1.5T and 3.0T 16 CH GE Shoulder Coils

K162001 · Invivo Corporation · MOS · Aug 31, 2016 · Radiology

Device Facts

• Record ID: K162001
• Device Name: 1.5T and 3.0T 16 CH GE Shoulder Coils
• Applicant: Invivo Corporation
• Product Code: MOS · Radiology
• Decision Date: Aug 31, 2016
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 892.1000
• Device Class: Class 2
• Attributes: 3rd-Party Reviewed

Indications for Use

The 16 Channel Shoulder Coil is to be used in conjunction with Magnetic Resonance Scanners to produce diagnostic images of the shoulder that can be interpreted by a trained physician.

Device Story

16-channel receive-only phased array RF coils for 1.5T and 3.0T MRI systems; designed for high-resolution shoulder imaging. Coils receive RF signals from excited nuclei in tissue; operate in conjunction with MRI system body coil (transmit). Features redundant decoupling via PIN/dual diodes and LC tank circuits; electrical isolation provided by FR4 PCB encased in plastic housing. Used in clinical MRI environments; operated by trained radiology staff. Output consists of raw RF data processed by the MRI scanner into diagnostic images. Benefits include improved workflow and image quality via increased channel count and adjustable two-part housing design.

Clinical Evidence

No clinical study required. Substantial equivalence supported by bench performance testing (SNR, image uniformity) and clinical demonstration via review of DICOM images by a radiologist to confirm adequate image quality.

Technological Characteristics

Receive-only phased array RF coil; 16-channel. Materials: Lexan 925A housing, Polyscan-coated urethane foam pads. Decoupling: LC tank circuit with PIN/dual diodes. Connectivity: ODU P port connector for GE 1.5T/3.0T scanners. Standards: IEC 60601-1, IEC 60601-2-33, ISO 14971, ISO 10993-1.

Indications for Use

Indicated for use with Magnetic Resonance Scanners to produce diagnostic images of the shoulder for interpretation by a trained physician.

Regulatory Classification

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

• HRS-63-8 and HRS-127-8 Shoulder Array Coils (K053017)

Submission Summary (Full Text)

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

August 31, 2016

INVIVO CORPORATION C/O MARK JOB REGULATORY TECHNOIOGY SERVICES LLC 1394 25TH STREET, NW BUFFALO MN 55313

Re: K162001

Trade/Device Name: 1.5T and 3.0T 16CH GE Shoulder Coils Regulation Number: 21 CFR 892.1000 Regulation Name: Magnetic resonance diagnostic device Regulatory Class: II Product Code: MOS Dated: August 18, 2016 Received: August 19, 2016

Dear Mr. Job:

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 forth in the quality systems (QS) 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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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/Resourcesfor You/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 yours.

Michael D. O'Hara

For

Robert Ochs. PhD 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) K162001

#### Device Name

1.5T and 3.0T 16CH GE Shoulder Coils

Indications for Use (Describe)

The 16 Channel Shoulder Coil is to be used in conjunction with Magnetic Resonance Scanners to produce diagnostic images of the shoulder that can be interpreted by a trained physician.

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)

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# 510(k) Summary

| Submitted by: | Invivo Corporation<br>3545 SW 47th Ave<br>Gainesville, FL 32608 |
|---------------------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Establishment Name: | Invivo Corporation |
| Establishment<br>Registration Number: | 1056069 |
| Contact Person: | Ken Revennaugh<br>Title: Director of Quality and Regulatory<br>Invivo Corporation<br>3545 SW 47th Ave<br>Gainesville, FL 32608<br>Phone: [phone]<br>E-mail: [e-mail] |
| Date Prepared: | August 15, 2016 |
| Trade Name: | 1.5T and 3.0T 16 Ch GE Shoulder Coils |
| Common Name: | Magnetic resonance diagnostic device |
| Classification Name: | Coil, Magnetic Resonance, Specialty |
| Classification<br>Regulation Number: | 892.1000 |
| Classification: | Class II |
| Classification Panel: | Radiology |
| Product code: | MOS |

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### Device Description:

The proposed 1.5T and 3.0T 16 Ch GE Shoulder Coils are designed for use with Magnetic Resonance Imaging (MRI) systems. The coil is designed to work in unison with the Body Coil of the MRI system, which will transmit the radio frequency (RF) signals, so that the coil may receive the resultant RF signal from the excited nuclei.

The proposed 1.5T and 3T 16Ch GE Shoulder Coils are identical to each other in construction with the exception that they are tuned to their respective frequencies and additional cable trap baluns are included on the 3T coil due to the shorter wavelengths associated with 3T. The proposed 1.5T and 3.0T 16 Ch GE Shoulder Coils are designed as receive-only coils for high resolution diagnostic imaging of shoulder. The coils provide unilateral images (Left and Right) of the anatomy of interest.

Variations between the proposed 1.5T and 3T 16Ch GE Shoulder Coils and the predicate devices HRS-63-8 and HRS-127-8 Shoulder Array Coils include MR system compatibility and a 16-channel connection to the MRI system. Mechanical design changes include modifications to the connector to permit the 16-channel connection and the specified MR system compatibility. In addition, modifications to the housing from three-part adjustable to two-part adjustable design improves workflow as well as meets customer requirements.

#### Proposed changes to the device

- . Coil housing material changed from Lexan 950 to Lexan 925A for ease of availability with no impact to device safety and effectiveness
- o Coil pad coating changed from Guardian MPGX to Polyscan coating for ease of availability with no impact to device safety or effectiveness.
- Channel count was increased from 8 channels to 16 channels to meet the customer/market needs with no impact on device to safety and effectiveness.
- The overall coil dimensions were changed from 9.1" x 6.2" x 11.7" to 11" x 11" x 12.25" to accommodate more channels with no impact to device safety and effectiveness.
- The housing design was changed from a three-part adjustable housing to a two-part o adjustable housing to improve ease of use and workflow with no impact to device safety and effectiveness.
- o The GE OEM connector was updated from an ODU Bendix connector to an ODU P port connector to accommodate specified MRI Scanners with no impact to device safety and effectiveness.

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Image /page/5/Picture/0 description: The image shows the logo for Invivo. The logo consists of a circle with the number 1 inside, followed by the word "Invivo" in a stylized font. The color of the logo is purple. There is a trademark symbol to the right of the word Invivo.

# Photograph:

Image /page/5/Picture/2 description: The image shows a CAD model of a medical device or equipment. The device has a gray rectangular base with a clear plastic component on top. The text at the bottom of the image says "side iso view w pods", which suggests that the image is a side isometric view of the device with pods.

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### System Compatibility:

The proposed 1.5T and 3.0T 16 Ch GE Shoulder Coils are designed to be used with GE 1.5T and 3.0T MRI Systems respectively. The Models 1.5T and 3.0T 16 Ch GE Shoulder Coils are 16-channel receive-only coils. Models 1.5T and 3.0T 16 Ch GE Shoulder Coils include identical coils with slight variations between system connectors to allow compatibility with respective MRI Scanners.

The Model 1.5T 16 Ch GE Shoulder Coil will operate with the GE 1.5T MRI Scanners such as GE Signa Voyager MRI Scanner and the Model 3.0T 16 Ch GE Shoulder Coil will operate with GE 3.0T MRI Scanners such as GE Signa Pioneer MRI Scanner.

### Patient Safety

#### Description of design that assures that the coil will remain decoupled:

The coil incorporates a redundant decoupling strategy. Back-to-back fast recovery PIN diodes or Dual diodes are placed in series with an inductor across a capacitor. The inductor is tuned to shift the resonant frequency of the coil. During system transmitted pulses, a D.C. voltage is supplied to each channel of the array by the MRI system. This voltage drives the PIN diodes or Dual diodes they conduct, thus engaging the decoupling circuit. The coil resonant frequency then shifts away from the system resonant frequency. The coil therefore becomes a very poor receiver of RF energy at the system operating frequency during the transmit pulses.

In the event that the coil is placed in the magnet and the operator neglects to plug in the coil, the PIN diodes or Dual diodes function as a passive decoupling system. In this case, the decoupling takes place without the need for the voltage supplied by the MRI system.

### Description of electrical isolation of the patient from the surface coil electrical conductors:

The electrical conductors are etched on FR4 printed circuit board. The circuit boards are encased in plastic housing. The plastic housing wall and/or foam is provided with a minimum of .10" thickness. At no time it is possible for the coil conductors to touch the patient.

The cable exits the coil superior to the patient's head to connect to the MRI system connector. The cables are of such a length to reach the MRI system coil part by running the cables away from patient. The cable is designed such that the cable is difficult to make the loop shape during use. The cables have insulation jackets and additional pad that increase separation of the cable if it did somehow become looped.

### Indications for Use:

The 16 Channel Shoulder Coil is to be used in conjunction with a Magnetic Resonance Scanner to produce diagnostic images of the shoulder that can be interpreted by a trained physician.

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### Predicate Device Information:

| Predicate Device Name | Predicate 510(k)<br>Submission Reference |
|---------------------------------------------|------------------------------------------|
| HRS-63-8 and HRS-127-8 Shoulder Array Coils | K053017 |

### Safety and Effectiveness:

The proposed 1.5T and 3.0T 16 Ch GE Shoulder Coils labeling contain instructions for use and necessary cautions, warnings and notes to provide for safe and effective use of the device. Risk Management is ensured via Invivo Risk Management procedure, which is used to identify potential hazards. These potential hazards are controlled via the product development process, verification and validation testing and safety features provided by the MRI Scanners.

## Technological Characteristics:

The technological characteristics of the proposed 1.5T and 3.0T 16 Ch GE Shoulder Coils are exactly the same as the predicate devices HRS-63-8 and HRS-127-8 Shoulder Array Coils.

The technological characteristic of a receive-only radio frequency (RF) coil is that the coil receives radio frequency signals from the tissue of interest. This technological characteristic of the proposed 1.5T and 3.0T 16 Ch GE Shoulder Coils has not changed as compared to the technological characteristic of the predicate devices HRS-63-8 and HRS-127-8 Shoulder Array Coils.

Based on the information provided above, the proposed 1.5T and 3.0T 16 Ch GE Shoulder Coils are considered substantially equivalent to the predicate devices HRS-63-8 and HRS-127-8 Shoulder Array Coils (K053017) in terms of technological characteristics.

The proposed 1.5T and 3.0T 16 Ch GE Shoulder Coils utilize the same technological characteristic as the predicate devices. Both have similar design, intended use, patient safety features, housing materials, overall dimensions, and operating principals; and substantially equivalent in their performance and effectiveness for their intended uses.

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Following is the comparison of technological characteristics between the Predicate and the proposed devices:

| Table-01<br>Comparison of the Technological Characteristics of the Predicate Device and the Proposed Device | | | |
|-------------------------------------------------------------------------------------------------------------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|---------------------------------------------------------------------------------------------------------------------------------------|
| Device Features | Predicate Device<br>K053017<br>HRS-63-8 and HRS-127-<br>8 Shoulder Array Coils | Proposed Device<br>1.5T and 3.0T 16 Ch<br>GE Shoulder Coils | Comments |
| Indications for Use | The coil is to be used in<br>conjunction with a<br>Magnetic Resonance<br>Scanner to produce<br>diagnostic images of the<br>shoulder that can be<br>interpreted by a trained<br>physician | The 16 Channel<br>shoulder coil is to be<br>used in conjunction<br>with a Magnetic<br>Resonance Scanner to<br>produce diagnostic<br>images of the shoulder<br>that can be interpreted<br>by a trained physician | Similar, changed<br>from a coil to<br>specific 16 Channel<br>Shoulder Coil.<br>No Change in the<br>Intended Use of the<br>Coil |
| Coil Dimensions<br>Length x Width x<br>Height | 9.1 x 6.2 x 11.70 inches | 11 x 11 x 12.25 inches | The change in<br>dimensions is to<br>accommodate more<br>channels. No impact<br>to device safety and<br>effectiveness. |
| Coil Frequency | 63.87 MHz for 1.5T<br>(or 127.73 MHz for 3.0T) | Identical | No Change |
| Coil Design | Receive-only Phased Array | Identical | No Change |
| Magnetic Field<br>Orientation (B0) | Horizontal | Identical | No Change |
| Coil Geometry/<br>Housing Design | Three-part adjustable<br>housing | Two-part adjustable<br>housing | The change in<br>housing design was<br>to improve ease of<br>use and workflow.<br>No impact to device<br>safety and<br>effectiveness. |
| Housing Thickness | .10 inch insulation<br>minimum | Identical | No Change |
| Decoupling Method | LC Tank Circuit | Identical | No Change |

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| Table-01<br>Comparison of the Technological Characteristics of the Predicate Device and the Proposed Device | | | | | |
|-------------------------------------------------------------------------------------------------------------|--------------------------------------------------------------------------------|-------------------------------------------------------------|---------------------------------------------------------------------------------------------------------------------------------------------|--|--|
| Device Features | Predicate Device<br>K053017<br>HRS-63-8 and HRS-127-<br>8 Shoulder Array Coils | Proposed Device<br>1.5T and 3.0T 16 Ch<br>GE Shoulder Coils | Comments | | |
| Number of<br>Channels/<br>Preamplifiers | 8 channels / 8<br>preamplifiers | 16 channels / 16<br>preamplifiers | The number of<br>channels was<br>increased to meet the<br>customer and market<br>needs. No impact to<br>device safety and<br>effectiveness. | | |
| Housing Material | Lexan 950 | Lexan 925A | Both are similar<br>materials and have<br>been used in current<br>products. No impact<br>to device safety and<br>effectiveness. | | |
| Base Pad | Urethane Foam with<br>Guardian MPGX coating | Urethane Foam with<br>Polyscan Coating | Both are similar<br>materials and have<br>been used in current<br>products. No impact<br>to device safety and<br>effectiveness. | | |
| System Connector /<br>Compatibility | ODU Bendix Connector<br>for GE 1.5T/3.0T Scanner | ODU P Port Connector<br>for GE 1.5T/3.0T<br>Scanner | To be compatible<br>with the specified<br>MRI Scanners. No<br>impact to device<br>safety &<br>effectiveness. | | |

### Non-Clinical testing and Performance Information:

The proposed 1.5T and 3.0T 16 Ch GE Shoulder Coils comply with the following international and FDA-recognized consensus standards:

- IEC 60601-1, 3rd edition ●
- IEC 60601-2-33, 3rd edition ●
- ISO 14971, 2nd edition ●
- ISO 10993-1 ●
- Device specific draft guidance document, entitled "Submission of Premarket ● Notifications for Magnetic Resonance Diagnostic Devices - July 14, 2015"

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Bench performance testing includes both non-clinical testing and clinical demonstrations of the representative anatomic region (shoulder imaging) using FDA-cleared GE 1.5T and 3.0T scanners. The non-clinical testing characterizes the Signal-to-Noise Ratio (SNR), Image Uniformity and special purpose of the RF receive-only coil. The clinical demonstration DICOM images were reviewed by a clinical radiologist to confirm the image quality is adequate.

Non-clinical verification and validation test results demonstrate that the proposed 1.5T and 3.0T 16 Ch GE Shoulder Coils

- Comply with the device specifications, identified international and FDA-recognized . consensus standards, and device specific guidance document entitled "Submission of Premarket Notifications for Magnetic Resonance Diagnostic Devices"
- Meets the acceptance criteria and is adequate for its intended use. .

Therefore, the proposed 1.5T and 3.0T 16 Ch GE Shoulder Coils are as safe and effective as the predicate devices (K053017) in terms of safety and effectiveness.

### Summary of Clinical Data:

The proposed 1.5T and 3.0T 16 Ch GE Shoulder Coils do not require clinical study since substantial equivalence to the predicate device was demonstrated with the following attributes:

- Design features:
- Indication for use;
- Technological characteristic;
- Non-clinical performance testing, including Clinical Images review by Radiologist, and ●
- Device Safety and effectiveness

### Conclusion:

The proposed 1.5T and 3.0T 16 Ch GE Shoulder Coils are substantially equivalent to the predicate devices HRS-63-8 and HRS-127-8 Shoulder Array Coils (K053017). The substantial equivalency is based on design features, principles of operation, technological characteristic, indications for use, magnet system compatibility, clinical image review, and safety and effectiveness of the proposed devices. Additionally, the non-clinical performance (verification and validation) tests, which complied with the device specifications, and requirements specified in the international and FDA-recognized consensus standards demonstrated that the proposed 1.5T and 3.0T 16 Ch GE Shoulder Coils meet the acceptance criteria and are adequate for the established intended use. The electrical isolation methods, decoupling method and housing material are similar for the predicate and proposed devices.

The results of both non-clinical and device performance tests demonstrate that the proposed device is as safe, as effective, and performs as well as the predicate device.