K Number
K172675
Device Name
Varian Cervical Sleeves
Date Cleared
2018-05-16

(253 days)

Product Code
Regulation Number
892.5700
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The Varian Cervical Sleeves are intended for use for treatment of any case where high dose irradiation with an intrauterine tandem is an acceptable clinical practice.
Device Description
Varian Cervical Sleeves are brachytherapy applicator accessories. The cervical sleeves are used for insertion into the cervix prior to treatment and acts to guide the radioactive source to the correct locations for treatment. The sleeve can be sutured in place and left for a series of treatments. Presence of the sleeve helps to insure against perforation of the uterine wall by the distal end of the tandem.
More Information

Not Found

No
The document describes a physical brachytherapy applicator accessory and its intended use, with no mention of software, algorithms, or any terms related to AI or ML. The performance studies focus on hardware verification, biocompatibility, and cleaning validation.

Yes
The Varian Cervical Sleeves are intended for the "treatment of any case where high dose irradiation with an intrauterine tandem is an acceptable clinical practice," which is a therapeutic purpose.

No

The device description indicates that Varian Cervical Sleeves are used to guide radioactive sources for treatment, not to diagnose a condition.

No

The device description and performance studies clearly indicate this is a physical medical device (brachytherapy applicator accessories) and not software. The performance studies focus on hardware verification, validation, biocompatibility, and cleaning validation.

No, this device is not an IVD (In Vitro Diagnostic).

Here's why:

  • IVD Definition: In vitro diagnostics are tests performed on samples taken from the human body, such as blood, urine, or tissue, to detect diseases, conditions, or infections. They are used to provide information for diagnosis, monitoring, or screening.
  • Device Function: The Varian Cervical Sleeves are physical accessories used in brachytherapy treatment. They are inserted into the cervix to guide a radioactive source for direct treatment of a condition. They do not analyze biological samples to provide diagnostic information.
  • Intended Use: The intended use clearly states "for treatment of any case where high dose irradiation with an intrauterine tandem is an acceptable clinical practice." This is a therapeutic use, not a diagnostic one.
  • Device Description: The description details its function as a guide for a radioactive source and a safeguard against uterine wall perforation during treatment. This is a mechanical/physical function within a treatment procedure.

The information provided describes a medical device used in a therapeutic procedure, not a diagnostic test performed on biological samples.

N/A

Intended Use / Indications for Use

The Varian Cervical Sleeves are intended for use for treatment of any case where high dose irradiation with an intrauterine tandem is an acceptable clinical practice.

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

JAO

Device Description

Varian Cervical Sleeves are brachytherapy applicator accessories. The cervical sleeves are used for insertion into the cervix prior to treatment and acts to guide the radioactive source to the correct locations for treatment. The sleeve can be sutured in place and left for a series of treatments. Presence of the sleeve helps to insure against perforation of the uterine wall by the distal end of the tandem.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

cervix, uterine wall

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)

Hardware verification and validation testing was conducted according to the FDA Quality System Regulation (21 CFR §820), ISO 13485 Quality Management System standard, ISO 14971 Risk Management Standard and the other FDA recognized consensus standards listed below. Test results showed conformance to applicable requirements specifications and assured hazard safeguards functioned properly. Biocompatibilty testing requirements in conformance with ANSI/AAMI/ ISO 10993 1 “Biological Evaluation of Medical Devices - Part 1” for irritation, sensitization, and acute systemic injection have been met. Cleaning validation test requirements have been met. Based on the verification, validation and non-clinical 10993 standard testing, the Varian Cervical Sleeves are as safe, effective and performs as well as or better than the legally marketed device identified in section III above.

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.

K955844

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

§ 892.5700 Remote controlled radionuclide applicator system.

(a)
Identification. A remote controlled radionuclide applicator system is an electromechanical or pneumatic device intended to enable an operator to apply, by remote control, a radionuclide source into the body or to the surface of the body for radiation therapy. This generic type of device may include patient and equipment supports, component parts, treatment planning computer programs, and accessories.(b)
Classification. Class II.

0

May 16, 2018

Image /page/0/Picture/1 description: The image shows the logo of the U.S. Food and Drug Administration (FDA). The logo consists of two parts: the Department of Health & Human Services logo on the left and the FDA logo on the right. The FDA logo is a blue square with the letters "FDA" in white, followed by the words "U.S. FOOD & DRUG ADMINISTRATION" in blue.

Varian Medical Systems, Inc. % Mr. Peter Coronado Director, Varian Oncology Systems Regulatory Affairs 911 Hansen Way PALO ALTO CA 94304

Re: K172675

Trade/Device Name: Varian Cervical Sleeves Regulation Number: 21 CFR 892.5700 Regulation Name: Remote controlled radionuclide applicator system Regulatory Class: II Product Code: JAO Dated: April 19, 2018 Received: April 19, 2018

Dear Mr. Coronado:

We have reviewed vour 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 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.

1

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 mediation-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,

Michael D. 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)

K172675

Device Name

Cervical Sleeves

Indications for Use (Describe)

The Varian Cervical Sleeves are intended for use for treatment of any case where high dose irradiation with an intrauterine tandem is an acceptable clinical practice.

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

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Premarket Notification [510(k)] Summary Cervical sleeves

The following information is provided following the format of 21 CFR 807.92.

  • Varian Medical Systems, Inc. I. Submitter's Name: 3120 Hansen Way C-260 Palo Alto, CA 94304 Contact Name: Peter J. Coronado Phone: 650.424.5731 Fax: 650.842.5040 Date: August 2017 II. Trade Name: Varian Cervical Sleeves
    Common Name: Cervical sleeves

Classification Name: Remote controlled radionuclide applicator system 21 CFR 892.5700, Class II Product Code: JAQ

  • III. Predicate Device: Cervical sleeves: K955844
  • IV. Device Description: Varian Cervical Sleeves are brachytherapy applicator accessories. The cervical sleeves are used for insertion into the cervix prior to treatment and acts to guide the radioactive source to the correct locations for treatment. The sleeve can be sutured in place and left for a series of treatments. Presence of the sleeve helps to insure against perforation of the uterine wall by the distal end of the tandem.
  • The Varian Cervical Sleeves are intended for use for treatment of any case V. Intended Use Statement: where high dose irradiation with an intrauterine tandem is an acceptable clinical practice.

Indications for Use The Varian Cervical Sleeves are intended for use for treatment of any case Statement where high dose irradiation with an intrauterine tandem is an acceptable clinical practice.

VI. Technological Characteristics:

The differences between the cleared predicate device and this device are:

  • · Low density polyethylene (with BaS04 for CT contrast) material;
  • · MR safe compatibility

The similarities are:

  • · Indications and Intended Use;
  • · Use location;
  • · Dimensions, Biocompatibility, Sterility, Sterilization & Packaging

VII. Summary of Hardware verification and validation testing was conducted according to the FDA Quality System Regulation (21 CFR §820), ISO 13485 Quality Management performance

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Premarket Notification [510(k)] Summary Cervical sleeves

| testing: | System standard, ISO 14971 Risk Management Standard and the other FDA
recognized consensus standards listed below. Test results showed conformance
to applicable requirements specifications and assured hazard safeguards
functioned properly.
Biocompatibilty testing requirements in conformance with ANSI/AAMI/ ISO 10993
1 “Biological Evaluation of Medical Devices - Part 1” for irritation, sensitization,
and acute systemic injection have been met.
Cleaning validation test requirements have been met. | |
|-----------------------------------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|----------------------------|
| Standards
conformance: | The Varian Cervical Sleeves conform in whole or in part with the following
standards: | |
| | ISO 14971:2007 | ISO 15223:2012 |
| | ISO 10993-1:2009 | ISO 10993-5:2009 |
| | ISO 10993-10:2002 | ISO 10993-12:2012 |
| | ISO 11138-1:2006 | ISO 11737-2:2009 |
| | AAMI/ANSI ST79:2010 +A2:2011 | AAMI/ANSI ST81:2004 +R2010 |
| | ISO 14161:2009 | IEC 62366:2007 |
| Conclusion: | Based on the verification, validation and non-clinical 10993 standard testing, the
Varian Cervical Sleeves are as safe, effective and performs as well as or better | |

than the legally marketed device identified in section III above.