AIR-BAG SYSTEM

K112969 · Niigata Mechatronics Co., Ltd. · LHN · Mar 14, 2012 · Radiology

Device Facts

• Record ID: K112969
• Device Name: AIR-BAG SYSTEM
• Applicant: Niigata Mechatronics Co., Ltd.
• Product Code: LHN · Radiology
• Decision Date: Mar 14, 2012
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 892.5050
• Device Class: Class 2

Intended Use

The intended use of this Air-Bag System is to monitor patient's respiratory cycle and to fix the trunk of the body of patient during radiation therapy. This Air-Bag System can properly press the abdomen and stabilize patient's positioning repeatability easily in continuous radiation therapy.

Device Story

Air-Bag System functions as a patient positioning and stabilization device for radiation therapy. It uses an inflatable air bag to apply pressure to the patient's abdomen, which serves to stabilize the trunk and improve positioning repeatability during treatment. The system monitors the patient's respiratory cycle to assist in managing motion during radiation delivery. It is intended for use in a clinical radiation therapy setting, operated by trained medical personnel. By stabilizing the patient and monitoring respiration, the device aims to improve the accuracy and consistency of radiation dose delivery to the target area.

Clinical Evidence

No clinical data provided; bench testing only.

Technological Characteristics

The device is an inflatable air-bag system designed for abdominal compression and respiratory monitoring. It functions as an accessory to radiation therapy systems. Technical specifications, materials, and specific energy sources are not detailed in the provided documentation.

Indications for Use

Indicated for patients undergoing radiation therapy requiring respiratory cycle monitoring and abdominal compression for trunk stabilization and positioning repeatability.

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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## DEPARTMENT OF HEALTH & HUMAN SERVICES

Public Health Service

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

MAR 1 4 2012

Mr. Toshiya Nimonji Product Manager Niigata Mechatronics Co., Ltd. Electronics Systems Division 3268-18. Shimami-cho. Kita-ku 950-3102 NIIGATA-CITY JAPAN

Re: K112969

Trade/Device Name: Air-Bag System Regulation Number: 21 CFR 892.5050 Regulation Name: Medical charged-particle radiation therapy system Regulatory Class: II Product Code: LHN Dated: January 1, 2012 Received: February 6, 2012

## Dear Mr. Nimonji:

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 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 r read or as nove a determination that your device complies with other requirements of the Act that I Dr Has intate a aowd regulations administered by other Federal agencies. You must or any I vith 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 (21 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/MedicalDevices/Safety/ReportaProblem/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,

Janine M. Morris

Acting 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 (if known):

Device Name:

Air-Bag System

112969

Indications For Use:

The intended use of this Air-Bag System is to monitor patient's respiratory cycle and to fix the trunk of the body of patient during radiation therapy.

This Air-Bag System can properly press the abdomen and stabilize patient's positioning repeatability easily in continuous radiation therapy.

Prescription Use X (Part 21 CFR 801 Subpart D) AND/OR

Over-The-Counter Use (21 CFR 801 Subpart C)

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

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

(Divisigh Sign-Off)
Division of Radiological Devices
Office of In Vitro Diagnostic Device Evaluation and Safety
510K. K112969