K Number
K241764
Device Name
Mould Probe MR Safe
Date Cleared
2025-01-10

(204 days)

Product Code
Regulation Number
892.5700
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The Mould Probe MR Safe is intended for IORT, interstitial and intraluminal treatments of cancer and treatments of cancer or other superficial disease using HDR or PDR brachytherapy. IORT = Intraoperative Radiation Therapy.
Device Description
The Mould Probe MR Safe is a Brachytherapy applicator. Brachytherapy is a form of radiotherapy using Gamma rays from a radioactive source placed at locations close to or within a tumor or other treatment area to a predefined treatment plan. The treatment plan defines the positions and times for the source to ensure the correct dose for the treatment area. The applicator acts to guide the radioactive source to the correct location or locations for treatment. The Mould Probe MR Safe is intended for HDR or PDR brachytherapy and the key performance characteristics are as follows: - Suitable for intraoperative, intraluminal, and interstitial brachytherapy. - Can be used for surface treatments in combination with the suitable Varian flap. - Equipped with stabilizing mandrins for easy insertion. - MR Safe, if used without mandrins. - CT compatible, if used without mandrins. - Elastomer material construction provides increased flexibility for easy placement as well as luminal rigidity, which prevents kinks. - Steam sterilizable. - Suitable for patient contact for up to 24 hours. The stainless steel mandrins are not intended to have patient contact.
More Information

No
The device description and performance studies focus on the physical properties and sterilization of a brachytherapy applicator, with no mention of AI or ML for treatment planning, image analysis, or any other function.

Yes
The device is described as an applicator for brachytherapy, which is a form of radiotherapy used for the treatment of cancer and other superficial diseases. Its intended use is to guide a radioactive source to a specific location for treatment, directly contributing to a therapeutic outcome.

No

This device is a brachytherapy applicator, which is used to deliver radiation therapy for cancer treatment. It acts to guide a radioactive source to the correct location for treatment rather than to diagnose a condition.

No

The device description explicitly states it is a "Brachytherapy applicator" made of elastomer material and includes physical components like stabilizing mandrins. The performance studies also focus on material properties, sterilization, and physical testing, not software verification and validation.

Based on the provided information, the Mould Probe MR Safe is not an In Vitro Diagnostic (IVD) device.

Here's why:

  • Intended Use: The intended use is for delivering radiation therapy (brachytherapy) directly to a tumor or treatment area. This is a therapeutic procedure performed in vivo (within the body), not a diagnostic test performed in vitro (outside the body) on biological samples.
  • Device Description: The device is described as a brachytherapy applicator that guides a radioactive source. This aligns with a therapeutic device used for treatment delivery.
  • Lack of IVD Characteristics: The description does not mention any of the typical characteristics of an IVD, such as:
    • Analyzing biological samples (blood, urine, tissue, etc.).
    • Detecting or measuring substances in biological samples.
    • Providing information for diagnosis, monitoring, or screening.
  • Performance Studies: The performance studies focus on aspects relevant to a therapeutic device used in a clinical setting (biocompatibility, sterilization, electrical safety, MR safety, product verification), not on the analytical or clinical performance of an IVD.

In summary, the Mould Probe MR Safe is a therapeutic medical device used for delivering radiation treatment, not a diagnostic device used for testing biological samples.

N/A

Intended Use / Indications for Use

The Mould Probe MR Safe is intended for IORT, interstitial and intraluminal treatments of cancer and treatments of cancer or other superficial disease using HDR or PDR brachytherapy.

IORT - Intraoperative Radiation Therapy

Product codes

JAQ

Device Description

The Mould Probe MR Safe is a Brachytherapy applicator. Brachytherapy is a form of radiotherapy using Gamma rays from a radioactive source placed at locations close to or within a tumor or other treatment area to a predefined treatment plan. The treatment plan defines the positions and times for the source to ensure the correct dose for the treatment area. The applicator acts to guide the radioactive source to the correct location or locations for treatment.

The Mould Probe MR Safe is intended for HDR or PDR brachytherapy and the key performance characteristics are as follows:

  • Suitable for intraoperative, intraluminal, and interstitial brachytherapy. ●
  • Can be used for surface treatments in combination with the suitable Varian flap.
  • Equipped with stabilizing mandrins for easy insertion.
  • MR Safe, if used without mandrins.
  • CT compatible, if used without mandrins.
  • Elastomer material construction provides increased flexibility for easy placement as ● well as luminal rigidity, which prevents kinks.
  • . Steam sterilizable.
  • Suitable for patient contact for up to 24 hours. The stainless steel mandrins are ● not intended to have patient contact.

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

Radiation therapy or radiation oncology department in a hospital environment.

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

Non-Clinical Testing:

  • Biocompatibility Testing: Evaluation conducted according to ISO 10993-1:2020 and FDA Guidance. Tests included: Cytotoxicity, Irritation, Delayed Type Hypersensitivity, Material Mediated Pyrogens, Acute Systemic Toxicity.
  • Cleaning, Disinfection, Sterilization, Reprocessing: Sterilization testing for the supplied nonsterile device conducted according to ANSI/AAMI, ASTM and ISO standards to assess the effectiveness of cleaning, disinfection, and sterilization procedures.
  • Electrical Safety and Electromagnetic Compatibility (EMC): Review report with applicable clauses of IEC 60601-2-17 conducted, showing the device meets requirements.
  • Magnetic Resonance Testing (MR): No tests required as the device is made from non-metallic, non-magnetic materials and is MR Safe after Mandrin removal prior to entering the MR environment.
  • Software Verification and Validation Testing: Not applicable as the device does not contain or consist of software/firmware.
  • Product Verification and Validation Testing: Formal design verification and validation testing performed, demonstrating the device performs as intended, in accordance with 21 CFR §820, ISO 13485, and ISO 14971.

Clinical Testing: No animal or clinical studies were conducted.

Key Metrics

Not Found

Predicate Device(s)

K162615

Reference Device(s)

K073133

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 892.5700 Remote controlled radionuclide applicator system.

(a)
Identification. A remote controlled radionuclide applicator system is an electromechanical or pneumatic device intended to enable an operator to apply, by remote control, a radionuclide source into the body or to the surface of the body for radiation therapy. This generic type of device may include patient and equipment supports, component parts, treatment planning computer programs, and accessories.(b)
Classification. Class II.

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January 10, 2025

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.

Varian Medical Systems, Inc. Lynn Allman Sr. Director, Regulatory Affairs 3100 Hansen Way Palo Alto, California 94304

Re: K241764

Trade/Device Name: Mould Probe MR Safe Regulation Number: 21 CFR 892.5700 Regulation Name: Remote Controlled Radionuclide Applicator System Regulatory Class: Class II Product Code: JAQ Dated: June 18, 2024 Received: June 20, 2024

Dear Lynn Allman:

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 (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"

1

(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).

Your device is also subject to, among other requirements, the Quality System (QS) 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.

All medical devices, including Class I and unclassified devices and combination product device constituent parts are required to be in compliance with the final Unique Device Identification System rule ("UDI Rule"). The UDI Rule requires, among other things, that a device bear a unique device identifier (UDI) on its label and package (21 CFR 801.20(a)) unless an exception or alternative applies (21 CFR 801.20(b)) and that the dates on the device label be formatted in accordance with 21 CFR 801.18. The UDI Rule (21 CFR 830.300(a) and 830.320(b)) also requires that certain information be submitted to the Global Unique Device Identification Database (GUDID) (21 CFR Part 830 Subpart E). For additional information on these requirements, please see the UDI System webpage at https://www.fda.gov/medical-device-advicecomprehensive-regulatory-assistance/unique-device-identification-system-udi-system.

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-regulatory

2

assistance/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

Enclosure

3

Indications for Use

Form Approved: OMB No. 0910-0120 Expiration Date: 07/31/2026 See PRA Statement below.

Submission Number (if known)

K241764

Device Name

Mould Probe MR Safe

Indications for Use (Describe)

The Mould Probe MR Safe is intended for IORT, interstitial and intraluminal treatments of cancer and treatments of cancer or other superficial disease using HDR or PDR brachytherapy.

IORT - Intraoperative Radiation Therapy

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)

CONTINUE ON A SEPARATE PAGE IF NEEDED.

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Premarket Notification - 510(k) Summary

Mould Probe MR Safe

l. Submitter's Name

  • Varian Medical Systems 3100 Hansen Way Palo Alto, CA 94304
    Contact Name: Lynn Allman, PhD., Senior Director Regulatory Affairs Phone: (650) 424-5369 E-mail: submissions.support@varian.com Date Prepared: 18 June 2024

II. Device Information

Proprietary Name: Mould Probe MR Safe Classification Name: Remote Controlled Radionucleotide Applicator System Regulation Number: §892.5700 Product Code: JAQ

  • lll. Predicate Device Mould Applicator Set (K162615)

IV. Reference Device Interstitial Needles (K073133)

V. Device Description

The Mould Probe MR Safe is a Brachytherapy applicator. Brachytherapy is a form of radiotherapy using Gamma rays from a radioactive source placed at locations close to or within a tumor or other treatment area to a predefined treatment plan. The treatment plan defines the positions and times for the source to ensure the correct dose for the treatment area. The applicator acts to guide the radioactive source to the correct location or locations for treatment.

The Mould Probe MR Safe is intended for HDR or PDR brachytherapy and the key performance characteristics are as follows:

  • Suitable for intraoperative, intraluminal, and interstitial brachytherapy. ●
  • Can be used for surface treatments in combination with the suitable Varian flap.
  • Equipped with stabilizing mandrins for easy insertion.
  • MR Safe, if used without mandrins.
  • CT compatible, if used without mandrins.
  • Elastomer material construction provides increased flexibility for easy placement as ● well as luminal rigidity, which prevents kinks.
  • . Steam sterilizable.
  • Suitable for patient contact for up to 24 hours. The stainless steel mandrins are ● not intended to have patient contact.

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Image /page/5/Picture/0 description: The image shows the logo for Varian, a Siemens Healthineers Company. The word "Varian" is written in a bold, sans-serif font. Below the word "Varian" is the text "A Siemens Healthineers Company" in a smaller font. The logo is simple and modern.

VI. Intended Use/Indications for Use

The Mould Probe MR Safe is indicated for IORT, interstitial and intraluminal treatments of cancer and treatments of cancer or other superficial disease using HDR or PDR brachytherapy. IORT = Intraoperative Radiation Therapy.

Comparison of Technological Characteristics with the Predicate Device VII.

The following are the major changes that are a part of this 510(k):

  • Change in material type of the probe connector material from titanium to PEEK. This 1. changes the MR condition of Mould Probe from MR Conditional to MR Safe.
  • The clinical use of Mould probe MR Safe is contact for up to 24 hours. Full 2. biocompatibility for Mould Probe MR Safe 1.8 mm has been tested for contact duration of 24 hours.
    1. The Single use limitation has been removed from 1.8 mm Mould Probe MR Safe as the cleaning validation demonstrate it can be re-used for 25 cycles.
    1. As part of the Mould Probe MR Safe, the Mandrin is considered a principal component rather than a separately cleared device.

Minor changes include:

  • Addition of the BRAVOS Afterloader system to the Compatible Afterloaders. .
  • Availability of the Mould Probe MR Safe in kits with different quantities ●
    • Mould Probe MR Safe, 1.8 mm diameter x 320 mm, with mandrin, pack of 5 o
    • Mould Probe MR Safe, 1.8 mm diameter x 320 mm, with mandrin, pack of 10 O
    • Mould Probe MR Safe, 1.8 mm diameter x 320 mm, with mandrin, pack of 20 O
  • Addition of machine cleaning process for Mould Probe MR Safe.
  • Removal of expiration dating per assessment of lifetime limited factors used to ● establish expiration date in the prior 510(k).
  • . Removal of Mould Probe, ø 2.8 mm diameter x 320 mm
  • . The description of intended environment has been clarified for use in other suitable radiation oncology rooms as appropriate.

The device comparison table below demonstrates the substantial equivalence of the subject Mould Probe MR Safe to the predicate Mould Applicator Set (K162615). The differences between the subject and predicate are indicated in purple fill. Features which are adapted from the reference device are explained in Table 2 and appear in grev fill in the table below. The indications for use and the intended use of the subject device are the same as the predicate device.

| Features and/or
specification | Predicate Device
Mould Applicator Set
K162615 | Subject Device
Mould Probe MR Safe | Comparison |
|----------------------------------|-----------------------------------------------------|---------------------------------------|-------------------------------------------------------------------------|
| Device name | Mould Applicator Set | Mould Probe MR Safe | Device name has changed to
reflect change in included
components. |

Table 1 Comparison of Subject Device to Predicate Device

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varian

A Siemens Healthineers Company
------------------------------------
Features and/orPredicate DeviceSubject DeviceComparison
specificationMould Applicator SetMould Probe MR Safe
K162615
As compared to the Mould
Applicator Set, the Mould
Probe MR Safe includes only
the mould probe, probe
connector and mandrin. See
Design and Materials sections
in this table.
Intended UseThe Mould Applicator Set isThe Mould Probe MR Safe isNo change.
intended for IORT, interstitial
and intraluminal treatmentsintended for IORT, interstitial
and intraluminal treatments
of cancer and treatments ofof cancer and treatments of
cancer or other superficialcancer or other superficial
disease using HDR or PDRdisease using HDR or PDR
brachytherapy.brachytherapy.
IORT - IntraoperativeIORT - Intraoperative
CompatibleRadiation Therapy
GammaMedplusRadiation Therapy
GammaMedplus AfterloaderNow also compatible with
AfterloaderseriesBRAVOS Afterloader system.
BRAVOS Afterloader System
DesignMould Probe Applicator SetMould Probe MR SafeNo change in design for 1.8
mm Mould Probe
Mould Probe
Diameter: 1.8 or 2.8mm1.8 mm Mould Probe
Diameter:1.8mmThe ø 2.8 mm diameter x 320
Length: 320 mmLength: 320 mmmm has been discontinued.
Supplied with
Mould probe MR safe, 1.8
mm diameter x 320 mm,
with mandrin, pack of
5/10/20*
*Refer to Packaging row in
this table
Mandrin (GM11003100)Mandrin (GM11010470)Substantially the same.
[K073133]Mould Probe MR Safe
includes mandrin. Refer to
Table 2 for comparison to
reference device.
The Mould Probe MR Safe
now includes the mandrin as a
principle component. As such,
the mandrin will no longer use
the existing clearance
K073133, as the prior cleared
mandrin component is
Features and/orPredicate DeviceSubject DeviceComparison
specificationMould Applicator SetMould Probe MR Safe
K162615
Leak stop buttons, pack of 50
(GM11003810)[K152018]Nonecomposed of Titanium (probe
connector) and Stainless Steel
(mandrin).
Cleaning Cap, dark blue (pack
of 25) GM11010770
[K152018]The other components of the
applicator set are not
included in the same
packaging as a set and are
now sold and cleared
separately.
Materials1.8mm Mould Probe:
Polyamide (PA)Mould probe MR safe, 1.8
mm diameter x 320 mm:
Polyamide (PA)No change.
2.8mm Mould Probe:
Fluorinated ethylene
propylene (FEP)The Ø 2.8 mm size has been
discontinued.
Probe connector: TitaniumProbe connector: PEEK
Victrex 450GThe connector material
change to PEEK renders
Mould Probe to be MR Safe.
Mandrin: Stainless steelMandrin: Stainless steelThe material is diamagnetic,
and it is non-conducting, has
non-metallic properties and
non-magnetic properties.
Refer to Table 2 for further
information.
PackagingIndividualIndividual and packsSubstantially the same.
The product is available as
individual and in packs
with different quantities.
Mould probe MR safe, 1.8 mm
diameter x 320 mm, with
Mandrin:
Individual:
• 1 Mould Probe with 1
Mandrin
In packs:
• pack of 5
• pack of 10
• pack of 20
Reprocessing,
Sterility and Shelf
life1.8mm and 2.8mm Mould
Probes:
Manual Cleaning or Steam
sterilization.
1.8mm Mould Probe is a
single use product
when steam sterilized1.8mm Mould Probe MR
Safe:
Manual Cleaning and
Disinfection, Machine
Cleaning and Disinfection, or
Steam sterilization.Substantially the same.
The Single use limitation has
been removed from 1.8 mm
Mould probe as the cleaning
validation demonstrate it can
be re-used for 25 cycles

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varian

ens Healthineers Company

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varian

A Siemens Healthineers Company
------------------------------------

| Features and/or
specification | Predicate Device
Mould Applicator Set
K162615 | Subject Device
Mould Probe MR Safe | Comparison |
|---------------------------------------------------------------|-----------------------------------------------------|----------------------------------------------------------------------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| | Expiry date of 4 years for
1.8mm. | Removal of expiration date
from 1.8mm Mould Probe
MR Safe. | Additionally, 1.8mm can now
be reprocessed through
machine cleaning.
The ø 2.8 mm size has been
discontinued. |
| Biocompatibility | Full biocompatibility | Full biocompatibility | The clinical use of Mould
probe MR Safe is suitable for
patient contact for up to 24
hours. Full biocompatibility
for Mould Probe 1.8 mm has
been tested for contact
duration of 24 hours.
The 2.8 mm size has been
discontinued. |
| Compatibility
with the
environment and
other devices | MR conditional 1.5 and 3 T
CT compatible | MR Safe, if used without
Mandrins
CT compatible, if used
without Mandrins | Mould Probe is MR Safe and
CT compatible after Mandrin
removal, prior to entering the
MR environment. |
| Intended
environment | Brachytherapy treatment
room. | Radiation therapy or
radiation oncology
department in a hospital
environment. | Clarification of intended
environment.
Mould Probe MR Safe is to be
used in a shielded, dedicated
room/space for radiation
therapy. |

Table 2 Comparison of Subject Device to Reference Device

| Features and/or
specification | Reference Device
Interstitial Needles
K073133
(Compatible with Mould
Probe Applicator Set) | Subject Device
Mould Probe MR Safe | Comparison |
|----------------------------------|--------------------------------------------------------------------------------------------------------|-------------------------------------------------------------------|-------------------------------------------------------------------------------------------------------|
| Design | Mandrin (GM11003100)
Stainless steel | Mandrin (GM11010470)
Stainless steel | No change. |
| Materials | Probe connector: Titanium
Mandrin: Stainless steel | Probe connector: PEEK
Victrex 450G
Mandrin: Stainless steel | The probe connector
material change from
Titanium to PEEK renders
Mould Probe to be MR Safe. |

Summary of Performance Testing (Non-Clinical Testing) VIII.

The following performance data was provided in support of the substantial equivalence determination.

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Image /page/9/Picture/0 description: The image shows the logo for Varian, a Siemens Healthineers Company. The word "Varian" is written in a bold, sans-serif font. Below the logo is the text "A Siemens Healthineers Company" in a smaller, sans-serif font. The logo and text are both black and are set against a white background.

Biocompatibility Testing:

The biocompatibility evaluation for the subject device was conducted according to ISO 10993-1:2020: 'Biological Evaluation of a Medical Device – Part 1: Evaluation and Testing Within a Risk Management Process" and the FDA Guidance: "Use of International Standard ISO 10993-1, Biological evaluation and testing within a risk management process". This includes the following tests:

  • Cytotoxicity
  • Irritation
  • Delayed Type Hypersensitivity
  • Material Mediated Pyrogens
  • Acute Systemic Toxicity

Cleaning, Disinfection, Sterilization, Reprocessing:

Mould Probe MR Safe is supplied nonsterile. Sterilization testing for the subject device was conducted according to ANSI/AAMI, ASTM and ISO standards to assess the effectiveness of the provided cleaning, disinfection and sterilization procedures for the device.

Electrical Safety and Electromagnetic Compatibility (EMC):

A review report with applicable clauses of IEC 60601-2-17 to Mould Probe MR Safe, along with evidence for successful implementation of the clauses has been conducted. The result of this review is that Mould Probe MR Safe meets the requirements of the abovementioned clauses.

Magnetic Resonance Testing (MR):

Mould Probe MR Safe is made from non-metallic, non-magnetic materials. It is MR Safe after Mandrin removal and prior to entering the MR environment. Therefore, no tests according to ASTM F2052-21, ASTM F 2213-17, ASMT F2182-19E02 are required.

Software Verification and Validation Testing:

This item is not applicable to the subject device. The devices do not contain or consist of software/firmware. No software verification and validation testing have been included in this submission in support of the substantial equivalence determination.

Product verification and Validation testing

Mould Probe MR Safe has undergone formal design verification and validation testing; and it demonstrates that Mould Probe MR Safe performs as intended. Testing was performed according to the FDA Quality System Regulation (21 CFR §820), ISO 13485 Quality Management System Standard, and ISO 14971 Risk Management Standard.

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Image /page/10/Picture/0 description: The image shows the logo for Varian, a Siemens Healthineers Company. The word "varian" is written in a bold, sans-serif font. Below the word "varian" is the text "A Siemens Healthineers Company" in a smaller, sans-serif font. The logo is black and white.

Use of Consensus Standards:

The following list of FDA-recognized, voluntary consensus standards were utilized in the design and evaluation of the subject device's safety and efficacy.

Standard
AAMI ANSI ST108:2023ASTM F3208-20ISO 10993-17ISO 17665-1
ANSI AAMI ST79:2017IEC 60601-2-17ISO 10993-18ISO 14971:2019
ANSI AAMI ST8:2013/(R) 2018ISO 10993-1ISO 10993-23ASTM D4332-22
ANSI AAMI ST98:2022ISO 10993-2ISO 11138-1
ANSI AAMI ISO TIR 17665-2ISO 10993-5ISO 11737-1
ASTM D4169-22ISO 10993-10ISO 11737-2
ASTM F2503-23ISO 10993-11ISO 17664-1
ASTM F3293-18ISO 10993-12ISO 17664-2

Table 3 List of Consensus Standards

IX. Clinical Testing

No animal or clinical studies were conducted.

X. Determination of Substantial Equivalence to the Predicate Device

The intended use and indications for use are the same as the predicate device. There is no change to the principle operation of the device. Varian believes the major technological characteristics are substantially equivalent to the predicate device and the differences do not raise new questions of safety and effectiveness. The results of verification and validation as well as conformance to relevant safety standards demonstrate that the device meets the safety and performance criteria. Varian considers Mould Probe MR Safe to be as safe and effective as the predicate and to perform at least as well as the predicate device (K162615).