K Number
K992305
Manufacturer
Date Cleared
1999-09-08

(62 days)

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

It is intended for accurate transit time blood volume flow measurements during cardiovascular, vascular and transplantation surgery.

Device Description

The Medi-Stim Butterfly Flowmeter estimates blood volume flow by measuring the transit time difference between an ultrasonic signal propagated through a blood vessel in the downstream direction and one propagated in the upstream direction. The measuring unit consists of two ultrasonic transducers on one side of the vessel aimed at a common point on a flat reflector on the other side of the vessel.

AI/ML Overview

Here's a breakdown of the acceptance criteria and study information for the Medi-Stim Butterfly Flowmeter, based on the provided 510(k) summary:

1. Table of Acceptance Criteria and Reported Device Performance

Acceptance Criteria (Probe Accuracy)Reported Device Performance
Perivascular probes: ±10%Perivascular: ±10%
Cardiac output probes: ±15%Cardiac output: ±15%
Tubing probes: ±5%Tubings: ±5%

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

The document does not explicitly state the sample size used for the test set or the data provenance (e.g., country of origin, retrospective or prospective nature of the study). The submission primarily focuses on comparing the new device to a predicate device based on technical specifications and intended use.

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

This information is not provided in the document. The submission relies on a comparison to a predicate device and established accuracy criteria for similar devices, rather than a clinical study with expert-established ground truth.

4. Adjudication Method for the Test Set

This information is not provided in the document, as no explicit clinical test set with adjudicated ground truth is described.

5. Multi-Reader Multi-Case (MRMC) Comparative Effectiveness Study

A multi-reader multi-case (MRMC) comparative effectiveness study was not conducted or reported in this 510(k) summary. The submission focuses on substantial equivalence to a predicate device based on technical specifications.

6. Standalone (Algorithm Only) Performance

A standalone performance study of the algorithm without human-in-the-loop performance was not explicitly described or reported as a separate study. However, the accuracy percentages (e.g., ±10% for perivascular) refer to the device's inherent measurement accuracy, implying a form of standalone technical performance assessment against known flow rates. The document states: "The flowmeter displays the measurement results with a flow curve and it's associated mean flow value." This suggests the algorithm is directly providing measurements.

7. Type of Ground Truth Used

The ground truth for the declared accuracy percentages (e.g., ±10%, ±15%, ±5%) is implied to be an objective measurement of "true" blood volume flow during device testing, likely established through controlled experiments or calibrated flow models. The document doesn't specify the exact method (e.g., gold-standard flow measurement devices, in-vitro testing with known flow rates). The comparison to the predicate device's accuracy implies that the acceptance criteria are based on established standards for this type of medical device.

8. Sample Size for the Training Set

The document does not mention a training set or any development of an AI algorithm in the context of machine learning. The device described uses a "transit time technology that interfaces with this platform" and "The transit time signal processing is performed by hardware that uses algorithms similar to an ultrasound scanner, and the received ultrasound phase shifts are processed digitally." This suggests traditional signal processing algorithms rather than trainable machine learning models.

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

As no training set is mentioned (see point 8), this information is not applicable/not provided.

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

510(k) - Medi-Stim Butterfly Flowmeter 510(k) Summary

K992305

4.9. 510(k) Summary

510(k) Summary

as required by 807.92 (c)

for Medi-Stim Butterfly Flowmeter, BF1000 - BF2004

Prepared June 28th, 1999

Submitted by:Medi-Stim A/S
Sandakerveien 110
P.O. Box 35 Grefsen
N-0475 Oslo
Norway
tel. +47 23 05 96 70 (direct), +47 23 05 96 60 (switch board)
fax +47 23 05 96 61
Contact Person:Jon H. Hoem, VP International Sales & Marketing
Device Trade Name:Medi-Stim Butterfly Flowmeter
Common Name:Cardiovascular Blood Flowmeter
Classification:Class II
Predicate Device:Transonic Flowmeter
Transonic Systems. Inc.
34 Dutch Mill Road
Ithaca, NY 14850
K872048

Description of Device:

The Medi-Stim Butterfly Flowmeter estimates blood volume flow by measuring the transit time difference between an ultrasonic signal propagated through a blood vessel in the downstream direction and one propagated in the upstream direction. The measuring unit consists of two ultrasonic transducers on one side of the vessel aimed at a common point on a flat reflector on the other side of the vessel.

Intended Use of Device:

:

. 1992 - 1992 - 1992 - 1992 - 1992 - 1992 - 1992 - 1992 - 1992 - 1992 - 1992 - 1992 - 1992 - 1992 - 1992 - 1992 - 1992 - 1992 - 1992 - 1992 - 1992 - 1992 - 1992 - 1992 - 1992

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

It is intended for accurate transit time blood volume flow measurements during cardiovascular, vascular and transplantation surgery.

Substantial Equivalence to Predicate Device:

The intended use of the Transonic Flowmeter is intraoperatively through a venous or arterial wall of an adult or pediatric patient to measure the approximate instantaneous and average blood volume flow through exposed peripheral and/or cardio-thoracic veins or arteries. It is not intended for fetal use. The same indications for use apply to the Medi-Stim flowmeter.

Both the Medi-Stim Butterfly Flowmeter and the Transonic Flowmeter uses the transit time principle to measure volume flow. The main differences between the systems lie in the implementation and presentation of the measurement results. Medi-Stim has utilized a commercial available platform and developed a transit time technology that interfaces with this platform. The transit time signal processing is performed by hardware that uses algorithms similar to an ultrasound scanner, and the received ultrasound phase shifts are processed digitally. The flowmeter displays the measurement results with a flow curve and it's associated mean flow value. All other measurement results are displayed simultaneously on an active matrix touch screen. The predicate utilizes hardware that needs more calibration points and where the signal processing is mainly analog.

There is also a difference with regard to the design of the transit time probes which in the case of Medi-Stim has a flat front face design providing a more stable and reproducible measurement.

However, there is no safety or effectivity issues associated with these differences. The table below summarizes the differences between the Medi-Stim flowmeter and the predicate device.

{2}------------------------------------------------

Medi-Stim Butterfly Flowmeter vs. the predicate device
The Medi-Stim Butterfly FlowmeterTransonic Flowmeter
1. Intended useCardiovascular, vascular and transplantation surgeryCardiac surgery, vascular reconstructions and transplanted organs
2. Patient groupAdult and pediatricAdult and pediatric
3. Flow measurements
TechnologyTransit timeTransit time
No. of channels1 or 21 or 2
Measured parametersMean flow value and flow volume patternsMean flow value + "instantaneous value"
Simulated Doppler soundYesNo
Type of probesPerivascular, cardiac output and tubing measurementsPerivascular, cardiac output and tubing measurements
Perivascular probe designFlat Front Face DesignAngular Front Face Design
Probe sizes1.5mm – 35mm1/8" – ½"6mm, 32mm3/8"(Whole range of probes added later)
Probe accuracyPerivascular: ±10%Cardiac output: ±15%Tubings: ±5%Perivascular: ±10%Cardiac output: ±15%Tubings: ±5%
Probe sterilization methodsEthylene Oxide Gas (ETO), formaldehyde, Steris, J & J Sterrad, or 5% buffered glutaraldehydeETO or standard/cold liquid sterilization
Probe count limitationYesNo
Medi-Stim Butterfly Flowmeter vs. the predicate device
The Medi-Stim ButterflyFlowmeterTransonic Flowmeter
4. Pressure measurements
Intended useIntraoperatively during surgeryNone
TechnologyCommercial availabledisposable pressure transducersN/A
Alarm settingsNoN/A
5. Derived parameters
Flow parametersPulsatility IndexInstant Q valueFlow integralYesYesYesNoNoNo
Vascular resistanceYesNo
Auxiliary inputYesNo
6. User interface
Flow probe zero line calibrationAutomatic (EEPROM)Manual
ControlsTouch screen or keyboardPush-button
Read-outActive matrix 13" displayLED display + analog meter
DocumentationPatient database (hard disk) orprint-outNone
7. Technology platform
HardwarePentium microprocessorProprietary digital transit timefront endProprietary analog transit timefront end and dedicatedelectronics
SoftwareWindows '95 and softwaredeveloped in C++All algorithms programmed inhardware
8. Acoustic OutputMI < 0,022Ispta < 0,189 mW/cm²Isppa < 0,0462 W/cm²Isata < 0,0833MI < 0,033Ispta < 0,53 mW/cm²Isppa < 0,028 W/cm²Isata N/A
Isata below pre-amendment level ? YesIsata below pre-amendment level ? Yes

:

j


--

ート | アイト | アイト | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |

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

Table 16. The Medi-Stim Butterfly Flowmeter vs. the predicate device

:

(

--


{4}------------------------------------------------

Image /page/4/Picture/2 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo consists of a circular seal with the text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" around the perimeter. Inside the circle is a stylized image of three human profiles facing to the right, one behind the other, with a flowing, ribbon-like design connecting them.

SEP 8 1999 Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

Jon H. Hoem, VP International Sales & Marketing Medi-Stim AS P.O. Box 35 Grefsen, N-0409 Sandakervein 110, N-0475 Oslo NORWAY

Re: K992305

Medi-Stim Butterfly Flowmeter: Models BF1000 BF2000 BF1001 BF2001 BF1004 BF2004 and BF2004 Regulatory Class: II 21 CFR 892.1570/ Procode: 90 ITX, Diagnostic Ultrasound Transducer 21 CFR 870.2100/ Procode: 74 DPT. Cardiovascular Blood Flow-meter 21 CFR 870.2120/ Procode: 74 DPW, Extravascular Blood Flow Probe 21 CFR 870.1110/ Procode: 74 DSK, Blood P0ressure Computer Dated: July 2, 1999 Received: July 8, 1999

Dear Mr. Hoem:

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 (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.

This determination of substantial equivalence applies to the following transducer intended for use with the Medi-Stim Butterfly Flowmeters, models: BF1000 Single channel flowmeter, BF2000 Dual channel flowmeter, BF1001 Single channel flowmeter with AUX/ECG channel, BF2001 Dual channel flowmeter with AUX/ECG channel, BF1004 Single channel flowmeter with 2 pressure channels and two AUX/ECG channels, and the BF2004 Dual channel flowmeter with 2 pressure channels and two AUX/ECG channels, as described in your premarket notification:

{5}------------------------------------------------

Transducer Model Numbers

PJ100011 1.5mmPB100041 4mmPB100082 8mmPA100271 27mm
PA100021 2mmPA100042 4mmPA100121 12mmPB100271 27mm
PB100021 2mmPB100042 4mmPB100121 12mmPR100151 15mm
PA100022 2mmPA100051 5mmPA100122 12mmPR100181 18mm
PB100022 2mmPB100051 5mmPB100122 12mmPR100211 21mm
PA100031 3mmPA100052 5mmPA100161 16mmPR100251 25mm
PB100031 3mmPA100052 5mmPB100161 16mmPR100301 30mm
PA100032 3mmPA100081 8mmPA100211 21mmPR100351 35mm
PB100032 3mmPB100081 8mmPB100211 21mm
PA100041 4mmPA100082 8mm
PI100181 InLine probe, 1/8"PC100141 ClampOn probe, 1/4", 1/32" wall
PI100141 InLine probe, 1/4"PC100142 ClampOn probe, 1/4", 1/16" wall
PI100381 InLine probe, 3/8"PC100382 ClampOn probe, 3/8", 1/16" wall
PI100121 InLine probe, 1/2"PC100383 ClampOn probe, 3/8", 3/32" wall
PC100181 ClampOn probe, 1/8", 1/32" wallPC100122 ClampOn probe, 1/2", 1/16" wall
PC100182 ClampOn probe, 1/8", 1/16" wallPC100123 ClampOn probe, 1/2", 3/32" wall
PC103161 ClampOn probe, 3/16", 1/32" wallPC100124 ClampOn probe, 1/2", 1/8" wall
PC103162 ClamnOn probe 3/16" 1/16" wall

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 Good Manufacturing Practice requirement, as set forth in the Quality System Regulation (OS) for Medical Devices: General (GMP) regulation (21 CFR Part 820) and that, through periodic QS inspections, the FDA will verify such assumptions. Failure to comply with the GMP regulation may result in regulatory action. In addition, the Food and Drug Administration (FDA) may publish further announcements concerning your device in the Federal Register. Please note: this response to your premarket notification does not affect any obligation you may have under sections 531 and 542 of the Act for devices under the Electronic Product Radiation Control provisions, or other Federal laws or regulations.

This determination of substantial equivalence is granted on the condition that prior to shipping the first device, you submit a postclearance special report. This report should contain complete information, including acoustic output measurements based on production line devices, requested in Appendix G, (enclosed) of the Center's September 30, 1997 "Information for Manufacturers Seeking Marketing Clearance of Diagnostic Ultrasound Systems and Transducers." If the special report is incomplete or contains unacceptable values (e.g., acoustic output greater than approved levels), then the 510(k) clearance may not apply to the production units which as a result may be considered adulterated or misbranded.

{6}------------------------------------------------

Page -3- Mr. Hoem

The special report should reference the manufacturer's 510(k) number. It should be clearly and prominently marked "ADD-TO-FILE" and should be submitted in duplicate to:

Food and Drug Administration Center for Devices and Radiological Health Document Mail Center (HFZ-401) 9200 Corporate Boulevard Rockville, Maryland 20850

This letter will allow you to begin marketing your device as described in your 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 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) 594-4591. 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 at (301) 443-6597 or at its internet address "http://www.fda.gov/cdrh/dsmamain.html".

If you have any questions regarding the content of this letter, please contact Paul M. Gammell, Ph.D. at (301) 594-1212.

Sincerely yours,

Edward A. Boyanom

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

Enclosures

{7}------------------------------------------------

Diagnostic Ultrasound Indications for Use Form

PJ100011 1.5mm Medi-Stim transit-time probe without handle (to be used with BF1000 -- BF2004)

Intended Use: Diagnostic ultrasound imaging or fluid flow analysis of the human body as follows:

Mode of Operation
Clinical ApplicationABMPWDCWDColorDopplerAmplitudeDopplerColorVelocityImagingCombined(specify)Other(specify)
Ophthalmic
Fetal
Abdominal
Intraoperative (specify)N
IntraoperativeNeurological
Pediatric
Small Organ (specify)
Neonatal Cephalic
Adult Cephalic
Cardiac
Transesophageal
Transrectal
Transvaginal
Transurethral
Intravascular
Peripheral Vascular
Laparoscopic
Musculo-skeletal
Conventional
Musculo-skeletalSuperficial
Other (specify)

N= new indication; P= previously cleared by FDA; E= added under Appendix E

Additional Comments: PJ100011 1.5mm Medi-Stim transit-time probe without handle (J-reflector)

interfaced with a transit-time volume flowmeter for volume flow measurements during cardiovascular,

vascular and transplantation surgery.

(PLEASE DO NOT WRITE BELOW THIS LINE - CONTINUE ON ANOTHER PAGE IF NEEDED Concurrence of CDRH, Office of Device Evaluation (ODE

Prescription Use (Per 21 CFR 801.109)

David A. Gynn

(Division Sign-Off) Division of Reproductive, Abdominal, EN

Radiological Devices
510(k) Number K992305

{8}------------------------------------------------

Diagnostic Ultrasound Indications for Use Form

PC100181, PC100182, PC103161, PC103162, PC100141, PC100142, PC100382, PC100122, PC100123, PC100124: 1/8", 3/16", ¼", 3/8" and ½" ClampOn Medi-Stim transit-time probe (to be used with BF1000 - BF2004)

Mode of Operation
Clinical ApplicationABMPWDCWDColorDopplerAmplitudeDopplerColorVelocityImagingCombined(specify)Other(specify)
Ophthalmic
Fetal
Abdominal
Intraoperative (specify)
IntraoperativeNeurological
Pediatric
Small Organ (specify)
Neonatal Cephalic
Adult Cephalic
Cardiac
Transesophageal
Transrectal
Transrectal
Transvaginal
Transurethral
Intravascular
Peripheral Vascular
Laparoscopic
Musculo-skeletal
Conventional
Musculo-skeletalSuperficial
Other (specify)N

Intended Use: Diagnostic ultrasound imaging or fluid flow analysis of the human body as follows:

N= new indication; P= previously cleared by FDA; E= added under Appendix E

Additional Comments: PC100181, PC100182, PC103161, PC103162, PC100141, PC100142,

PC100382, PC100383, PC100123, PC100124: 1/8", 3/16", ¼", 3/8" and ½" ClampOn Medi-

Stim transit-time probe; interfaced with a transit-time volume flow measurements in tubings. Placed around tubings.

(PLEASE DO NOT WRITE BELOW THIS LINE - CONTINUE ON ANOTHER PAGE IF NEEDED) Concurrence of CDRH, Office of Deyice Evaluation (OL

Prescription Use (Per 21 CFR 801.109)

David A. Segner

Reproductive odominal

{9}------------------------------------------------

Diagnostic Ultrasound Indications for Use Form

PI100181, PI100141, PI100381, PI100121: 1/8", ¼", 3/8" and ½" InLine Medi-Stim transit-time probe (to be used with BF1000 – BF2004)

Intended Use: Diagnostic ultrasound imaging or fluid flow analysis of the human body as follows:

Mode of Operation
Clinical ApplicationABMPWDCWDColorDopplerAmplitudeDopplerColorVelocityImagingCombined(specify)Other(specify)
Ophthalmic
Fetal
Abdominal
Intraoperative (specify)
IntraoperativeNeurological
Pediatric
Small Organ (specify)
Neonatal Cephalic
Adult Cephalic
Cardiac
Transesophageal
Transrectal
Transrectal
Transvaginal
Transurethral
Intravascular
Peripheral Vascular
Laparoscopic
Musculo-skeletalConventional
Musculo-skeletalSuperficial
Other (specify)N

N= new indication; P= previously cleared by FDA; E= added under Appendix E

Additional Comments: Pl100181, Pl100141, Pl100121: 1/8", ¼", 3/8″ and ½" InLine Medi-Stim transit-time probe; interfaced with a transit-time volume flowmeter for volume flow measurements in

tubings. Spliced into tubings - not for clinical use.

(PLEASE DO NOT WRITE BELOW THIS LINE - CONTINUE ON ANOTHER PAGE IF IN Concurrence of CDRH, Office of Device Evaluation Prescription Use (Per 21 CFR 801.109)

Thrist A. Segerstrom

on of Reproductive, Abdominal, ENT

Radiological Devices
510(k) Number K992305

{10}------------------------------------------------

Diagnostic Ultrasound Indications for Use Form

PR100151. PR100181. PR100211. PR100251. PR100301 and PR100351 15mm, 18mm, 21mm, 25mm, 30mm and 35mm Medi-Stim transit-time probe without handle (to be used with BF1000 – BF2004)

Intended Use: Diagnostic ultrasound imaging or fluid flow analysis of the human body as follows:

Mode of Operation
Clinical ApplicationABMPWDCWDColorDopplerAmplitudeDopplerColorVelocityImagingCombined(specify)Other(specify)
Ophthalmic
Fetal
Abdominal
Intraoperative (specify)N
IntraoperativeNeurological
Pediatric
Small Organ (specify)
Neonatal Cephalic
Adult Cephalic
Cardiac
Transesophageal
Transrectal
Transrectal
Transvaginal
Transurethral
Intravascular
Peripheral Vascular
Laparoscopic
Musculo-skeletal
Conventional
Musculo-skeletalSuperficial
Other (specify)

N= new indication; P= previously cleared by FDA; E= added under Appendix E

Additional Comments: PR100151, PR100181, PR100251, PR100251, PR100301 and PR100351: 15mm,

18mm, 21mm, 25mm, 30mm and 35mm Medi-Stim transit-time probe without handle; interfaced with a

transit-time volume flowmeter for volume flow measurements during cardiovascular, vascular and

transplantation surgery.

(PLEASE DO NOT WRITE BELOW THIS LINE - CONTINUE ON ANOTHER PAGE IF NEEDED Concurrence of CDRH, Office of Device Evaluation (6 Prescription Use (Per 21 CFR 801.109)

510(k) Number

David G. Nguyen
(Division Sign-Off)
Division of Reproductive, Abdominal, ENT,

(Division of Reproductive, Abdominal, ENT,
and Radiological Devices

{11}------------------------------------------------

Diagnostic Ultrasound Indications for Use Form

PA100271 and PB100271 27mm Medi-Stim transit-time probe without handle (to be used with BF1000 - BF2004)

Intended Use: Diagnostic ultrasound imaging or fluid flow analysis of the human body as follows:

Mode of Operation
Clinical ApplicationABMPWDCWDColorDopplerAmplitudeDopplerColorVelocityImagingCombined(specify)Other(specify)
Ophthalmic
Fetal
Abdominal
Intraoperative (specify)N
IntraoperativeNeurological
Pediatric
Small Organ (specify)
Neonatal Cephalic
Adult Cephalic
Cardiac
Transesophageal
Transrectal
Transrectal
Transvaginal
Transurethral
Intravascular
Peripheral Vascular
Laparoscopic
Musculo-skeletal
Conventional
Musculo-skeletalSuperficial
Other (specify)

N= new indication; P= previously cleared by FDA; E= added under Appendix E

Additional Comments: PA100271 and PB100271 27mm Medi-Stim transit-time probe without handle;

510 k

interfaced with a transit-time volume flowmeter for volume flow measurements during cardiovascular,

vascular and transplantation surgery.

(PLEASE DO NOT WRITE BELOW THIS LINE - CONTINUE ON ANOTHER PAGE IF NEEDED Concurrence of CDRH, Office of Device Evaluation (ODE) Prescription Use (Per 21 CFR 801.109)

David G. Seymann

ision Sign-Off) ivision of Reproductive, Abdominal, El and Radiological I

{12}------------------------------------------------

Diagnostic Ultrasound Indications for Use Form

PA100211 and PB100211 21mm Medi-Stim transit-time probe without handle (to be used with BF1000 – BF2004)

Intended Use: Diagnostic ultrasound imaging or fluid flow analysis of the human body as follows:

Mode of Operation
Clinical ApplicationABMPWDCWDColorDopplerAmplitudeDopplerColorVelocityImagingCombined(specify)Other(specify)
Ophthalmic
Fetal
Abdominal
Intraoperative (specify)N
IntraoperativeNeurological
Pediatric
Small Organ (specify)
Neonatal Cephalic
Adult Cephalic
Cardiac
Transesophageal
Transrectal
Transrectal
Transvaginal
Transurethral
Intravascular
Peripheral Vascular
Laparoscopic
Musculo-skeletalConventional
Musculo-skeletalSuperficial
Other (specify)

N= new indication; P= previously cleared by FDA; E= added under Appendix E

Additional Comments: PA100211 21mm Medi-Stim transit-time probe without handle; interfaced with a transit-time volume flowmeter for volume flow measurements during cardiovascular, vascular and transplantation surgery.

(PLEASE DO NOT WRITE BELOW THIS LINE - CONTINUE ON ANOTHER PAGE IF NEEDED)
Prescription Use (Per 21 CFR 801.109)

Yamil h. Syam

(Division Sign-Off) Division of Reproductive, Abdominal, EN and Radiological D

510(k) Number K99236

{13}------------------------------------------------

Diagnostic Ultrasound Indications for Use Form

PA100161 and PB100161 16mm Medi-Stim transit-time probe without handle (to be used with BF1000 – BF2004)

Intended Use: Diagnostic ultrasound imaging or fluid flow analysis of the human body as follows:

Mode of Operation
Clinical ApplicationABMPWDCWDColorDopplerAmplitudeDopplerColorVelocityImagingCombined(specify)Other(specify)
Ophthalmic
Fetal
Abdominal
Intraoperative (specify)N
IntraoperativeNeurological
Pediatric
Small Organ (specify)
Neonatal Cephalic
Adult Cephalic
Cardiac
Transesophageal
Transrectal
Transrectal
Transvaginal
Transurethral
Intravascular
Peripheral Vascular
Laparoscopic
Musculo-skeletal
Conventional
Musculo-skeletalSuperficial
Other (specify)

N= new indication; P= previously cleared by FDA; E= added under Appendix E

Additional Comments: PA100161 and PB100161 16mm Medi-Stim transit-time probe without handle; interfaced with a transit-time volume flowmeter for volume flow measurements during cardiovascular, vascular and transplantation surgery.

(Please do not write below this line - continge on another page if needed) Concurrence of CDRH, Office of Deyice Evaluation (ODF Prescription Use (Per 21 CFR 801.109)

Thind A. Segerson
(Division Sign-Off)

(Division of Reproductive, Abdominal, ENT and Radiological De

510(k) Number

{14}------------------------------------------------

Diagnostic Ultrasound Indications for Use Form

PA100122 and PB100122 12mm Medi-Stim transit-time probe with handle (to be used with BF1000 – BF2004)

Intended Use: Diagnostic ultrasound imaging or fluid flow analysis of the human body as follows:

Mode of Operation
Clinical ApplicationABMPWDCWDColorDopplerAmplitudeDopplerColorVelocityImagingCombined(specify)Other(specify)
Ophthalmic
Fetal
Abdominal.
Intraoperative (specify)N
IntraoperativeNeurological
Pediatric
Small Organ (specify)
Neonatal Cephalic
Adult Cephalic
Cardiac
Transesophageal
Transrectal
Transrectal
Transvaginal
Transurethral
Intravascular
Peripheral Vascular
Laparoscopic
Musculo-skeletal
Conventional
Musculo-skeletalSuperficial
Other (specify)

N= new indication; P= previously cleared by FDA; E= added under Appendix E

Additional Comments: PA100122 and PB100122 12mm Medi-Stim transit-time probe with handle;

interfaced with a transit-time volume flowmeter for volume flow measurements during cardiovascular,

vascular and transplantation surgery.


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

Concurrence of CDRH, Office of Device Evaluation (ODE)

Prescription Use (Per 21 CFR 801.109)
(Division Sign-Off)

(Division Sign-Off)
Division of Reproductive, Abdominal, ENT,
and Radiological Devices
K992305

510(k) Number

{15}------------------------------------------------

Diagnostic Ultrasound Indications for Use Form

PA100121 and PB100121 12mm Medi-Stim transit-time probe without handle (to be used with BF1000 - BF2004)

Intended Use: Diagnostic ultrasound imaging or fluid flow analysis of the human body as follows:

Mode of Operation
Clinical ApplicationABMPWDCWDColorDopplerAmplitudeDopplerColorVelocityImagingCombined(specify)Other(specify)
Ophthalmic
Fetal
Abdominal
Intraoperative (specify)N
IntraoperativeNeurological
Pediatric
Small Organ (specify)
Neonatal Cephalic
Adult Cephalic
Cardiac
Transesophageal
Transrectal
Transrectal
Transvaginal
Transurethral
Intravascular
Peripheral Vascular
Laparoscopic
Musculo-skeletal
Conventional
Musculo-skeletalSuperficial
Other (specify)

N= new indication; P= previously cleared by FDA; E= added under Appendix E

Additional Comments: PA100121 and PB100121 12mm Medi-Stim transit-time probe without handle; interfaced with a transit-time volume flowmeter for volume flow measurements during cardiovascular, vascular and transplantation surgery.

(PLEASE DO NOT WRITE BELOW THIS LINE - CONTINUE ON ANOTHER PAGE IF Concurrence of CDRH, Office of Device Evalyation (OD Prescription Use (Per 21 CFR 801.109) AN

oductive, Abdominal, El

{16}------------------------------------------------

Diagnostic Ultrasound Indications for Use Form

PA100082 and PB100082 8mm Medi-Stim transit-time probe with handle (to be used with BF1000 – BF2004)

Intended Use: Diagnostic ultrasound imaging or fluid flow analysis of the human body as follows:

Mode of Operation
Clinical ApplicationABMPWDCWDColorDopplerAmplitudeDopplerColorVelocityImagingCombined(specify)Other(specify)
Ophthalmic
Fetal
Abdominal
Intraoperative (specify)N
IntraoperativeNeurological
Pediatric
Small Organ (specify)
Neonatal Cephalic
Adult Cephalic
Cardiac
Transesophageal
Transrectal
Transrectal
Transvaginal
Transurethral
Intravascular
Peripheral Vascular
Laparoscopic
Musculo-skeletal
Conventional
Musculo-skeletalSuperficial
Other (specify)

N= new indication; P= previously cleared by FDA; E= added under Appendix E

Additional Comments: PA100082 and PB100082 8mm Medi-Stim transit-time probe with handle; interfaced with a transit-time volume flowmeter for volume flow measurements during cardiovascular,

vascular and transplantation surgery.

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

Concurrence of CDRH, Office of Device Evaluation, (ODE)
---------------------------------------------------------

Prescription Use (Per 21 CFR 801.109)

Division of Reproductive, Abdominal, ENT,
and Radiological Devices
510(k) Number K992305

{17}------------------------------------------------

Diagnostic Ultrasound Indications for Use Form

PA100081 and PB100081 8mm Medi-Stim transit-time probe without handle (to be used with BF1000 - BF2004)

Intended Use: Diagnostic ultrasound imaging or fluid flow analysis of the human body as follows:

Mode of Operation
Clinical ApplicationABMPWDCWDColorDopplerAmplitudeDopplerColorVelocityImagingCombined(specify)Other(specify)
Ophthalmic
Fetal
Abdominal
Intraoperative (specify)N
IntraoperativeNeurological
Pediatric
Small Organ (specify)
Neonatal Cephalic
Adult Cephalic
Cardiac
Transesophageal
Transrectal
Transrectal
Transvaginal
Transurethral
Intravascular
Peripheral Vascular
Laparoscopic
Musculo-skeletal
Conventional
Musculo-skeletalSuperficial
Other (specify)

N= new indication; P= previously cleared by FDA; E= added under Appendix E

Additional Comments: PA100081 and PB100081 2mm Medi-Stim transit-time probe without handle; interfaced with a transit-time volume flowmeter for volume flow measurements during cardiovascular, vascular and transplantation surgery.

(PLEASE DO NOT WRITE BELOW THIS LINE - CONTINUE ON ANOTHER PAGE IF NEEDED) Concurrence of CDRH, Office of Deyice Evaluation (ODE)

Prescription Use (Per 21 CFR 801.109)

David A. Severson

(Division Sign-Off)
Division of Reproductive, Abdominat, ENT,
and Radiological Devices
510(k) Number K992305

{18}------------------------------------------------

Diagnostic Ultrasound Indications for Use Form

PA100052 and PB100052 5mm Medi-Stim transit-time probe with handle (to be used with BF1000 - BF2004)

Intended Use: Diagnostic ultrasound imaging or fluid flow analysis of the human body as follows:

Mode of Operation
Clinical ApplicationABMPWDCWDColorDopplerAmplitudeDopplerColorVelocityImagingCombined(specify)Other(specify)
Ophthalmic
Fetal
Abdominal
Intraoperative (specify)N
IntraoperativeNeurological
Pediatric
Small Organ (specify)
Neonatal Cephalic
Adult Cephalic
Cardiac
Transesophageal
Transrectal
Transrectal
Transvaginal
Transurethral
Intravascular
Peripheral Vascular
Laparoscopic
Musculo-skeletal
Conventional
Musculo-skeletalSuperficial
Other (specify)

N= new indication; P= previously cleared by FDA; E= added under Appendix E

Additional Comments: PA100052 and PB100052 5mm Medi-Stim transit-time probe with handle;

interfaced with a transit-time volume flowmeter for volume flow measurements during cardiovascular,

のお店舗の賃貸マンション (賃貸マンション) (賃貸マンション) (賃貸マンション) (賃貸マンション) (賃貸マンション (賃貸マンション) (賃貸マンション (賃貸マンション) (賃貸マンション (賃貸マンション) (賃貸マンション (賃貸マンション) (賃貸マンション (賃貸マンション) (賃貸マンション (賃貸マンション) (賃貸マンシ

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510(k) Number .

vascular and transplantation surgery.

and the same of the same of the same of the same of the same of the same of the states of the states of the states of the states of the states of the states of the states of

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

Concurrence of CDRH, Office of Device Evaluation (ODE)

Prescription Use (Per 21 CFR 801.109)
(Division Sign-Off)
Division of Reproductive, Abdominal, ENT,
and Radiological Devices

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92305

{19}------------------------------------------------

Diagnostic Ultrasound Indications for Use Form

PA100051 and PB100051 5mm Medi-Stim transit-time probe without handle (to be used with BF1000 – BF2004)

Intended Use: Diagnostic ultrasound imaging or fluid flow analysis of the human body as follows:

Mode of Operation
Clinical ApplicationABMPWDCWDColorDopplerAmplitudeDopplerColorVelocityImagingCombined(specify)Other(specify)
Ophthalmic
Fetal
Abdominal
Intraoperative (specify)N
IntraoperativeNeurological
Pediatric
Small Organ (specify)
Neonatal Cephalic
Adult Cephalic
Cardiac
Transesophageal
Transrectal
Transrectal
Transvaginal
Transurethral
Intravascular
Peripheral Vascular
Laparoscopic
Musculo-skeletal
Conventional
Musculo-skeletalSuperficial
Other (specify)

N= new indication; P= previously cleared by FDA; E= added under Appendix E

Additional Comments: PA100051 and PB100051 5mm Medi-Stim transit-time probe without handle; interfaced with a transit-time volume flowmeter for volume flow measurements during cardiovascular, vascular and transplantation surgery.

(PLEASE DO NOT WRITE BELOW THIS LINE - CONTINUE ON ANOTHER PAGE IF NEEDED) Concurrence of CDRH, Office of Device Evaluation (ODE)

Prescription Use (Per 21 CFR 801.109)

David h. Segerson

(Division Sign-Off) sion Sign-Off)
sion of Reproductive, Abdominal, ENT

Radiological Devices
510(k) Number K992305

{20}------------------------------------------------

Diagnostic Ultrasound Indications for Use Form

PA100042 and PB100042 4mm Medi-Stim transit-time probe with handle (to be used with BF1000 - BF2004)

Intended Use: Diagnostic ultrasound imaging or fluid flow analysis of the human body as follows:

Mode of Operation
Clinical ApplicationABMPWDCWDColorDopplerAmplitudeDopplerColorVelocityImagingCombined(specify)Other(specify)
Ophthalmic
Fetal
Abdominal
Intraoperative (specify)N
IntraoperativeNeurological
Pediatric
Small Organ (specify)
Neonatal Cephalic
Adult Cephalic
Cardiac
Transesophageal
Transrectal
Transrectal
Transvaginal
Transurethral
Intravascular
Peripheral Vascular
Laparoscopic
Musculo-skeletal
Conventional
Musculo-skeletalSuperficial
Other (specify)

N= new indication; P= previously cleared by FDA; E= added under Appendix E

Additional Comments: PA100042 and PB100042 4mm Medi-Stim transit-time probe with handle;

interfaced with a transit-time volume flowmeter for volume flow measurements during cardiovascular,

vascular and transplantation surgery.

(PLEASE DO NOT WRITE BELOW THIS LINE - CONTINUE ON ANOTHER PAGE Concurrence of CDRH, Office of Device Evaluation

Prescription Use (Per 21 CFR 801.109)

David A. Sepsion

Y
(Division Sign-Off)
Division of Reproductive, Abdominal, ENT,
Devices

{21}------------------------------------------------

Diagnostic Ultrasound Indications for Use Form

PA100041 and PB100041 4mm Medi-Stim transit-time probe without handle (to be used with BF1000 - BF2004)

Intended Use: Diagnostic ultrasound imaging or fluid flow analysis of the human body as follows:

Mode of Operation
Clinical ApplicationABMPWDCWDColorDopplerAmplitudeDopplerColorVelocityImagingCombined(specify)Other(specify)
Ophthalmic
Fetal
Abdominal
Intraoperative (specify)N
IntraoperativeNeurological
Pediatric
Small Organ (specify)
Neonatal Cephalic
Adult Cephalic
Cardiac
Transesophageal
Transrectal
Transrectal
Transvaginal
Transurethral
Intravascular
Peripheral Vascular
Laparoscopic
Musculo-skeletalConventional
Musculo-skeletalSuperficial
Other (specify)

N= new indication; P= previously cleared by FDA; E= added under Appendix E

Additional Comments: PA100041 and PB100041 4mm Medi-Stim transit-time probe without handle; interfaced with a transit-time volume flowmeter for volume flow measurements during cardiovascular, vascular and transplantation surgery.

510(k) Number

and States State Mariel - Books Callery Contral Collect - Society - Society - Society - Society - Society - Society - Society - Society - Society - Society - Society - Societ

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

Concurrence of CDRH, Office of Device Evaluation (ODE)
Prescription Use (Per 21 CFR 801.109)
(Division Sign-Off)
Division of Reproductive, Abdominal, ENT,
and Radiological Devices

{22}------------------------------------------------

Diagnostic Ultrasound Indications for Use Form

PA100032 and PB100032 3mm Medi-Stim transit-time probe with handle (to be used with BF1000 - BF2004)

Intended Use: Diagnostic ultrasound imaging or fluid flow analysis of the human body as follows:

Mode of Operation
Clinical ApplicationABMPWDCWDColorDopplerAmplitudeDopplerColorVelocityImagingCombined(specify)Other(specify)
Ophthalmic
Fetal
Abdominal
Intraoperative (specify)N
IntraoperativeNeurological
Pediatric
Small Organ (specify)
Neonatal Cephalic
Adult Cephalic
Cardiac
Transesophageal
Transrectal
Transrectal
Transvaginal
Transurethral
Intravascular
Peripheral Vascular
Laparoscopic
Musculo-skeletal
Conventional
Musculo-skeletalSuperficial
Other (specify)

N= new indication; P= previously cleared by FDA; E= added under Appendix E

Additional Comments: PA100032 and PB100032 3mm Medi-Stim transit-time probe with handle;

interfaced with a transit-time volume flowmeter for volume flow measurements during cardiovascular,

vascular and transplantation surgery.

(PLEASE DO NOT WRITE BELOW THIS LINE - CONTINUE ON ANOTHER PAGE IF NEEDED) Concurrence of CDRH, Office of Device Evaluation (ODE)

510(k) Number

Prescription Use (Per 21 CFR 801.109)

Office of Device Evaluation (ODE)

David A. Symon

(Division Sign-Off) (Division Sign-Off)
Division of Reproductive, Abdominal, ENT and Radiological De

{23}------------------------------------------------

Diagnostic Ultrasound Indications for Use Form

PA100031 and PB100031 3mm Medi-Stim transit-time probe without handle (to be used with BF1000 - BF2004)

Intended Use: Diagnostic ultrasound imaging or fluid flow analysis of the human body as follows:

Mode of Operation
Clinical ApplicationABMPWDCWDColorDopplerAmplitudeDopplerColorVelocityImagingCombined(specify)Other(specify)
Ophthalmic
Fetal
Abdominal
Intraoperative (specify)N
IntraoperativeNeurological
Pediatric
Small Organ (specify)
Neonatal Cephalic
Adult Cephalic
Cardiac
Transesophageal
Transrectal
Transrectal
Transvaginal
Transurethral
Intravascular
Peripheral Vascular
Laparoscopic
Musculo-skeletal
Conventional
Musculo-skeletalSuperficial
Other (specify)

N= new indication; P= previously cleared by FDA; E= added under Appendix E

Additional Comments: PA100031 and PB100031 3mm Medi-Stim transit-time probe without handle; interfaced with a transit-time volume flowmeter for volume flow measurements during cardiovascular, vascular and transplantation surgery.

510(k) Number

(PLEASE DO NOT WRITE BELOW THIS LINE - CONTINUE ON ANOTHER PAGE IF NEEDED) Concurrence of CDRH, Office of Device Evaluation (ODE Prescription Use (Per 21 CFR 801.109)

Yavid A. Segerson
(Division Sign-Off)

(Division Sign-Off),
Division of Reproductive, Abdominal, ENT,
and Radiological Devices

{24}------------------------------------------------

Diagnostic Ultrasound Indications for Use Form

PA100022 and PB100022 2mm Medi-Stim transit-time probe with handle (to be used with BF1000 - BF2004)

Intended Use: Diagnostic ultrasound imaging or fluid flow analysis of the human body as follows:

Mode of Operation
Clinical ApplicationABMPWDCWDColorDopplerAmplitudeDopplerColorVelocityImagingCombined(specify)Other(specify)
Ophthalmic
Fetal
Abdominal
Intraoperative (specify)N
IntraoperativeNeurological
Pediatric
Small Organ (specify)
Neonatal Cephalic
Adult Cephalic
Cardiac
Transesophageal
Transrectal
Transvaginal
Transurethral
Intravascular
Peripheral Vascular
Laparoscopic
Musculo-skeletalConventional
Musculo-skeletalSuperficial
Other (specify)

N= new indication; P= previously cleared by FDA; E= added under Appendix E

Additional Comments: PA100022 and PB100022 2mm Medi-Stim transit-time probe with handle;

interfaced with a transit-time volume flowmeter for volume flow measurements during cardiovascular,

vascular and transplantation surgery.

(PLEASE DO NOT WRITE BELOW THIS LINE - CONTINUE ON ANOTHER PAGE IF NEEDED) Concurrence of CDRH, Office of Device Evaluation (ODE)

Prescription Use (Per 21 CFR 801.109)

Daniel A. Seaman

(Division Sign-Off) Division of Reproductive, Abdominal, and Radiological I

510(k) Number

{25}------------------------------------------------

Diagnostic Ultrasound Indications for Use Form

PA100021 and PB100021 2mm Medi-Stim transit-time probe without handle (to be used with BF1000 -- BF2004)

Intended Use: Diagnostic ultrasound imaging or fluid flow analysis of the human body as follows:

Mode of Operation
Clinical ApplicationABMPWDCWDColorDopplerAmplitudeDopplerColorVelocityImagingCombined(specify)Other(specify)
Ophthalmic
Fetal
Abdominal
Intraoperative (specify)N
IntraoperativeNeurological
Pediatric
Small Organ (specify)
Neonatal Cephalic
Adult Cephalic
Cardiac
Transesophageal
Transrectal
Transvaginal
Transurethral
Intravascular
Peripheral Vascular
Laparoscopic
Musculo-skeletalConventional
Musculo-skeletalSuperficial
Other (specify)

N= new indication; P= previously cleared by FDA; E= added under Appendix E

Additional Comments: PA100021 and PB100021 2mm Medi-Stim transit-time probe without handle; interfaced with a transit-time volume flowmeter for volume flow measurements during cardiovascular, vascular and transplantation surgery.

(PLEASE DO NOT WRITE BELOW THIS LINE - CONTINUE ON ANOTHER PAGE IF NEEDED) Concurrence of CDRH, Office of Device Evaluation (ODE)

Prescription Use (Per 21 CFR 801.109)

David A. Seymann

Division of Reproductive, Abdominal, EN and Radiological D

510(k) Number

{26}------------------------------------------------

Diagnostic Ultrasound Indications for Use Form

Medi-Stim Butterfly Flowmeter BF1000 Single channel flowmeter BF2000 Dual channel flowmeter BF1001 Single channel flowmeter with AUX/ECG channel BF2001 Dual channel flowmeter with AUX/ECG channel BF1004 Single channel flowmeter with 2 pressure channels and two AUX/ECG channels BF2004 Dual channel flowmeter with 2 pressure channels and two AUX/ECG channels

Intended Use: Diagnostic ultrasound imaging or fluid flow analysis of the human body as follows:

Mode of Operation
Clinical ApplicationABMPWDCWDColorDopplerAmplitudeDopplerColorVelocityImagingCombined(specify)Other(specify)
Ophthalmic
Fetal
Abdominal
Intraoperative (specify)N
IntraoperativeNeurological
Pediatric
Small Organ (specify)
Neonatal Cephalic
Adult Cephalic
Cardiac
Transesophageal
Transrectal
Transrectal
Transvaginal
Transurethral
Intravascular
Peripheral Vascular
Laparoscopic
Musculo-skeletal
Conventional
Musculo-skeletalSuperficial
Other (specify)

N= new indication; P= previously cleared by FDA; E= added under Appendix E

Additional Comments: Medi-Stim Butterfly Flowmeter BF1000 - BF2004; transit-time volume flowmeter;

volume flow measurements during cardiovascular, vascular and transplantation surgery.

(PLEASE DO NOT WRITE BELOW THIS YINE - CONTINUE ON ANOTHER PAGE IF NEEDED) Concurrence of CDRH/Office of Device Evaluation (ODE)

Prescription Use (Per 21 CFR 801.109)

Hamid A. Slammon

(Division Sign-Off) (Division of Reproductive, Abdominal, ENT, and Radiological De

510(k) Number

§ 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.