Recall StatusOpen, Classified
Date Initiated2021-06-14
Product Quantity27 worldwide, 11 in U.S.
Reason for Recall
Users may be misled by the popup message displayed by the Proton Therapy System when the Oncology Information System appears disconnected, may cause mistreatment
Firm Action
IBA issued an Urgent Medical Device Correction notification users of the device, starting June 14, 2021. Letter states reason for recall, health risk and action to take:
IBA would like to remind Proteus235 users to verify with X-ray images
or other means, after the display of the popup message, that the
patient positions (represented by the couch position, mainly the 3
translations and 3 rotations parameters) recorded in the OIS are
correct Labelling change
IBA will update the user manuals to:
- Describe under which conditions the popup message appears
and the subsequent risks, especially that the equipment
positions may not be up to date in the OIS,
- Remind the user to verify with X-ray images or other means,
after the display of the popup message, that the patient
positions (represented by the couch position, mainly the 3
translations and 3 rotations parameters) recorded in the OIS
are correct,
- Recommend the user to verify the OIS user manuals for
measures preventing saving outdated patient positions in case
of disconnection and to apply these measures before saving
the positions in the OIS.
The action will be completed for your site by May 31, 2022.
By signing below, the customer representative confirms that this notice has been read,
understood and communicated to the appropriate employees within the organization.
Please transfer this notice to other organizations on which this action has an impact.
Your IBA representative is able to provide you with additional information and/or guidelines if necessary.
Please return the copy of the notice signed to IBA within 10 working days .
Distribution Pattern
Worldwide distribution - US Nationwide distribution in the states of FL, OK, VA, IL, NJ, TN, WA, LA, TX, MI and the countries of Germany, Italy, Russia, Sweden, India, Japan, France, England, Spain.
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.