K Number
K192700
Device Name
Xcam
Manufacturer
Date Cleared
2019-12-27

(92 days)

Product Code
Regulation Number
872.1800
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
This X-ray Unit is intended to be used in portable applications, by a qualified/trained dentist or technician on both adult and pediatric subjects for taking diagnostic radiographic exposures of dental structures.
Device Description
The Xcam is a portable X-ray for taking diagnostic radiographic exposures of body parts and operates on 11.1V DC supplied by a battery. Xcam is composed of x-ray generator including x-ray tubes, equipment controller, power controller, user interface and x-ray collimator. Xcam can be used with an imaging sensor. The image receptor, necessary component for a fully functional x-ray system, is not part of the submitted device.
More Information

Not Found

No
The summary describes a standard portable X-ray unit and explicitly states "Not Found" for mentions of AI, DNN, or ML, as well as descriptions of training and test sets typically associated with AI/ML development.

No
The device is used for taking diagnostic radiographic exposures, which means it aids in diagnosis rather than providing therapy.

Yes

The "Intended Use / Indications for Use" states that the device is "for taking diagnostic radiographic exposures of dental structures," explicitly indicating its role in diagnosis.

No

The device description explicitly states it is a portable X-ray unit composed of hardware components like an x-ray generator, x-ray tubes, controllers, user interface, and collimator. It is not solely software.

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

Here's why:

  • IVD Definition: In Vitro Diagnostics are medical devices used to examine specimens taken from the human body, such as blood, urine, or tissue, to provide information for diagnosis, monitoring, or screening.
  • Device Function: This device is an X-ray unit. It uses radiation to create images of dental structures within the body. It does not analyze samples taken from the body.
  • Intended Use: The intended use clearly states it's for taking diagnostic radiographic exposures of dental structures, which is an imaging procedure, not an in vitro test.

Therefore, based on the provided information, this X-ray unit falls under the category of a medical imaging device, not an In Vitro Diagnostic.

N/A

Intended Use / Indications for Use

This X-ray Unit is intended to be used in portable applications, by a qualified/trained dentist or technician on both adult and pediatric subjects for taking diagnostic radiographic exposures of dental structures.

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

EHD

Device Description

The Xcam is a portable X-ray for taking diagnostic radiographic exposures of body parts and operates on 11.1V DC supplied by a battery.

Xcam is composed of x-ray generator including x-ray tubes, equipment controller, power controller, user interface and x-ray collimator. Xcam can be used with an imaging sensor.

The imaqe receptor, necessary component for a fully functional x-ray system, is not part of the submitted device.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

X-ray

Anatomical Site

dental structures

Indicated Patient Age Range

adult and pediatric subjects

Intended User / Care Setting

qualified/trained dentist or technician in portable applications

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 Test Summary:

  • Electrical Safety, Electromagnetic Compatibility and Performance: The Xcam complies with the electrical safety and electromagnetic compatibility requirements established by the standards: ES60601-1, IEC 60601-1-2, IEC 60601-1-3, and IEC 60601-2-65.
  • Software Validations: The Xcam use original software, which contains MODERATE level of concern. Software was designed and developed according to a software development process and was verified and validated.
  • Biocompatibility: Not necessary, proper device cleaning is sufficient.

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.

K132041

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

§ 872.1800 Extraoral source x-ray system.

(a)
Identification. An extraoral source x-ray system is an AC-powered device that produces x-rays and is intended for dental radiographic examination and diagnosis of diseases of the teeth, jaw, and oral structures. The x-ray source (a tube) is located outside the mouth. This generic type of device may include patient and equipment supports and component parts.(b)
Classification. Class II.

0

December 27, 2019

Image /page/0/Picture/1 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 square is the text "U.S. FOOD & DRUG ADMINISTRATION" in blue.

HDX WILL Corp. % Myoung-Joon Lee General Manager #105,106,201,202,203,204,38, Osongsaengmyeong 4-ro Osong-eup, Heungdeok-gu Cheongju-si. Chungcheonbuk-do 28161 REPUBLIC OF KOREA

Re: K192700

Trade/Device Name: Xcam Regulation Number: 21 CFR 872.1800 Regulation Name: Extraoral source x-ray system Regulatory Class: Class II Product Code: EHD Dated: November 8, 2019 Received: November 13, 2019

Dear Myoung-Joon Lee:

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

1

801); medical device reporting of medical device-related adverse events) (21 CFR 803) for 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 medical devices and radiation-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

2

Indications for Use

510(k) Number (if known) K192700

Device Name Xcam

Indications for Use (Describe)

This X-ray Unit is intended to be used in portable applications, by a qualified/trained dentist or technician on both adult and pediatric subjects for taking diagnostic radiographic exposures of dental structures.

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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Image /page/3/Picture/0 description: The image shows the logo for HDX Will. The logo consists of a green and blue square with a white "W" inside, followed by the text "HDX Will" in blue. The text is in a bold, sans-serif font.

510(k) Summary - K192700

1. Date Prepared [21 CFR 807.92(a)(1)]

November 8th, 2019

2. Submitter's Information [21 CFR 807.92(a)(1)]

- Name of Manufacturer:HDX WILL CORP.
- Address:#105, 106, 201, 202, 203, 204, 38, Osongsaengmyeong
4-ro, Osong-eup, Heungdeok-gu, Cheongju-si,
Chungcheongbuk-do, 28161, Republic of Korea
- Contact Person:Myoung-Joon Lee / General Manager
- Telephone No.:+82-43-710-7318
- Fax No.:+82-43-710-7312
- Email Address:mjlee@iwillmed.com
- Registration No.:3013511605

3. Trade Name, Regulation Name, Classification [21 CFR 807.92(a)(2)]

Device NameXcam
Regulation Number21 CFR 872.1800
Common/Usual NamePortable Dental X-ray System
Regulatory ClassClass II
Product CodeEHD
Classification NameUnit, X-Ray, Extraoral With Timer
PanelRadiology

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Image /page/4/Picture/0 description: The image shows the logo for HDxWill. The logo consists of a green and blue square with the letter "W" inside, followed by the text "HDxWill" in blue. The logo is simple and modern, and the colors are bright and eye-catching.

4. Identification of Predicate Device(s) [21 CFR 807.92(a)(3)]

The identified predicate devices within this submission are shown as follow;

Predicate device

- 510(k) Number:K132041
- Applicant:POSDION CO., LTD.
- Device Name:REXTAR X
- Regulation Number:21 CFR 872.1800
- Regulation Name:Extraoral source x-ray system
- Regulatory Class:Class II
- Product Code:EHD
- Classification Name:Unit. X-Ray. Extraoral With Time

There are no significant differences between the Xcam and the predicate device that would adversely affect the use of the product. It is substantially equivalent to these devices in technical characteristics, output characteristics and operation mode.

5. Description of the Device [21 CFR 807.92(a)(4)]

The Xcam is a portable X-ray for taking diagnostic radiographic exposures of body parts and operates on 11.1V DC supplied by a battery.

Xcam is composed of x-ray generator including x-ray tubes, equipment controller, power controller, user interface and x-ray collimator. Xcam can be used with an imaging sensor.

The imaqe receptor, necessary component for a fully functional x-ray system, is not part of the submitted device.

6. Indications for Use [21 CFR 807.92(a)(5)]

This X-ray Unit is intended to be used in portable applications, by a qualified/trained dentist or technician on both adult and pediatric subjects for taking diagnostic radiographic exposures of dental structures.

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Image /page/5/Picture/0 description: The image shows the logo for HDXWILL. The logo consists of a green square with a white "W" inside, followed by the text "HDXWILL" in a dark blue, bold font. The logo is simple and modern, and the colors are eye-catching.

7. Determination of Substantial Equivalence

Summary of technological characteristics of the device compared to the predicate device. [21 CFR 807.92(a)(6)]

ApplicantHDX WILL CORP.POSDION CO., LTD.SE Note
Device NameXcamRextar X
Subject DevicePredicate Device-
510(k) NumberK192700K132041-
Common/Usual
NamePortable Dental X-ray SystemPortable X-ray System-
Regulation
Number872.1800872.1800-
Product CodeEHDEHD-
ClassClass IIClass II-
ModelXcamRextar X-
Indications for
UseThis X-ray Unit is intended to be used
in portable applications, by a
qualified/trained dentist or technician on
both adult and pediatric subjects for
taking diagnostic radiographic
exposures of dental structures.REXTAR X is a portable X-ray system
to be used by trained dentists and
dental technicians as a mobile,
extraoral x-ray source for producing
diagnostic x-ray images using intraoral
image receptors. It is intended for both
adult and pediatric subjects.Similar
Dimension
(Length x Height
x Width)167.51 mm x 127.55 mm x 97.05 mm146 mm x 155 mm x 139 mmSimilar
Weight1.8 kg2 kgSimilar
Energy Source11.1 VDC11.1 VDCSame
Battery TypeRechargeableRechargeableSame
DisplayLCD Panel DisplayLCD Panel DisplaySame
Tube Voltage70 kV70 kVSame
Tube Current2 mA2 mASame
Exposure Time0.05-1.3 s (39 steps)0.01-1.30 sec (43 steps)Similar
Inherent
FiltrationAt least 1.0 mm AlAt least 1.0 mm AlSame
Total FiltrationAt least 1.5 mm AlAt least 1.5 mm AlSame
Focal Spot Size0.4 mm0.4 mmSame
Anode MaterialTungstenTungstenSame
Target Angle12.5°12°Similar
Compatible with
Digital ImagingApplicableApplicableSame

a) Technological Characteristics

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Image /page/6/Picture/0 description: The image shows the logo for HDXWILL. The logo consists of a green and blue square with the letter "W" in white inside the square. To the right of the square is the text "HDXWILL" in blue.

b) Substantial Equivalence Discussion

There are no significant differences between the Xcam and the predicate device that would adversely affect the use of the product. It is substantially equivalent to these devices in technical characteristics, output characteristics and operation mode.

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8. Non-Clinical Test Summary

The Xcam complies with voluntary standards for electrical safety, electromagnetic compatibility. The following data were provided in support of the substantial equivalence determination:

1) Electrical Safety, Electromagnetic Compatibility and Performance:

The Xcam complies with the electrical safety and electromagnetic compatibility requirements established by the standards.

  • Electrical Basic Safety and Essential Performance requirements in accordance with ES60601-1
  • Electromagnetic Compatibility Testing in accordance with IEC 60601-1-2
  • Radiation Protection In diagnostic X-Ray Equipment requirements of IEC 60601-1-3
  • Dental Intra-Oral X-Ray Equipment requirements of 60601-2-65

The manufacturing facility is in conformance with the relevant EPRC standards as specified in 21 CFR 1020.30, and 1020.31. The records are available for review.

2) Software Validations

The Xcam use original software. The Xcam contains MODERATE level of concern software. Software was designed and developed according to a software development process and was verified and validated.

Software information is provided in accordance with FDA guidance: "Guidance for the Content of Premarket Submissions for Software Contained in Medical Devices, issued on May 11, 2005."

Cybersecurity information is provided in accordance with FDA guidance: "Content of Premarket Submissions for Management of Cybersecurity in Medical Devices, issued on October 2, 2014"

3) Biocompatibility

A biocompatibility study is not necessary and proper device cleaning is sufficient to address any health concerns.

9. Conclusion [21 CFR 807.92(b)(3)]

The Xcam has same indications for use and technical characteristic to the predicate device. The differences in technological characteristics do not raise different questions of safety and effectiveness. In addition, performance testing conducted demonstrate that the subject device is as safe as effective as the predicate. Therefore, the subject device is substantially equivalent to the predicate device.