Medical Device
Manufacturing
THE TRADE PAPER OF THE FACTORY FLOOR
Z-3126-2024Class II

Brand Name: PROBEAT Product Name: PROBEAT-CR Model/Catalog Number: N/A Software Version: N/A Product...

Hitachi High-Tech America, Inc. Radiation Therapy Division / initiated 2024-05-27 / Open, Classified / root cause: software

Hitachi America, Ltd., Particle Therapy Division began a recall of Brand Name: PROBEAT Product Name: PROBEAT-CR Model/Catalog Number: N/A Software Version: N/A Product Description: The PROBEAT-CR is a proton beam irradiation... on . FDA classified it as Class II and gives the reason as "During positioning within the system's 3D to 3D matching mode while transferring CBCT images, when the Float Image Selection button is pressed, it may display CBCT images that are insufficient in number". As of , the recall status on record is Open, Classified, and MDM tags the root cause as software.

Recall record

Recall number
Z-3126-2024
Classification
Class II
Status
Open, Classified
Initiated
Posted
Recalling firm
Hitachi High-Tech America, Inc. Radiation Therapy Division
Product
Brand Name: PROBEAT Product Name: PROBEAT-CR Model/Catalog Number: N/A Software Version: N/A Product Description: The PROBEAT-CR is a proton beam irradiation system, which provides a therapeutic proton beam for clinical treatment. It is designed to deliver a proton beam with the prescribed dose, dose distribution and directed to the prescribed patient treatment site. Component: N/A
Product code
LHN System, Radiation Therapy, Charged-Particle, Medical
Reason for recall
During positioning within the system's 3D to 3D matching mode while transferring CBCT images, when the Float Image Selection button is pressed, it may display CBCT images that are insufficient in number.
Root cause tag
software
FDA root cause
Software design
Action
Between 08/05-09/2024, the firm communicated/hand-delivered an "URGENT: MEDICAL DEVICE RECALL" letter to customers informing them that during positioning in the Positioning Image Analysis Systems (PIAS) 3D3D matching mode, while transferring Cone Beam CT systems (CBCT) images from CT Image Reconstruction Software (CIRS) to PIAS, when the Float Image Selection button on the PIAS screen is pressed, it may display CBCT images that are insufficient in number. This may reveal a clear displacement in the Y-direction (body axis direction) compared to the planning CT. There may potentially be a possibility of completing 3D3D patient positioning approximately 5mm off in the body axis direction (with 5 images missing) and proceeding with treatment. Customers are instructed, until the software has been replaced with the corrected version, all users of the device are directed to follow the interim countermeasure. When users operate as described in the operation manual, no such event should occur. Countermeasure references: Engineering Document: PBT-40E-1042 Instruction for patient positioning assistance using CBCT [PROBEAT-FR] Operation Manual TS.16F0147-1 Page.1-105 / 1-108 [PROBEAT-CR] Operation Manual TS.16F0147-1 Page. 1-4-20 / 1-4-23 [PROBEAT-V] Operation Manual TS.16A1850-1E Page.1-126 / 1-131 For questions/assistance -
Quantity in commerce
1
Distribution
U.S. Nationwide distribution in the states of TN, TX, and WA.
Product codes and lots
Lot Code: (01)04560333350006(21)CRUS01(11)190920

Enforcement reports

One row per recalled product line
FDA enforcement reports joined to recall event Z-3126-2024
Recall numberClassStatusVoluntary or mandatedReport dateClassified
Z-3125-2024Class IIOngoingVoluntary: Firm initiated
Z-3126-2024Class IIOngoingVoluntary: Firm initiated
Z-3127-2024Class IIOngoingVoluntary: Firm initiated