K Number
K192453
Device Name
DIAMOND-5A/6A/8A
Manufacturer
Date Cleared
2019-10-01

(22 days)

Product Code
Regulation Number
892.1680
Reference & Predicate Devices
Predicate For
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
Intended Use

DIAMOND-5A/6A/8A, is a stationary digital diagnostic x-ray system that is indicated for use in generating radiographic images of human anatomy. This device is not intended for mammographic applications.

Device Description

DIAMOND-5A/6A/8A, system is a digital radiographic system. There are 3 power output configurations which are reflected in the model designation "5A/6A/8A". The models have 3 different output power ratings: 52kW, 68kW, 82kW. DIAMOND 5A/6A/8A. incorporates digital flat panel detector technology, along with an automatic motorized U-arm radiographic stand and mobile patient table that can fit into smaller rooms without the need of ceiling support structures for X-Ray tube suspensions. The digital flat panel digital detectors that are used in DIAMOND-5A/6A/8A, are the VAREX Model 4343Rv3 (Ethernet interface) and 4336Wv4 (wireless). The main components of the x-ray source are the tube assembly, motorized x-ray collimator, HV cable assembly and high frequency x-ray generator. A touch screen LCD based x-ray control console provides a user interface and technique selection. The automatic collimator supports high accuracy for selected x-ray field size over SID. Selection of an anatomical study on the imaging software automatically sets up the x-ray generator's pre-programmed exposure technique setting, motorized radiographic stand positioning, x-ray collimation and post image processing for selected study. Also, removable high-resolution grids which have 100 and 180cm (40 and 72 inch) focal distance supplies excellent image quality per each SID. The integrated touch screen console located in the tube side, operator can easily control the radiographic techniques and stand positioning. Furthermore, the operator can verify the digital x-ray image on this screen. The GUI, automatically rotates corresponds to rotation angle of U-arm. The Radiographic stand has four motorized joints, and automatic positioning can be accomplished by preprogrammed data which can be easily reprogrammed by operator. Total of seven safety sensors are located over U-arm, detector and tube side to protect. against collision with patient or obstacles to control the speed or stop the positioning. Also, a mobile patient table with heavy patient load is provided for radiographic study which needs table. A remote-control is provided for remote motorized control of the stand, and the movement will stop as soon as the key is no longer pressed. The predicate device contains image handling software that was designed at the same time the product was originally developed. The subject device will replace the original image handling module with the RADMAX Digital Image Software cleared under K182537. This will improve the software changeability when a change is needed and also will improve cyber security since there was no documented cyber security plan at the time of the original product development. RADMAX can also perform system control such as the collimation size, filter selection, etc. for the GXR series x-ray generators.

AI/ML Overview

The provided document, a 510(k) summary for the DRGEM Corporation's DIAMOND-5A/6A/8A digital X-ray system, describes the device, its indications for use, and a comparison to predicate devices, along with performance data. However, it does not include detailed acceptance criteria or a study design for evaluating the diagnostic performance of the device, particularly for an AI component.

The document primarily focuses on demonstrating substantial equivalence to a predicate device, specifically regarding:

  • Physical and functional characteristics (e.g., power output, detectors, image management software features).
  • Compliance with various international safety and electromagnetic compatibility (EMC) standards for medical electrical equipment and software lifecycle processes.
  • Risk management and usability engineering.

Therefore, I cannot extract specific information about acceptance criteria for diagnostic performance (e.g., sensitivity, specificity, or reader improvement with AI assistance) or a detailed diagnostic performance study (e.g., MRMC study, expert ground truth establishment) because that information is not present in the provided text.

The Performance Data section explicitly states: "The DIAMOND-5A/6A/8A system, has been assessed and tested and has passed predetermined testing criteria. The Validation Test Plan was designed to evaluate input functions, output functions, and actions performed by the subject device and followed the process documented in the System Validation Test Plan. Nonclinical testing results are provided in the 510(k). Validation testing indicated that as required by the risk analysis, designated individuals performed all verification and validation activities and that the results demonstrated that the predetermined acceptance criteria were met."

This phrasing suggests that the "testing criteria" and "acceptance criteria" referred to are for ensuring the functionality, safety, and compliance with standards of the X-ray system itself, and not necessarily for demonstrating specific diagnostic performance metrics (like the accuracy of an AI algorithm in detecting pathologies). The core of the submission seems to be the replacement of an older image handling module with "RADMAX Digital Image Software," and the impact of this change on the system's safety and efficacy, not the introduction of AI for diagnostic assistance.

Based on the provided text, the device is a stationary digital diagnostic x-ray system, and the "AI component" referred to in your prompt (if it were present) would likely be part of the "RADMAX Digital Image Software" if it contained any AI-driven diagnostic features beyond basic image processing. However, the document does not elaborate on such diagnostic AI features or their performance evaluation.


Hypothetical Answer (if the document had contained the requested information for an AI-powered diagnostic device):

(Please note: The following is a hypothetical answer structured as if the document provided details for an AI-powered diagnostic device, which it does not. I've used placeholder values where specific information about diagnostic performance would typically be found in such a submission.)


Acceptance Criteria and Study for AI-Powered Diagnostic Device (Hypothetical)

This document describes the validation of a stationary digital diagnostic X-ray system. While the submission primarily focuses on functional safety and feature equivalence, if it were an AI-powered diagnostic device, the following hypothetical information would be expected for a performance study.

1. Table of Acceptance Criteria and Reported Device Performance (Hypothetical)

Performance MetricAcceptance CriteriaReported Device Performance
Standalone Performance (AI Algorithm Only)
Sensitivity (for X-condition)≥ 90%Y%
Specificity (for X-condition)≥ 85%Z%
AUC (for X-condition)≥ 0.900.YY
Human-in-the-Loop Performance Change
Sensitivity (reader + AI vs. reader only)Increase of ≥ 5% pointsX% increase
Specificity (reader + AI vs. reader only)No significant decrease (< 2% points)Y% change
Reading Time (with AI vs. without AI)Reduction of ≥ 10%Z% reduction

2. Sample Size and Data Provenance for Test Set (Hypothetical)

  • Sample Size: [e.g., 500 cases (250 positive for condition X, 250 negative)]
  • Data Provenance: [e.g., Retrospective, multi-center data from hospitals in the United States and Europe]

3. Number and Qualifications of Experts for Ground Truth (Hypothetical)

  • Number of Experts: [e.g., 3]
  • Qualifications: [e.g., Board-certified Radiologists with >10 years of experience in diagnostic radiography, specializing in chest imaging (if applicable to the indication).]

4. Adjudication Method for Test Set (Hypothetical)

  • Method: [e.g., 2+1 Adjudication: Each case was initially reviewed independently by two experts. In cases of disagreement, a third, senior expert reviewed the case to establish the final ground truth. Alternatively, 3-reader consensus.]

5. Multi-Reader Multi-Case (MRMC) Comparative Effectiveness Study (Hypothetical)

  • Was an MRMC study done? [e.g., Yes]
  • Effect Size of Human Reader Improvement: [e.g., The MRMC study demonstrated that human readers, when assisted by the AI algorithm, showed an average XX% improvement in sensitivity for detecting condition X (e.g., from 75% to 85%), while maintaining specificity. The study used methods such as observer performance studies (e.g., ROC analysis) to quantify this improvement.]

6. Standalone Algorithm Performance (Hypothetical)

  • Was a standalone performance evaluation done? [e.g., Yes]
  • Metrics: The algorithm demonstrated a standalone sensitivity of Y% and specificity of Z% for condition X on the test set. (As per the table above).

7. Type of Ground Truth Used (Hypothetical)

  • Ground Truth Type: [e.g., Expert consensus (as described in point 4), confirmed by available clinical outcomes data and/or pathology reports where possible.]

8. Sample Size for Training Set (Hypothetical)

  • Sample Size: [e.g., 10,000 cases]

9. How Ground Truth for Training Set was Established (Hypothetical)

  • Method: [e.g., A combination of initial annotations by trained technicians or junior radiologists, followed by review and verification by a single or small panel of senior radiologists. Cases were sometimes cross-referenced with electronic health records for clinical context and pathology reports if available.]

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Image /page/0/Picture/0 description: The image contains the logo of the U.S. Food and Drug Administration (FDA). On the left is the Department of Health & Human Services logo. To the right of that is the FDA logo, which is a blue square with the letters "FDA" in white. To the right of the blue square is the text "U.S. FOOD & DRUG ADMINISTRATION" in blue.

DRGEM Corporation % Mr. Carl Alletto Consultant OTech Inc 8317 Belew Drive MCKINNEY TX 75071 October 1, 2019

Re: K192453

Trade/Device Name: Diamond-5A/6A/8A Regulation Number: 21 CFR 892.1680 Regulation Name: Stationary x-ray system Regulatory Class: Class II Product Code: KPR Dated: September 2, 2019 Received: September 9, 2019

Dear Mr. Alletto:

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. Although this letter refers to your product as a device, please be aware that some cleared products may instead be combination products. The 510(k) Premarket Notification Database located at https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm identifies combination product submissions. 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) for

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devices or postmarketing safety reporting (21 CFR 4, Subpart B) for combination products (see https://www.fda.gov/combination-products/guidance-regulatory-information/postmarketing-safety-reportingcombination-products); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820) for devices or current good manufacturing practices (21 CFR 4, Subpart A) for combination products; 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 https://www.fda.gov/medical-device-safety/medical-device-reportingmdr-how-report-medical-device-problems.

For comprehensive regulatory information about mediation-emitting products, including information about labeling regulations, please see Device Advice (https://www.fda.gov/medicaldevices/device-advice-comprehensive-regulatory-assistance) and CDRH Learn (https://www.fda.gov/training-and-continuing-education/cdrh-learn). 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 (https://www.fda.gov/medical-device-advice-comprehensive-regulatoryassistance/contact-us-division-industry-and-consumer-education-dice) for more information or contact DICE by email (DICE@fda.hhs.gov) or phone (1-800-638-2041 or 301-796-7100).

Sincerely,

For

Thalia T. Mills, Ph.D. Director Division of Radiological Health OHT7: Office of In Vitro Diagnostics and Radiological Health Office of Product Evaluation and Quality Center for Devices and Radiological Health

Enclosure

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Indications for Use

510(k) Number (if known) K192453

Device Name DIAMOND-5A/6A/8A

Indications for Use (Describe)

DIAMOND-5A/6A/8A, is a stationary digital diagnostic x-ray system that is indicated for use in generating radiographic images of human anatomy. This device is not intended for mammographic applications.

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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Image /page/3/Picture/0 description: The image contains the logo for DRGEM. The logo has the letters "DR" in bold black font, followed by "GEM" in a teal font. Below the logo is the text "Your Best Healthcare" in a smaller font size.

510(k) Summary - K192453

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

I. SUBMITTER

DRGEM Corporation 7F E-B/D Gwangmyeong Techno-Park 60, Haan-ro, Gwangmyeong-si, Gyeonggi-do, 14322 Korea Email: radcheck@drgem.co.kr TEL: +82-2-869-8566, FAX: +82-2-869-8567

Contact Person: Mr. Ki-Nam YANG, Director | QM representative

Date Prepared: September 22, 2019

II. DEVICE

Product Name: DIAMOND-5A/6A/8A Common Name: Digital Diagnostic X-ray System Regulation Name: Stationary X-Ray System Product Code: KPR Regulation number: 892.1680 Requlatory Class: =

III. PREDICATE DEVICES

Primary Predicate Device

DIGITAL DIAGNOSTIC X-RAY SYSTEM (K102408) (DIAMOND), by DRGEM, product code KPR. Regulation 892.1680

Reference Predicate Device

RADMAX Digital Imaging Software, K182537, by DRGEM, product code: LLZ. Regulation 892.2050

IV. DEVICE DESCRIPTION

DIAMOND-5A/6A/8A, system is a digital radiographic system. There are 3 power output configurations which are reflected in the model designation "5A/6A/8A". The models have 3 different output power ratings:

System ModelDIAMOND-5ADIAMOND-6ADIAMOND-8A
X-Ray GeneratorGXR-52GXR-68GXR-82
Output Rating52kW68kW82kW

DIAMOND 5A/6A/8A. incorporates digital flat panel detector technology, along with an automatic motorized U-arm radiographic stand and mobile patient table that can fit into smaller rooms without the need of ceiling support structures for X-Ray tube suspensions.

The digital flat panel digital detectors that are used in DIAMOND-5A/6A/8A, are the VAREX Model 4343Rv3 (Ethernet interface) and 4336Wv4 (wireless). The Model 4343Rv3 (Ethernet interface) was cleared with the primary predicate device and both the Model 4343Rv3 (Ethernet interface) and 4336Wv4 (wireless) were cleared with RADMAX the reference predicate device.

The main components of the x-ray source are the tube assembly, motorized x-ray collimator, HV cable assembly and high frequency x-ray generator. A touch screen LCD

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Image /page/4/Picture/0 description: The image contains a logo for "DRGEM Your Best Healthcare". The word "DR" is in bold black font, while "GEM" is in a teal color. Below the company name is the slogan "Your Best Healthcare" in a smaller font size.

based x-ray control console provides a user interface and technique selection. The automatic collimator supports high accuracy for selected x-ray field size over SID.

Selection of an anatomical study on the imaging software automatically sets up the x-ray generator's pre-programmed exposure technique setting, motorized radiographic stand positioning, x-ray collimation and post image processing for selected study. Also, removable high-resolution grids which have 100 and 180cm (40 and 72 inch) focal distance supplies excellent image quality per each SID. The integrated touch screen console located in the tube side, operator can easily control the radiographic techniques and stand positioning. Furthermore, the operator can verify the digital x-ray image on this screen. The GUI, automatically rotates corresponds to rotation angle of U-arm.

The Radiographic stand has four motorized joints, and automatic positioning can be accomplished by preprogrammed data which can be easily reprogrammed by operator. Total of seven safety sensors are located over U-arm, detector and tube side to protect. against collision with patient or obstacles to control the speed or stop the positioning. Also, a mobile patient table with heavy patient load is provided for radiographic study which needs table. A remote-control is provided for remote motorized control of the stand, and the movement will stop as soon as the key is no longer pressed.

The predicate device contains image handling software that was designed at the same time the product was originally developed. The subject device will replace the original image handling module with the RADMAX Digital Image Software cleared under K182537. This will improve the software changeability when a change is needed and also will improve cyber security since there was no documented cyber security plan at the time of the original product development. RADMAX can also perform system control such as the collimation size, filter selection, etc. for the GXR series x-ray generators.

V. INDICATIONS FOR USE

DIAMOND-5A/6A/8A, is a stationary digital diagnostic x-ray system that is indicated for use in generating radiographic images of human anatomy. This device is not intended for mammographic applications.

VI. COMPARISON OF TECHNOLOGICAL CHARACTERISTICS WITH THE PREDICATE DEVICES

The subject device and the predicate device are stationary digital x-ray systems devices. The predicate device, K102408, DIGITAL DIAGNOSTIC X-RAY SYSTEM (DIAMOND) from DRGEM and the reference predicate device K182537, RADMAX Digital Imaging Software are being merged. The reference predicate device is replacing the digital imaging handling software module that was originally developed for the predicate. The intended use of the modified device, as described in the labeling, has not changed as a result of the modification.

Any difference between the subject device and the predicate device does not affect safety or efficacy. No other changes were made to the predicate, besides the stated differences.

SpecificationSubject DevicePredicate Device(K102408)Reference PredicateRADMAX (K182537)Impact of Differences
Device NameDIAMOND5A/6A/8ADIGITALDIAGNOSTIC X-RAY SYSTEMRADMAX DigitalImaging SystemSoftwareNot applicable
ManufacturerDRGEMCorporationDRGEMCorporationDRGEM CorporationNot applicable
Model NumberDIAMOND5A/6A/8ADIAMOND5A/6A/8ARADMAXNot applicable
SpecificationSubject DevicePredicate Device(K102408)Reference PredicateRADMAX (K182537)Impact of Differences
High FrequencyX-ray Generator
Output Power52KW, 68KW,82KW52KW, 68KW,82KWNot applicable,RADMAX is imagemanagement softwareand does not haveOutput Power.No differences
Generator models(manufactured byDRGEM)GXR-52, GXR-68,GXR-82GXR-52, GXR-68,GXR-82Not applicableNo differences
Line voltage400/480VAC400/480VACNot applicableNo differences
ImageAcquisition
DetectorVAREXModel 4343Rv3(Ethernet)/ 4336Wv4 (wireless)VAREXModel 4343Rv3(Ethernet)VAREXModel 4343Rv3(Ethernet)/ 4336W v4(wireless)The predicate device uses anEthernet interface and the subjectdevice interfaces to either Ethernetor wireless detectors. The detectorswere cleared with the primarypredicate and reference predicate.The subject device system hasbeen tested and there is "Nonegative impact on safety orefficacy" and there are no newpotential or increased safety risksconcerning this difference.
ImageManagementSoftware
Horizontal FlipAvailableAvailableAvailableThese features between thePrimary Predicate, ReferencePredicate and Subject device aresimilar. There may be somerearrangement of headers and orbutton locations since RADMAX isthe latest Image Managementsoftware. The subject devicesystem has been tested and there is"No negative impact on safety orefficacy" and there are no newpotential or increased safety risksconcerning this difference.
Vertical FlipAvailableAvailableAvailableSame as above
Rotate CW/CCWAvailableAvailableAvailableSame as above
Text AnnotationAvailableAvailableAvailableSame as above
Ruler: DistancetoolAvailableAvailableAvailableSame as above
Anglemeasurement toolAvailableAvailableAvailableSame as above
ZoomAvailableAvailableAvailableSame as above
MagnifyAvailableAvailableAvailableSame as above
Image panningAvailableAvailableAvailableSame as above
Auto fitting towindow sizeAvailableAvailableAvailableSame as above
Image crop/cutfunctionAvailableAvailableAvailableSame as above
SpecificationSubject DevicePredicate Device(K102408)Reference PredicateRADMAX (K182537)Impact of Differences
Image CopyAvailableAvailableAvailableSame as above
Recover theoriginal imageAvailableAvailableAvailableSame as above
Window levelCD BurningAvailableAvailableAvailableSame as above
DICOM PrintAvailableAvailableAvailableSame as above
Image StitchingAvailableAvailableAvailableSame as above

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Image /page/5/Picture/0 description: The image contains a logo for DRGEM. The letters "DR" are in black, and the letters "GEM" are in teal. Below the logo is the text "Your Best Healthcare" in a smaller font.

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Image /page/6/Picture/0 description: The image contains the logo for DRGEM, a healthcare provider. The letters "DR" are in bold, black font, while "GEM" is in a teal color. Below the company name is the slogan "Your Best Healthcare" in a smaller, lighter font. The logo is simple and professional, conveying a sense of trust and reliability.

VII. PERFORMANCE DATA

Nonclinical Testing:

The DIAMOND-5A/6A/8A system, has been assessed and tested and has passed predetermined testing criteria. The Validation Test Plan was designed to evaluate input functions, output functions, and actions performed by the subject device and followed the process documented in the System Validation Test Plan.

Nonclinical testing results are provided in the 510(k). Validation testing indicated that as required by the risk analysis, designated individuals performed all verification and validation activities and that the results demonstrated that the predetermined acceptance criteria were met.

Summary:

Based on the performance as documented in the V&V Testing, the subject device was found to have a safe and effectiveness profile that is similar to the predicate device.

The following International Standards were used to develop and verify the system. DIAMOND-5A/6A/8A, device has met all the requirements listed in the Standards except for inapplicable requirements (which are listed in the various test reports):

Std #Safety/EMC Standards DescriptionFDA Rec.Standard #
IEC 60601-1-3Medical electrical equipmentPart 1-3: General Requirements for Radiation Protection in Diagnostic X-RayEquipment12-269
IEC 62366 (IEC60601-1-6)IEC 62366:2007 + A1:2014 - Usability engineering process checklist5-114
IEC 60601-2-28IEC 60601-2-28Medical electrical equipment Part 2: Particular requirements for the safety of X-raysource assemblies and X-ray tube assemblies for medical diagnosis12-204
IEC 60601-2-54IEC 60601-2-54Medical electrical equipmentPart 2: Particular requirements for the basic safety and essentialperformance of X-ray equipment for radiography and radioscopy12-296
IEC 62304:2006ANSI AAMI IEC 62304:2006Medical device software - Software life cycle processes13-32
IEC 60601-1Medical electrical equipment, Part 1: General requirements for basic safety andessential performance19-4
NEMA PS 3.1NEMA PS 3.1 - 3.20 (2016). Digital Imaging and Communications in Medicine(DICOM) Set DICOM Standard.12-300

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Image /page/7/Picture/0 description: The image shows the logo for DRGEM. The letters "DR" are in bold black font, while the letters "GEM" are in a teal color. Below the letters is the text "Your Best Healthcare" in a smaller font.

Std #Safety/EMC Standards DescriptionFDA Rec.Standard #
IEC/ISO10918-1JPEG Standard IEC/ISO10918-1 First edition 1994-02-15, Information technology- Digital compression and coding of continuous-tone still images: Requirementsand guidelines [Including: Technical Corrigendum 112-261
IEC 62494-1IEC 62494-1 Edition 1.0 (2008-08), Medical electrical equipment - Exposure indexof digital X-ray imaging systems - Part 1: Definitions and requirements for generalradiography.12-215
ISO 14971:2007ISO 14971:2007/(R)2010 (Corrected 4 October 2007), Medical devices -Applications of risk management to medical devices.5-40
ISO 15223-1ISO 15223-1 Third Edition 2016-11-01, Medical devices - Symbols to be usedwith medical device labels, labelling, and information to be supplied - Part 1:General requirements.5-117

VIII. CONCLUSIONS

The 510(k) Pre-Market Notification for DIAMOND-5A/6A/8A, contains adequate information, data, and nonclinical test results to enable FDA - CDRH to determine substantial equivalence to the predicate device. The new device and the primary predicate device are substantially equivalent in the areas of technical characteristics, general function, application, and intended use does not raise any new potential safety risks and is equivalent in performance to existing legally marketed devices.

Nonclinical tests demonstrate that the device is as safe, as effective, and performs comparably to the predicate devices.

§ 892.1680 Stationary x-ray system.

(a)
Identification. A stationary x-ray system is a permanently installed diagnostic system intended to generate and control x-rays for examination of various anatomical regions. This generic type of device may include signal analysis and display equipment, patient and equipment supports, component parts, and accessories.(b)
Classification. Class II (special controls). A radiographic contrast tray or radiology diagnostic kit intended for use with a stationary x-ray system only is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 892.9.