K Number
K223234
Device Name
Delta4 Insight
Manufacturer
Date Cleared
2024-01-16

(454 days)

Product Code
Regulation Number
892.5050
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdparty
Intended Use
Delta4 Insight is a software intended to provide quality assurance of radiotherapy treatment dose calculation. Delta4 Insight is not a treatment planning system or a radiation delivery device. Information provided by Delta4 Insight shall not be used to directly modify or influence radiation treatments. Delta4 Insight is to be used radiation oncology personnel for quality assurance purposes.
Device Description
Delta4 Insight is software specifically design for quality assurance of radiotherapy treatment plans generated by a treatment planning system. The device calculates a secondary dose calculation via an independent Monte-Carlo based dose calculation software and compares this to the treatment planning system dose. The device is used as a secondary check for the results of a TPS and not for comparison with a measurement. Delta4 Insight is a software module within the General Delta4 software. The software module is independent of all other software modules within the Delta4 software. The device is NOT a treatment planning system or a radiation therapy delivery device. It is only used by trained radiation therapy oncology personnel for the purposes of quality assurance in a hospital setting. Insight supports treatments with MV photons. No other radiation type is supported.
More Information

Not Found

No
The description focuses on Monte-Carlo based dose calculation and comparison, with no mention of AI or ML terms or methodologies.

No
Explanation: This device is a quality assurance tool for radiotherapy treatment dose calculation and not used for direct modification or influence of radiation treatments, thus it is not a therapeutic device.

No

Explanation: While the device performs a secondary dose calculation for quality assurance of radiotherapy treatment plans, its stated purpose is not to diagnose medical conditions in patients. It is used to check the accuracy of treatment planning systems, not to identify diseases or conditions.

Yes

The device description explicitly states "Delta4 Insight is software specifically design for quality assurance of radiotherapy treatment plans". It performs calculations and comparisons based on input data (DICOM patient treatment plans) and does not mention any associated hardware components that are part of the device itself.

Based on the provided information, the Delta4 Insight 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 (like blood, urine, tissue) to provide information about a person's health.
  • Delta4 Insight's Function: Delta4 Insight's intended use and description clearly state that it is a software for quality assurance of radiotherapy treatment dose calculation. It takes input from a treatment planning system (TPS) and performs a secondary dose calculation for comparison.
  • No Specimen Analysis: The device does not analyze any biological specimens from a patient. Its input is data from a treatment planning system, not patient samples.
  • Purpose: Its purpose is to verify the accuracy of a dose calculation performed by another system, not to diagnose or monitor a patient's health based on biological samples.

Therefore, Delta4 Insight falls outside the scope of an In Vitro Diagnostic device. It is a software tool used in the quality assurance process of radiotherapy treatment planning.

N/A

Intended Use / Indications for Use

Delta4 Insight is a software intended to provide quality assurance of radiotherapy treatment dose calculation.

Delta4 Insight is not a treatment planning system or a radiation delivery device. Information provided by Delta4 Insight shall not be used to directly modify or influence radiation treatments. Delta4 Insight is to be used radiation oncology personnel for quality assurance purposes.

Product codes

IYE

Device Description

Delta4 Insight is software specifically design for quality assurance of radiotherapy treatment plans generated by a treatment planning system. The device calculates a secondary dose calculation via an independent Monte-Carlo based dose calculation software and compares this to the treatment planning system dose. The device is used as a secondary check for the results of a TPS and not for comparison with a measurement.

Delta4 Insight is a software module within the General Delta4 software. The software module is independent of all other software modules within the Delta4 software. The device is NOT a treatment planning system or a radiation therapy delivery device. It is only used by trained radiation therapy oncology personnel for the purposes of quality assurance in a hospital setting.

Insight supports treatments with MV photons. No other radiation type is supported.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

Not Found

Indicated Patient Age Range

Not Found

Intended User / Care Setting

radiotherapy department, hospital

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

Non-clinical testing was conducted in accordance with the FDA guidance document "The 510(k) Program: Evaluating Substantial Equivalence in Premarket Notifications [510(k)]." The dose from anonymized DICOM patient treatment plans from chosen reference algorithms were re-calculated with Insight and the dose compared. Test plans were chosen to span the space of test parameters for the types of treatment types/modalities/energies/TPS/machines that are supported. The variety of plans tested are reflective of common clinical treatments and turnor sites and span many field sizes and tissue depths. The results were analyzed using a gamma comparison between Insight dose results and the original reference TPS dose.

Summary of Performance Studies (study type, sample size, AUC, MRMC, standalone performance, key results)

Software verification and validation testing were conducted and documentation was provided as recommended by FDA's Guidance for Industry and FDA Staff, "Guidance for the Content of Premarket Submissions for Software Contained in Medical Devices." Validation testing involved testing of clinical treatment plans and simulated clinical workflows and environment. Verification tests were performed to verify the product performed to specification and functions as it was designed. These tests include tests to verify requirements for functionality, accuracy, compatibility, tests to ensure risk mitigations function as intended, and regression tests to ensure the safety and effectiveness of functionality.

Test plans

Non-clinical testing was conducted in accordance with the FDA guidance document "The 510(k) Program: Evaluating Substantial Equivalence in Premarket Notifications [510(k)]." The dose from anonymized DICOM patient treatment plans from chosen reference algorithms were re-calculated with Insight and the dose compared. Test plans were chosen to span the space of test parameters for the types of treatment types/modalities/energies/TPS/machines that are supported. The variety of plans tested are reflective of common clinical treatments and turnor sites and span many field sizes and tissue depths. The results were analyzed using a gamma comparison between Insight dose results and the original reference TPS dose.

Summary

The device passed verification and validation testing and was deemed safe and effective for its intended use. All test plans passed using a similar criteria to that of the predicate. Based on results of this testing the device was found to have a safety and effectiveness profile similar to the predicate device, supporting the claim of substantial equivalence.

Key Metrics (Sensitivity, Specificity, PPV, NPV, etc.)

The results were analyzed using a gamma comparison between Insight dose results and the original reference TPS dose.

Predicate Device(s)

K180595

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 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.

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January 16, 2024

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 consists of the letters "FDA" in a blue square, followed by the words "U.S. FOOD & DRUG" in blue, and then the word "ADMINISTRATION" in a smaller font size, also in blue.

ScandiDos AB % Daniel Pederson QA & RA Manager Dag Hammarskjölds väg 52A Uppsala, Uppland 752 37 SWEDEN

Re: K223234

Trade/Device Name: Delta4 Insight Regulation Number: 21 CFR 892.5050 Regulation Name: Medical Charged-Particle Radiation Therapy System Regulatory Class: Class II Product Code: IYE Dated: December 1, 2023 Received: December 12, 2023

Dear Daniel Pederson:

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 (the 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 available 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.

Additional information about changes that may require a new premarket notification are provided in the FDA guidance documents entitled "Deciding When to Submit a 510(k) for a Change to an Existing Device" (https://www.fda.gov/media/99812/download) and "Deciding When to Submit a 510(k) for a Software Change to an Existing Device" (https://www.fda.gov/media/99785/download).

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Your device is also subject to, among other requirements, the Quality System (OS) regulation (21 CFR Part 820), which includes, but is not limited to, 21 CFR 820.30, Design controls; 21 CFR 820.90, Nonconforming product; and 21 CFR 820.100, Corrective and preventive action. Please note that regardless of whether a change requires premarket review, the QS regulation requires device manufacturers to review and approve changes to device design and production (21 CFR 820.30 and 21 CFR 820.70) and document changes and approvals in the device master record (21 CFR 820.181).

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 Part 803) for devices or postmarketing safety reporting (21 CFR Part 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 Part 4. Subpart A) for combination products; and, if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR Parts 1000-1050.

Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR 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,

Locon Weidner

Lora D. Weidner, Ph.D. Assistant Director Radiation Therapy 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

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Indications for Use

510(k) Number (if known) K223234

Device Name Delta4 Insight

Indications for Use (Describe)

Delta4 Insight is a software intended to provide quality assurance of radiotherapy treatment dose calculation.

Delta4 Insight is not a treatment planning system or a radiation delivery device. Information provided by Delta4 Insight shall not be used to directly modify or influence radiation treatments. Delta4 Insight is to be used radiation oncology personnel for quality assurance purposes.

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

1 APPLICANT

510(k) owner's NameScandiDos AB
Street addressDag Hammarskjölds väg 52A
Postal Code, CitySE-75237 Uppsala
CountrySweden
Phone Number (mobile)+46-73-502 81 50
Fax Number+46-18-10 74 02
Name of official correspondentDaniel Pederson
Date the summary
was prepared (yyyy-mm-dd)2023-12-01

ମ DEVICE

Trade NameDelta4 Insight
Common/Usual NameSecondary Check QA Software
Device Classification NameMedical charged-particle radiation therapy system
(§892.5050)
Product codeIYE

3 PREDICATE DEVICES/

| Predicate Devices | Registered
Establishment Number | 510(k) Premarket submission
number |
|-------------------|------------------------------------|---------------------------------------|
| SciMoCa | 3009140718 | K180595 |

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4 DESCRIPTION OF THE DEVICE

Delta4 Insight is software specifically design for quality assurance of radiotherapy treatment plans generated by a treatment planning system. The device calculates a secondary dose calculation via an independent Monte-Carlo based dose calculation software and compares this to the treatment planning system dose. The device is used as a secondary check for the results of a TPS and not for comparison with a measurement.

Delta4 Insight is a software module within the General Delta4 software. The software module is independent of all other software modules within the Delta4 software. The device is NOT a treatment planning system or a radiation therapy delivery device. It is only used by trained radiation therapy oncology personnel for the purposes of quality assurance in a hospital setting.

Insight supports treatments with MV photons. No other radiation type is supported.

5 INTENDED USE OF THE DEVICE

Delta4 Insight is a software intended to provide quality assurance of radiotherapy treatment plans by an independent dose calculation.

Delta4 Insight is not a treatment planning system or a radiation delivery device. Information provided by Delta4 Insight shall not be used to directly modify or influence radiation treatments. Delta4 Insight is to be used only by trained radiation oncology personnel for quality assurance purposes.

The intended use of the new device is contained within the intended use of the predicate device.

6 SAFETY AND ESSENTIAL PERFORMANCE

The following standards apply to the device (general use): IEC 62304:2006/A1:2016

7 PERFORMANCE DATA

The following performance data were provided in support of substantial equivalence:

Software verification and validation testing

Software verification and validation testing were conducted and documentation was provided as recommended by FDA's Guidance for Industry and FDA Staff, "Guidance for the Content of Premarket Submissions for Software Contained in Medical Devices." Validation testing involved testing of clinical treatment plans and simulated clinical workflows and environment. Verification tests were performed to verify the product performed to specification and functions as it was designed. These tests include tests to verify requirements for functionality, accuracy,

5

compatibility, tests to ensure risk mitigations function as intended, and regression tests to ensure the safety and effectiveness of functionality.

Test plans

Non-clinical testing was conducted in accordance with the FDA guidance document "The 510(k) Program: Evaluating Substantial Equivalence in Premarket Notifications [510(k)]." The dose from anonymized DICOM patient treatment plans from chosen reference algorithms were re-calculated with Insight and the dose compared. Test plans were chosen to span the space of test parameters for the types of treatment types/modalities/energies/TPS/machines that are supported. The variety of plans tested are reflective of common clinical treatments and turnor sites and span many field sizes and tissue depths. The results were analyzed using a gamma comparison between Insight dose results and the original reference TPS dose.

Summary

The device passed verification and validation testing and was deemed safe and effective for its intended use. All test plans passed using a similar criteria to that of the predicate. Based on results of this testing the device was found to have a safety and effectiveness profile similar to the predicate device, supporting the claim of substantial equivalence.

8 TECHNOLOGICAL COMPARISON WITH THE PREDICATE DEVICES

The primary technological components of the device and its predicate device are an independent dose calculation algorithm and functionality that allows comparison between an independentlycalculated dose and a dose generated by a treatment planning system, all for quality assurance purposes. The technological characteristics are believed to be substantially equivalent to the predicate device. This is summarized in the table below:

AreaSciMoCa (primary predicate Device)Delta4 Insight
Intended UseSciMoCa is a software product intended to provide quality assurance of a radiotherapy dose calculated by a treatment planning system by allowing a clinician to re-calculate the dose with an independent dose calculation algorithm and compare the two doses. SciMoCa is not a treatment planning system or a radiation delivery device. It is to be used only by trained radiation oncology personnel for quality assuranceDelta4 Insight is a software intended to provide quality assurance of the radiotherapy treatment process by an independent dose calculation. Delta4 Insight is not a treatment planning system or a radiation delivery device. Information provided by Delta4 Insight shall not be used to modify or influence radiation treatments. Delta4 Insight is to be used only by trained radiation oncology personnel for quality assurance purposes.
purposes.
Intended UserThe intended user is a
health care professional in
the field of radiotherapy
like a medical physicist or
a dosimetrist who have
been educated in the safe
use of the device.Same as predicate device
Spatial use contextThe device is a software
program used on a
computer in a radiotherapy
departmentSame as predicate device
Social use contextOnly health care
professionals have access
to the software. See
"Intended user"Same as predicate device
Hygienic use contextN/A- Software programSame as predicate device
Physical use contextThe device is a software
program installed on a
computer in a radiotherapy
department. Radiotherapy
departments have highly
controlled environmental
conditions to allow for
patient comfort. The
temperature is typically very
stable at about 22 C°. Also,
the humidity is typically
controlled (non condensing,
30-70%),Same as predicate device
Activity use contextIndependent calculation of
radiotherapy dose is set up
to calculate automatically.
User can access and
analyze results using the
program just like any
other PC program- often
by sitting in front of the
screen and interacting with
a mouse and short phrases
of text. No further
physical interaction is
required.Same as predicate device
BiocompatibilityN/A- Software programSame as predicate device
CommunicationTCP/IP protocol between
server and clients through
hospital network. Input
files sent to server via
DICOM protocol.Same as predicate device
Energy deliveredNo energy is delivered.Same as predicate device
Device is a software
Intended medical indicationSee “Intended Use”See “Intended Use”
Intended patient populationVerification of treatment plans of patients undergoing radiotherapy treatments-typically curative or palliative treatmentsSame as predicate device
Intended part of the body or type of tissue applied to or interacted withThe device is never applied to a body part. No patients ever interact with the device. No patients are ever intended to touch the PC.Same as predicate device
Intended user profileThe device is a software.
See “Intended user”See “Intended user”
Intended condition of use (environment, including hygienic requirement, frequency of use, location, mobility)See “IntendedUse environment”See “Intended Use environment”
Sterile or non sterileN/A the device is a software. PC (not part of the device) is non-sterileSame as predicate device
Single or re-usableN/A device is a softwareSame as predicate device
Hospital or home useThe device is used in a radiotherapy device in a hospitalSame as predicate device
Measured quantitySoftware uses input from the treatment planning system for an independent dose calculation.Same as predicate device
Operating PrincipleThe software is independent of any measuring device or treatment planning system. The software receives data from the treatment planning system and independently calculates dose. The user can then analyze the dose calculated with the software and compare with the dose from the treatment planning system.Same as predicate device
Various metrics are
available for analysis.
Software analysisComparing TPS dose with
dose calculated from PC
programSame as predicate device
Dose calculation engine
typeMonte CarloSame as predicate device
Dose calculation engine
& viewing station
arrangementDose calculated on a
server inside hospital.
User can access results
from multiple devices
which are on the same
network.Same as predicate device
Main inputsTPS dose, plan, CT, and
structures. Beam model
information and CT to
density table.Same as predicate device
Commissioning data
collectionMachine specific beam
information (proprietary
beam modeling)Same as predicate device
Dose reporting typeDose to water or dose to
mediumSame as predicate device
Accuracy/Performance
of calculationWhen comparing the dose
calculation results of
patient plans to a reference
algorithm (Acuros), 97%
of the dose voxels with
more than 5% of the
maximum dose pass a
gamma criteria of
2%/2mm [Hoffman et al,
Validation of the Acuros XB
dose algorithm versus Monte
Carlo for clinical treatment
plans. MedPhys 2018 June 16].Calculation results of
patient plans to a reference
algorithm (Monaco,
Acuros) have a similar
gamma pass rate to that of
the predicate.

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7

8

Although proprietary details of the calculation algorithms differ, the technological characteristics of the device are the same as the predicate. The intended use of the new device is contained within the intended use of the predicate device. Performance test plans using the device passed with a similar gamma criteria to that of the predicate.

CONCLUSIONS 9

The non-clinical performance data support the safety of the device and the software verification and validation demonstrate that the device performs as intended in the specified use conditions.

9

Performance test plans using the device passed with a similar gamma criteria to the predicate, demonstrating that the device performs comparably to the predicate device that is currently marketed for a comparable intended use. It is the opinion of Scandidos AB that the device, Delta4 Insight, is as safe, is as effective, and performs as well as the predicate device.