(84 days)
Class I exemption under registration A 743531
Not Found
No
The device is described as a "passive device" that requires user evaluation and interpretation of a film image for quality assurance. There is no mention of automated analysis, algorithms, or learning capabilities.
No.
The device is a phantom used for quality assurance testing of medical devices, not for diagnosing, treating, or preventing disease in patients.
No
The device is a phantom used in quality assurance testing to produce an image on film, which is then analyzed by an operator for consistency. It does not directly diagnose a medical condition in a patient; instead, it assesses the performance of a medical device (HDR system).
No
The device description clearly states it is a physical phantom with a radio-opaque scale embedded in it, designed to be placed between a radiation source and film. This is a hardware device, not software.
Based on the provided information, this device is not an IVD (In Vitro Diagnostic).
Here's why:
- IVD Definition: In vitro diagnostics are tests performed on samples taken from the human body, such as blood, urine, or tissue, to detect diseases, conditions, or infections.
- Device Function: The Perma-Doc Phantom is used for quality assurance testing of a medical device (HDR system). It is a passive device that provides a physical object for radiographic exposure and analysis of the resulting film image.
- No Biological Samples: The device does not interact with or analyze any biological samples from a human body. Its purpose is to assess the performance of a radiation delivery system.
- Intended Use: The intended use is for quality assurance of a medical device, not for diagnosing or monitoring a patient's health condition.
The device falls under the category of a quality assurance tool for a medical device, not an in vitro diagnostic test.
N/A
Intended Use / Indications for Use
In order to ensure the day to day performance of medical devices, many quality assurance tests are performed. In all quality assurance testing a phantom or measurement device is used to either validate a system parameter or measure some aspect of system performance. These test objects/devices can easily be classified as one of two types, passive or active. An active device is one that can make a direct measurement or perform a test without user evaluation or interpretation, while a passive device merely provides an environment or condition for testing, but the result requires the user or operator to make an evaluation and determination. Examples of passive devices are test phantoms or film cassettes.
The Mick Radio-Nuclear Perma-Doc Phantom is an example of a passive device. It is designed to be placed between the source from a HDR system and a piece of film. Radiographic exposure of the film by the HDR source results in the production of an image on the film which can then be analyzed by the operator for consistency from the prior test exposure. The Perma-Doc Phantom does not alter, change or moderate the radiation field in any manner. It has a radio-opaque scale embedded into it that can be visualized on standard x-ray film when exposed to the radiation output from the HDR system. Inspection of the image on the film is then used as part of the quality assurance process.
Product codes (comma separated list FDA assigned to the subject device)
90 IYE
Device Description
In order to ensure the day to day performance of medical devices, many quality assurance tests are performed. In all quality assurance testing a phantom or measurement device is used to either validate a system parameter or measure some aspect of system performance. These test objects/devices can easily be classified as one of two types, passive or active. An active device is one that can make a direct measurement or perform a test without user evaluation or interpretation, while a passive device merely provides an environment or condition for testing, but the result requires the user or operator to make an evaluation and determination. Examples of passive devices are test phantoms or film cassettes.
The Mick Radio-Nuclear Perma-Doc Phantom is an example of a passive device. It is designed to be placed between the source from a HDR system and a piece of film. Radiographic exposure of the film by the HDR source results in the production of an image on the film which can then be analyzed by the operator for consistency from the prior test exposure. The Perma-Doc Phantom does not alter, change or moderate the radiation field in any manner. It has a radio-opaque scale embedded into it that can be visualized on standard x-ray film when exposed to the radiation output from the HDR system. Inspection of the image on the film is then used as part of the quality assurance process.
Mentions image processing
Not Found
Mentions AI, DNN, or ML
Not Found
Input Imaging Modality
Radiographic exposure
Anatomical Site
Not Found
Indicated Patient Age Range
Not Found
Intended User / Care Setting
user or operator in a quality assurance process
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 (study type, sample size, AUC, MRMC, standalone performance, key results)
Not Found
Key Metrics (Sensitivity, Specificity, PPV, NPV, etc.)
Not Found
Predicate Device(s): If the device was cleared using the 510(k) pathway, identify the Predicate Device(s) K/DEN number used to claim substantial equivalence and list them here in a comma separated list exactly as they appear in the text. List the primary predicate first in the list.
Class I exemption under registration A 743531
Reference Device(s): Identify the Reference Device(s) K/DEN number and list them here in a comma separated list exactly as they appear in the text.
Not Found
Predetermined Change Control Plan (PCCP) - All Relevant Information for the subject device only (e.g. presence / absence, what scope was granted / cleared under the PCCP, any restrictions, etc).
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.
0
FEB 1 4 2000
K993960
Page 1 of 2
ct
Summary of Safety and Effectiveness Compliance with 513 (i) of the Federal Food, Drug and Cosmetic Act
October 2, 1999
1. General Provisions
Common/Usual Name: Radiologic Quality Assurance Instrument
Proprietary Name: Perma-Doc Phantom
Applicant Name and Address:
Mick Radio-Nuclear Instruments, Inc. 1470 Outlook Avenue Bronx, New York 10465
2. Name of Predicate Devices:
- (1)
| Manufacturer | K Number |
|---|---|
| Med Tec, Inc. Iso-Align | Class I exemption |
| under registration A | |
| 743531 |
l Any statement made in conjunction with this submission regarding substantial equivalence to any other product only relates to whether the product can be lawfully marketed without pre-market approval or reclassification and is not to be interpreted as an admission or used as evidence in patent infringement litigation. As the Commissioner of the FDA has indicated, "...a determination of substantial equivalence under the Federal Food, Drug, and Cosmetic Act relates to the fact that the product can be lawfully marketed without pre-market approval or reclassification. This determination is not intended to have any bearing whatsoever on the resolution of patent infringement suits." 42 Fed. Reg. 42,520 et seg. (1977).
1
K99=
Page 2
3. Classification
This device is classified as a class I device according to 21 CFR 892.1940.
4. Performance Standards
Performance standards for radiologic quality assurance instruments have not been established by the FDA under Section 514 of the Food, Drug and Cosmetic Act.
ડ. Intended Use and Device Description
In order to ensure the day to day performance of medical devices, many quality assurance tests are performed. In all quality assurance testing a phantom or measurement device is used to either validate a system parameter or measure some aspect of system performance. These test objects/devices can easily be classified as one of two types, passive or active. An active device is one that can make a direct measurement or perform a test without user evaluation or interpretation, while a passive device merely provides an environment or condition for testing, but the result requires the user or operator to make an evaluation and determination. Examples of passive devices are test phantoms or film cassettes.
The Mick Radio-Nuclear Perma-Doc Phantom is an example of a passive device. It is designed to be placed between the source from a HDR system and a piece of film. Radiographic exposure of the film by the HDR source results in the production of an image on the film which can then be analyzed by the operator for consistency from the prior test exposure. The Perma-Doc Phantom does not alter, change or moderate the radiation field in any manner. It has a radio-opaque scale embedded into it that can be visualized on standard x-ray film when exposed to the radiation output from the HDR system. Inspection of the image on the film is then used as part of the quality assurance process.
Biocompatibility 6.
No new issues of biocompatability are raised with regard to this device.
7. Summary of Substantial Equivalence
This device is similar in design and construction, utilizes the identical materials, and has the same intended use and performance characteristics to the predicate devices. No new issues of safety or effectiveness are introduced by using this device.
2
Image /page/2/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services (HHS). The logo consists of a circular seal with the words "DEPARTMENT OF HEALTH & HUMAN SERVICES" around the perimeter. Inside the circle is a stylized representation of a caduceus, a symbol often associated with medicine and healthcare. The caduceus features a staff with a snake winding around it, and a pair of wings at the top.
Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850
FEB 1 4 2000
Felix Mick President Mick Radio-Nuclear Instruments, Inc. P.O. Box 99 Bronx, NY 10465
Re:
K993960 Perma-Doc Phantom Dated: November 17, 1999 Received: November 22, 1999 Regulatory class: II 21 CFR 892.5050/Procode: 90 IYE
Dear Mr. Mick:
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 redassified 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.
If your device is classified (see above) into either class III (Special Controls) or dass 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/dsma/dsmamain.html".
Sinceraty 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
3
Indications for Use
K993960 510(k) Number: To be assigned
Device Name: Perma-Doc Phantom
Indications for Use:
In order to ensure the day to day performance of medical devices, many quality assurance tests are performed. In all quality assurance testing a phantom or measurement device is used to either validate a system parameter or measure some aspect of system performance. These test objects/devices can easily be classified as one of two types, passive or active. An active device is one that can make a direct measurement or perform a test without user evaluation or interpretation, while a passive device merely provides an environment or condition for testing, but the result requires the user or operator to make an evaluation and determination. Examples of passive devices are test phantoms or film cassettes.
The Mick Radio-Nuclear Perma-Doc Phantom is an example of a passive device. It is designed to be placed between the source from a HDR system and a piece of film. Radiographic exposure of the film by the HDR source results in the production of an image on the film which can then be analyzed by the operator for consistency from the prior test exposure. The Perma-Doc Phantom does not alter, change or moderate the radiation field in any manner. It has a radio-opaque scale embedded into it that can be visualized on standard x-ray film when exposed to the radiation output from the HDR system. Inspection of the image on the film is then used as part of the quality assurance process.
Concurrence of CDRH, Office of Device Evaluation (ODE)
| Prescription Use: | ✓ | or Over-The Counter Use: | (Per 21 CFR 801.109) |
|---|---|---|---|
| ------------------- | --- | -------------------------- | ---------------------- |
(Division Sign-Off)
Division of Reproductive, Abdominal, ENT,
and Radiological Devices
| 510(k) Number | K993960 |
|---|---|
| --------------- | --------- |
Perma-Doc 510(k)