← Product Code [LNH](/submissions/RA/subpart-b%E2%80%94diagnostic-devices/LNH) · K173451

# Ingenia Elition S and Ingenia Elition X (K173451)

_Philips Medical Systems Nederland B.V. · LNH · Mar 20, 2018 · Radiology · SESE_

**Canonical URL:** https://fda.innolitics.com/submissions/RA/subpart-b%E2%80%94diagnostic-devices/LNH/K173451

## Device Facts

- **Applicant:** Philips Medical Systems Nederland B.V.
- **Product Code:** [LNH](/submissions/RA/subpart-b%E2%80%94diagnostic-devices/LNH.md)
- **Decision Date:** Mar 20, 2018
- **Decision:** SESE
- **Submission Type:** Abbreviated
- **Regulation:** 21 CFR 892.1000
- **Device Class:** Class 2
- **Review Panel:** Radiology

## Indications for Use

This system is a Magnetic Resonance Medical Electrical Systems indicated for use as a diagnostic device. The system can produce cross-sectional images, spectroscopic images and/or spectra in any orientation of the internal structure of the head, body or extremities. Magnetic Resonance images represent the spatial distribution of protons or other nuclei with spin. Image appearance is determined by many different physical properties of the tissue and the MR scan technique applied. The image acquisition process can be synchronized with the patient's breathing or cardiac cycle. The systems can use combinations of images to produce physical parameters, and related derived images. Images, spectra, and measurements of physical parameters, when interpreted by a trained physician, provide information that may assist the diagnosis and therapy planning. The accuracy of determined physical parameters depends on system and scan parameters, and must be controlled and validated by the clinical user. The use of contrast agents for diagnostic imaging applications should be performed consistent with the approved labeling for the contrast agent. In addition the Philips MR systems provide imaging capabilities, such as MR fluoroscopy, to guide and evaluate interventional and minimally invasive procedures in the head, body and extremities. MR Interventional procedures, performed inside or adjacent to the Philips MR system, must be performed with MR Conditional or MR Safe instrumentation as selected and evaluated by the clinical user for use with the system configuration in the hospital. The appropriateness and use of information from a Philips MR system for a specific interventional procedure and specific MR system configuration must be validated by the clinical user.

## Device Story

Magnetic resonance diagnostic device; utilizes atomic nuclei relaxation signals in strong magnetic field; radio signal excitation at precession frequency. System analyzes emitted signals; performs computed image reconstruction; displays on video screen. Used in clinical settings by trained physicians/technicians for diagnostic imaging and interventional procedure guidance. Input: proton/nuclei spin signals; Output: cross-sectional images, spectra, physical parameters. Supports cardiac/respiratory synchronization. Assists diagnosis and therapy planning. Modifications include new gradient system hardware, updated Windows 10/PSC 6.1 software platform, and PerformanceBridge Protocol Manager.

## Clinical Evidence

No clinical data. Substantial equivalence demonstrated via non-clinical verification and validation testing, including compliance with IEC 60601 series, NEMA MS standards, and FDA guidance for MR diagnostic devices.

## Technological Characteristics

Magnetic resonance diagnostic device; 70 cm bore; utilizes strong magnetic field and RF excitation. Components: magnet, receive coils, patient support, and new gradient system hardware. Connectivity: NEMA PS 3.1-3.20 (DICOM). Software: Windows 10 platform, PSC 6.1. Standards: IEC 60601-1, 60601-1-2, 60601-1-6, 60601-1-8, 60601-2-33, IEC 62304, IEC 62366, ISO 14971, NEMA MS-1, MS-4, MS-8.

## Regulatory Identification

A magnetic resonance diagnostic device is intended for general diagnostic use to present images which reflect the spatial distribution and/or magnetic resonance spectra which reflect frequency and distribution of nuclei exhibiting nuclear magnetic resonance. Other physical parameters derived from the images and/or spectra may also be produced. The device includes hydrogen-1 (proton) imaging, sodium-23 imaging, hydrogen-1 spectroscopy, phosphorus-31 spectroscopy, and chemical shift imaging (preserving simultaneous frequency and spatial information).

## Special Controls

*Classification.* Class II (special controls). A magnetic resonance imaging disposable kit intended for use with a magnetic resonance diagnostic device 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

- Ingenia 1.5T, Ingenia 1.5T S and Ingenia 3.0T R5.3 ([K163116](/device/K163116.md))

## Reference Devices

- mDIXON ([K102344](/device/K102344.md))
- SWIp ([K131241](/device/K131241.md))
- mDIXON-Quant ([K133526](/device/K133526.md))
- MRE ([K140666](/device/K140666.md))
- mDIXON XD ([K143128](/device/K143128.md))
- O-MAR ([K143253](/device/K143253.md))
- MultiBand SENSE ([K143606](/device/K143606.md))

## Submission Summary (Full Text)

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March 20, 2018

Image /page/0/Picture/1 description: The image contains two logos. The logo on the left is the Department of Health & Human Services - USA logo. The logo on the right is the FDA U.S. Food & Drug Administration logo. The FDA logo is in blue and white.

Philips Medical Systems Nederland B.V. % Mr. Henrie Daniels Regulatory Affairs Specialist Veenpluis 4-6 5684 PC, Best THE NETHERLANDS

### Re: K173451

Trade/Device Name: Ingenia Elition S and Ingenia Elition X Regulation Number: 21 CFR 892.1000 Regulation Name: Magnetic resonance diagnostic device Regulatory Class: II Product Code: LNH, LNI Dated: February 7, 2018 Received: February 12, 2018

Dear Mr. Daniels:

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

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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.

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/DeviceRegulationandGuidance/) and CDRH Learn (http://www.fda.gov/Training/CDRHLearn). 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 (http://www.fda.gov/DICE) for more information or contact DICE by email (DICE@fda.hhs.gov) or phone (1-800-638-2041 or 301-796-7100).

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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## Indications for Use

510(k) Number (if known)

### K173451

Device Name Ingenia Elition S and Ingenia Elition X

#### Indications for Use (Describe)

This system is a Magnetic Resonance Medical Electrical Systems indicated for use as a diagnostic device. The system can produce cross-sectional images, spectroscopic images and/or spectra in any orientation of the internal structure of the head, body or extremities.

Magnetic Resonance images represent the spatial distribution of protons or other nuclei with spin. Image appearance is determined by many different physical properties of the tissue and the MR scan technique applied. The image acquisition process can be synchronized with the patient's breathing or cardiac cycle. The systems can use combinations of images to produce physical parameters, and related derived images.

Images, spectra, and measurements of physical parameters, when interpreted by a trained physician, provide information that may assist the diagnosis and therapy planning. The accuracy of determined physical parameters depends on system and scan parameters, and must be controlled and validated by the clinical user. The use of contrast agents for diagnostic imaging applications should be performed consistent with the approved labeling for the contrast agent.

In addition the Philips MR systems provide imaging capabilities, such as MR fluoroscopy, to guide and evaluate interventional and minimally invasive procedures in the head, body and extremities.

MR Interventional procedures, performed inside or adjacent to the Philips MR system, must be performed with MR Conditional or MR Safe instrumentation as selected and evaluated by the clinical user for use with the system configuration in the hospital. The appropriateness and use of information from a Philips MR system for a specific interventional procedure and specific MR system configuration must be validated by the clinical user.

| Type of Use (Select one or both, as applicable) | <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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Philips Medical Systems Nederland B.V. Magnetic Resonance Imaging Abbreviated 510(k)

# Ingenia Elition S and Ingenia Elition X R5.4

# Section 5

# 510(k) Summary

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## 510(k) Summary of Safety and Effectiveness

This 510(k) summary of safety and effectiveness information is prepared in accordance with 21 CFR §807.92.

| Date Prepared:            | October 20, 2017                                                                                                                                                                                                                                                                                                                                                  |
|---------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Manufacturer:             | Philips Medical Systems Nederland B.V.<br>Veenpluis 4-6, 5684 PC, Best, The Netherlands<br>Establishment Registration Number: 3003768277                                                                                                                                                                                                                          |
| Primary Contact Person:   | Jan van de Kerkhof<br>Sr. Manager Regulatory Affairs<br>Phone: +31 613300542<br>E-mail: jan.van.de.kerkhof@philips.com                                                                                                                                                                                                                                            |
| Secondary Contact Person  | Henrie Daniels<br>Regulatory Affairs Specialist<br>Telephone: +31 643837374<br>E-mail: henrie.daniels@philips.com                                                                                                                                                                                                                                                 |
| Device Name:              | Ingenia Elition S and Ingenia Elition X R5.4                                                                                                                                                                                                                                                                                                                      |
| Classification:           | Classification name: Magnetic Resonance Diagnostic Device (MRDD)<br>Classification Regulation: 21CFR 892.1000<br>Classification Panel: Radiology<br>Device Class: Class II<br>Primary Product Code: 90LNH<br>90LNI                                                                                                                                                |
| Primary Predicate Device: | Trade name: Ingenia 1.5T, Ingenia 1.5T S and Ingenia 3.0T R5.3<br>Manufacturer: Philips Medical Systems Nederland B.V.<br>510(k) Clearance: K163116<br>Classification Regulation: 21CFR 892.1000<br>Classification name: Magnetic Resonance Diagnostic Device (MRDD)<br>Classification Panel: Radiology<br>Device class: Class II<br>Product Code: 90LNH<br>90LNI |

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Image /page/5/Picture/0 description: The image shows the word "PHILIPS" in large, bold, blue letters. The letters are evenly spaced and fill the majority of the frame. The background is plain white, which makes the blue letters stand out.

The proposed Ingenia Elition S and Ingenia Elition X R5.4 with Device Description: new gradient system/specifications are modifications of the 70 cm Ingenia 3.0T system, included in the legally marketed predicate device Ingenia 1.5T, Ingenia 1.5T S and Ingenia 3.0T R5.3 (K163116, 01/06/2017). The systems and control software are substantially equivalent to the legally marketed predicate device Ingenia 1.5T, Ingenia 1.5T S and Ingenia 3.0T R5.3 (K163116, 01/06/2017). Hereafter Ingenia Elition S and Ingenia Elition X R5.4 will be used to indicate the proposed device Ingenia Elition S and Ingenia Elition X R5.4 with new gradient system/specifications The proposed Ingenia Elition S and Ingenia Elition X R5.4 also includes minor software changes since the clearance of the legally marketed predicate device, Ingenia 1.5T, Ingenia 1.5T S and Ingenia 3.0T R5.3 (K163116, 01/06/2017). The following modifications are covered compared to legally marketed predicate device: 1. Upgrade of SW platform to Windows 10 and PSC 6.1 (to be compatible with Windows 10); 2. PerformanceBridge Protocol Manager Release 1.0; 3. Introduction of new gradient system hardware with new qradient specifications: 4. Introduction of new product name and covers. The proposed Ingenia Elition S and Ingenia Elition X R5.4 are intended to be marketed with the following pulse sequences and coils that were previously cleared by FDA: 1. mDIXON K102344 2. SWIp K131241 3. mDIXON-Quant K133526 4. MRE K140666 5. mDIXON XD K143128 6. O-MAR K143253 7. MultiBand SENSE K143606 8. Ingenia Coils See Appendix 004

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| Indications for Use: | This system is a Magnetic Resonance Medical Electrical Systems                                                                                                                                                                                                                                                                                                                                                                                                                                    |
|----------------------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
|                      | indicated for use as a diagnostic device. The system can produce<br>cross-sectional images, spectroscopic images and/or spectra in<br>any orientation of the internal structure of the head, body or<br>extremities.                                                                                                                                                                                                                                                                              |
|                      | Magnetic Resonance images represent the spatial distribution of<br>protons or other nuclei with spin. Image appearance is determined<br>by many different physical properties of the tissue and the<br>anatomy, and the MR scan technique applied. The image<br>acquisition process can be synchronized with the patient's<br>breathing or cardiac cycle. The systems can use combinations of<br>images to produce physical parameters, and related derived<br>images.                            |
|                      | Images, spectra, and measurements of physical parameters,<br>when interpreted by a trained physician, provide information that<br>may assist the diagnosis and therapy planning. The accuracy of<br>determined physical parameters depends on system and scan<br>parameters, and must be controlled and validated by the clinical<br>user. The use of contrast agents for diagnostic imaging<br>applications should be performed consistent with the approved<br>labeling for the contrast agent. |
|                      | In addition the Philips MR systems provide imaging capabilities,<br>such as MR fluoroscopy, to guide and evaluate interventional and<br>minimally invasive procedures in the head, body and extremities.                                                                                                                                                                                                                                                                                          |
|                      | MR Interventional procedures, performed inside or adjacent to the<br>Philips MR system, must be performed with MR Conditional or MR<br>Safe instrumentation as selected and evaluated by the clinical<br>user for use with the specific MR system configuration in the<br>hospital. The appropriateness and use of information from a<br>Philips MR system for a specific interventional procedure and<br>specific MR system configuration must be validated by the clinical<br>user.             |

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| Design Features/<br>Fundamental Scientific<br>Technology: | The proposed Ingenia Elition S and Ingenia Elition X R5.4 are<br>based on the principle that certain atomic nuclei present in the<br>human body will emit a weak relaxation signal when placed in a<br>strong magnetic field and excited by a radio signal at the<br>precession frequency. The emitted relaxation signals are analyzed<br>by the system and a computed image reconstruction is displayed<br>on a video screen.<br><br>The principal technological components (magnet, receive coils<br>and patient support) of the proposed Ingenia Elition S and<br>Ingenia Elition X R5.4 are identical to those used in the legally<br>marketed predicate device, Ingenia 1.5T, Ingenia 1.5T S and<br>Ingenia 3.0T R5.3 (K163116, 01/06/2017), except for the transmit<br>body coil and the gradient coil, which have been changed to adapt<br>to the changed voltage levels of the gradient amplifier.<br><br>Based on the information provided above, the proposed Ingenia<br>Elition S and Ingenia Elition X R5.4 does not raise different<br>questions of safety and effectiveness compared to the legally<br>marketed predicate device Ingenia 1.5T, Ingenia 1.5T S and<br>Ingenia 3.0T R5.3 (K163116, 01/06/2017). |
|-----------------------------------------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
|-----------------------------------------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

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| Summary of Non-<br>Clinical Performance<br>Data: | The proposed Ingenia Elition S and Ingenia Elition X R5.4<br>comply with the following international and FDA-recognized<br>consensus standards:                                                                                 |
|--------------------------------------------------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
|                                                  | • IEC60601-1 Edition 3                                                                                                                                                                                                          |
|                                                  | • IEC60601-1-2 Edition 3                                                                                                                                                                                                        |
|                                                  | • IEC60601-1-6 Edition 3                                                                                                                                                                                                        |
|                                                  | • IEC62366 Edition 1                                                                                                                                                                                                            |
|                                                  | • IEC60601-1-8 Edition 2                                                                                                                                                                                                        |
|                                                  | • IEC60601-2-33 Edition 3                                                                                                                                                                                                       |
|                                                  | • IEC 62304 Edition 1                                                                                                                                                                                                           |
|                                                  | • NEMA MS-1 2008                                                                                                                                                                                                                |
|                                                  | • NEMA MS-4 2010                                                                                                                                                                                                                |
|                                                  | • NEMA MS-8 2008                                                                                                                                                                                                                |
|                                                  | • NEMA PS 3.1-PS 3.20                                                                                                                                                                                                           |
|                                                  | • ISO 14971 Edition 2                                                                                                                                                                                                           |
|                                                  | • Device specific guidance document, entitled "Guidance for the<br>Submission Of Premarket Notifications for Magnetic Resonance<br>Diagnostic Devices – November 18, 2016"                                                      |
|                                                  | • Guidance for Industry and FDA Staff - Guidance for the Content<br>of Premarket Submissions for Software Contained in Medical<br>Devices (issued May 11, 2005)                                                                 |
|                                                  | • Guidance for Industry and FDA Staff - Applying Human Factors<br>and Usability Engineering to Medical Devices 9 issued February<br>3, 2016)                                                                                    |
|                                                  | • Guidance for Industry and FDA Staff - Content of Premarket<br>Submissions for Management of Cybersecurity in Medical<br>Devices issued October 2, 2014                                                                        |
|                                                  | • Guidance for Industry and FDA Staff – Use of International<br>Standard ISO 10993-1, "Biological evaluation of medical<br>devices – Part 1: Evaluation and testing within a risk<br>management process" (issued June 16, 2016) |
|                                                  | • Guidance for Industry and FDA Staff – Information to Support a<br>Claim of Electromagnetic Compatibility (EMC) of Electrically-<br>Powered Medical Devices (issued July 11, 2016)                                             |
|                                                  | Non-Clinical verification and or validation tests have been<br>performed with regards to the intended use, the technical claims,<br>the requirement specifications and the risk management results.                             |
|                                                  | The verification and/or validation test results demonstrate that the                                                                                                                                                            |

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|                              | • Complies with the aforementioned international and FDA<br>recognized consensus standards and Device specific<br>guidance document, entitled "Guidance for the Submission Of<br>Premarket Notifications for Magnetic Resonance Diagnostic<br>Devices - November 18, 2016"<br>• Meets the acceptance criteria and is adequate for its intended<br>use.                                                                                                                                                                                                                                                                                                                                                                                                                             |
|------------------------------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
|                              | Therefore, the proposed Ingenia Elition S and Ingenia Elition X<br>R5.4 are substantially equivalent to the legally marketed predicate<br>device Ingenia 1.5T, Ingenia 1.5T S and Ingenia 3.0T R5.3<br>(K163116, 01/06/2017) in terms of safety and effectiveness.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 |
| Summary of Clinical<br>Data: | The proposed Ingenia Elition S and Ingenia Elition X R5.4 did<br>not require a clinical study since substantial equivalence to the<br>legally marketed predicate device was proven with the<br>verification/validation testing.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    |
| Substantial<br>Equivalence:  | The proposed Ingenia Elition S and Ingenia Elition X R5.4 and<br>the legally marketed predicate device Ingenia 1.5T, Ingenia 1.5T<br>S and Ingenia 3.0T R5.3 (K163116, 01/06/2017) have the same<br>indications for use with respect to the following:<br>• Providing cross-sectional images based on the magnetic<br>resonance phenomenon<br>• Interpretation of the images is the responsibility of trained<br>physicians<br>• Images can be used for interventional and treatment planning<br>purposes<br>The proposed Ingenia Elition S and Ingenia Elition X R5.4 are<br>substantially equivalent to the legally marketed predicate device<br>Ingenia 1.5T, Ingenia 1.5T S and Ingenia 3.0T R5.3 (K163116,<br>01/06/2017) in terms of design features, fundamental scientific |
|                              | technology, indications for use, and safety and effectiveness.<br>Additionally, substantial equivalence was demonstrated with non-<br>clinical performance (verification and validation) tests, which<br>complied with the requirements specified in the international and<br>FDA-recognized consensus standards and device-specific<br>guidance.                                                                                                                                                                                                                                                                                                                                                                                                                                  |
| Conclusion:                  | The results of these tests demonstrate that the proposed Ingenia<br>Elition S and Ingenia Elition X R5.4 meet the acceptance criteria<br>and is adequate for its intended use.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     |

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**Source:** [https://fda.innolitics.com/submissions/RA/subpart-b%E2%80%94diagnostic-devices/LNH/K173451](https://fda.innolitics.com/submissions/RA/subpart-b%E2%80%94diagnostic-devices/LNH/K173451)

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