Who is the manufacturer of FDR D-EVO III flat panel detector system?

Fujifilm Corporation filed the 510(k) submission for FDR D-EVO III flat panel detector system (K192932).

What is the FDA product code for FDR D-EVO III flat panel detector system?

MQB. It is classified under 21 CFR 892.1680 as a Class 2 device in the Radiology panel.

What is the regulatory pathway for FDR D-EVO III flat panel detector system?

510(k) clearance (submission type: Special).

What are the predicate devices for FDR D-EVO III flat panel detector system?

FUJIFILM FDR D-EVO II Flat Panel Detector System (DR-ID 1200) (K142003).

Who can help prepare an FDA 510(k) submission like FDR D-EVO III flat panel detector system?

Innolitics — a medical-device software consultancy — provides regulatory and engineering support for FDA 510(k) submissions. See https://innolitics.com/services/510ks/ or contact https://innolitics.com/contact.

FDR D-EVO III flat panel detector system

K192932 · Fujifilm Corporation · MQB · Nov 12, 2019 · Radiology

Device Facts

Record ID	K192932
Device Name	FDR D-EVO III flat panel detector system
Applicant	Fujifilm Corporation
Product Code	MQB · Radiology
Decision Date	Nov 12, 2019
Decision	SESE
Submission Type	Special
Regulation	21 CFR 892.1680
Device Class	Class 2
Attributes	Pediatric

Intended Use

The Wireless/Wired FDR D-EVO III flat panel detector system is intended to capture for display radiographic images of human anatomy. It is intended for use in general projection radiographic applications including pediatric and neonatal exams wherever conventional film/screen or CR systems may be used. The FDR D-EVO III is not intended for mammography, fluoroscopy, tomography, and angiography applications.

Device Story

Portable digital flat panel detector system (DR-ID1800) captures x-ray exposures from standard radiographic systems; digitizes signals for display. Supports wireless or wired/tethered communication. Used in clinical environments (bucky or free-cassette) by radiology staff. Employs film-based TFT substrate and GOS scintillator for indirect x-ray conversion. Output is digital radiographic image for clinician review; aids diagnostic decision-making. Benefits include improved detector weight and handling compared to predicate; maintains equivalent image quality.

Clinical Evidence

No clinical data. Substantial equivalence demonstrated via non-clinical performance testing, including image quality evaluation, software testing, and adherence to voluntary standards (AAMI/ANSI ES60601-1, IEC 60601-1-2, IEC 62304, IEC 62366-1, IEC 62494-1).

Technological Characteristics

Indirect conversion (a-Si) flat panel detector; GOS scintillator; film-based TFT substrate. Dimensions: 38.4x46x1.5cm or 46x46x1.5cm. Connectivity: Wireless/wired. Standards: AAMI/ANSI ES60601-1, IEC 60601-1-2, IEC 62304, IEC 62366-1, IEC 62494-1, DICOM. Software: FDX Console Version 13.0.

Indications for Use

Indicated for general projection radiographic imaging of human anatomy, including pediatric and neonatal patients, in environments where conventional film/screen or CR systems are used. Contraindicated for mammography, fluoroscopy, tomography, and angiography.

Regulatory Classification

Identification

A stationary x-ray system is a permanently installed diagnostic system intended to generate and control x-rays for examination of various anatomical regions. This generic type of device may include signal analysis and display equipment, patient and equipment supports, component parts, and accessories.

Special Controls

*Classification.* Class II (special controls). A radiographic contrast tray or radiology diagnostic kit intended for use with a stationary x-ray system only is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 892.9.

Predicate Devices

FUJIFILM FDR D-EVO II Flat Panel Detector System (DR-ID 1200) (K142003)

Related Devices

K192440 — FDR SE Lite · Fujifilm Corporation · Nov 1, 2019
K162344 — INNOLUX RIC · Innolux Corporation · Dec 20, 2016
K120629 — FDR GO FLEX · Fujifilm Medical System U.S.A., Inc. · Aug 28, 2012
K142003 — FDR D-EVO II FLAT PANEL DETECTOR SYSTEM · Fujifilm Medical System U.S.A., Inc. · Oct 21, 2014
K191939 — Yushan X-Ray Flat Panel Detector · Innocare Optoelectronics Corp. · Aug 29, 2019

Submission Summary (Full Text)

{0}------------------------------------------------ November 12, 2019 Image /page/0/Picture/1 description: The image contains the logo of the U.S. Food and Drug Administration (FDA). The logo consists of two parts: the Department of Health & Human Services logo on the left and the FDA logo on the right. The FDA logo includes the letters 'FDA' in a blue square, followed by the words 'U.S. FOOD & DRUG' in blue, and 'ADMINISTRATION' in a smaller font size below. FUJIFILM Corporation % Ms. Kamila Sak Regulatory Affairs Specialist FUJIFILM Medical Systems U.S.A, Inc. 81 Hartwell Avenue, Suite 300 LEXINGTON MA 02421 ## Re: K192932 Trade/Device Name: FDR D-EVO III flat panel detector system Regulation Number: 21 CFR 892.1680 Regulation Name: Stationary x-ray system Regulatory Class: Class II Product Code: MQB Dated: October 16, 2019 Received: October 17, 2019 Dear Ms. Sak: 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. Although this letter refers to your product as a device, please be aware that some cleared products may instead be combination products. The 510(k) Premarket Notification Database located at https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm identifies combination product submissions. 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 of medical device-related adverse events) (21 CFR 803) for devices or postmarketing safety reporting (21 CFR 4, Subpart B) for combination products (see https://www.fda.gov/combination-products/guidance-regulatory-information/postmarketing-safety-reporting- {1}------------------------------------------------ Page 2 combination-products); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820) for devices or current good manufacturing practices (21 CFR 4, Subpart A) for combination products; and, if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050. 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 https://www.fda.gov/medical-device-safety/medical-device-reportingmdr-how-report-medical-device-problems. For comprehensive regulatory information about medical devices and radiation-emitting products, including information about labeling regulations, please see Device Advice (https://www.fda.gov/medicaldevices/device-advice-comprehensive-regulatory-assistance) and CDRH Learn (https://www.fda.gov/training-and-continuing-education/cdrh-learn). Additionally, you may contact the Division of Industry and Consumer Education (DICE) to ask a question about a specific regulatory topic. See the DICE website (https://www.fda.gov/medical-device-advice-comprehensive-regulatoryassistance/contact-us-division-industry-and-consumer-education-dice) for more information or contact DICE by email (DICE@fda.hhs.gov) or phone (1-800-638-2041 or 301-796-7100). Sincerely, For Thalia T. Mills, Ph.D. Director Division of Radiological Health OHT7: Office of In Vitro Diagnostics and Radiological Health Office of Product Evaluation and Quality Center for Devices and Radiological Health Enclosure {2}------------------------------------------------ DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration ## Indications for Use 510(k) Number (if known) K192932 Device Name FDR D-EVO III flat panel detector system #### Indications for Use (Describe) The Wireless/Wired FDR D-EVO III flat panel detector system is intended to capture for display radiographic images of human anatomy. It is intended for use in general projection radiographic applications including pediatric and neonatal exams wherever conventional film/screen or CR systems may be used. The FDR D-EVO III is not intended for mammography, fluoroscopy, tomography, and angiography applications. | Type of Use (Select one or both, as applicable) | | | | |-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------|--|--| | X Prescription Use (Part 21 CFR 801 Subpart D) | Over-The-Counter Use (21 CFR 801 Subpart C) | | | | CONTINUE ON A SEPARATE PAGE IF NEEDED. | | | | | | This section applies only to requirements of the Paperwork Reduction Act of 1995. | | | | | *DO NOT SEND YOUR COMPLETED FORM TO THE PRA STAFF EMAIL ADDRESS BELOW.* | | | | The burden time for this collection of information is estimated to average 79 hours per response, including the time to review instructions, search existing data sources, gather and maintain the data needed and complete and review the collection of information. Send comments regarding this burden estimate or any other aspect of this information collection, including suggestions for reducing this burden, to: | | | | | Food and Druq Administration Office of Chief Information Officer PRAStaff(@fda.hhs.gov | Department of Health and Human Services Paperwork Reduction Act (PRA) Staff | | | | | "An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB number." | | | ============================================================================================================================================================================== {3}------------------------------------------------ # 510(k) Summary K192932 #### Date Prepared: November 05, 2019 #### Submitter's Information: FUJIFILM Corporation 798 Miyanodai Kaisei-Machi Ashigarakami-Gun, Kanagawa, 258-8538, Japan FDA Establishment Registration Number: 3001722928 #### Contact Person: Kamila Sak Specialist, Regulatory Affairs Telephone: (347) 577-2309 Email: kamila.sak@fujifilm.com #### Device Name and Classification: | Product Name: | FUJIFILM FDR D-EVO III Flat Panel Detector System | |-----------------------|---------------------------------------------------| | Model Number: | DR-ID 1800 | | Classification Name: | Stationary x-ray system | | Classification Panel: | Radiology | | CFR Section: | 21 CFR 892.1680 | | Device Class: | Class II | | Product Code: | MQB | ### Predicate Device: | Product Name | FUJIFILM FDR D-EVO II Flat Panel Detector System (DR-ID 1200) | |----------------------|------------------------------------------------------------------| | 510(k) Number | K142003 | | Classification Name | Stationary x-ray system | | Classification Panel | Radiology | | CFR Section | 21 CFR 892.1680 | | Device Class | Class II | | Product Code | MQB | The subject device FDR D-EVO III Flat Panel Detector System (DR-ID1800) is essentially a modified version of legally marketed FDR D-EVO II Flat Panel Detector System (DR- {4}------------------------------------------------ ID1200). The predicate device DR-ID 1200 had received 510(k) clearance via K142003 on October 21, 2014, and was documented internally several times after that. ### Indications for Use: The Wireless/Wired FDR D-EVO III flat panel detector system is intended to capture for display radiographic images of human anatomy. It is intended for use in general projection radiographic applications including pediatric and neonatal exams wherever conventional film/screen or CR systems may be used. The FDR D-EVO III is not intended for mammography, fluoroscopy, tomography, and angiography applications. ## Description of the Device: The subject device FDR D-EVO III Flat Panel Detector System (DR-ID1800) is a portable digital detector system that interfaces with, and acquires and digitizes x-ray exposures from, standard radiographic systems. DR-ID1800 is designed to be used in any environment that would typically use a radiographic cassette for examinations of adults, pediatrics and neonates. The detector models support both wireless and wired/tethered data communication between the detector and the system. Detectors can be placed in a wall bucky for upright exams, a table bucky for recumbent exams, or removed from the bucky for non-grid or free cassette exams. The software that supports the functions of the FDR D-EVO III Flat Panel Detector System is unchanged from the predicate device, cleared under K142003. ## Comparison of Technological Characteristics: A comparison of the technological characteristics between the subject device and predicate device is provided below: {5}------------------------------------------------ | Comparison Item | Subject Device FDR D-EVO III FPD system (DR-ID1800) | Predicate Device FDR D-EVO II FPD system (DR-ID 1200) | Discussion & Conclusion | |----------------------------------------------------------------------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------| | Indications for Use | The Wireless/Wired FDR D-EVO III flat panel detector system is intended to capture for display radiographic images of human anatomy. It is intended for use in general projection radiographic applications including pediatric and neonatal exams wherever conventional film/screen or CR systems may be used. The FDR D-EVO III is not intended for mammography, fluoroscopy, tomography, and angiography applications. | The Wireless/Wired FDR D-EVO II flat panel detector system is intended to capture for display radiographic images of human anatomy. It is intended for use in general projection radiographic applications including pediatric and neonatal exams wherever conventional film /screen or CR systems may be used. The FDR D- EVO II is not intended for mammography, fluoroscopy, tomography, and angiography applications. | Same(Except device name) | | Detector characteristics | | | | | Panel variation | DR-ID 1801SE (14" x 17") DR-ID 1802SE (17" x 17") | DR-ID 1201SE (14" x 17"),DR-ID 1202SE (17" x 17") DR-ID 1211SE (14" x 17"),DR-ID 1212SE (17" x 17") DR-ID 1213SE (9" x 11") | Described as below | | Scintillator | GOS (Gadolinium oxysulfide) | GOS (Gadolinium oxysulfide); DR-ID 1201SE (14" x 17") DR-ID 1202SE (17" x 17") CsI(Secium Iodide); DR-ID 1211SE (14" x 17") DR-ID 1212SE (17" x 17") DR-ID 1213SE (9" x 11") | The subject device has only GOS based detector. No impact on safety or effectiveness of the device. | | Dimensions (Detector exterior) | DR-ID1801SE : 38.4 cm x 46 cm x 1.5 cm DR-ID1802SE : 46 cm x 46 cm x 1.5 cm | DR-ID1201SE, DR-ID1211SE : 38.4 cm x 46 cm x 1.5 cm DR-ID1202SE, DR-ID1212SE : 46 cm x 46 cm x 1.5 cm DR-ID1213SE : 26.8 cm x 32.8 cm x 1.5 cm | Same* | | Number of Pixels | DR-ID1801SE: 2336 x 2836 DR-ID1802SE: 2832 x 2836 | DR-ID1201SE, DR-ID1211SE : 2336 x 2836 DR-ID1202SE, DR-ID1212SE : 2832 x 2836 DR-ID1213SE :1920 x 1536 | Same* | | Pixel Size | 150 μm | 150 μm | Same | | Comparison Item | Subject Device FDR D-EVO III FPD system (DR-ID1800) | Predicate Device FDR D-EVO II FPD system (DR-ID 1200) | Discussion & Conclusion | | X-ray Conversion | Indirect conversion (a-Si) | Indirect conversion (a-Si) | Same | | TFT sensor substrate | Film-based TFT substrate | Glass-based TFT substrate | Only the material of substrate is changed, there is no change in the mechanism. No impact on safety or effectiveness of the device. | | DQE (RQA5, 1 lp/mm, 1mR) - detector alone, without tabletop | 33% Measurement tolerance (±10%) | 31% Measurement tolerance (±10%) | Slightly improved DQE by using Film-based TFT substrate This difference of DQE does not impact clinical Image Quality. | | MTF (RQA5, 1 lp/mm) | Two options are available by setting. -Normal 60% -High 75% | Two options are available by setting. -Normal 60% -High 75% | Same | | Appearance characteristics | - Adopt more rounded shape - Changed alighnment of LEDs/Operation button that is easier to use | - Rounded corners and curved edges are adopted. - LEDs/Operation button is placed. | This difference of detector appearance does not impact on safety or effectiveness of the device. | | Detector Weight | DR-ID1801SE: : Approx. 1.8kg (without battery) DR-ID1802SE : Approx. 2.1kg (without battery) | DR-ID1201SE : Approx. 2.3kg (without battery) DR-ID1202SE : Approx. 2.9kg (without battery) DR-ID1211SE : Approx. 2.4kg (without battery) DR-ID1212SE : Approx. 3.0kg (without battery) DR-ID1213SE : Approx. 1.3kg (without battery) | This difference of detector weight does not impact on safety or effectiveness of the device. | | Comparison Item | Subject Device FDR D-EVO III FPD system (DR-ID1800) | Predicate Device FDR D-EVO II FPD system (DR-ID 1200) | Discussion & Conclusion | | Software Charactisctic | | | | | Workstation | FDX Console Version 13.0 | FDX Console Version 8.0 and above (Latest version: 12.1) | This difference of the workstation is only to add this subject detector as the connectable Flat panel detector options. No impact on safety or effectiveness of the device. | {6}------------------------------------------------ {7}------------------------------------------------ *Note: Csl scintillator has not been adopted in DR-ID 1800 yet. Then, we discuss and conclude the substantial equivalence by excluding Csl scintillator. {8}------------------------------------------------ #### Substantial Equivalence: Both the subject device and predicate device have the same Indication for Use. There are some differences, but the differences are minor and do not affect fundamental scientific technology, principles of operation, safety and effectiveness, and image quality. Therefore, the subject device FDR D-EVO III Flat Panel Detector System (DR-ID1800) can be considered to be substantially equivalent to the predicate device FDR D-EVO II Flat Panel Detector System (DR-ID1200) limited to the flat panel detector with GOS scintillator. ## Summary Of Studies: Non-clinical Performance Data: FDR D-EVO III Flat Panel Detector System (DR-ID1800) conforms to the voluntary standards such as AAMI/ANSI ES60601-1, IEC 60601-1-2, IEC 62304, IEC 62366-1, IEC 62494-1 and DICOM. In addition, the FDA's Guidance for the Submission of 510(k)'s for Solid State X-ray Imaging Devices (September 1, 2016) was followed to describe the detector characteristics, and Radio Frequency Wireless Technology in Medical Devices (August 14, 2013) was followed to test wireless features. As required by the risk analysis, necessary verification and validation activities were performed including software testing, and the results were satisfactory. Furthermore, the image quality evaluation confirmed that the image quality of the FDR D-EVO III Flat Panel Detector System (DR-ID1800) is substantially equivalent to that of the predicate device. Clinical Performance Data: No clinical study has been performed. The substantial equivalence has been demonstrated by non-clinical studies. #### Conclusion: This Special 510(k) premarket notification submission has demonstrated Substantial Equivalence as defined and understood in the Federal Food Drug and Cosmetic Act and various guidance documents issued by the Center for Devices and Radiological Health. We conclude the subject device to be as safe and effective as the predicate device.