Recall Z-0957-2015

Brainlab AG · initiated November 19, 2014

Class II Terminated

Class II – products that might cause a temporary health problem or pose a slight threat of a serious nature

Product

iPlan RT is a radiation treatment planning system that is intended for use in stereotactic, conformal, computer planned, Linac based radiation treatment of cranial, head and neck, and extracranial lesions.

Codes / lots: Software Versions: 1) 21213 IPLAN RT DOSE 3.0 PLATFORM; 2) 21213A IPLAN RT DOSE 3.0.1 PLATFORM; 3) 21213B IPLAN RT DOSE 3.0.2 PLATFORM; 4) 21213D IPLAN RT DOSE 4.1.0 PLATFORM; 5) 21213E IPLAN RT DOSE 4.1.1 PLATFORM; 6) 21213F IPLAN RT DOSE 4.1.2 PLATFORM; 7) 21213G IPLAN RT DOSE 4.1.3 PLATFORM; 8) 21213H IPLAN RT DOSE 4.1.4 PLATFORM; 9) 21381 IPLAN RT DOSE 4.5.0 PLATFORM; 10) 21381A IPLAN RT DOSE 4.5.1 PLATFORM; 11) 21381B IPLAN RT DOSE 4.5.2 PLATFORM; 12) 21381C IPLAN RT DOSE 4.5.3 PLATFORM; 13) 21385 UPGRADE IPLAN RT DOSE 4.X TO 4.5.0; 14) 21385A UPGRADE IPLAN RT DOSE 4.X TO 4.5.1; 15) 21385B UPGRADE IPLAN RT DOSE 4.X TO 4.5.2; 16) 21385C UPGRADE IPLAN RT DOSE 4.X TO 4.5.3; 17) 21387 iPLAN RT DOSE PLATFORM 4.1 (21213); 18) 21387A iPLAN RT DOSE PLATFORM 4.1.2 (21213); 19) 21387B iPLAN RT DOSE PLATFORM 4.5.1 (21381); 20) 21387C iPLAN RT DOSE PLATFORM 4.5.2 (21381); 21) 21387D IPLAN RT DOSE PLATFORM 4.5.3(21381) V; 22) 70213 UPGRADE BRAINSCAN 5.X TO iPLAN RT DOSE 3; 23) 70213A UPGRADE BRAINSCAN 5.X TO iPLAN RT DOSE 3; 24) 70213B UPG BRAINSCAN 5.X TO iPLAN RT DOSE 3.0; 25) 70213C UPG BRAINSCAN 5.X TO iPLAN RT DOSE4.1.0; 26) 70213D UPG BRAINSCAN 5.X TO iPLAN RT DOSE 4.1.1; 27)…

Reason for recall

iPlan RT Radiation Treatment Planning Software: Potentially incorrect patient positioning when using multiple localized CT image data sets.

FDA-determined cause: Software in the Use Environment

Action taken

Brainlab sent a FIELD SAFETY NOTICE / PRODUCT NOTIFICATION letter dated November 19, 2014, to all affected customers. The letter included instructions to: 1) If clinically not required, do not use multiple localized CT scans within one treatment plan (to avoid potentially incorrect Reference and Alignment Set assignments in the first place). 2) If you must use multiple localized CT scans, e.g. for recurrent treatment planning of the same patient, always guarantee that the latest (see note *) CT scan is defined as both Alignment Set and Reference Set during treatment planning. Brainlab will provide a software solution to prevent the described scenario from occurring. Brainlab will actively contact affected customers tentatively starting January 2016 to schedule the update. Brainlab will additionally refine the instructions for use of the iPlan RT treatment planning software in regard to implications of Alignment Set and Reference Set selections and will provide this user guide update to existing affected customers together with the software update. Customers with questions can contact Brainlab at 800-597-5911 or via e-mail at us.support@brainlab.com.

Details

Recall number
Z-0957-2015
Initiated
November 19, 2014
Posted by FDA
January 15, 2015
Terminated
March 28, 2018
Product code
MUJ – System, Planning, Radiation Therapy Treatment
Quantity
1412 systems total
Distribution
Worldwide Distribution - USA including Alabama, Arizona, Arkansas, California, Colorado, Connecticut, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode…
Recalling firm
Brainlab AG, Feldkirchen

Official FDA recall record

Other products in the same recall event

RecallProductInitiated
Z-0956-2015 Class IIiPlan RT Dose is a stereotactic radiation treatment planning system that is intended for…iPlan RT Radiation Treatment Planning Software: Potentially incorrect patient positioning when using… 11/19/2014Terminated