K Number
K221278
Date Cleared
2023-01-11

(253 days)

Product Code
Regulation Number
892.1570
Reference & Predicate Devices
Predicate For
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
Intended Use

Transducer Probe Cover placed over diagnostic ultrasound transducer/ probe scan head instruments. The cover allows use of the transducer in scanning and needle guided procedures for external intact skin diagnostic ultrasound, while helping to prevent transfer of microorganisms, body fluids, and particulate material to the patient and healthcare worker during reuse of the transducer. The cover also provides a means for maintenance of a sterile field. Transducer Probe Cover are furnished sterile; single use patient/procedure, disposable.

Device Description

The subject device is composed of transparent thin-walled polyurethane sleeve, rubber ring and (or) tape strip. A conventional 0.05mm thin, 49 GSM (Grams per Square Meter), transparent high strength polyurethane film tube shape, in various dimensions with heat sealed distal end to be applied over a transducer probe to provide a Transducer Cover that can be used to minimize contamination between patient and ultrasound probe during ultrasound scanning procedures for external intact skin. This may help with easier cleaning and disinfection of the probe. Ultrasound imaging is not impaired by use of the cover as it is intended. Adequate coupling between the cover and the transducer is required. The Transducer Probe Cover is utilized by applying sterile transmission, coupling, or lubricating gel onto the transducer face or into closed end of cover, inserting ultrasound transducer into closed end of cover and unrolling cover over length of the transducer as desired, and securing open end of cover with bands as necessary the removal process is accomplished by pulling the cover off the transducer in a reverse method from the application. The subject device is furnished in sterile condition, for single use patient/procedure use, disposable. As the device is single use device, which is individually packaged sterile devices. The packaging is compatible with the product's EO sterilization method. The sterilization validation confirms the packaging is qualified bacterial film to maintain the sterilization condition of the device.

AI/ML Overview

The provided text describes the performance and acceptance criteria for a medical device called "Transducer Probe Cover". Here's a breakdown of the requested information:

1. Table of Acceptance Criteria and Reported Device Performance

Test ItemAcceptance CriteriaReported Device Performance
Viral PenetrationTo validate the ability to withstand viral penetration per ASTM F1671-13.Meets requirements of ASTM F1671 for prevention of blood-borne pathogens, and the material has been tested and proven to be a viral barrier for microbes 25 nanometers and larger in size.
TensileThe maximum tensile force for longitudinal breaking of the membrane of the Transducer Probe Cover shall be no less than 20N, the maximum tensile force for transverse breaking shall not be less than 10N, and the elongation at break of the membrane of the disposable ultrasonic inspection sheath shall not be less than 100%.Meets requirements of ISO 527-3:1995. Tensile strength: 37.41N/25mm, longitudinal tensile strength: 39.25N/25mm, elongation at break: 517.51%
Tear resistanceUnder the specified conditions, test the tearing strength of the disposable ultrasonic inspection sheath is not less than 5NMeets requirements of ISO 9073-4-2021. Longitudinal crack resistance: 16.64N, Lateral crack resistance: 17.64N
Water resistanceTo determine the resistance of the materials to the penetration of water by impact. The time that can withstand 500mm hydrostatic pressure should not be less than 300s.Met the requirements
Acoustic propertiesSound Attenuation: Measured at 35°C, Sound Attenuation shall be ≤0.1dB/(cm·MHz); Acoustic Impedance: Measured at 35°C, Acoustic Impedance shall be 1.5x10^6 - 1.7x10^6 Pa·s/m; Sound Velocity: Measured at 35°C, the Sound Velocity (Acoustic Velocity) shall be 1520-1620m/s.Acoustic Velocity: 1594.4 m/s; Acoustic Attenuation: 0.01dB/(cm·MHz); Acoustic Impedance: 1.60 Pa·s/m. The Transducer Probe Cover does not affect the acoustic properties of the ultrasound device.
Force at Break and Tear Resistance PropertiesTo demonstrate material breaking force property and tear resistance property per ISO 527-3:2018Meets requirements of ISO 527-3:2018: Force at break: 28.85 N/25mm; Tear resistance: 515%.
Water LeakageWatertightness Test for Detection of Holes. The subject probe cover shall be free of pinholeNo Water Leakage
Airburst pressure and VolumeTo demonstrate the mechanical strength and durability. The Airburst Pressure shall not be less than 1.0 kpa and the volume shall be not less than 28 dm³ for cover with a mid-body width greater than or equal to 65,0 mm and less than 75,0 mmThe document states "To demonstrate the mechanical strength anddurability. The Airburst Pressure shall not be lessthan 1.0 kpa and the volume shall be not less than28 dm³ for cover with a mid-body width greaterthan or equal to 65,0 mm and less than 75,0 mm" but does not explicitly state the results. However, given that all other tests explicitly state "Meets requirements" or "Met the requirements", it can be inferred that this criterion was also met for the purpose of regulatory acceptance.
Ultrasound imaging effectUltrasound imaging is not impaired by use of the cover as it is intendedMeets requirements; The image is clear.

2. Sample Size Used for the Test Set and the Data Provenance

The document details performance testing for various physical and acoustic properties. It does not explicitly state the sample sizes for each specific test (e.g., how many covers were tested for tensile strength). The data provenance is from bench testing conducted by Hony Medical Co., Ltd. in China. The studies described are non-clinical tests, not involving human subjects, and therefore are inherently prospective in their setup (designed and executed to prove compliance).

3. Number of Experts Used to Establish the Ground Truth for the Test Set and the Qualifications of Those Experts

Not applicable. The tests performed are bench tests evaluating physical properties and acoustic effects of the device. There's no mention of human experts defining "ground truth" for these types of engineering and material science evaluations. The ground truth for these tests is defined by established international standards (e.g., ASTM, ISO).

4. Adjudication Method for the Test Set

Not applicable. As noted above, these are bench tests against defined international standards. There is no human interpretation or adjudication beyond the direct measurement of physical properties against a set threshold.

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

No. The document explicitly states: "No clinical study is included in this submission." This device is a transducer probe cover, not an AI-powered diagnostic tool, so an MRMC study comparing human readers with and without AI assistance is not relevant.

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

No, as this is not an algorithm-based device. The "standalone" performance refers to the physical and acoustic properties of the cover itself.

7. The Type of Ground Truth Used

The ground truth for the non-clinical tests is established by:

  • International Consensus Standards: For example, ASTM F1671-13 for viral penetration, ISO 527-3:1995 for tensile properties, ISO 9073-4-2021 for tear resistance, ISO 10993 for biocompatibility, etc.
  • Defined Physical and Acoustic Parameters/Thresholds: The acceptance criteria for acoustic properties (sound attenuation, impedance, velocity) and physical properties (force at break, tear resistance, water resistance, airburst pressure) serve as the ground truth.

8. The Sample Size for the Training Set

Not applicable. This is not an AI/machine learning device; therefore, there is no "training set."

9. How the Ground Truth for the Training Set was Established

Not applicable. There is no training set for this device.

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January 11, 2023

Image /page/0/Picture/1 description: The image shows 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.

Hony Medical Co., Ltd. % Boyle Wang Official Correspondent Shanghai Truthful Information Technology Co., Ltd. RM.1801, No.161, East Lujiazui Rd. Pudong, Shanghai 200120 CHINA

Re: K221278

Trade/Device Name: Transducer Probe Cover Regulation Number: 21 CFR 892.1570 Regulation Name: Diagnostic Ultrasonic Transducer Regulatory Class: Class II Product Code: ITX Dated: December 7, 2022 Received: December 15, 2022

Dear Boyle Wang:

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

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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 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 (OS) 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,

Yanna S. Kang -S

Yanna Kang, Ph.D. Assistant Director Mammography and Ultrasound Team DHT8C: 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) K221278

Device Name Transducer Probe Cover

Indications for Use (Describe)

Transducer Probe Cover placed over diagnostic ultrasound transducer/ probe scan head instruments. The cover allows use of the transducer in scanning and needle guided procedures for external intact skin diagnostic ultrasound, while helping to prevent transfer of microorganisms, body fluids, and particulate material to the patient and healthcare worker during reuse of the transducer. The cover also provides a means for maintenance of a sterile field. Transducer Probe Cover are furnished sterile; single use patient/procedure, disposable.

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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510(k) Summary K221278

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

1.0 Submitter's Information

Name:Hony Medical Co., Ltd.
Address:No.12,9Road,Changlong Ind.Zone,Taishan City,GuangdongChina 529222
Tel:+86 15916327827
Contact:Zhu Huina

Designated Submission Correspondent

Contact:Mr. Boyle Wang
Name:Shanghai Truthful Information Technology Co., Ltd.
Address:Room 1801, No. 161 East Lujiazui Rd., Pudong Shanghai, 200120 China
Tel:+86-21-50313932
Email:Info@truthful.com.cn

Date of Preparation: Jan.11,2023

2.0 Device Information

Trade name:Transducer Probe Cover
Common name:Ultrasonic Diagnostic Transducer Probe Cover
Classification name:Transducer, Ultrasonic, Diagnostic.
Model(s):Various Dimension
Production code:ITX
Regulation number:21 CFR 892.1570
Classification:Class II
Panel:Radiology

3.0 Predicate and Reference Device Information

Predicate#

Manufacturer:CIVCO MEDICAL INSTRUMENTS CO., INC.
Trade Device:GENERAL PURPOSE TRANDUCER COVER

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510(k) number: K970513

Reference#

Manufacturer:CIVCO MEDICAL INSTRUMENTS CO., INC.
Trade Device:CIV-Clear cover
510(k) number:K211270

4.0 Device Description

The subject device is composed of transparent thin-walled polyurethane sleeve, rubber ring and (or) tape strip. A conventional 0.05mm thin, 49 GSM (Grams per Square Meter), transparent high strength polyurethane film tube shape, in various dimensions with heat sealed distal end to be applied over a transducer probe to provide a Transducer Cover that can be used to minimize contamination between patient and ultrasound probe during ultrasound scanning procedures for external intact skin. This may help with easier cleaning and disinfection of the probe.

Ultrasound imaging is not impaired by use of the cover as it is intended. Adequate coupling between the cover and the transducer is required. The Transducer Probe Cover is utilized by applying sterile transmission, coupling, or lubricating gel onto the transducer face or into closed end of cover, inserting ultrasound transducer into closed end of cover and unrolling cover over length of the transducer as desired, and securing open end of cover with bands as necessary the removal process is accomplished by pulling the cover off the transducer in a reverse method from the application.

The subject device is furnished in sterile condition, for single use patient/procedure use, disposable.

As the device is single use device, which is individually packaged sterile devices. The packaging is compatible with the product's EO sterilization method. The sterilization validation confirms the packaging is qualified bacterial film to maintain the sterilization condition of the device.

5.0 Indication for Use Statement

Transducer Probe Cover placed over diagnostic ultrasound transducer/ probe scan head instruments. The cover allows use of the transducer in scanning and needle guided procedures for external intact skin diagnostic ultrasound, while helping to prevent transfer of microorganisms, body fluids, and particulate material to the patient and healthcare worker during reuse of the transducer. The cover also provides a means for maintenance of a sterile field. Transducer Probe Cover are furnished sterile; single use patient/procedure, disposable.

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6.0 Summary of Non-Clinical Testing

Summary of non-clinical and performance testing-bench testing was performed to evaluate the performance and functionality of the subject device against requirement specification. The subject device has been subjected to compliance testing according to, by FDA, recognized consensus standards ISO 10993-1, ISO 10993-7, ISO 11607-1. Results from testing performed confirms that the design requirement specification and user needs have been met. The subject device is confirmed to be safe and effective for the intended use.

6.1 Sterilization and shelf life - Transducer Probe Cover is delivered sterile and have successfully been tested according to ISO 11607- 1. The label shelf life is 3 years. 6.2 Biocompatibility testing - Transducer Probe Cover has successfully been tested for cytotoxicity, sensitization, intracutaneously irritation, acute systemic toxicity, material medicated pyrogenicity and Hemolysis Testing. The test results verify that the biocompatibility criteria given in ISO 10993 are fulfilled. Transducer Probe Cover is non-toxic and biocompatible.

6.3 Performance testing – Bench The performance of Transducer Probe Cover has been verified. Tests as described in table 1 have been completed.

Test ItemAcceptance CriteriaResult Summary
Viral PenetrationTo validate the ability to withstand viral penetration per ASTM F1671-13.Meets requirements of ASTM F1671 for prevention of blood-borne pathogens, and the material has been tested and proven to be a viral barrier for microbes 25 nanometers and larger in size.
TensileThe maximum tensile force for longitudinal breaking of the membrane of the Transducer Probe Cover shall be no less than 20N, the maximum tensile force for transverse breaking shall not be less than 10N, and the elongation at break of the membrane of the disposable ultrasonic inspection sheath shall not be less than 100%.Meets requirements of ISO 527-3:1995.Tensile strength: 37.41N/25mm, longitudinal tensile strength: 39.25N/25mm, elongation at break: 517.51%
Tear resistanceUnder the specified conditions, test the tearing strength of the disposable ultrasonic inspection sheath is not less than 5NMeets requirements of ISO 9073-4-2021Longitudinal crack resistance: 16.64NLateral crack resistance: 17.64N
Water resistanceTo determine the resistance of the materials to the penetration of water by impact.The time that can withstand 500mm hydrostatic pressure should not be less than 300s.Meet the requirements
Acoustic propertiesSound Attenuation: Measured at 35°C, SoundMeet the requirements:

Table 1: Performance testing summary - Bench

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Attenuation shall be ≤0.1dB/(cm·MHz);Acoustic Impedance: Measured at 35°C ,AcousticImpedance shall be $1.5x10^6~1.7x10^6$ Pa·s/mSound Velocity: Measured at 35°C, the SoundVelocity (Acoustic Velocity) shall be 1520-1620m/s.Acoustic Velocity: 1594.4 m/s;Acoustic Attenuation: 0.01dB/(cm·MHz)Acoustic Impedance:1.60 Pa·s/mThe Transducer Probe Cover does not affectthe acoustic properties of the ultrasounddevice.
Force at Break andTear ResistancePropertiesTo demonstrate material breaking force propertyand tear resistance property per ISO 527-3:2018Meets requirements of ISO 527-3:2018:Force at break:28.85 N/25mm;Tear resistance:515%.
Water LeakageWatertightness Test for Detection of Holes.The subject probe cover shall be free of pinholeNo Water Leakage
Airburst pressureand VolumeTo demonstrate the mechanical strength anddurability. The Airburst Pressure shall not be lessthan 1.0 kpa and the volume shall be not less than28 dm³ for cover with a mid-body width greaterthan or equal to 65,0 mm and less than 75,0 mm
Ultrasound imagingeffectUltrasound imaging is not impaired by use of thecover as it is intendedMeets requirementsThe image is clear.

7.0 _Summary of Clinical Testing

No clinical study is included in this submission.

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8.0 Technological Characteristic Comparison Table

ItemSubject DevicePredicate DeviceReference DeviceConclusion
510(k) No.K221278K970513K211270--
Product CodeITXITXITXSame
Regulation No.21 CFR 892.157021 CFR 892.157021 CFR 892.1570Same
ClassIIIIIISame
IntendedUse/Indication forUseTransducer Probe Cover placed overdiagnostic ultrasound transducer/probe scan head instruments. Thecover allows use of the transducer inscanning and needle guidedprocedures for external intact skindiagnostic ultrasound, while helping toprevent transfer of microorganisms,body fluids, and particulate material tothe patient and healthcare workerduring reuse of the transducer. Thecover also provides a means formaintenance of a sterile field.Transducer Probe Cover are furnishedsterile; single use patient/procedure,disposable.Protective cover or sheath placedover diagnostic ultrasoundtransducer / probe scan headinstruments. The cover allows use ofthe transducer in scanning andneedle guided procedures for bodysurface, endocavity, andintra-operative diagnostic ultrasound,while helping to prevent transfer ofmicroorganisms, body fluids , andparticulate material to the patient andhealthcare worker during reuse ofthe transducer (both sterile andnon-sterile covers) . The cover alsoprovides a means for maintenance ofa sterile field (sterile covers only) .CIVCO Poly Ultrasound TransducerThe cover is intended as a microbialbarrier between the patient andmedical imaging equipment.The transducer covers are used foradult of all body sizes in sterile andnon-sterile fields and for the followingapplications.• Abdominal - Diagnostic imagingand minimally invasive punctureprocedures.• Small Parts - Diagnostic imagingand minimally invasive punctureprocedures.• Regional Anesthesia - Minimallyinvasive puncture procedures.• Vascular Access - Vesselidentification and catheterSimilar with thepredicate device
Covers are furnished sterile &non-sterile single use patient /procedure, disposable.placement.• Surgical - Diagnostic imaging andpuncture procedures.• Transesophageal - Diagnosticimaging and monitoring of heartchamber, valves and vessels.• Transrectal - Diagnostic imagingand minimally invasive punctureprocedures.• Transvaginal - Diagnostic imagingand minimally invasive punctureprocedures
Materials &ConstructionPolyurethane, tubular, sealedPolyurethane and polyethyleneextruded thermoplastic film, inone-piece, open on one end, closedon other end.Ethyl Methyl Acrylate(EMA) and Polyethylene blendAll the device havepassed thebiocompatibilityevaluation
ModelVarious SizeVarious SizeVarious SizeSame
Microbial BarrierMeets requirements of ASTMF1671-13 for prevention ofblood-borne pathogensNot Publicly AvailableMeets requirements of ASTMF1671-13 for prevention ofblood-borne pathogensSame with theReference device.
AcousticPerformanceAcoustic Impedance: $1.60 x 10^6$ Pas/mNot Publicly Available$1.54 x 10^6$ Pa s/mThe subject transducerprobe cover hasnegligible effect on thetransmission ofultrasound signal andthe transducer probe
Acoustic Velocity: 1594 m/sNot Publicly Available1630 m/s
Acoustic Attenuation:0.01dB/(cm-MHz)Not Publicly AvailableNot Publicly Available
cover does not degradesignal or image.
SterileEO sterilization, SAL 10-6Both in EO sterilization andnon-sterileBoth in EO sterilization andnon-sterileSame
Disposable,Single Use OnlyYesYesYesSame
Shelf Life3 yearsNot Publicly Available3 yearsSame with the ReferenceDevice
BiocompatibilityConform with ISO10993-1(ISO10993-4, ISO10993-5,ISO10993-10, ISO10993-11)Conform with ISO 10993 standardsConform with ISO10993-1(ISO10993-4, ISO10993-5,ISO10993-10, ISO10993-11)Same

Table 2- Comparison of Technology Characteristics

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The technological characteristics of the subject device are identical to those of predicate device. The subject device has the same basic design as the predicate device. The comparison between the subject and predicate devices is based on the following:

  • Same intended use
  • · Similar material types that meet ISO 10993 biocompatibility requirements
  • · Same sterilization methods
  • · Same fundamental technology/principal of operation/user interface

The subject device is just provided in sterile condition while the predicate device is provided both in sterile and non-sterile condition, there is no significant risk raised by the difference.

9.0 Conclusion

The conclusions drawn from the comparison and analysis above demonstrate that the proposed device is as safe, as effective, and performs as well as the legally marketed predicated device and raises no new questions of safety or effectiveness. The differences between both devices are insignificant in terms of safety and effectiveness.

§ 892.1570 Diagnostic ultrasonic transducer.

(a)
Identification. A diagnostic ultrasonic transducer is a device made of a piezoelectric material that converts electrical signals into acoustic signals and acoustic signals into electrical signals and intended for use in diagnostic ultrasonic medical devices. Accessories of this generic type of device may include transmission media for acoustically coupling the transducer to the body surface, such as acoustic gel, paste, or a flexible fluid container.(b)
Classification. Class II.