MULTIPLE

K112460 · Larson Medical Products, Inc. · IYE · Oct 7, 2011 · Radiology

Device Facts

• Record ID: K112460
• Device Name: MULTIPLE
• Applicant: Larson Medical Products, Inc.
• Product Code: IYE · Radiology
• Decision Date: Oct 7, 2011
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 892.5050
• Device Class: Class 2

Intended Use

To be used by trained medical professionals for the stable support and positioning of patients undergoing external beam radiation therapy treatment in a clinic or hospital setting. In particular, these items provide the stable positioning of patients in various positions, chosen to facilitate accurate treatment of tumors. Patients are those that have been diagnosed and are undergoing treatment for cancerous tumors. Treatment is supervised and administered by licensed doctors and therapists trained in the application of radiation therapy treatments.

Device Story

Devices are patient positioning and immobilization systems for external beam radiation therapy. Product line includes various baseplates (Head/Neck/Shoulder, Multi-Purpose, HipLok, Head/Shoulder, Head, Breast Board, Pelvis/Belly, Prone Breast). Used in clinical or hospital settings by trained medical professionals (doctors, therapists). Devices provide stable, accurate patient positioning to facilitate tumor treatment. No electronic or software components; purely mechanical support structures.

Clinical Evidence

No clinical data provided; bench testing only.

Technological Characteristics

Mechanical patient positioning and immobilization baseplates. Materials are rigid, radiolucent materials suitable for radiation therapy environments. Devices are non-powered, standalone mechanical supports. No software, electronics, or connectivity.

Indications for Use

Indicated for patients diagnosed with cancerous tumors undergoing external beam radiation therapy. Used for stable support and positioning during treatment. Contraindications not specified.

Regulatory Classification

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.

Submission Summary (Full Text)

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Image /page/0/Picture/0 description: The image shows a logo with the text "DEPARTMENT OF HEALTH & HUMAN SERVICES USA" arranged in a circular fashion around a symbol. The symbol consists of three curved lines that resemble a stylized human figure. To the right of the symbol, the word "DEPARTMENT" is printed in a sans-serif font. The overall design is simple and professional, suggesting an official government document or publication.

Public Health Service

Food and Drug Administration 10903 New Hampshire Avenue Document Control Room - WO66-G609 Silver Spring, MD 20993-0002

Mr. Peter Larson President Larson Medical Products, Inc. 80 Westgate Drive NEWARK OH 43055

7311

Re: K112460

Trade/Device Name: OPTEK Head/Neck/Shoulder Baseplate (Klarity R630), Klarity Multi-Purpose Baseplate (R605), Klarity HipLok™ Baseplate (R606), Klarity Head/Shoulder Baseplate (R604), Klarity Head Baseplate (R601/R602), Klarity Breast Board (R610), Klarity Pelvis/Belly System (R620-A), Klarity Prone Breast System (R620-B) Regulation Number: 21 CFR 892.5050 Regulation Name: Medical charged-particle radiation therapy system Regulatory Class: II Product Code: IYE Dated: August 19, 2011 Received: August 26, 2011

Dear Mr. Larson:

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. Ilsting of devices, good manufacturing practice, labeling, and prohibitions against misbranding and adulteration.

If your device is classified (see above) into class II (Special Controls), it may be subject to such additional controls. Existing major regulations affecting your device can be found in Title 21, Code of Federal Regulations (CFR), Parts 800 to 895. 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 Parts 801 and 809); medical device reporting (reporting of

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medical device-related adverse events) (21 CFR 803); and good manufacturing practice requirements as set forth in the quality systems (QS) regulation (2) CFR Part 820). 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 Parts 801 and 809), please contact the Office of in Vitro Diagnostic Device Evaluation and Safety at [phone]. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR Part 807.97). For questions regarding the reporting of adverse events under the MDR regulation (21 CFR. Part 803), please go to

http://www.fda.gov/McdicalDevices/Safety/ReportalProblem/default.htm for the CDRH's Office of Surveillance and Biometrics/Division of Postmarket Surveillance.

You may obtain other general information on your responsibilities under the Act 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/industry/support/index.html.

Sincerely Yours.

Mary Patel

Mary S. Pastel, Sc.D. Director Division of Radiological Devices Office of In Vitro Diagnostic Device Evaluation and Safety Center for Devices and Radiological Health

Enclosure

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## Indications for Use

510(k) Number:

Device Names:

- 1. OPTEK Head/Neck/Shoulder Baseplate (Klarity R630)
- 2. Klarity Multi-Purpose Baseplate (R605)
- 3. Klarity HipLok™ Baseplate (R606)
- 4. Klarity Head/Shoulder Baseplate (R604)
- 5. Klarity Head Baseplate (R601/R602)
- 6. Klarity Breast Board (R610)
- 7. Klarity Pelvis/Belly System (R620-A)
- 8. Klarity Prone Breast System (R620-B)

Indications for Use:

To be used by trained medical professionals for the stable support and positioning of patients undergoing external beam radiation therapy treatment in a clinic or hospital setting.

In particular, these items provide the stable positioning of patients in various positions, chosen to facilitate accurate treatment of tumors.

Patients are those that have been diagnosed and are undergoing treatment for cancerous tumors. Treatment is supervised and administered by licensed doctors and therapists trained in the application of radiation therapy treatments.

Prescription Use (Part 21 CFR 801 Subpart D)

AND/OR

Over-The-Counter Use (21 CFR 807 Subpart C)

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

Concurrence of CDRH, Office of In Vitro Diagnostic Devices (OIVD)

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(Division Sign-Off) Division of Radiological Devices Office of In Vitro Diagnostic Device Evaluation and Safety

510(k) Number K112460

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