MEDICAL IMAGE PROCESSING UNIT

K113360 · Humanray Co,Ltd · EAP · Feb 7, 2012 · Dental

Device Facts

• Record ID: K113360
• Device Name: MEDICAL IMAGE PROCESSING UNIT
• Applicant: Humanray Co,Ltd
• Product Code: EAP · Dental
• Decision Date: Feb 7, 2012
• Decision: SESE
• Submission Type: Special
• Regulation: 21 CFR 872.1810
• Device Class: Class 2

Intended Use

EzSensor T, Intra-oral Imaging System, is intended to collect dental x-ray photons and convert them into electronic impulses that may be stored, viewed, and manipulated for diagnostic use by dentists.

Device Story

Solid state x-ray imager; captures dental x-ray photons; converts to electronic impulses; transfers digital images to PC via USB 2.0 interface. Used in dental clinics for radiographic examinations; replaces film/screen systems. Operated by dentists. Output viewed on PC for diagnostic decision-making; facilitates dental diagnosis through digital image manipulation.

Clinical Evidence

Bench testing only. Electrical, mechanical, and environmental safety testing performed per IEC 60601-1 and IEC 60601-1-1. EMC testing performed per IEC 60601-1-2. Non-clinical considerations addressed per FDA guidance for solid state x-ray imaging devices. No clinical data provided.

Technological Characteristics

Solid state x-ray imager; GOS (Gd2O2S: Tb) scintillator layer; USB 2.0 connectivity; pixel size 35x35μm; resolution 14.28 lp/mm. Dimensions vary by size (1.0, 1.5, 2.0). Standards: IEC 60601-1, IEC 60601-1-1, IEC 60601-1-2.

Indications for Use

Indicated for use by dentists to collect dental x-ray photons and convert them into electronic impulses for storage, viewing, and manipulation during dental diagnostic procedures.

Regulatory Classification

Identification

An intraoral source x-ray system is an electrically powered device that produces x-rays and is intended for dental radiographic examination and diagnosis of diseases of the teeth, jaw, and oral structures. The x-ray source (a tube) is located inside the mouth. This generic type of device may include patient and equipment supports and component parts.

Predicate Devices

• EzSensor (K090526)

Submission Summary (Full Text)

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K113360
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# Special 510(k) Summary

This summary of 510(k) safety and effectiveness information is being submitted in accordance with requirements of 21 CFR Part 807.92.

Date

November 10, 2011

#### Manufacturer

HUMANRAY Co., Ltd.

1,3F 23-8, Seokwoo-Dong, Hwaseong-Si, Gyeonggi-Do, 445-170, Korea Republic

Tel: [phone]

Fax: [phone]

Contact person: Mr. Sang-Wook, Yang

United States Sales Representative (U.S. Designated agent)

Dave Kim / Mtech Group

· 12946 Kimberley Ln, Houston, TX 77079

Tel: [phone]

Fax: [phone]

Contact person: Mr. Dave Kim

Trade/Proprietary Name: EzSensor T

#### Common Name:

Medical Image Processing Unit

## Classification Name:

Solid State X-Ray Imager (21CFR 892.1650, Product Code MQB) Description:

EzSensor T is a solid state x-ray imager designed for dental radiographic applications. EzSensor T provides digital image capture for conventional film/screen radiographic dental examinations. The device is used to replace radiographic film/screen systems in general dental

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diagnostic procedures. The captured digital image is transferred to Personal Computer via USB interface port.

### Indication for use:

in

EzSensor T, Intra-oral Imaging System, is intended to collect dental x-ray photons and convert them into electronic impulses that may be stored, viewed, and manipulated for diagnostic use by dentists.

#### Predicate Device:

| Manufacturer | : HUMANRAY Co., Ltd. |
|---------------|-----------------------------------------|
| Device | : EzSensor |
| 510(k) Number | : K090526 (Decision Date - DEC/02/2009) |

## Substantial Equivalence:

EzSensor T described in this 510(k) has the same intended use and similar technical characteristics as EzSensor (K090526) of HUMANRAY Co., Ltd.

| Characteristic | Proposed<br>HUMANRAY Co., Ltd.<br>EzSensor T | Predicate<br>HUMANRAY Co., Ltd.<br>EzSensor |
|------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Feature | Image: Proposed HUMANRAY Co., Ltd. EzSensor T | Image: Predicate HUMANRAY Co., Ltd. EzSensor |
| 510(k) number | - | K090526 |
| Indications<br>for use | EzSensor T, Intra-oral Imaging System,<br>is intended to collect dental x-ray<br>photons and convert them into electronic<br>impulses that may be stored, viewed,<br>and manipulated for diagnostic use by<br>dentists. | EzSensor, Intra-oral Imaging System,<br>is intended to collect dental x-ray<br>photons and convert them<br>into<br>electronic impulses that may be<br>stored, viewed, and manipulated for<br>diagnostic use by dentists. |

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K113360
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| Device Description | EzSensor T is a solid state x-ray imager<br>designed for dental radiographic<br>applications. EzSensor T provides digital<br>image capture for conventional film/screen<br>radiographic dental examinations. The<br>device is used to replace radiographic<br>film/screen systems in general dental<br>diagnostic procedures. The captured digital<br>image is transferred to Personal Computer<br>via USB interface port. | EzSensor is a solid state x-ray imager<br>designed for dental radiographic<br>applications. EzSensor provides digital<br>image capture for conventional<br>film/screen radiographic dental<br>examinations. The device is used to<br>replace radiographic film/screen systems<br>in general dental diagnostic procedures.<br>The captured digital image is transferred<br>to Personal Computer via USB interface<br>port. |
|-------------------------|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Sensor<br>Dimension(mm) | Size "1.0" : 36.8x26.1<br>Size "1.5" : 38.7x29.2<br>Size "2.0" : 42.8x31.5 | Size "1.0" : 35.7x25.2<br>Size "1.5" : 38.7x29.2 |
| Sensor<br>Thickness | 4.95 | 4.9 |
| Active Area(mm) | Size "1.0" : 20.02x30.03<br>Size "1.5" : 24.01x33.04<br>Size "2.0" : 26.04x36.05 | Size "1.0" : 20.02x30.03<br>Size "1.5" : 24.08x31.85 |
| USB Module | Integrated USB 2.0 module | Integrated USB 2.0 module |
| Pixel Size(\u03bcm) | 35x35 | 35x35 |
| Pixel Matrix | Size "1.0" : 572x858 pixel<br>Size "1.5" : 686x944 pixel<br>Size "2.0" : 744x1030 pixel | Size "1.0" : 572x858 pixel<br>Size "1.5" : 686x944 pixel |
| Pixel<br>Pitch(Spacing) | 0.035 mm x 0.035 mm | 0.035 mm x 0.035 mm |
| Resolution | 14.28 lp/mm (Intrinsic Property) | 14.3 lp/mm (Intrinsic Property) |

The indications for use, material, form factor, performance, and safety characteristics between EzSensor T and the predicate device are the same. The primary differences are size, active area and scintillator layer materials; GOS (Gd2O2S: Tb) for EzSensor T and cesium iodide (CsI) for EzSensor, respectively. Accordingly we can claim the substantially equivalence of EzSensor T.to the predicate device.

# Safety, EMC and Performance Data:

Electrical, mechanical, environmental safety and performance testing according to standard IEC 60601-1 (A1+A2, 1995), IEC 60601-1-1(2ª edition, 2000) for use with IEC60601-

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1(Al+A2, 1995) was performed, and EMC testing were conducted in accordance with standard IEC 60601-1-2:2007.

Non-clinical & Clinical considerations according to FDA Guidance "Guidance for the Submissions of 510(k)'s for Solid State X-ray Imaging Devices" was performed. All test results were satisfactory.

## Conclusion:

In accordance with the Federal Food, Drug and Cosmetic Act, 21 CFR Part 807 and based on the information provided in this premarket notification. HUMANRAY Co., Ltd. concludes that EzSensor T is safe and effective and substantially equivalent to predicate device as described herein. ﻜ

END

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Image /page/4/Picture/0 description: The image shows the logo for the Department of Health & Human Services USA. The logo features a stylized eagle with three stripes forming its body and wings. The eagle is enclosed within a circle, and the text "DEPARTMENT OF HEALTH & HUMAN SERVICES USA" is arranged around the circumference of the circle.

# 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

Humanray Co., Ltd. Mr. Dave Kim Medical Device Regulatory Affairs Mtech Group 12946 Kimberly Lane HOUSTON TX 77079

AUG 2 3 2013

Re: K113360

Trade/Device Name: EzSensor T Regulation Number: 21 CFR 872.1810 Regulation Name: Intraoral source x-ray system Regulatory Class: II Product Code: EAP and MOB Dated: January 11, 2012 Received: January 12, 2012

Dear Mr. Kim:

This letter corrects our substantially equivalent letter of February 7, 2012.

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 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 (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 Statement

510(K) Number (if known):

Device Name: EzSensor T

Classification: Solid State X-Ray Imager

Indications for Use:

EzSensor T, Intra-oral Imaging System, is intended to collect dental x-ray photons and convert them into electronic impulses that may be stored, viewed, and manipulated for diagnostic use by dentists.

Prescription Use______________________________________________________________________________________________________________________________________________________________ V Over-The-Counter Use

(Part 21 CFR 801 Subpart D)

(Part 21 CFR 801 Subpart C)

.

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

AND/OR

Concurrence of CDRH, Office of Device Evaluation(ODE)

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K113360

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