K Number
K212909
Manufacturer
Date Cleared
2022-05-11

(240 days)

Product Code
Regulation Number
892.5050
Reference & Predicate Devices
Predicate For
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
Intended Use

Positioning of the patient during radiotherapy and radio diagnostics, including MR where indicated.

Device Description

The VacuumCushions (Vacuum Cushions) are cushions which are formed around the patient to create a rigid impression of the patient's anatomy in order to facilitate reproducible positioning. The impression is created through drawing the air out of the cushion whilst the patient is in the desired position.

The FeetSupports facilitate the positioning of the patient's feet. They are available in fixed and rotatable variants and can be fixed to various baseplates and couchtops.

The LEPS enables a patient's lower extremities to be positioned, using a Kneesupport, FeetSupport and, as desired, a LiftBlock. Shoulder Retractors can also be used to support the retraction of the patient's shoulders. The base of the LEPS is the LEPS baseplate. The LEPS Short baseplate enables the patient's feet to be positioned using a FeetSupport. The LEPS baseplates can be positioned on the couch treatment table using couch strips.

CouchStrips are bars which connect the patient positioning device onto the treatment table at indexed positions. Depending on the indexing system of the treatment table, its width, the preference in transverse adjustability and required MR safety, different types and indexing styles are available. VacuumCushion Positioning Strips (VCPS) are CouchStrips which are placed onto other CouchStrips in order to secure a VacuumCushion in place.

AI/ML Overview

Here's an analysis of the provided text in relation to your request about acceptance criteria and study proving device performance, specifically for an AI/device related to medical imaging.

However, it's crucial to understand a key limitation:

The provided text, a 510(k) submission for MacroMedics BV, describes patient positioning devices (Vacuum Cushions, FeetSupports, LEPS, CouchStrips) used in radiotherapy and radiodiagnostics. These are physical devices, not AI-powered software or diagnostic tools.

Therefore, most of the points in your request, such as "effect size of how much human readers improve with AI vs without AI assistance," "standalone (i.e., algorithm only without human-in-the-loop performance)," "sample size for training set," and "ground truth for training set," are not applicable to this type of device and submission.

A 510(k) submission for physical devices primarily focuses on demonstrating substantial equivalence to an already legally marketed predicate device, rather than proving novel performance against a clinical ground truth using statistical studies in the same way an AI/software device would.


Despite this, I will extract and interpret the relevant information as best as possible within the context of a physical device submission:

1. A table of acceptance criteria and the reported device performance

For a physical device demonstrating substantial equivalence, the "acceptance criteria" are typically the characteristics of the predicate device, and the "reported device performance" is the demonstration that the new device shares those characteristics. It's not about quantitative performance metrics in the way you'd see for an AI algorithm (e.g., sensitivity, specificity).

Acceptance Criteria (based on Predicate Device Characteristics)Reported Device Performance (Claimed by MacroMedics)
Vacuum Cushions: Equivalent design, construction materials, and functionality to MEDTEC, Inc. (CIVCO Medical Solutions and CIVCO Radiotherapy) Vac-Lok cushions. Made of Polystyrene Beads in Polyurethane-coated Nylon bag with a vacuum valve.Vacuum Cushions: "The designs of the MacroMedics and predicate device are equivalent in shape, construction, materials and functionality. Both [predicate] devices and the MacroMedics devices are made out of Polystyrene Beads in Polyurethane-coated Nylon bag, and feature a valve for creating the vacuum." "MacroMedics claims the proposed VacuumCushions to be substantially equivalent... because the proposed devices have equivalent designs, intended uses, target populations and used materials."
FeetSupports: Equivalent shape, construction materials, and functionality as MacroMedics BV's own previously cleared LEPS and FeetSupports devices.FeetSupports: "The designs of the MacroMedics subjective device (the Feetsupports which are part of the LEPS), and predicate device are equivalent in shape, construction materials and functionality." "MacroMedics claims this equivalence because the proposed devices have equivalent designs, intended uses, target population and used materials."
LEPS (Lower Extremities Positioning System): Equivalent shape, construction materials, and functionality as MacroMedics BV's own previously cleared LEPS and FeetSupports devices, and made of the same materials.LEPS: "The designs of the MacroMedics subjective device and predicate device are equivalent in shape, construction materials and functionality. The MacroMedics predicate device and the subject device are made out of the same materials." "MacroMedics claims this equivalence because the proposed devices have equivalent designs, intended uses, target population and used materials."
CouchStrips: Equivalent shape, construction materials, and functionality as MacroMedics BV's own previously cleared CouchStrips.CouchStrips: "The designs of the MacroMedics subjective device and predicate device are equivalent in shape. construction materials and functionality." "MacroMedics claims this equivalence because the proposed devices have equivalent designs, intended uses, target population and used materials."

2. Sample size used for the test set and the data provenance (e.g., country of origin of the data, retrospective or prospective)

  • Not Applicable. For this type of physical device 510(k), there isn't a "test set" of patient data in the way there would be for an AI diagnostic device. The "test" is a comparison of the new device's engineering specifications and performance to the predicate device's, often through bench testing or design verification rather than a clinical study with patient samples. The submission highlights equivalence in design, materials, and intended use.

3. Number of experts used to establish the ground truth for the test set and the qualifications of those experts (e.g., radiologist with 10 years of experience)

  • Not Applicable. As there's no "test set" of clinical data requiring expert review to establish ground truth for a diagnostic outcome, this information is not relevant to this submission.

4. Adjudication method (e.g., 2+1, 3+1, none) for the test set

  • Not Applicable. No clinical test set requiring adjudication of findings.

5. If a multi-reader multi-case (MRMC) comparative effectiveness study was done, If so, what was the effect size of how much human readers improve with AI vs without AI assistance

  • Not Applicable. This is specific to AI-assisted diagnostic tools. The devices are patient positioning equipment, not AI software.

6. If a standalone (i.e. algorithm only without human-in-the-loop performance) was done

  • Not Applicable. This is specific to AI algorithms.

7. The type of ground truth used (expert consensus, pathology, outcomes data, etc.)

  • Not Applicable (in the diagnostic sense). The "ground truth" for this submission is effectively the established safety and effectiveness profile of the predicate devices. The new devices demonstrate substantial equivalence by matching the predicate's characteristics (materials, design, function, intended use), implying they would have the same safety and effectiveness.

8. The sample size for the training set

  • Not Applicable. There is no "training set" for physical patient positioning devices because they do not involve machine learning or data-driven model training.

9. How the ground truth for the training set was established

  • Not Applicable. As there is no training set, this is not relevant.

In summary of the provided document:

The 510(k) submission for MacroMedics BV's patient positioning devices (Vacuum Cushions, FeetSupports, LEPS, CouchStrips) is a substantial equivalence claim. The "acceptance criteria" and "proof of meeting criteria" are demonstrated by showing that the new devices are equivalent in design, materials, intended use, target population, and functionality to previously cleared predicate devices. This type of submission does not involve clinical studies with patient data, AI algorithms, or the evaluation of human reader performance with or without AI assistance, which are typical requirements for AI/diagnostic software.

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Image /page/0/Picture/0 description: The image shows the logo for 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 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.

MacroMedics BV % Elizabeth Hajos QARA Manager Oostbaan 670 2841ML Moordrecht, South Holland NETHERLANDS

Re: K212909

Trade/Device Name: Vacuum Cushions, FeetSupports, LEPS (Lower Extremities Positioning System) CouchStrips Regulation Number: 21 CFR 892.5050 Regulation Name: Medical charged-particle radiation therapy system Regulatory Class: Class II Product Code: IYE, LNH Dated: April 7, 2022 Received: April 18, 2022

Dear Elizabeth Hajos:

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

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801 and Part 809); 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 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,

Julie Sullivan, Ph.D. Assistant Director DHT 8C: Division of Radiological Imaging and Radiation Therapy Devices OHT8: Office of 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) K212909

Device Name

VacuumCushions, Feetsupports, LEPS (Lower Extremities Positioning System) CouchStrips

Indications for Use (Describe)

Both the Intended Use and the Indications for Use of the devices included in this submission are as follows:

Positioning of the patient during radiotherapy and radio diagnostics, including MR where indicated.

Type of Use (Select one or both, as applicable)
Residential Use (Part 21 CFR 201 Subpart D)
Over-The-Counter Use (21 CFR 201 Subpart C)

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 is a logo for Macromedics, a company that provides solutions in radiotherapy. The logo consists of a stylized "m" symbol on the left, followed by the company name "macromedics" in a sans-serif font. Below the company name is the tagline "SOLUTIONS IN RADIOTHERAPY" in a smaller font. The entire logo is in a light blue color.

Product Name – Patient Positioning Devices

510(k) Summary

K212909

Statement: Information supporting claims of substantial equivalence, as defined under the Federal Food, Drug, and Cosmetic Act, respecting safety and effectiveness is summarized below. For the convenience of the Reviewer, this summary is formatted in accordance with the Agency's final rule "510(k) Summarises and 510(k) Statements" (21 CFR 807) and can be used to provide a substantial equivalence summary to anyone requesting it from the Agency.

Submitter Details 1.

Name:MacroMedics BV
Address:Oostbaan 670, 2841ML Moordrecht, The Netherlands
Contact Person:Jaap Drenth
Phone Number:+31 (0)182 389777
Date Prepared:09-SEP-2021

2. Device Details

Name:Vacuum Cushions, FeetSupports, LEPS (Lower Extremities PositioningSystem), CouchStrips
Trade Name:MacroMedics
Common Name:Patient Positioning Devices
Classification:Class II
Regulation:21 CFR 892.5050, 21 CFR 892.1000
Regulation Name:Medical Charged-Particle Radiation Therapy System,System, Nuclear Magnetic Resonance Imaging
Product Code:IYE, LNH

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Image /page/4/Picture/0 description: The image shows the logo for Macromedics. The logo consists of a stylized lowercase "m" inside a circle on the left, followed by the word "macromedics" in a sans-serif font. Below the word "macromedics" is the phrase "SOLUTIONS IN RADIOTHERAPY" in a smaller font. The logo is primarily in a light blue color.

Review Panel: Radiology

3. Predicate Device Details

510k NumberDevice NameManufacturer
K180021Cushions (Vac-Lok)MEDTEC, Inc. d/b/a “CIVCO MedicalSolutions” and “CIVCO Radiotherapy”
K142420LEPS (Lower ExtremitiesPositioning System),FeetSupportsMacroMedics BV
K142420CouchStripsMacroMedics BV

4. Subject Device Description, Intended Use, Technological Characteristics, Substantial Equivalence & Conclusion

Device (1) - VacuumCushions 4.1

Model/Variants

Selling codeBrand nameDevice Identifier
155110VacuumCushion 30x4008719425702940
155140VacuumCushion 25x5008719425702957
155150VacuumCushion 50x70 T08719425702964
155210VacuumCushion 50x7008719425702971
155300VacuumCushion 65x6508719425702988
155400VacuumCushion 100x7008719425702995
155410VacuumCushion 100x8008719425703008
155430VacuumCushion 120x8008719425703015
155450VacuumCushion 100x15008719425703022
155510VacuumCushion 200x10008719425703039
155520VacuumCushion 120x120 T08719425705194
123450VacuumCushion, abdom.S08719425702650
123470VacuumCushion, abdom.XL08719425702667

Intended Use and/or Indications for Use

Positioning of the patient during radiotherapy and radio diagnostics, including MR where indicated.

Description

The VacuumCushions (Vacuum Cushions) are cushions which are formed around the patient to create a rigid impression of the patient's anatomy in order to facilitate reproducible positioning.

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Image /page/5/Picture/0 description: The image shows the logo for Macromedics. The logo consists of a circular icon with a stylized "m" inside, followed by the word "macromedics" in a sans-serif font. Below the word "macromedics" is the phrase "SOLUTIONS IN RADIOTHERAPY" in a smaller font.

The impression is created through drawing the air out of the cushion whilst the patient is in the desired position.

Comparison of technological characteristics

The designs of the MacroMedics and predicate device are equivalent in shape, construction, materials and functionality. Both the MEDTEC, Inc. d/b/a "CIVCO Medical Solutions" and "CIVCO Radiotherapy" devices and the MacroMedics devices are made out of Polystyrene Beads in Polyurethane-coated Nylon bag, and feature a valve for creating the vacuum.

Substantial equivalence summary

MacroMedics claims the proposed VacuumCushions to be substantially equivalent to the devices previously cleared by the FDA in the 510(k) specified above. These devices are also cleared for use in a radiotherapy and/or MR environment.

MacroMedics claims this equivalence because the proposed devices have equivalent designs, intended uses, tarqet populations and used materials. These products have very similar positioning and immobilization characteristics for use in radiotherapy and radio-diagnostics.

Conclusion

The substantial equivalence comparison in this premarket submission toqether with the additional provided information has demonstrated substantial equivalence to the predicate devices with respect to use, safety and effectiveness for their intended and indicated use.

4.2 Device (2) - FeetSupports

Model/Variants

Selling codeBrand nameDevice Identifier
130260FeetSupport™™, rotatable, 3P08719425702308
130250FeetSupport™™, fixed, indexable on LEPS and DSCP platforms, 3P08719425702315
130460FeetSupport 2.0™, rotatable08720168160263
130450FeetSupport 2.0™, fixed08720168160362

Intended Use and/or Indications for Use

Positioning of the patient during radiotherapy and radio diagnostics, including MR where indicated.

Description

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Image /page/6/Picture/0 description: The image shows the logo for "macromedics". The logo consists of a circular icon with a stylized "m" inside, followed by the word "macromedics" in a sans-serif font. Below the word "macromedics" is the tagline "SOLUTIONS IN RADIOTHERAPY" in a smaller font size. The logo is a light blue color.

The FeetSupports facilitate the positioning of the patient's feet. They are available in fixed and rotatable variants and can be fixed to various baseplates and couchtops.

Comparison of technological characteristics

The designs of the MacroMedics subjective device (the Feetsupports which are part of the LEPS), and predicate device are equivalent in shape, construction materials and functionality.

Substantial equivalence summary

MacroMedics claims the proposed FeetSupports to be substantially equivalent to the devices previously cleared by the FDA in the 510(k)'s specified above. These devices are also cleared for use in a radiotherapy and/or MR environment.

MacroMedics claims this equivalence because the proposed devices have equivalent designs, intended uses, target population and used materials. These products have similar position and immobilization characteristics for use radiotherapy and radio-diagnostics.

Conclusion

The substantial equivalence comparison in this premarket submission together with the additional provided information has demonstrated substantial equivalence to the predicate devices with respect to use, safety and effectiveness for their intended and indicated use.

4.3 Device (3) - LEPS (Lower Extremities Positioning System)

Model/Variants

LEPS with the rotatable FeetSupport LEPS with the fixed FeetSupport

Selling codeBrand nameDevice Identifier
130300LEPS ™, FeetSupport™, rot.08719425702261
130310LEPS™ FeetSupport™, fixed08719425702278
130260FeetSupport™, rotatable08719425702308
130250FeetSupport™, fixed08719425702315
130200LEPS™ baseplate08719425702322
130420LEPS™ baseplate short08719425709772
130100KneeSupport™08719425702285
130120KneeSupport™ LiftBlock™08719425702292
130130KneeSupport™ low,plastic08719425707129
130140KneeSupport™, plastic08719425707136
130350Shoulder retr. for LEPS™08719425702339

Intended Use and/or Indications for Use

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Image /page/7/Picture/0 description: The image shows the logo for "macromedics". The logo consists of a stylized letter "m" inside a circle on the left, followed by the word "macromedics" in a sans-serif font. Below the word "macromedics" is the phrase "SOLUTIONS IN RADIOTHERAPY" in a smaller font. The logo is in a light blue color.

Positioning of the patient during radiotherapy and radio diagnostics, including MR where indicated.

Description

The LEPS enables a patient's lower extremities to be positioned, using a Kneesupport, FeetSupport and, as desired, a LiftBlock. Shoulder Retractors can also be used to support the retraction of the patient's shoulders. The base of the LEPS is the LEPS baseplate.

The LEPS Short baseplate enables the patient's feet to be positioned using a FeetSupport. The LEPS baseplates can be positioned on the couch treatment table using couch strips.

Comparison of technological characteristics

The designs of the MacroMedics subjective device and predicate device are equivalent in shape, construction materials and functionality. The MacroMedics predicate device and the subject device are made out of the same materials.

Substantial equivalence summary

MacroMedics claims the proposed LEPS to be substantially equivalent to the devices previously cleared by the FDA in the 510(k)'s specified above. These devices are also cleared for use in a radiotherapy and/or MR environment.

MacroMedics claims this equivalence because the proposed devices have equivalent designs, intended uses, target population and used materials. These products have similar position and immobilization characteristics for use radiotherapy and radio-diagnostics.

Conclusion

The substantial equivalence comparison in this premarket submission together with the additional provided information has demonstrated substantial equivalence to the predicate devices with respect to use, safety and effectiveness for their intended and indicated use.

Device (4) - CouchStrips 4.4

Model/Variants

Selling codeBrand nameDevice Identifier
147930CouchStrip CS53FGF-EX08719425709802
147110CouchStrip CS53FCF-IB08720168160317
147130CouchStrip CS53FCF-S08720168160188
147140CouchStrip CS50FCF-S08720168160324
147950CouchStrip CS50FCF-EX08719425705606
147960CouchStrip CS53FCF-EX08719425709796
155950VacuumCushion Pos.Strip MR08720168160355
147150CouchStrip CS53FGF-S08720168160331

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Image /page/8/Picture/0 description: The image is a logo for "macromedics solutions in radiotherapy". The logo consists of a stylized letter "m" in a circle on the left, followed by the word "macromedics" in a sans-serif font. Below the word "macromedics" is the phrase "solutions in radiotherapy" in a smaller font. The logo is in a light blue color.

155870 VacuumCushion positioning strip
------------------------------------------

08719425705231

Description

CouchStrips are bars which connect the patient positioning device onto the treatment table at indexed positions. Depending on the indexing system of the treatment table, its width, the preference in transverse adjustability and required MR safety, different types and indexing styles are available. VacuumCushion Positioning Strips (VCPS) are CouchStrips which are placed onto other CouchStrips in order to secure a VacuumCushion in place.

Indications for Use

Positioning of the patient during radiotherapy and radio diagnostics, including MR where indicated.

Comparison of technological characteristics

The designs of the MacroMedics subjective device and predicate device are equivalent in shape. construction materials and functionality.

Substantial equivalence summary

MacroMedics claims the proposed CouchStrips to be substantially equivalent to the devices previously cleared by the FDA in the 510(k)'s specified above. These devices are also cleared for use in a radiotherapy and/or MR environment.

MacroMedics claims this equivalence because the proposed devices have equivalent designs, intended uses, target population and used materials. These products have very similar position characteristics for use radiotherapy and radio-diagnostics.

Conclusion

The substantial equivalence comparison in this premarket submission toqether with the additional provided information has demonstrated substantial equivalence to the predicate devices with respect to use, safety and effectiveness for their intended and indicated use.

§ 892.5050 Medical charged-particle radiation therapy system.

(a)
Identification. A medical charged-particle radiation therapy system is a device that produces by acceleration high energy charged particles (e.g., electrons and protons) intended for use in radiation therapy. This generic type of device may include signal analysis and display equipment, patient and equipment supports, treatment planning computer programs, component parts, and accessories.(b)
Classification. Class II. When intended for use as a quality control system, the film dosimetry system (film scanning system) included as an accessory to the device described in paragraph (a) of this section, is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 892.9.