← Product Code [GEX](/submissions/SU/subpart-e%E2%80%94surgical-devices/GEX) · K243993

# Photon Therapy Apparatus (BL-10) (K243993)

_Xemis Medical Technology (Shenzhen) Co., Ltd. · GEX · Mar 13, 2025 · General, Plastic Surgery · SESE_

**Canonical URL:** https://fda.innolitics.com/submissions/SU/subpart-e%E2%80%94surgical-devices/GEX/K243993

## Device Facts

- **Applicant:** Xemis Medical Technology (Shenzhen) Co., Ltd.
- **Product Code:** [GEX](/submissions/SU/subpart-e%E2%80%94surgical-devices/GEX.md)
- **Decision Date:** Mar 13, 2025
- **Decision:** SESE
- **Submission Type:** Traditional
- **Regulation:** 21 CFR 878.4810
- **Device Class:** Class 2
- **Review Panel:** General, Plastic Surgery
- **Attributes:** Therapeutic

## Intended Use

Photon therapy apparatus use of the red, blue, Yellow and infrared regions of the spectrum is intended to emit energy to treat dermatological conditions. The red light (633±8nm wavelength) is generally indicated to treatment of superficial, benign vascular, and pigmented lesions. The blue light (417±8nm wavelength) indicated to treat dermatological conditions and specifically indicated to treat moderate inflammatory acne vulgaris. The Yellow light (590±8nm wavelength) is generally indicated to treat dermatological conditions and specifically indicated for treatment of periorbital wrinkles and rhytides. The infrared light (830±8mm wavelength) is generally use for the temporary relief of minor muscle and joint pain, atthritis and muscle spasm; relieving stiffness; promoting the relaxation of muscle tissue; and to temporarily increase local blood circulation where applied.

## Device Story

Photon Therapy Apparatus (BL-10) uses LED-based light therapy to manage aesthetic and dermatological conditions. Device consists of a main frame, support arm, and interchangeable irradiator panels (RBY, IBY, or IRY configurations). Emits specific wavelengths: red (633nm), blue (417nm), yellow (590nm), and infrared (830nm). Operated by healthcare professionals in clinical settings via a display screen interface. Device delivers light energy to target tissues; clinical effects include lesion treatment, acne management, wrinkle reduction, and pain relief. System is powered by AC 100-240V.

## Clinical Evidence

No clinical data. Substantial equivalence supported by bench testing, including electrical safety (ANSI AAMI ES60601-1, IEC 60601-1), electromagnetic compatibility (IEC 60601-1-2), photobiological safety (IEC 62471), and performance requirements for non-laser light source equipment (IEC 60601-2-57).

## Technological Characteristics

LED-based light therapy system; wavelengths: 633nm (red), 417nm (blue), 590nm (yellow), 830nm (infrared). Structural style: wheeled main frame with support arm and 3 or 5-panel irradiators. Power: AC 100-240V, 50/60Hz. Standards: IEC 60601-1, IEC 60601-1-2, IEC 60601-2-57, IEC 62471.

## Regulatory Identification

(1) A carbon dioxide laser for use in general surgery and in dermatology is a laser device intended to cut, destroy, or remove tissue by light energy emitted by carbon dioxide.(2) An argon laser for use in dermatology is a laser device intended to destroy or coagulate tissue by light energy emitted by argon.

## Predicate Devices

- LED Light Therapy Device ([K222751](/device/K222751.md))
- Phototherapy System ([K190938](/device/K190938.md))
- Oxylight ([K200104](/device/K200104.md))

## Submission Summary (Full Text)

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Xemis Medical Technology (Shenzhen) Co., Ltd. Yongfen Yang RA Engineer 1101/1102/1201/1202, Unit 1, Building 2, Hongpeng Building, Tiegang Community, Xixiang Street, Baoan Shenzhen, Guangdong 518102 China

Re: K243993

Trade/Device Name: Photon Therapy Apparatus (BL-10) Regulation Number: 21 CFR 878.4810 Regulation Name: Laser Surgical Instrument For Use In General And Plastic Surgery And In Dermatology Regulatory Class: Class II Product Code: GEX Dated: December 26, 2024 Received: December 26, 2024

Dear Yongfen Yang:

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 (the 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 available 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.

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Additional information about changes that may require a new premarket notification are provided in the FDA guidance documents entitled "Deciding When to Submit a 510(k) for a Change to an Existing Device" (https://www.fda.gov/media/99812/download) and "Deciding When to Submit a 510(k) for a Software Change to an Existing Device" (https://www.fda.gov/media/99785/download).

Your device is also subject to, among other requirements, the Quality System (QS) regulation (21 CFR Part 820), which includes, but is not limited to, 21 CFR 820.30. Design controls; 21 CFR 820.90. Nonconforming product; and 21 CFR 820.100, Corrective and preventive action. Please note that regardless of whether a change requires premarket review, the QS regulation requires device manufacturers to review and approve changes to device design and production (21 CFR 820.30 and 21 CFR 820.70) and document changes and approvals in the device master record (21 CFR 820.181).

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 Part 803) for devices or postmarketing safety reporting (21 CFR Part 4, Subpart B) for combination products (see https://www.fda.gov/combination-products/guidance-regulatory-information/postmarketing-safety-reportingcombination-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 Part 4, Subpart A) for combination products; and, if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR Parts 1000-1050.

All medical devices, including Class I and unclassified devices and combination product device constituent parts are required to be in compliance with the final Unique Device Identification System rule ("UDI Rule"). The UDI Rule requires, among other things, that a device bear a unique device identifier (UDI) on its label and package (21 CFR 801.20(a)) unless an exception or alternative applies (21 CFR 801.20(b)) and that the dates on the device label be formatted in accordance with 21 CFR 801.18. The UDI Rule (21 CFR 830.300(a) and 830.320(b)) also requires that certain information be submitted to the Global Unique Device Identification Database (GUDID) (21 CFR Part 830 Subpart E). For additional information on these requirements, please see the UDI System webpage at https://www.fda.gov/medical-device-advicecomprehensive-regulatory-assistance/unique-device-identification-system-udi-system.

Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR 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 mediation-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-regulatory

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assistance/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,

Image /page/2/Picture/3 description: The image shows a digital signature from "YAN FU -S". The signature includes the date and time of the signature, which is March 13, 2025, at 18:24:57. The time zone is indicated as -04'00'. The signature appears to be an electronic verification of a document or file.

for Tanisha Hithe

Assistant Director DHT4A: Division of General Surgery Devices OHT4: Office of Surgical and Infection Control Devices Office of Product Evaluation and Quality Center for Devices and Radiological Health

Enclosure

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# Indications for Use

510(k) Number (if known) K243993

Device Name Photon Therapy Apparatus (BL-10)

## Indications for Use (Describe)

Photon therapy apparatus use of the red, blue, Yellow and infrared regions of the spectrum is intended to emit energy to treat dermatological conditions.

The red light (633±8nm wavelength) is generally indicated to treatment of superficial, benign vascular, and pigmented lesions.

The blue light (417±8nm wavelength) indicated to treat dermatological conditions and specifically indicated to treat moderate inflammatory acne vulgaris.

The Yellow light (590±8nm wavelength) is generally indicated to treat dermatological conditions and specifically indicated for treatment of periorbital wrinkles and rhytides.

The infrared light (830±8mm wavelength) is generally use for the temporary relief of minor muscle and joint pain, atthritis and muscle spasm; relieving stiffness; promoting the relaxation of muscle tissue; and to temporarily increase local blood circulation where applied.

| 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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# K243993 - 510(K) Summary

Prepared in accordance with the requirements of 21 CFR Part 807.92

Prepared Date: 2025-02-26

### Submitter's identifications 1.

Name: Xemis Medical Technology (Shenzhen) Co., Ltd.

Address: 1101/1102/1201/1202, Unit 1, Building 2, Hongpeng Building, Tiegang

Community, Xixiang Street, Baoan, Shenzhen, China

Contact person: Yang Yongfen

Title: RA Engineer

E-mail: yangyongfen(@ximisihn.com

Tel: 86-755-23316735

| Trade/Device Name    | Photon Therapy Apparatus  |
|----------------------|---------------------------|
| Model                | BL-10                     |
| Product Code         | GEX                       |
| Classification Panel | General & Plastic Surgery |
| Regulatory Class     | Class II                  |
| Regulation Number    | 21 CFR878.4810            |
| Submission type      | Traditional 510(K)        |

#### 2. Subject Device Information

### Predicate Device 3.

| Device name and model    | K number | Manufacturer                                   |
|--------------------------|----------|------------------------------------------------|
| LED Light Therapy Device | K222751  | Xuzhou Kernel Medical<br>Equipment Co., Ltd.   |
| Phototherapy System      | K190938  | Shanghai Apolo Medical<br>Technology Co., Ltd. |
| Oxylight                 | K200104  | RAJA Trading Company, Inc.                     |

### Device Description 4.

The photon therapy apparatus (BL-10) use specific wavelengths of light, produced by LEDs (Light emitting diodes), to manage aesthetic conditions. The device produces light in the red light region of the spectrum (633±8nm), in the blue light regions of the light spectrum (417±8nm), yellow light area (590±8nm) and infrared light region of light spectrum (835±8nm).

The photon therapy apparatus (BL-10) are equipped with six type of optional irradiators, each of which emits three different colors of light sources. The details of different irradiators are as follows:

Table 1 Specification of different irradiators

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| REF No. | Types of irradiator | Specification                        |
|---------|---------------------|--------------------------------------|
| LT01    | RBY Irradiator      | Red/Blue/Yellow light, 3 panels      |
| LT02    | RBY Irradiator      | Red/Blue/Yellow light, 5 panels      |
| LT03    | IBY Irradiator      | Infrared/Blue/Yellow light, 3 panels |
| LT04    | IBY Irradiator      | Infrared/Blue/Yellow light, 5 panels |
| LT05    | IRY Irradiator      | Infrared/Red/Yellow light, 3 panels  |
| LT06    | IRY Irradiator      | Infrared/Red/Yellow light, 5 panels  |

### 5. Intended use & Indication for use

Photon therapy apparatus use of the red, blue, Yellow and infrared regions of the spectrum is intended to emit energy to treat dermatological conditions.

The red light (633±8nm wavelength) is generally indicated to treatment of superficial, benign vascular, and pigmented lesions.

The blue light (417±8nm wavelength) is generally indicated to treat dermatological conditions and specifically indicated to treat moderate inflammatory acne vulgaris.

The Yellow light (590±8nm wavelength) is generally indicated to treat dermatological

conditions and specifically indicated for treatment of periorbital wrinkles and rhytides.

The infrared light (830±8nm wavelength) is generally use for the temporary relief of minor muscle and joint pain, arthritis and muscle spasm; relieving stiffness; promoting the relaxation of muscle tissue; and to temporarily increase local blood circulation where applied.

|                                            | Proposed<br>Device                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  | Predicate device                                                                                                                                                                                                                                                                                                                                                                                                                                                                               | Predicate<br>device                                                                                                                                                                                                                                                                                                                                                                                  | Predicate<br>device                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               |
|--------------------------------------------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| 510k Number                                | /                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   | K222751                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        | K190938                                                                                                                                                                                                                                                                                                                                                                                              | K200104                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           |
| Product Code                               | GEX                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 | GEX                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            | GEX                                                                                                                                                                                                                                                                                                                                                                                                  | GEX                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               |
| Proprietary Name                           | Photon Therapy<br>Apparatus                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         | LED Light<br>Therapy Device                                                                                                                                                                                                                                                                                                                                                                                                                                                                    | Phototherapy<br>System                                                                                                                                                                                                                                                                                                                                                                               | Oxylight                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          |
| Model                                      | BL-10                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               | KN-7000L                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       | HS-770                                                                                                                                                                                                                                                                                                                                                                                               | /                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 |
| Manufacturer                               | Xemis Medical<br>Technology                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         | Xuzhou Kernel<br>Medical                                                                                                                                                                                                                                                                                                                                                                                                                                                                       | Shanghai<br>Apolo Medical                                                                                                                                                                                                                                                                                                                                                                            | RAJA Trading<br>Company, Inc.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     |
|                                            | Proposed<br>Device                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  | Predicate device                                                                                                                                                                                                                                                                                                                                                                                                                                                                               | Predicate device                                                                                                                                                                                                                                                                                                                                                                                     | Predicate device                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  |
|                                            | (Shenzhen) Co.,<br>Ltd.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             | Equipment Co.,<br>Ltd.                                                                                                                                                                                                                                                                                                                                                                                                                                                                         | Technology<br>Co., Ltd.                                                                                                                                                                                                                                                                                                                                                                              |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   |
|                                            | Photon Therapy<br>Apparatus use<br>of the red, blue,<br>yellow and<br>infrared regions<br>of the spectrum<br>is intended to<br>emit energy to<br>treat<br>dermatological<br>conditions.                                                                                                                                                                                                                                                                                                                             | LED Light<br>Therapy Device<br>use of the red,<br>blue, Yellow and<br>infrared regions<br>of the spectrum<br>is intended to<br>emit energy to<br>treat<br>dermatological<br>conditions.                                                                                                                                                                                                                                                                                                        | Phototherapy<br>Systems use of<br>the red, blue<br>and infrared<br>regions of the<br>spectrum is<br>intended to<br>emit energy to<br>treat<br>dermatological<br>conditions.                                                                                                                                                                                                                          | The Oxylight<br>is intended for<br>dermatological<br>use by<br>physicians and<br>healthcare<br>professionals<br>for the<br>following:<br>LED<br>Technology is<br>intended for:<br>-Blue LED –<br>465nm - to<br>treat<br>dermatological<br>conditions and<br>specifically<br>indicated to<br>treat moderate<br>inflammatory<br>acne<br>vulgaris.<br>-Red LED<br>625nm- for<br>treatment of<br>superficial,<br>benign<br>vascular and<br>pigmented<br>lesions.<br>-Yellow LED<br>590nm -<br>treatment of<br>periorbital<br>wrinkles and<br>rhytides |
| Indications for Use                        | The red light<br>(633±8nm<br>wavelength) is<br>generally<br>indicated to<br>treatment of<br>superficial,<br>benign vascular,<br>and pigmented<br>lesions.<br>The blue light<br>(417±8nm<br>wavelength) is<br>generally<br>indicated to<br>treat<br>dermatological<br>conditions and<br>specifically<br>indicated to<br>treat moderate<br>inflammatory<br>acne vulgaris.<br>The yellow<br>light (590±8nm<br>wavelength) is                                                                                           | The red light<br>(633±10nm<br>wavelength) is<br>generally<br>indicated to<br>treatment of<br>superficial,<br>benign vascular,<br>and pigmented<br>lesions.<br>The blue light<br>(417±10 nm<br>wavelength) is<br>generally<br>indicated to treat<br>dermatological<br>conditions and<br>specifically<br>indicated to treat<br>moderate<br>inflammatory<br>acne vulgaris.<br>The Yellow light<br>(590±10nm<br>wavelength) is<br>generally                                                        | The blue light<br>(415nm<br>wavelength) is<br>generally<br>indicated to<br>treat<br>dermatological<br>conditions and<br>specifically<br>indicated to<br>treat moderate<br>inflammatory<br>acne vulgaris<br>The red light<br>(630nm<br>wavelength) is<br>generally<br>indicated to<br>treatment of<br>superficial,<br>benign<br>vascular, and<br>pigmented<br>lesions<br>The infrared<br>light (835nm |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   |
|                                            | Proposed<br>Device                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  | Predicate device                                                                                                                                                                                                                                                                                                                                                                                                                                                                               | Predicate<br>device                                                                                                                                                                                                                                                                                                                                                                                  | Predicate<br>device                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               |
|                                            | generally<br>indicated to<br>treat<br>dermatological<br>conditions and<br>specifically<br>indicated for<br>treatment of<br>periorbital<br>wrinkles and<br>rhytides.<br>The infrared<br>light (830±8nm<br>wavelength) is<br>generally use<br>for the<br>temporary relief<br>of minor muscle<br>and joint pain,<br>arthritis and<br>muscle spasm;<br>relieving<br>stiffness;<br>promoting the<br>relaxation of<br>muscle tissue;<br>and to<br>temporarily<br>increase local<br>blood<br>circulation<br>where applied. | indicated to treat<br>dermatological<br>conditions and<br>specifically<br>indicated for<br>treatment of<br>periorbital<br>wrinkles and<br>rhytides.<br>The infrared<br>light (835±15nm<br>wavelength) is<br>generally use for<br>the temporary<br>relief of minor<br>muscle and joint<br>pain, arthritis and<br>muscle spasm;<br>relieving<br>stiffness;<br>promoting the<br>relaxation of<br>muscle tissue;<br>and to<br>temporarily<br>increase local<br>blood circulation<br>where applied. | wavelength) is<br>generally use<br>for the<br>temporary<br>relief of minor<br>muscle and<br>joint pain,<br>arthritis and<br>muscle spasm;<br>relieving<br>stiffness;<br>promoting the<br>relaxation of<br>muscle<br>tissue; and to<br>temporarily<br>increase local<br>blood<br>circulation<br>where applied.                                                                                        |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   |
| Wavelength(s)(nm)                          | Red light<br>633±8nm<br>Blue light<br>417±8nm<br>Yellow light<br>590±8nm                                                                                                                                                                                                                                                                                                                                                                                                                                            | Red light 633 ±<br>10nm<br>Blue light<br>417±10nm<br>Yellow light<br>590±10nm                                                                                                                                                                                                                                                                                                                                                                                                                  | Red light 630<br>± 15nm<br>Blue light 415<br>± 15nm<br>Infrared 835 ±<br>15nm                                                                                                                                                                                                                                                                                                                        | Red light<br>625nm<br>Blue light<br>465nm<br>Yellow light<br>590nm                                                                                                                                                                                                                                                                                                                                                                                                                                                                                |
|                                            | Proposed<br>Device                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  | Predicate device                                                                                                                                                                                                                                                                                                                                                                                                                                                                               | Predicate<br>device                                                                                                                                                                                                                                                                                                                                                                                  | Predicate<br>device                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               |
|                                            | Infrared<br>830±8nm                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 | Infrared 835 ±<br>15nm                                                                                                                                                                                                                                                                                                                                                                                                                                                                         |                                                                                                                                                                                                                                                                                                                                                                                                      |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   |
| Panels Type                                | 3 panel and 5<br>panel.<br>The panels may<br>emit the three<br>light<br>(red/yellow/blu<br>e, or infrared<br>/yellow/blue, or<br>infrared<br>/yellow/red)<br>individual or in<br>combination                                                                                                                                                                                                                                                                                                                        | 5 Panels<br>The panels may<br>emit the three<br>light<br>(red/blue/infrare<br>d, or<br>red/blue/yellow)<br>individual or in<br>combination                                                                                                                                                                                                                                                                                                                                                     | 3 panel and 4<br>Panel<br>The panels<br>may emit the<br>three light<br>(red, blue,<br>infrared)<br>individual or<br>in combination                                                                                                                                                                                                                                                                   | Three type,<br>each head type<br>has only one<br>light. Red,<br>Blue, yellow.                                                                                                                                                                                                                                                                                                                                                                                                                                                                     |
| Output Power                               | Each panel has<br>three different<br>kinds of light-<br>emitting diodes,<br>and the energy<br>power of the<br>diode is<br>as<br>follows:<br>Red<br>light:<br>1.5~1.8W<br>Yellow<br>light:<br>1.5~1.8W<br>light:<br>Blue<br>2.2~2.5W<br>Infrared:<br>1.1~1.4W                                                                                                                                                                                                                                                        | Each panel has<br>three different<br>kinds of light-<br>emitting diodes,<br>and the energy<br>power of the<br>diode is 0.5W                                                                                                                                                                                                                                                                                                                                                                    | Each<br>LED<br>lamp bead has<br>4<br>diodes<br>that<br>emit different<br>colors,<br>the<br>energy power<br>of a<br>diode is 3W.                                                                                                                                                                                                                                                                      | unknown                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           |
| Maximum power<br>density in mW<br>(mW/CM²) | (1)Red:<br>80mW/cm²<br>(2)Blue:<br>100mW/cm2<br>(3)Yellow<br>35W/cm2                                                                                                                                                                                                                                                                                                                                                                                                                                                | Red light: 20~<br>96 mw/cm2<br>Blue light: 10~<br>120 mw/cm2<br>Yellow light:<br>5~35 mw/cm2                                                                                                                                                                                                                                                                                                                                                                                                   | (1)Red light:<br>115mW/cm2,<br>(2)Blue light:<br>120mW/cm²,<br>(3)IR:<br>70mW/cm²,<br>(4)Red/IR:                                                                                                                                                                                                                                                                                                     | (1)Red:<br>100mW/cm²<br>(2)Blue:<br>45mW/cm2<br>(3)Yellow<br>35W/cm2                                                                                                                                                                                                                                                                                                                                                                                                                                                                              |
|                                            | Proposed<br>Device                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  | Predicate device                                                                                                                                                                                                                                                                                                                                                                                                                                                                               | Predicate<br>device                                                                                                                                                                                                                                                                                                                                                                                  | Predicate<br>device                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               |
|                                            | (4)Infrared:<br>50mW/cm²                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            | Infrared: ≤ 70<br>mw/cm ²                                                                                                                                                                                                                                                                                                                                                                                                                                                                      | 120mW/cm²,<br>(5)Blue/IR:<br>150mW/cm²                                                                                                                                                                                                                                                                                                                                                               |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   |
| Standard does in<br>Joules                 | (1)Red: 96J/cm²<br>(2)Blue:<br>120J/cm²<br>(3)Yellow:<br>42J/cm²<br>(4)Infrared:<br>60J/cm²                                                                                                                                                                                                                                                                                                                                                                                                                         | Red light:<br>155J/cm2,<br>Blue light:<br>144J/cm2,<br>Yellow light:<br>42J/cm2,<br>IR: 84J/cm2                                                                                                                                                                                                                                                                                                                                                                                                | (1)Red light:<br>138J/cm2,<br>(2)blue light:<br>144J/cm²,<br>(3)IR:<br>84J/cm²,<br>(4)Red/IR:<br>144J/cm²<br>(5)Blue/IR:<br>180J/cm²                                                                                                                                                                                                                                                                 | (1)Red:<br>120J/cm²<br>(2)Blue:<br>54J/cm²<br>(3)Yellow:<br>42J/cm²                                                                                                                                                                                                                                                                                                                                                                                                                                                                               |
| Adjustable dose<br>range                   | (1) Red light: 1-<br>144J/cm²<br>(2) Blue light:<br>1-180J/cm²<br>(3) Yellow light:<br>1-63J/cm²<br>(4) Infrared: 3-<br>90J/cm²                                                                                                                                                                                                                                                                                                                                                                                     | Red light: 20 ~ 96 J/cm²<br>Blue light: 10 ~ 120J/cm²<br>Yellow light: 5 ~ 35 J/cm²<br>Infrared: ≤ 70<br>J/cm²<br>Red/IR: 20 ~ 166<br>J/cm²<br>Blue/IR: 10 ~ 190 J/cm²                                                                                                                                                                                                                                                                                                                         | (1)Red light:<br>1-242J/cm²,<br>(2)blue light:1-<br>180J/cm²,<br>(3)IR:1-<br>147J/cm²,<br>(4)Red/IR: 1-<br>144J/cm2,<br>(5)Blue/IR:1-<br>180J/cm²                                                                                                                                                                                                                                                    | (1)Red light:<br>1-240J/cm2,<br>(2)blue light:<br>1-108J/cm2,<br>(3)Yellow<br>IR:1-84J/cm2                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
| Effective irradiation<br>area: (CM²)       | 825cm² and<br>1375cm²                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               | 900 cm² ±10%                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   | 756cm² and<br>1008cm²                                                                                                                                                                                                                                                                                                                                                                                | 500cm² and<br>860cm²                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              |
| Structural style                           | Wheeled                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             | Wheeled                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        | Wheeled                                                                                                                                                                                                                                                                                                                                                                                              | Wheeled                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           |
| Structure<br>composition                   | Main frame,<br>irradiator,<br>support arm                                                                                                                                                                                                                                                                                                                                                                                                                                                                           | Main frame,<br>irradiator, lifting<br>frame                                                                                                                                                                                                                                                                                                                                                                                                                                                    | Main frame,<br>irradiator,<br>lifting frame                                                                                                                                                                                                                                                                                                                                                          | Irradiator and<br>support                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         |
| Power supply                               | AC 100-240V<br>50/60Hz                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              | AC 100-240V<br>50/60Hz                                                                                                                                                                                                                                                                                                                                                                                                                                                                         | AC 100-240V<br>50/60Hz                                                                                                                                                                                                                                                                                                                                                                               | AC 100-240V<br>50/60Hz                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            |
| Treatment time                             | 20min<br>(Recommended<br>treatment time)                                                                                                                                                                                                                                                                                                                                                                                                                                                                            | 20min<br>(Recommended<br>treatment time)                                                                                                                                                                                                                                                                                                                                                                                                                                                       | 20min<br>(Recommended treatment<br>time)                                                                                                                                                                                                                                                                                                                                                             | 20min<br>(Recommended treatment<br>time)                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          |
|                                            | Proposed<br>Device                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  | Predicate device                                                                                                                                                                                                                                                                                                                                                                                                                                                                               | Predicate device                                                                                                                                                                                                                                                                                                                                                                                     | Predicate device                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  |
| Operation interface                        | Display Screen                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      | Display Screen                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 | Display Screen                                                                                                                                                                                                                                                                                                                                                                                       | Display Screen                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    |
| Software                                   | Yes                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 | Yes                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            | Yes                                                                                                                                                                                                                                                                                                                                                                                                  | Yes                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               |
| Safety classification                      | Class I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             | Class I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        | Class I                                                                                                                                                                                                                                                                                                                                                                                              | Class I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           |
| Standard                                   | IEC 60601-1<br>IEC 60601-1-2<br>IEC 60601-2-57<br>IEC 62471                                                                                                                                                                                                                                                                                                                                                                                                                                                         | IEC 60601-1<br>IEC 60601-1-2<br>IEC 60601-2-57<br>IEC 62471                                                                                                                                                                                                                                                                                                                                                                                                                                    | IEC 60601-1<br>IEC 60601-1-2<br>IEC 60601-2-57<br>IEC 62471                                                                                                                                                                                                                                                                                                                                          | IEC 60601-1<br>IEC 60601-1-2<br>IEC 60601-2-57<br>IEC 62471                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       |

### 6. Summary of Substantial Equivalence

Table 2 Comparison to Predicate Device

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Image /page/9/Picture/0 description: The image shows the logo for XEMIS. The logo is in black text, except for the accent mark over the "i" and a curved line to the right of the "s", which are in red. The logo is simple and modern.

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# Substantial Equivalence discussion:

The indications for use of the Photon Therapy Apparatus are the same as those for the predicate devices. Most technical specifications of the Photon Therapy Apparatus are either the same or substantially equivalent as compared to the predicate devices. There are no significant technological differences that raise new or different questions of safety or effectiveness.

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Image /page/11/Picture/1 description: The image shows the logo for Xemis. The word "XEMİ" is written in black font, except for the accent mark over the "i", which is red. The logo is simple and modern.

### 7. Non-clinical tests

The following performance data were provided in support of the substantial equivalence determination.

# Electrical safety, electromagnetic compatibility (EMC) and performance

Electrical safety, EMC and performance testing were performed to, and passed, the following standards:

- · ANSI AAMI ES60601-1 Medical electrical equipment -Part 1: General requirements for basic safety and essential performance
- · IEC 60601-1: 2020 Medical electrical equipment Part 1: General requirements for basic safety and essential performance
- · IEC 60601-1-2:2020 Medical electrical equipment -Part 1-2: General requirements for basic safety and essential performance -Collateral standard: electromagnetic compatibility Requirements and tests
- · IEC 60601-2-57: 2023 Medical Electrical Equipment…

---

**Source:** [https://fda.innolitics.com/submissions/SU/subpart-e%E2%80%94surgical-devices/GEX/K243993](https://fda.innolitics.com/submissions/SU/subpart-e%E2%80%94surgical-devices/GEX/K243993)

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