QSC-127 SHOULDER ARRAY COIL SET

K032429 · Mri Devices Corp. · MOS · Aug 21, 2003 · Radiology

Device Facts

• Record ID: K032429
• Device Name: QSC-127 SHOULDER ARRAY COIL SET
• Applicant: Mri Devices Corp.
• Product Code: MOS · Radiology
• Decision Date: Aug 21, 2003
• Decision: SESE
• Submission Type: Special
• Regulation: 21 CFR 892.1000
• Device Class: Class 2

Intended Use

To be used in conjunction with a Magnetic Resonance Scanner to produce diagnostic images of the shoulder that can be interpreted by a trained physician.

Device Story

The Model QSC-127 Shoulder Array Coil Set is an accessory device used in conjunction with a Magnetic Resonance (MR) scanner. It functions as a radiofrequency (RF) coil to receive MR signals from the shoulder anatomy during imaging procedures. The device is operated by trained medical personnel in a clinical setting. The coil captures electromagnetic signals which are processed by the MR scanner to generate diagnostic images. These images are then interpreted by a physician to assist in clinical diagnosis. The device facilitates high-quality imaging of the shoulder region, aiding in the assessment of musculoskeletal conditions.

Clinical Evidence

No clinical data provided; bench testing only.

Technological Characteristics

The device is a radiofrequency (RF) coil designed for magnetic resonance imaging. It functions as a signal receiver for an MR scanner. It is a passive accessory component. No specific materials, software, or connectivity features are described.

Indications for Use

Indicated for use with a Magnetic Resonance Scanner to produce diagnostic images of the shoulder for interpretation by a trained physician. No specific patient population, age, or gender restrictions are provided.

Regulatory Classification

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).

Special Controls

*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.

Submission Summary (Full Text)

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Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

AUG 2 1 2003

Mr. Thomas Schubert President MRI Devices Corporation 1515 Paramount Drive WAUKESHA WI 53186

Re: K032429

Trade/Device Name: Model QSC-127 Shoulder Array Coil Regulation Number: 21 CFR 892.1000 Regulation Name: Magnetic resonance diagnostic device Regulatory Class: II

Product Code: 90 MOS Dated: July 30, 2003 Received: August 7, 2003

Dear Mr. Schubert:

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 (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. 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 (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.

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); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820); and if applicable, the electronic product radiation control provisions (sections 531-542 of the Act); 21 CFR 1000-1050.

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This letter will allow you to begin marketing your device as described in your Section 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), please contact the Office of Compliance at one of the following numbers, based on the regulation number at the top of the letter:

| 8xx.1xxx | [phone] |
|----------------------------------|----------------|
| 876.2xxx, 3xxx, 4xxx, 5xxx | [phone] |
| 884.2xxx, 3xxx, 4xxx, 5xxx, 6xxx | [phone] |
| 892.2xxx, 3xxx, 4xxx, 5xxx | [phone] |
| Other | [phone] |

Additionally, for questions on the promotion and advertising of your device, please contact the Office of Compliance at [phone]. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97) you may obtain. Other general information on your responsibilities under the Act may be obtained from the Division of Small Manufacturers. International and Consumer Assistance at its toll-free number [phone] or [phone] or at its Internet address http://www.fda.gov/cdrh/dsma/dsmamain.html.

Sincerely yours.

Nancy C. Brogdon Director, Division of Reproductive, Abdominal and Radiological Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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K022429

Special 510(K) Application, Device Modification Model QSC-127 Shoulder Array Coil Set, July 30, 2003

Page 3

## Section C – Statement of Indications for Use:

Applicant: MRI Devices Corporation (032429 510 (k) number (if known) : Device Name: Model QSC-127 Shoulder Array Coil Set

Indications for use:

To be used in conjunction with a Magnetic Resonance Scanner to produce diagnostic images of the shoulder that can be interpreted by a trained physician.

Concurrence of CDRH, Office of Device Evaluation (ODE)

Prescription Use

David A. Severson

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

510(k) Number _

Over-The-Counter Use or (Per 21 CFR 801.109)

(Optional Format 1-2-96)