fields strength of 1.5 T and 3.0 T

  • Maximum spatial gradient magnetic fields of 2,000 gauss/cm (20T/m) or less

  • Transmit body and head coil, quadrature driven

  • Maximum MR System reported whole-body averaged specific absorption rate (SAR) of

  • 2 W/kg and whole-head averaged SAR of 3.2 W/kg

  • The extension cable must be disconnected from the Ives MR Conditional Cup Electrodes before scanning and must remain disconnected throughout the entire MR scan.

Under the scan conditions defined above, the Ives MR Conditional Cup Electrodes is expected to produce a maximum temperature rise of less than 5℃ after 15 minutes of continuous scanning.

In clinical testing, the image artifact caused by the device extends approximately 3 mm from the Ives MR Conditional Cup Electrodes when imaged with a gradient echo pulse sequence in a 1.5 T and 3.0 T MRI system.

CONCLUSION:

Ives MR Conditional Cup electrodes are substantially equivalent to the predicate MRI Conditional EEG cutaneous electrode.