K Number
K991115
Date Cleared
1999-06-08

(68 days)

Product Code
Regulation Number
892.1000
Reference & Predicate Devices
N/A
Predicate For
N/A
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
Intended Use

Magnetic resonance imaging (MRI) of the shoulder joint and surrounding tissue.

Device Description

Model 414GE-09 Linear Shoulder Coil. Compatible with GE Signa Profile 0.2 T MRI systems.

AI/ML Overview

The provided text describes a 510(k) premarket notification for a new MRI coil, the Model 414GE-09 Linear Shoulder Coil. This submission aims to demonstrate substantial equivalence to a legally marketed predicate device rather than proving performance against specific acceptance criteria for a new type of AI/algorithmic device.

Therefore, many of the requested elements for an AI/algorithmic device study are not applicable or cannot be extracted from this document, as this is a physical medical device (an MRI coil).

However, I can extract information related to the device's technical specifications and how its "performance" (in terms of safety and imaging parameters) is compared to the predicate device to establish substantial equivalence.

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

For this device, "acceptance criteria" are implicitly defined by the safety and imaging performance parameters of the predicate device. The new device is considered acceptable if it performs "no change" or equivalently to the predicate device in these parameters. There are no numerical performance metrics or thresholds explicitly stated as acceptance criteria in the document for the new device itself, but rather a qualitative comparison to the predicate.

Acceptance Criteria (Implied by Predicate Performance)Reported Device Performance (vs. Predicate)
Maximum Static Magnetic Field: No change from predicateNo change
Rate of Magnetic Field Strength Change: No change from predicateNo change
RF Power Deposition: No change from predicateNo change
Acoustic Noise Levels: No change from predicateNo change
Specification Volume: No change from predicateNo change
Signal-to-Noise Ratio: No change from predicateNo change
Image Uniformity: No change from predicateNo change
Geometric Distortion: No change from predicateNo change
Slice Thickness and Gap: No change from predicateNo change
High Contrast Spatial Resolution: No change from predicateNo change

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

This information is not provided in the document. The submission focuses on demonstrating that the new coil, when used with the GE Signa Profile 0.2T MRI system, operates equivalently in terms of safety and imaging parameters to the predicate device. It doesn't describe a clinical study with a specific test set of patients or images.

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)

This information is not applicable and not provided. This device is an MRI coil, not an AI or algorithmic diagnostic tool requiring expert ground truth for interpretation. The "ground truth" here would relate to the physical and electrical performance of the coil itself.

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

This information is not applicable and not provided.

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

An MRMC study is not applicable and not mentioned. This is a physical device (MRI coil), not an AI algorithm for image interpretation.

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

A standalone performance study as described for AI algorithms is not applicable. This is a physical MRI coil. Its "performance" refers to its ability to generate MRI signals and images with specific physical characteristics.

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

The "ground truth" in this context would be based on physical measurements and engineering tests of the coil's performance against established specifications and comparison to the predicate device. It would involve objective measurements of magnetic field properties, RF power, signal-to-noise ratio, image uniformity, etc., using phantoms or controlled environments, not clinical ground truth like pathology for diagnostic algorithms. The document does not detail the specific method for establishing this "ground truth" beyond stating "no change" from the predicate.

8. The sample size for the training set

This information is not applicable and not provided. This is not an AI/ML device that requires a training set.

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

This information is not applicable and not provided. This is not an AI/ML device.

{0}------------------------------------------------

K991115

JUN = 8 1999

510(k) Summary of Safety and Effectiveness

Device NameModel 414GE-09 Linear Shoulder Coil
ApplicabilityCompatible with GE Signa Profile 0.2 T MRIsystems
Reason for 510(k)New device
Classification NameMagnetic Resonance Diagnostic Device
Device Classification PanelRadiology
Device Classification Number892.1000
Product Code90LNH
Common NameMagnetic Resonance Imaging Coil
Proprietary NameModel 414GE-09 Linear Shoulder Coil
Establishment Registration Number2183683
Address of MFG FacilityIGC Medical Advances Inc.10437 Innovation DriveMilwaukee, WI 53226
Point of ContactThomas E. TynesVice President - Operations(414) 258-3808 Ext. 407
ClassificationClass II
Intended Uses
Diagnostic Uses2D, 3D imaging, proton density, T1 and T2weighted imaging. 2D, 3D time of flight, phasecontrast imaging.
Anatomic RegionsShoulder and other related joint structures.

{1}------------------------------------------------

Standards

Performance StandardsNone Established under Section 514
Voluntary Safety StandardsUL 2601-1Medical Electrical Equipment,Part 1: General Requirements forSafety
UL 94Tests for Flammability of PlasticMaterials
IEC 601-1General Safety Requirements forMedical Electrical Equipment

Overview

The Radiology Devices Panel considered potential concerns regarding the safe and effective operation of Magnetic Resonance Diagnostic Devices when they recommended reclassification to Class II on July 27, 1987. After reclassification, the FDA's Center for Devices and Radiological Health released a draft guidance document for the content and review of Magnetic Resonance Diagnostic Device premarket notification submissions that offered clarification of these concerns. The following is a summary of the information contained within this premarket notification that addresses these concerns:

The GE Signa Profile 0.2T MRI system operated with the Medical Advances Linear Shoulder Coil is substantially equivalent to the same system operated with the legally marketed predicate device listed in section 4.0, within the Class II definition of Magnetic Resonance Diagnostic Device with respect to the safety parameter action levels:

Safety Parameters

Maximum Static Magnetic Field:No change
Rate of Magnetic Field Strength Change:No change
RF Power Deposition:No change
Acoustic Noise Levels:No change

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Imaging Performance Parameters

Specification Volume:No change
Signal-to-Noise Ratio:No change
Image Uniformity:No change
Geometric Distortion:No change
Slice Thickness and Gap:No change
High Contrast Spatial Resolution:No change

General Safety and Effectiveness Concerns

The device contains instructions for use. It includes indications for use, precautions, cautions, contraindications, warnings and quality assurance testing. This information assures safe and effective use of the device.

Substantial Equivalence Summary

The GE Signa Profile 0.2T MRI system operated with the Medical Advances Linear Shoulder Coil addressed in this PMN, has the same intended use and technological characteristics as the same system operated with the identified legally marketed predicate device. The use of this coil does not affect the GE Signa Profile 0.2T system safety parameter specifications.

{3}------------------------------------------------

Public Health Service

Rockville MD 20850

Food and Drug Administration 9200 Corporate Boulevard

DEPARTMENT OF HEALTH & HUM

JUN

Medical Advances, Inc.

10437 Innovation Drive

Milwaukee, Wisconsin 53226

Thomas E. Tynes Vice President, Operations

RE:

K991115 Model 414GE-09 Linear Shoulder Coil Dated: March 25, 1999 Received: April 1, 1999 Regulatory Class: II 21 CFR 892.1000/Procode: 90 MOS

Dear Mr. Tynes:

We have reviewed your Section 510(k) notification of intent to market the device referenced above and we 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). You may, therefore, market the device, subject to the general controls provisions of the Act. 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.

If your device is classified (see above) into either class II (Special Controls) or class III (Premarket Approval), it may be subject to such additional controls. Existing major regulations affecting your device can be found in the Code of Federal Regulations, Title 21, Parts 800 to 895. A substantially equivalent determination assumes compliance with the Current Good Manufacturing Practice requirements, as set forth in the Quality System Regulation (QS) for Medical Devices: General regulation (21 CFR Part 820) and that, through periodic QS inspections, the Food and Drug Administration (FDA) will verify such assumptions. Failure to comply with the GMP regulation may result in regulatory action. In addition, FDA may publish further announcements concerning your device in the Federal Register. Please note: this response to your premarket notification submission does not affect any obligation you might have under sections 531 through 542 of the Act for devices under the Electronic Product Radiation Control provisions, or other Federal laws or regulations.

This letter will allow you to begin marketing your device as described in your 510(k) premarket notification. The FDA finding of substantial equivalence of your device to a legally marketed predicate device results in a classification for your device and thus, permits your device to proceed to the market.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801 and additionally 809.10 for in vitro diagnostic devices), please contact the Office of Compliance at (301) 594-4613. Additionally, for questions on the promotion and advertising of your device, please contact the Office of Compliance at (301) 594-4639. Also, please note the regulation entitled, "Misbranding by reference to premarket notification"(21 CFR 807.97). Other general information on your responsibilities under the Act may be obtained from the Division of Small Manufacturers Assistance at its toll-free number (800) 638-2041 or (301) 443-6597, or at its internet address "http://www.fda.gov/cdrh/dsmaldsmamain.html".

Sincerely yours,

CAPT Daniel G. Schultz, M.D. Acting Director, Division of Reproductive, Abdominal, Ear, Nose and Throat, and Radiological Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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Page ______________________

510(k) Number (if known):_____________________________________________________________________________________________________________________________________________________

Device Name: Model 414GE Series: Linear Shoulder Coil

Indications for Use:

Magnetic resonance imaging (MRI) of the shoulder joint and surrounding tissue.

(PLEASE DO NOT WRITE BELOW THIS LINE-CONTINUE ON ANOTHER PAGE IF NEEDED)

Concurrence of CDRH, Office of Device Evaluation (ODE)
(Division Sign-Off) Division of Reproductive, Abdominal, ENT, and Radiological Devices
510(k) NumberK991115
Prescription Use (Per 21 CFR 801.109)OROver-The-Counter Use (Optional Format 1-2-96)

§ 892.1000 Magnetic resonance diagnostic device.

(a)
Identification. A magnetic resonance diagnostic device is intended for general diagnostic use to present images which reflect the spatial distribution and/or magnetic resonance spectra which reflect frequency and distribution of nuclei exhibiting nuclear magnetic resonance. Other physical parameters derived from the images and/or spectra may also be produced. The device includes hydrogen-1 (proton) imaging, sodium-23 imaging, hydrogen-1 spectroscopy, phosphorus-31 spectroscopy, and chemical shift imaging (preserving simultaneous frequency and spatial information).(b)
Classification. Class II (special controls). A magnetic resonance imaging disposable kit intended for use with a magnetic resonance diagnostic device only is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 892.9.