FREE ESSAY ON MEDICAL DEVICES AND THE FDA

MEDICAL DEVICES AND THE FDA

Marconi Medical Systems Magnetic Resonance division designs, manufactures, and installs
MRI systems and associated equipment for the worldwide medical diagnostic imaging market.
In addition, Marconi MR imports MRI systems from Nordstar (located in Helsinki, Finland)
and installs them in the United States. Associated equipment includes surface coils and
physician viewing stations. Surface coils are specialized transducers, which, when used
with an MRI machine, produce high-quality images of specific portions of the anatomy. MR
designs, manufactures, and installs surface coils as well.
Marconi Medical Systems as a whole, is a transnational corporation. While retaining its
strength in the United Stated, MR's products have achieved global recognition. Strengths
in markets such as Europe and South America have opened doors to Asian countries such as
Japan and China. MR has a variety of customers, but focuses primarily on hospitals and
imaging centers. MR customers expect high quality systems that are easy to use, have low
operating cost, high throughput, and can support new technology. An MR system must
provide superior image quality and offer a range of imaging techniques to support
diagnosis. Given the high cost of the equipment ($900,000 on average), customers expect
smoothly installed, easy to operate, reliable, low maintenance equipment that provides a
solid return on investment. To make all this possible, Marconi must pass the Food and
Drug Administration's (FDA) stringent policies and procedures for the safe and effective
use of a medical device.
Advantages of MRI
Unlike x-ray based medical diagnostic techniques such as computed tomography, magnetic
resonance imaging (MRI) and spectroscopy are techniques that do not employ ionizing
radiation. As such, it is considered to be less hazardous than other x-ray imaging
techniques. In addition, since x-rays can only discriminate different tissues by electron
density, which does not vary greatly between soft tissues, the injection of contrast
media is often necessary. In MRI, however, there are a number of tissue specific
parameters which can affect magnetic resonance (MR) signals. One of the most important
advantages of MRI is its capacity for displaying soft tissue contrast. An example of this
capacity is the discrimination between the gray and white matter of the brain that can be
accomplished with MRI. Image contrast can be tailored to the specific clinical
application so that specific types of pathology are emphasized. In addition, since MRI is
unobstructed by bone, it is especially beneficial in imaging of the brain and spinal
cord. MRI also has the unique ability to acquire images in numerous planes without
repositioning the patient. Three-dimensional recreations of anatomic structure can be
obtained. These characteristics render MRI a very effective and important tool for soft
tissue imaging. 
Regulations
Products meeting the definition of a device under the Federal Food, Drug and Cosmetic Act
(FD&C Act or the Act) are regulated by the Food and Drug Administration (FDA). Medical
devices are subject to general controls and other controls in the FD&C Act. General
controls of the FD&C Act are the baseline requirements that apply to all medical device
manufacturers. Unless specifically exempted, medical devices must be properly labeled and
packaged, be cleared for marketing by the FDA, meet their labeling claims, and be
manufactured under Good Manufacturing Practices (GMP), which is a mandated quality
assurance system.
FDA regulates devices to assure their safety and effectiveness. To fulfill provisions of
the FD&C Act, FDA develops rules to regulate devices intended for human use. These rules
regulate various aspects of the design, clinical evaluation, manufacturing, packaging,
labeling, commercial distribution, and postmarket surveillance of devices. These
regulations are published in the Federal Register. Final regulations are codified
annually in the Code of Federal Regulations (CFR).
What is a Medical Device?
The definition of a device appears in section 201(h) of the FD&C Act. A device is:
...an instrument, apparatus, implement, machine, contrivance, implant, in vitro reagent,
or other similar or related article, including a component, part, or accessory, which
is:
-  recognized in the official National Formulary, or the United States Pharmacopeia, or
any supplement to them,
-  intended for use in the diagnosis of disease or other conditions, or in the cure,
mitigation, treatment, or prevention of disease, in man or other animals, or
-  intended to affect the structure or any function of the body of man or other animals,
and which does not achieve any of its primary intended purposes through chemical action
within or on the body of man or other animals and which is not dependent upon being
metabolized for the achievement of any of its primary intended purposes... 
Accessories and Components
Certain components such as blood tubing sets, major diagnostic x-ray components, and
stand-alone software are regulated by the FDA as finished devices because they are
accessories to finished devices and meet the above definition of a device. Software that
is to be marketed to enhance the performance of a device is regulated as an accessory to
that device. Software that enhances the performance of a group of different devices is
regulated as an accessory to the device that poses the greatest risk to the patient. The
manufacturer of accessories is subject to the medical device regulations when the
accessory is labeled and marketed separately from the primary device for a health-related
purpose to a hospital, physician, or other end user.
So, you want to sell a medical device?
Each manufacturer who wants to market medical device intended for human use in the U.S.
must submit a 510(k) (premarket notification) to FDA at least 90 days before marketing
unless the device is exempt from 510(k) requirements. A 510(k) is a premarketing
submission made to FDA to demonstrate that the device to be marketed is as safe and
effective, that is, substantially equivalent, to a legally marketed device that is not
subject to premarket approval. Premarket approval (PMA) is the most stringent type of
device marketing application required by FDA. A PMA is an application submitted to FDA to
request clearance to market, or to continue marketing the medical device. Unlike
premarket notification, PMA approval is to be based on a determination by FDA that the
PMA contains sufficient valid scientific evidence that provides reasonable assurance that
the device is safe and effective for its intended use or uses. 
In the first stage of the design process, the Product team, with the assistance of the
Regulatory Affairs team, determines the regulatory requirements for a product. One of the
key requirements that must be considered is if a 510(k) submission is required in order
to distribute the product in the United States. The product team leader completes a
Regulatory Impact Assessment (RIA) to determine if such a submission is needed. After
completing the product information required by the RIA, the Product Team Leader submits
the information to the Regulatory Affairs section to determine whether the new product
requires a 510(k). If Regulatory determines that a 510(k) submission is needed for one or
more features included in the product, the Product Team Leader should incorporate the
submission strategy into the design plan for the product. The strategy should include
both the number of submissions required for the product (individual features may be
submitted separately) and the type of submission to be filed for each feature. Based on
the type of feature/product and the needs of the business, the Regulatory group may
recommend one of the four types of 510(k) submissions. 
-  Special 510(k): This type of a submission can be used in cases where there is no
change in the intended use of the device or in the fundamental scientific technology of
the device. Instead of submitting data to support the submission, the manufacturer
submits a Declaration of Conformity with the design control requirements in the Quality
System Regulations and a brief summary of their design control process. All design
control activities and verification/validation tests specified in the Risk Analysis must
be completed at the time of the submission. The advantage of this type of submission is
that FDA will make a clearance decision in 30 days. 
-  Abbreviated 510(k): This type of a submission can be used in cases where there is a
device-specific guidance document or FDA has recognized a relevant consensus standard.
Instead of submitting data to support the submission, the manufacturer submits a
Declaration of Conformity to the recognized standard and a brief summary of the
activities taken to meet that standard. All activities required by the recognized
standard must be completed at the time of the submission FDA does not guarantee a shorter
review time with this type of submission, but they believe review times should be
shorter. 
-  Traditional 510(k): This type of a submission can be used in all cases These
submissions can contain promissory notes on activities that will be done prior to
commercial distribution, but have not necessarily been completed at the time of the
submission. FDA is supposed to give a clearance decision for the submission in 90 days.
Note: if they formally request (i.e. in writing) additional information, the review time
clock starts over at zero once that information is submitted. 
-  Third-Party Reviewed 510(k) - These submissions are similar to traditional 510(k)
submissions. However, the initial review is conducted by a qualified third party at a
predetermined expense. Once the third party completes the review, the submission is
forwarded to FDA for final review and clearance. Although there is a cost involved with
this submission, the review time is typically shorter (30-45 days) since they bypass the
queue of submissions at FDA.
The Regulatory Affairs Group prepares and submits all documentation required for FDA
approval/clearance of new products and modifications/ upgrades to existing products. The
team is responsible for all interactions with government regulatory agencies and Industry
Relations (Corporate) Department. It also monitors and follows-up Medical Device
Reporting (MDR) requirements and monitors compliance with the Safe Medical Devices Act
and other medical device legislation.
When a manufacturer decides to modify an existing device, they must decide whether the
proposed device modification requires submission of a 510(k). It is not FDA's intent that
a 510(k) must be submitted for every modification. However, all changes in indications
for use require the submission of a 510(k). Examples of modifications that may require a
510(k) submission include the following: 
-  Sterilization method 
-  Structural material 
-  Manufacturing method 
-  Operating parameters or conditions for use 
-  Patient or user safety features 
-  Sterile barrier packaging material 
-  Stability or expiration claims 
-  Design 
FDA believes that the manufacturer is best qualified to determine when modifications to
their device could significantly affect safety or effectiveness. Therefore, every
modification to the device should be reviewed by appropriate personnel to determine if it
affects safety or efficacy. If it is determined that the modification is not significant,
the basis for this decision should be documented with supporting data in the
manufacturer's device master file. If it is determined that the modification is
significant, then a complete 510(k) must be submitted to FDA. 
If FDA finds the device to be substantially equivalent, FDA will send the manufacturer a
marketing clearance letter, referred to as an SE letter, and the device may be marketed
as described in the 510(k). If FDA finds the device not to be substantially equivalent,
FDA will send a not-substantially equivalent letter. In the latter instance, the
manufacturer may chose to resubmit another 510(k) with new information, may petition FDA
requesting the device be reclassified or may submit a PMA.
Manufacturers may not place their device into U.S. commerce until they receive a
marketing clearance letter from FDA. Once they receive the approval letter, they can then
sell the product to the U.S. market. In addition, before clearance is obtained the
manufacturer must assure that the device is properly labeled in accordance with FDA's
labeling regulations. Once clearance for marketing is obtained, the manufacturer must
register their establishment and list the type of device they plan to market with the
FDA. Finally, once on the market, there are postmarket surveillance controls that a
manufacturer must comply with; these include the Quality Systems and Medical Device
Reporting (MDR) regulations. The QS regulation is a quality assurance requirement that
covers the design, packaging, labeling and manufacturing of a medical device. The MDR
regulation provides a mechanism for FDA and manufacturers to identify and monitor
significant adverse events involving medical devices. The goals of the regulation are to
detect and correct problems in a timely manner. Although the requirements of the
regulation can be enforced through legal sanctions authorized by the Federal Food Drug
and Cosmetic Act, FDA relies on the goodwill and cooperation of all affected groups to
accomplish the objectives of the regulation.
Analysis
The medical device industry tends to comply with all government regulations to get the
product to market. The more time it takes to get the product to market, the less money
the business makes. Many laws tend to be vague and are subject to interpretation. The
problem for medical device manufacturers is that many of the laws are broad and written
for drugs and not for medical devices. As a consumer, the FDA is an excellent regulatory
body to have around. For an industry however, it can be very difficult to get through all
the red tape. Entire regulatory departments are needed just so the necessary paperwork
can be generated for market approval. The FDA does recognize that through constant
modification to the existing laws, and assisting the medical device industry in obtaining
market approvals, together industry and government can work together to improve
healthcare for the general public.
Bibliography
References
1. Marconi Medical Systems, Inc. MR GBC Work Instruction MR 313.
2. Duane Praschan, former Regulatory Affairs manager, Marconi Medical Systems.
3. http://www.fda.gov/