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Terminated

Elekta Unity, Philips Marlin Software versions: R5.3.30, R5.3.31, R6.0.5331, R5.7.0, R5.7.1, R6.1.571

FDA Recall Z-2297-2020 · Posted 2020-06-08

Recalling FirmElekta Limited
Recall StatusTerminated
Product CodeIYE
Date Initiated2020-05-21
Date Terminated2024-08-19
Product Quantity26 units

Reason for Recall

In TSM (Treatment Session Manager) Motion Monitoring workflows, under certain conditions there can be a mismatch between the contour data overlay with respect to the motion monitoring images of the monitored structure.

Firm Action

Elekta notified customers of the recalls on about 05/21/2020 via "URGENT IMPORTANT FIELD SAFETY NOTIFICATION" letter. Customers were informed that in TSM (Treatment Session Manager) Motion Monitoring workflows, under certain conditions there can be a mismatch between the contour data overlay with respect to the motion monitoring images of the monitored structure. Instructions included that although there is no method to correct the scaling issue for the affected protocols, the device can still be used under two options: 1. Without the use of Motion Monitoring and 2. compensation for intra-fraction motion can be done through the acquisition of a 3D Verification MRI, which is not impacted by the scaling issue. On 08/05/2020, Elekta issued an additional customer notification to provide additional details of the recall status and to clarify and provide a more generic message regarding the recall issue.

Root Cause

Device Design

Distribution Pattern

US distribution to IA, NY, PA, TX, WI. International distribution to Australia, Canada, China, Denmark, Germany, Hong Kong, Italy, Netherlands, Sweden, Switzerland, Turkey, United Kingdom.

Related FDA 510(k) Records

Devices referenced by this recall via K-numbers.

Official Source

View FDA Recall →

Source: FDA Enforcement Report / Recall database. Always confirm against the official FDA record.

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