GM85

K171119 · Samsung Electronics Co., Ltd. · IZL · May 12, 2017 · Radiology

Device Facts

• Record ID: K171119
• Device Name: GM85
• Applicant: Samsung Electronics Co., Ltd.
• Product Code: IZL · Radiology
• Decision Date: May 12, 2017
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 892.1720
• Device Class: Class 2

Intended Use

The GM85 Digital Mobile X-ray imaging System is intended for use in generating radiographic images of human anatomy by a qualified/trained doctor or technician. This device is not intended for mammographic applications.

Device Story

Mobile digital X-ray system captures radiographic images of human anatomy. X-rays pass through patient to detector; converted to electrical signals; amplified and digitized. S-Station software processes data, saves as DICOM files, and transmits to PACS server for clinical review. Includes Bone Suppression Image (BSI) software option to enhance chest pathology visualization by suppressing bone anatomy. Operated by qualified doctors or technicians in clinical settings. Output assists clinicians in diagnostic interpretation. Benefits include improved visualization of chest pathology via BSI and mobile imaging capability for patient convenience.

Clinical Evidence

No clinical data provided. Substantial equivalence supported by bench testing, including electrical, mechanical, and environmental safety (ES 60601-1, IEC 60601-1-2, IEC 60601-1-3, IEC 60601-2-28, IEC 60601-2-54, ISO 14971, 21 CFR 1020.30/31), and non-clinical performance metrics (MTF, DQE per IEC 62220-1). BSI software verified and validated via system test cases.

Technological Characteristics

Mobile digital X-ray system. Components: High Voltage Generator, X-ray tube, digital detector. Software features: BSI, SimGrid, TLE, PEM, S-DAP, S-Align, S-Share. Connectivity: DICOM, PACS integration. Standards: ES 60601-1, IEC 60601-1-2, IEC 60601-1-3, IEC 60601-2-28, IEC 60601-2-54, IEC 62220-1.

Indications for Use

Indicated for generating radiographic images of human anatomy. Intended for use by qualified/trained doctors or technicians. Not for mammographic applications.

Regulatory Classification

Identification

A mobile x-ray system is a transportable device system intended to be used to generate and control x-ray for diagnostic procedures. This generic type of device may include signal analysis and display equipment, patient and equipment supports, component parts, and accessories.

Predicate Devices

• GM85 (K162278)
• GC70 (K163115)

Submission Summary (Full Text)

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Public Health Service

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

May 12, 2017

Samsung Electronics Co., Ltd. % Chulsin Kim Regulatory Affairs Manager 129, Samsung-ro, Yeongtong-gu Suwon-si. 16677 Gveonggi-do REPUBLIC OF KOREA

Re: K171119

Trade/Device Name: GM85 Regulation Number: 21 CFR 892.1720 Regulation Name: Mobile x-ray system Regulatory Class: II Product Code: IZL. MOB Dated: April 7, 2017 Received: April 14, 2017

Dear Chulsin Kim:

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. Please note: CDRH does not evaluate information related to contract liability warranties. We remind you, however, that device labeling must be truthful and not misleading.

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); medical device reporting (reporting of medical device-related adverse events) (21 CFR 803); good manufacturing practice requirements as set

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forth in the quality systems (OS) regulation (21 CFR Part 820); and if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please contact the Division of Industry and Consumer Education at its toll-free number [phone] or [phone] or at its Internet address

http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm. 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 Industry and Consumer Education at its toll-free number [phone] or [phone] or at its Internet address

http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm.

Sincerely,

Michael D. O'Hara
For

Robert Ochs, Ph.D. Director Division of Radiological Health Office of In Vitro Diagnostics and Radiological Health Center for Devices and Radiological Health

Enclosure

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DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration

#### Indications for Use

510(k) Number (if known)

K171119

Device Name GM85

Indications for Use (Describe)

The GM85 Digital X-ray imaging System is intended for use in generating radiographic images of human anatomy by a qualified/trained doctor or technician. This device is not intended for mammographic applications.

| Type of Use (Select one or both, as applicable) | |
|-----------------------------------------------------------------------------------------------------------------|------------------------------------------------------------------------------------------|
| <span> <span style="font-size: 16px;">☑</span> Prescription Use (Part 21 CFR 801 Subpart D) </span> | <span> ☐ Over-The-Counter Use (21 CFR 801 Subpart C) </span> |

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510(k) Premarket Notification - Traditional

# Section 5: 510(k) Summary

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

- 1. Date: April 7, 2017
# 2. Submitter

- Company Name: SAMSUNG ELECTRONICS Co., Ltd. A.
- Address: 129, Samsung-ro, Yeongtong-gu, Suwon-si, Gyeonggi-do, 16677, B. Republic of Korea

# 3. Primary Contact Person

- A. Name: ChulSin Kim
- B. Title: Regulatory Affairs Manager
- Phone Number: [phone] ﻥ
- FAX Number: [phone] D. E-Mail:[e-mail]

# 4. Secondary Contact Person

- A. Name: Ninad Gujar
- B. Title: Director, Regulatory & Quality
- C. Phone Number: 978-564-8503
- D. FAX Number: 978-750-6677 E-Mail: [e-mail]

#### 5. Proposed Device

- A. Trade Name: GM85
- B. Device Name: GM85
- C. Common Name: Digital Diagnostic Mobile X-ray System
- D. Classification Name: Mobile X-ray System
- Product Code: IZL & MQB ட்
- ட் Regulation: 21 CFR 892.1720

#### 6. Predicate Devices

| | Predicate Device #1 | Predicate Device #2 |
|------------------------|---------------------|----------------------------|
| Device Name | GM85 | GC70 |
| Classification<br>Name | MobileX-ray system. | Stationary<br>X-ray System |
| Product Code | IZL | KPR |
| Regulation | 21 CFR 892.1720 | 21 CFR 892.1680 |
| 510(K)# | K162278 | K163115 |
| 510(K) Decision Date | November 15, 2016 | December 07, 2016 |

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#### 510(k) Premarket Notification - Traditional

### 7. Device Description

The GM85 Digital Mobile X-ray imaging System is the equipment that captures images by transmitting X-ray to a patient's body. The X-ray passing through a patient's body is sent to the detector and then converted into electrical signals. These signals go through the process of amplification and digital data conversion in the signal process device before being sent to the S-Station (Operation Software) and saved in DICOM file, a standard for medical imaging. The captured images are sent to the Picture Archiving & Communication System (PACS) server, and can be used for reading images.

The Bone Suppression Image (BSI) is a post-image processing software option which provides companion images to assist diagnosis in addition to the images obtained from normal diagnosis protocol. The BSI software option suppresses bone anatomy to enhance visualization of chest pathology in a companion image that is delivered in addition to the original diagnostic image.

The BSI option is designed to be exclusively installed in S-station, SAMSUNG digital Xray operation software, while it uses the radiological image as an input and do not depend on how the image is acquired or which radiology device is used.

#### 8. Intended Use

The GM85 Digital Mobile X-ray imaging System is intended for use in generating radiographic images of human anatomy by a qualified/trained doctor or technician. This device is not intended for mammographic applications.

# 9. Summary of Technological characteristic of the proposed device compared with the predicate devices

The proposed device GM85 applies a post-image processing software feature as BSI (Bone Suppression Image), which was cleared with K163115, to the predicate device GM85 (K162278) without changes in technical characteristics, materials, energy sources and biocompatibility such as High Voltage Generator(HVG), X-ray Tube Assembly and Detectors.

Comparisons of technological characteristics were executed and demonstrate the substantial equivalence to the predicates.

#### A. Comparing with Predicate Device #1 and #2

The proposed device is shown as its parts are identical or equivalent with predicate device #1 or #2 while the BSI is applied, which does not show significant difference in safety and effectiveness.

| Specification | Predicate Device #1 | Proposed Device | Predicate Device #2 | Discussion |
|------------------|-----------------------|-----------------------|-----------------------|------------|
| Device<br>Name | GM85 | GM85 | GC70 | |
| Manufacture | SAMSUNG | SAMSUNG | SAMSUNG | |
| | ELECTRONICS co., ltd. | ELECTRONICS co., ltd. | ELECTRONICS co., ltd. | |
| 510(k)<br>Number | K162278 | - | K163115 | |

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510(k) Premarket Notification - Traditional

| Appearances | Image: Samsung GM85 Digital Mobile X-ray | Image: Samsung GM85 Digital Mobile X-ray | Image: GC70 Digital X-ray Imaging System | Same as<br>PD#1 |
|-----------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-----------------|
| Intended<br>Use | The GM85 Digital<br>Mobile X-ray imaging<br>System is intended for<br>use in generating<br>radiographic images of<br>human anatomy by a<br>qualified/trained doctor<br>or technician. This<br>device is not intended<br>for mammographic<br>applications. | The GM85 Digital<br>Mobile X-ray imaging<br>System is intended for<br>use in generating<br>radiographic images of<br>human anatomy by a<br>qualified/trained doctor<br>or technician. This<br>device is not intended<br>for mammographic<br>applications. | The GC70 Digital X-ray<br>Imaging System is<br>intended for use in<br>generating radiographic<br>images of human<br>anatomy by a<br>qualified/trained doctor<br>or technician. This<br>device is not intended<br>for mammographic<br>applications. | Same as<br>PD#1 |

| Manufacturer Contents | Predicate Device #1 | Proposed Device<br>GM85 | Predicate Device<br>#2 | Discussion |
|---------------------------------------|---------------------|-------------------------|------------------------|-----------------|
| Software Feature | | | | |
| SimGrid | SimGrid | SimGrid | SimGrid | Same as<br>PD#1 |
| Tube & Line<br>Enhancement(TLE) | TLE | TLE | - | Same as<br>PD#1 |
| Pediatric Exposure<br>Management(PEM) | PEM | PEM | - | Same as<br>PD#1 |
| S-DAP | S-DAP | S-DAP | S-DAP | Same |
| S-Align | S-Align | S-Align | S-Align | Same as<br>PD#1 |
| S-Share | S-Share | S-Share | S-Share | Same |
| BSI | - | BSI | BSI | Same as<br>PD#2 |

#### B. Safety, EMC and Performance Data

Electrical, mechanical, environmental safety and performance testing according to standard ES 60601-1,IEC 60601-1-2, IEC 60601-1-3, IEC 60601-2-28, IEC 60601-2-54, ISO14971, 21CFR1020.30 and 21CFR1020.31 were performed, and EMC testing was conducted in accordance with standard IEC 60601-1-2. Wireless function was tested and verified followed by guidance, Radio frequency Wireless Technology in Medical Devices. All test results were satisfying the standards.

#### C. Non-clinical data

Non-clinical data was provided in conformance to the FDA "Guidance for the Submission of 510(k)'s for Solid-State X-ray Imaging Devices", which includes MTF and DQE measurements as tested by IEC 62220-1.

The proposed device has same detectors so it shows no difference in non-clinical testing data such as MTF and DQE measurements from the predicate device #1 and #2. BSI installed in S-Station of GM85 has been verified and validated through GM85

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#### 510(k) Premarket Notification - Traditional Software System Test Case.

# D. Clinical data

The application of BSI, cleared with K163115, to the proposed device GM85 does not require clinical data.

### E. Conclusions

The non-clinical demonstrates that the proposed device is as safe, as effective, and performs as well as the legally marketed predicate devices.