Siemens 3.0 Blanket Array Coil

K142755 · Resonance Innovations, LLC · MOS · Oct 23, 2014 · Radiology

Device Facts

• Record ID: K142755
• Device Name: Siemens 3.0 Blanket Array Coil
• Applicant: Resonance Innovations, LLC
• Product Code: MOS · Radiology
• Decision Date: Oct 23, 2014
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 892.1000
• Device Class: Class 2

Intended Use

The coil is indicated for use by the order of a physician to be used as an accessory to a Siemens 3.0T magnetic resonance scanner for general human anatomy imaging as supported by the scanner. These images, when interpreted by a trained physician, may assist in medical diagnosis.

Device Story

Siemens 3.0T Blanket Array Coil; flexible, quilt-like MRI antenna array; wraps around small bodies and adult extremities (e.g., bilateral brachial plexus, lower extremities, heads). Input: magnetic resonance signals received during MRI scanning. Operation: receive-only multi-channel coil; works with system body coil; uses blocking networks and impedance matching circuits; no energy transmitted into patient. Output: raw signal data processed by MRI scanner into diagnostic images. Used in clinical MRI suites; operated by MRI technicians/radiologists. Benefit: facilitates accurate positioning; improves patient comfort via lightweight, flexible design; provides high-quality diagnostic images.

Clinical Evidence

No clinical data. Bench testing only. Performance demonstrated via SNR and uniformity analysis, blocking network analysis, and imaging in three planes (sagittal, coronal, axial) to compare with predicate coil performance.

Technological Characteristics

Multi-channel, receive-only MRI coil. Materials: internal circuitry encapsulated in flame retardant EVA foam, covered with nylon fabric or compressed EVA. Dimensions: flexible blanket form factor. Connectivity: interfaces with Siemens 3.0T MRI scanner. Energy: passive (no internal power source). Safety standards: IEC60601-1 3rd Edition (equivalent to ES60601-1).

Indications for Use

Indicated for general human anatomy imaging as an accessory to a Siemens 3.0T MRI scanner; for use by physician order; images interpreted by trained physicians to assist in diagnosis.

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

• 1.5T and 3.0T GE PROCURETM Array Coil (K140606)

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

December 2, 2014

Resonance Innovations LLC % Mr. Brian Carter Quality Assurance Manager 9840 S. 140th Street, Suite 8 OMAHA NE 68138

Re: K142755

Trade/Device Name: Siemens 3.0T Blanket Array Coil Regulation Number: 21 CFR 892.1000 Regulation Name: Magnetic resonance diagnostic device Regulatory Class: II Product Code: MOS Dated: September 24, 2014 Received: September 25, 2014

Dear Mr. Carter:

This letter corrects our substantially equivalent letter of October 23, 2014. 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 (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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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'Hara

for

Janine M. Morris 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)

k142755

Device Name Siemens 3.0T Blanket Array Coil

Indications for Use (Describe)

The coil is indicated for use by the order of a physician to be used as an accessory to a Siemens 3.07 magnetic resonance scanner for general human anatomy imaging as supported by the scanner. These images, when interpreted by a trained physician, may assist in medical diagnosis.

Type of Use (Select one or both, as applicable)

2 Prescription Use (Part 21 CFR 801 Subpart D)

_ Over-The-Counter Use (21 CFR 801 Subpart C)

EF

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Concurrence of Center for Devices and Radiological Health (CDRH) (Signature)

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Image /page/3/Picture/0 description: The image is a logo for ScanMed. The word "ScanMed" is written in a large, bold, sans-serif font, with the letters in a dark blue color. Below the word "ScanMed" is the tagline "The Image is Everything" in a smaller, gray font. The logo is simple and modern, and the tagline suggests that ScanMed is a company that is focused on providing high-quality images.

| Section 8. | 510(k) Summary | |
|-------------------------------|----------------|----------------------------------------------------|
| Submitter's Name: | | Resonance Innovations LLC |
| Submitter's Address: | | 9840 South 140th St., Suite 8<br>Omaha, NE 68138 |
| Submitter's Telephone: | | 402-934-2650 |
| Submitter's Contact: | | Randall Jones, President |
| Date 510(k) Summary prepared: | | September 24, 2014 |
| Proprietary Name: | | Siemens 3.0T Blanket Array Coil Model<br>516SI3001 |
| Common or Usual Name: | | MRI coil(s) |
| Classification Name: | | Coil, Magnetic Resonance, Specialty |
| Classification Code: | | MOS |
| Predicate Device: | | 1.5T and 3.0T GE PROCURETM Array Coil<br>K140606 |

### Description of the Device

The Siemens 3.0T Blanket Array Coil embeds an MRI antenna set within a quilt-like enclosure providing high-quality images of general human anatomy. It is flexible enough to wrap snuggly around small bodies as well as large adult extremities so it can be used to image those challenging regions such as bilateral brachial plexus, bilateral lower extremities, and even heads. This lightweight SemiFlex™ design facilitates effortless and accurate positioning and ensures the multiple antenna elements as close as possible to the target anatomies regardless of patient size. The Blanket Array Coil is an MRI coil contained within a water-resistant case, featuring a soft and cleanable cover. What the patient feels is a lightweight, warm and soothing blanket. What the radiologist sees is a flawless image without compromising comfort. The underlying technology and materials used for manufacture are identical to standard MRI coil technology that has existed for several years. The coil uses similar blocking networks and impedance matching circuits, and it does not transmit energy into the patient, neither predicate nor current submission.

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Image /page/4/Picture/0 description: The image is a logo for ScanMed. The word "ScanMed" is written in a sans-serif font, with the "Sca" in a darker blue and the "nMed" in a lighter blue. Below the word "ScanMed" is the tagline "The Image is Everything" in a smaller, gray font. There is a registered trademark symbol in the upper right corner of the logo.

| Device Model Number | Device Description |
|---------------------|---------------------------------|
| 516SI3001 | Siemens 3.0T Blanket Array Coil |

### Indications for Use

The coil is indicated for use by the order of a physician to be used as an accessory to a Siemens 3.0T magnetic resonance scanner for general human anatomy imaging as supported by the scanner. These images, when interpreted by a trained physician, may assist in medical diagnosis.

### Technological Characteristics

The comparison between the predicate and the current submission is described, below.

- 1. Design. This submission is for a dedicated coil that mav give diagnostic quality images of general human anatomy. It is a multi-channel coil with all channels designed to work at once, receive-only, in conjunction with the system body coil. The predicate multi-channel GE PROCURE™ Array Coil covers similar anatomy, also working as receive-only to the body coil. Both predicate and modified coils have resonant coil elements enclosed in semi-flexible assemblies. The modified device has been slightly modified to integrate with the Siemens MRI scanner. All design principles employed are mature and well-known throughout the industry.
- 2. Principles of operation: The scientific principles of operation (magnetic resonance) are identical between the predicate and modified devices. Theory of operation is very well understood throughout the industry.
- 3. Materials. The same materials are used in the construction of the predicate and modified device. All internal circuitry is encapsulated in flame retardant EVA foam, then completely covered with a nylon fabric or compressed EVA. This nylon fabric has been successfully used for over 10 years in the predicate device with no reported biocompatibility issues. Both modified and predicate devices have been tested for mechanical and electrical safety using IEC60601-1 3rd Edition, which for our application is identical to ES60601-1.
- 4. Chemical Composition. Both predicate and modified devices have a successful biocompatibility track record, as demonstrated by cytotoxicity testing and by their history of use in previously cleared devices.
- 5. Energy Source. This device is a receive-only coil that does not generate its own power, but rather is controlled by the MRI system as the energy source.

### Non-Clinical Tests

The predicate and current submission have been subject to similar risk management studies, as listed below, and determined to be substantially equivalent.

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Image /page/5/Picture/0 description: The image shows the logo for ScanMed. The word "Scan" is in a bold, dark blue font, while the word "Med" is in a lighter blue, thinner font. Below the company name is the tagline "The Image is Everything" in a smaller, gray font.

- 1. Blocking network analysis
- 2. SNR and uniformity analysis
- 3. Risk management (including hazard analysis and FMEA)
- 4. Heat testing
- 5. Compliance testing to IEC60601-1 3rd Edition. IEC60601-1 was chosen for compliance in other world markets. A gap analysis of ES60601-1:2005/(R)2012 and C1:2009/(R)2012 and, a2:2010/(r)2012 with IEC60601-1 was performed and for our devices, the US deviations described by ES60601-1 do not modify the requirements of IEC60601-1. Consequently, we are compliant with ES60601-1.

# Clinical Tests

Analyses in all 3 planes (sagittal, coronal, and axial) were run on the Siemens 3.0T Blanket Array Coil to show that the anatomies of the submitted and predicate coils have substantial equivalence.

# Substantial Equivalence Decision

As described in this summary, the modified device is substantially equivalent to the predicate device based on the analysis herein. The modified device raises no new concerns of safety or efficacy.