K100236 · Stair Systems, Inc. · LLZ · Mar 29, 2010 · Radiology
Device Facts
Record ID
K100236
Device Name
STAIR SYSTEMS PACS & DICOM VIEWER
Applicant
Stair Systems, Inc.
Product Code
LLZ · Radiology
Decision Date
Mar 29, 2010
Decision
SESE
Submission Type
Traditional
Regulation
21 CFR 892.2050
Device Class
Class 2
Attributes
Software as a Medical Device
Indications for Use
The STAIR Systems PACS & DICOM Viewer Software system is a picture archiving and communications system (PACS) intended to be used as a networked Digital Imaging and Communications in Medicine (DICOM) and non-DICOM information and data management system. The STAIR System PACS & DICOM Viewer Software is comprised of modular software programs that run on standard "off-the-shelf" personal computers, business computers, and servers running standard operating systems, STAIR System & DICOM Viewer Software system is an image, data storage and display software that accepts DICOM data from any OEM modality which support DICOM standard imaging data; The system provides the capability to organize images generated by OEM vendor equipment, perform digital manipulation, create graphical representations of anatomical areas, and perform quantitative measurements. The STAIR PACS & DICOM Viewer Software system should not be used for Diagnostic review of full-field digital mammograms.
Device Story
Stair Systems Constellation Suite is a PACS software platform for medical image management. It accepts DICOM data from various OEM modalities; stores data in a central SQL Server database; and displays images on multi-monitor workstations. Operated by clinicians and hospital staff in clinical environments. Features include Northstar PACS client for image viewing; Cosmos for network security and workflow management; Apex for DICOM storage/import; and Cascade for transmission load balancing. System uses Microsoft DirectX for UI performance. Healthcare providers use the system to organize, manipulate, and perform quantitative measurements on anatomical images to support clinical decision-making. Benefits include streamlined office efficiency and centralized data access.
Clinical Evidence
Bench testing only. Verification and validation testing established that the device meets its intended use and design specifications.
Technological Characteristics
Software-based PACS running on off-the-shelf PCs and servers. Database: Microsoft SQL Server 2008 (adaptive star relational design). Connectivity: DICOM standard (SCP/SCU). UI: Multi-monitor native design using Microsoft DirectX. Architecture: Modular client-server (Northstar, Cosmos, Apex, Cascade).
Indications for Use
Indicated for use as a networked DICOM and non-DICOM information and data management system for image storage, display, organization, digital manipulation, and quantitative measurement of medical images from OEM modalities. Contraindicated for diagnostic review of full-field digital mammograms.
Regulatory Classification
Identification
A medical image management and processing system is a device that provides one or more capabilities relating to the review and digital processing of medical images for the purposes of interpretation by a trained practitioner of disease detection, diagnosis, or patient management. The software components may provide advanced or complex image processing functions for image manipulation, enhancement, or quantification that are intended for use in the interpretation and analysis of medical images. Advanced image manipulation functions may include image segmentation, multimodality image registration, or 3D visualization. Complex quantitative functions may include semi-automated measurements or time-series measurements.
Special Controls
*Classification.* Class II (special controls; voluntary standards—Digital Imaging and Communications in Medicine (DICOM) Std., Joint Photographic Experts Group (JPEG) Std., Society of Motion Picture and Television Engineers (SMPTE) Test Pattern).
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Image /page/0/Picture/0 description: The image shows a logo for a company called "Efficient Radiology AIRSYSTEMS Inc." The logo features a stylized sunburst design above the company name. The sunburst is made up of several triangular shapes that radiate outwards from a central point. The text is in a simple, sans-serif font.
STAIR Systems, Inc. 3801 (V. Market St.)
E-mail: sales alstairs vsterrss ner Hittp://w
#### ട. 510(k) Summary (21 CFR 807.92(c))
100256
2 6 21 11
### ADMINISTRATIVE INFORMATION
Manufacturer Name:
Contact Person:
Official Correspondent:
Stair Systems, Inc 3801 West Market St. Greensboro, NC 27407
Ray Eveland, Vice President, Tel: (336) 413-6967 Fax: (336) 852-0651 E-mail: jimowen@stairsytems.net
CALISO Consulting, LLC James W. Monroe, Regulatory Manager 1516 Oak Street, Suite 312 Alameda, CA 94501 (484) 894-4921
Establishment Registration Number:
Date prepared:
Name of Device:
Trade Name:
Suite
Common Name:
Medical Image Workstation
Stair Systems Constellation
January 11, 2010
Systems, PACS Classification Name: 21 CFR 892.2050
Product Code: LLZ
Identification of Predicate Device(s):
| Manufacturer | Device | 510(k) |
|--------------------------------|--------------------------------------|---------|
| Number | | |
| Mercury computer Systems, Inc. | Visage PACS/CS | K062490 |
| Ramsoft Inc. | Ramsoft PACS | K031562 |
| Advance Imaging Solutions, LLC | EZPACS | K062878 |
| CALGARY SCIENTIFIC, INC | ResolutionMD | K062164 |
| Fuji Medical System USA | Fuji Synapse Workstation<br>Software | K051553 |
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Image /page/1/Picture/0 description: The image shows a logo for Stair Systems, Inc. The logo includes a stylized image of stairs or steps radiating outward from a central point. The text "Efficient Radiology STAIRSYSTEMS, Inc." is present, along with the website address "HTTP://WWW.STAIRSYSTEMS.NET".
alor@crairossoms.com pot. Horniturems.com
#### Intended Use Statement
The STAIR Systems PACS & DICOM Viewer Software system is a picture archiving and communications system (PACS) intended to be used as a networked Digital Imaging and Communications in Medicine (DICOM) and non-DICOM information and data management system. The STAIR System PACS & DICOM Viewer Software is comprised of modular software programs that run on standard "off-the-shelf"
personal computers, business computers, and servers running standard operating systems, STAIR System & DICOM Viewer Software system is an image, data storage and display software that accepts DICOM data from any OEM modality which support DICOM standard imaging data; The system provides the capability to organize images generated by OEM vendor equipment, perform digital manipulation, create graphical representations of anatomical areas, and perform quantitative measurements. The STAIR PACS & DICOM Viewer Software system should not be used for Diagnostic review of full-field digital mammograms.
### DEVICE DESCRIPTION
STAIR Constellation Suite is a collection of applications Coded in the Microsoft C# application language. A color scheme defined as a way to identify both highlighted or important information within the user interface and as a "not so grey" environment that could stand up to a user who was likely to work 10-12 hours a day in front of it. The layout and design of the layers of the UI evolved from the "old design" of having 3 separate computers. each with a single monitor copy of a single element of the system into a modern, multimonitor native design which incorporates large performance gains through the use of Microsoft's DirectX technologies.
The core of the Suite is the database, is an adaptive star relational design for Microsoft SQL Server 2008
Enterprise. The data server provides a dedicated, central place to provide disaster recovery servicing, and the large multi-terabyte storage required for PACS. Attaching to this are Northstar PACS clients, Cosmos Enterprise Managmenet Clients, Apex Servers, and Cascade Servers; all of which are STAIR produced software products.
The Northstar PACS client is intended to be a desktop replacement product, with the interface dominating the screen space on a workstation.computer. TThis design decision was made to accommodate non- technical doctors who, we found, typically prefer to have a simplified and unobtrusive environment to work in. Color based exam status listings were evolutionary, and grew from the initial 'field of green' into the more advanced dynamic tree view seen today in the client. It is a multi-monitor capable client, currently configurable in a 1, 2, or 3 monitor footprint.
Cosmos represents the nerve center of the STAIR Constellation Suite, providing services for securing the STAIR network, maintaining Paperless workflow, and other such critical day-today system maintenance tasks. Typically users will include hospital or practice administrators and functional personnel who may need to make modifications to STAIR database entries. It is an OLTP client, and requires port level access to the main STAIR database central server installation to function (we use DSN-less connections to the
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Image /page/2/Picture/0 description: The image shows a logo for Tair Systems, Inc. The logo features a stylized sunburst design above the company name. The text "Efficient Radiology" is above the company name, and the website address is below the company name. The sunburst design is made up of several shapes that are arranged in a semi-circle.
database usually requiring port 1433 to be excepted in the workstation's firewall rule
STAIR Systems, Inc. 3801 W. Market St., Greensboro, NC 27407 1-336-856-857.
set). The client performs many tasks, some of which are not relevant to every customer. though we encourage adoption of STAIR electronic processes by our clients in order to help them streamline their office efficiency. RIS integration is partially available (per vendor, STAIR offers no supported HL7 interface at this time), and can be incorporated in most cases to allow a RIS system to perform synchronization and workflow tasks in harmony with STAIR kept data records.
The Apex DICOM Storage Server provides the primary server capabilities of the STAIR system. It was built to be automatable such that it typically runs unattended, but a user interface is used to both help monitor and control the various DICOM storage processes necessary to import each study from an external source (modality, another PACS, etc). The Apex server incorporates a DICOM SCP service grouping that allows for DICOM ping response, client protocol negotiation, transfer syntax negotiation, and several other system-level DICOM negotiations. As each case is received; it is stored via a Service host to the local hard drive (into the STAIRIMAGE hierarchy), it is queued for storage at the top, and it is stored as data to the main database in one of 8 available simultaneous thread 'putaway' processes (shown as 'idle').
The STAIR Cascade is a DICOM SCU, and auxiliary compression Server product originally designed to allow the send and receive functions of DICOM to be split from the STAIR Apex product and balanced onto a separate physical server. This was to allow for load balancing within the STAIR Enterprise, and the product has evolved now into a secondary server role, handling transmission queues for all enterprise clients. To allow for DICOM transmissions to be seamless, we use a database table XMISSION QUES, and each client transmission request to the database are handled as a threaded process (8 simultaneous). Each process begins by downloading the Imageset for a requested case from the STAIR database to a local cache, where it is then added to a queue within the program for processing. As each queue slot opens, another case is promoted until the queue empties.
Predicate Device Comparison
The Stair Systems Constellation Suite has similar intended use and technical features of the predicate devices listed above. The subject device is not indicated for Mammography use where as some of the predicate devices are indicated. This difference in the subject device does not raise any questions with respect to the safety and effectiveness of the device. substantially equivalent to similar features to the predicate devices. The Stair Systems Constellation Suite differs from the Fuji Medical Synapse in that it is not intended for Mammography use. The features of the subject device do not raise or affective the safety or effectiveness of the device.
The subject device does comply with the following voluntary Standards:
- . ACR/NEMA Digital Imaging and Communication in Medicine (DICOM) Standard.
#### Conclusions
A comparison of the labelling, substantial equivalence table, and verification and validation testing has established that the device meets its intended use and design specifications.
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Image /page/3/Picture/0 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo features a stylized eagle with three bars representing health, services, and people. The text "DEPARTMENT OF HEALTH & HUMAN SERVICES USA" is arranged in a circular fashion around the eagle.
Public Health Service
Food and Drug Administration 10903 New Hampshire Avenue Document Control Room - WO66-G609 Silver Spring, MD 20993-0002
## MAR 2 9 2010
STAIRS Systems, Inc. % Mr. James W. Monroe Regulatory Affairs CALISO Consulting, LLC 3801 W. Market St. GREENSBORO NC 27407
・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・
Re: K100236
Trade/Device Name: Stair Systems Constellation Suite Regulation Number: 21 CFR 892.2050 Regulation Name: Picture archiving and communications system Regulatory Class: II Product Code: LLZ Dated: January 11, 2010 Received: February 2, 2010
Dear Mr. Monroe:
We have reviewed your Section 510(k) premarket notification of intent to market the device referenced above and have determined the device is substantially equivalent (for the indications for use stated in the enclosure) to legally marketed predicate devices marketed in interstate commerce prior to May 28, 1976, the enactment date of the Medical Device Amendments, or to devices that have been reclassified in accordance with the provisions of the Federal Food. Drug. and Cosmetic Act (Act) that do not require approval of a premarket approval application (PMA). You may, therefore, market the device, subject to the general controls provisions of the Act. The general controls provisions of the Act include requirements for annual registration, listing of devices, good manufacturing practice, labeling, and prohibitions against misbranding and adulteration.
If your device is classified (see above) into class II (Special Controls), it may be subject to such additional controls. Existing major regulations affecting your device can be found in Title 21, Code of Federal Regulations (CFR), Parts 800 to 895. In addition, FDA may publish further announcements concerning your device in the Federal Register.
Please be advised that FDA's issuance of a substantial equivalence determination does not mean that FDA has made a determination that vour device complies with other requirements of the Act or any Federal statutes and regulations administered by other Federal agencies. You must comply with all the Act's requirements, including, but not limited to: registration and listing (21 CFR Part 807); labeling (21 CFR Parts 801 and 809); medical device reporting (reporting of
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medical device-related adverse events) (21 CFR 803); and good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820). This letter will allow you to begin marketing your device as described in your Section 510(k) premarket notification. The FDA finding of substantial equivalence of your device to a legally marketed predicate device results in a classification for your device and thus, permits your device to proceed to the market.
If you desire specific advice for your device on our labeling regulation (21 CFR Parts 801 and 809), please contact the Office of In Vitro Diagnostic Device Evaluation and Safety at (301) 796-5450. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR Part 807.97). For questions regarding the reporting of adverse events under the MDR regulation (21 CFR Part 803), please go to
http://www.fda.gov/MedicalDevices/Safety/ReportaProblem/default.htm for the CDRH's Office of Surveillance and Biometrics/Division of Postmarket Surveillance.
You may obtain other general information on your responsibilities under the Act from the Division of Small Manufacturers, International and Consumer Assistance at its toll-free number (800) 638-2041 or (301) 796-7100 or at its Internet address http://www.fda.gov/cdrh/industry/support/index.html.
Sincerely yours,
Amiel Jaffe
Donald J. St.Pierre Acting Director Division of Radiological Devices Office of In Vitro Diagnostic Device Evaluation and Safety Center for Devices and Radiological Health
Enclosure
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# Indications for Use
510(k) Number (if known): K100236
Device Name: Stair Systems Constellation Suite
Indications for Use:
The Stair Systems Constellation Suite Software system is a picture archiving and communications system (PACS) intended to be used as a networked Digital Imaging and Communications in Medicine (DICOM) and non- DICOM information and data management system. The STAIR System PACS & DICOM Viewer Software is comprised of modular software programs that run on standard "off-the-shelf" personal computers, business computers, and servers running standard operating systems. STAIR System & DICOM Viewer Software system is an image, data storage and display software that accepts DICOM data from any OEM modality which support DICOM standard imaging data: The system provides the capability to organize images generated by OEM vendor equipment, perform digital manipulation, create graphical representations of anatomical areas, and perform quantitative measurements.
The STAIR Systems Constellation Suite Software system should not be used for Diagnostic review of full-field digital mammograms.
Prescription Use X (Part 21 CFR 801 Subpart D) AND/OR
Over-The-Counter Use (21 CFR 801 Subpart C)
(PLEASE DO NOT WRITE BELOW THIS LINE - CONTINUE ON ANOTHER PAGE IF NEEDED)
Concurrence of CDRH, Office of In Vitro Diagnostic Devices (OIVD)
DML
Division of Radiological Dev
510K K100236
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Two short videos show you everything — or skip straight to the written tutorial if you'd rather read. You can reopen this any time from the Tutorial button in the top bar.
Part 1 — Search, results, and everyday workflows 16 min
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1. Search: exact and fuzzy
Type a phrase like "coronary artery calcification" into the search box. You get two kinds of results. Exact results match the literal phrase — prefix searches work ("coronary artery calcificati") but suffix searches do not. Fuzzy results match on the meaning and intent of your phrase rather than the exact words, and are sorted by relevance score. Hover over the Exact or Fuzzy badge on any row to see exactly why it matched.
Use the checkboxes above the results to narrow: SaMD keeps only software-only devices, AI / ML keeps only devices with AI.
Exact vs. fuzzy search: what's the difference?
Exact matches on the literal phrase (prefix search works, suffix does not). Fuzzy matches on the meaning and intent of the phrase rather than the exact words. Hover over the badge on any row to see why it matched.
You search "coronary artery calcification" and want only software devices with AI. What two filters do you apply?
Narrow by SaMD (software-only devices), then narrow by AI/ML (devices with AI).
2. The results table
Scroll right in the results table. The intended use is extracted for you — no need to open the PDF. The device story gives a high-level snapshot of what the device does and how it's used. The AI Performance sub-table shows each output name, acceptance criteria, observed values, and development/test dataset descriptions — the same format Innolitics uses for regulatory strategy outputs, and the fastest high-level fingerprint of an AI device. It is AI-generated but has been very reliable in practice.
Where do you find a device's intended use without opening the PDF?
Scroll right in the search results table. The intended use column is extracted for you; no need to dig into the 510(k) summary PDF.
What does the AI Performance sub-table show, and why is it useful?
Output name, acceptance criteria, observed values, development dataset description, and test dataset description. It's the same format we use for regulatory strategy output and Fast 510(k) input, and the fastest high-level fingerprint of an AI device. AI-generated but reliable in practice.
3. Judging fuzzy relevance
Fuzzy results trail off in relevance as you scroll. Use three signals to decide how far down to go: the fuzzy badge explanations, the intended use column, and whether your target output (e.g., Cobb angle) still appears in the AI Performance sub-table. Once it stops appearing, you're past the relevant zone. A top hit with a low score (~0.4) and a stretched explanation is a hint the closest predicates are far away — the project may be headed for De Novo. Note the fuzzy search is a pattern match: it doesn't handle negation ("not") well, and hardware devices can appear — filter by SaMD/AI ML to cut them.
How do you judge how far down fuzzy search results to go?
Use the relevancy signals: the fuzzy badge explanations, the intended use column, and whether the target output (e.g., Cobb angle) still appears in the AI Performance sub-table. Once it stops appearing, results are trailing off in relevancy.
4. Device detail page: chat and citations
Click a device name to open its detail page: device facts on the left, a chat window on the right. Ask something like "Describe the training data". The answer carries little citation bubbles — click one to jump to the highlighted passage in the source PDF, so you can verify every AI answer against the document. There's also a Download PDF button for sharing.
How do you verify an AI chat answer on the device detail page?
Click the citation bubbles to jump to the relevant highlight in the source document.
Reading rule for every project: how many summaries do you read in full?
At least the three most relevant 510(k) or De Novo summaries, in full. After that, use targeted chat questions to confirm your memory quickly. The tool supports this professional habit — it doesn't replace it.
5. Side-by-side comparison
Select multiple rows in the results table (aim for under ~10), then open the PDF Viewer tab. Ask one question — it goes to all selected devices in parallel, each with citations. This is the fastest way to compare and contrast devices: training data, PCCP scope, how they handled adding new scanners, and so on.
What does the side-by-side PDF viewer mode do?
Select multiple devices, open the PDF viewer tab, and ask one question (e.g., "Describe the training data"). It queries all selected devices simultaneously with citations, so you can compare and contrast quickly.
6. Collections
With rows selected, go to the Collections tab and create a labeled collection (e.g., "Cobb Angle Project"). Reload that selection any time — before a client call, pull up the collection and ask questions across all of its devices at once.
How do you save a set of selected devices for later use?
Select the rows, go to the Collections tab, and create a labeled collection (e.g., "Cobb Angle Project"). You can reload the selection anytime and carry it into the PDF viewer and other tabs that support selections.
7. Product codes and the regulations tree
Click a product code in the results to jump to it in the regulations tree — identification text, sibling product codes, and devices you can open in a PDF viewer on the right. Click a regulation number to see its identification, special controls, and related product codes. You can also search by product code or regulation number at the top of the tree. Always read the special controls if any exist for your device — it broadens your search and sharpens pre-kickoff research.
What can you do from the regulations tree view?
Browse product codes and regulation numbers, read the identification text and special controls, browse sibling product codes, open device PDFs on the right, and search by product code or regulation number at the top of the tree.
8. Chart view
Click Show Chart and segment by regulation number (or product code) to see which regulations dominate your result set. Clicking a regulation takes you into the regulations tree. Great for spotting that most matches are, say, hardware laparoscopic devices — a cue to go back and filter.
How do you see which regulations dominate a search result set?
Click "Show Chart" and segment by Regulation Number. Clicking a regulation takes you to the regulations tree.
9. The predicate graph
Open the Predicates tab for a family-tree view of predicate relationships. Click a node to trace its parents and children; selections from search carry over pre-selected. Commonly predicated devices are worth reading — a lot of people predicated them for a reason. The visual lineage is also handy on client calls, e.g. to show how a predicate family evolved and justify why your predicate still holds.
In the predicate graph, why are commonly predicated devices worth reading?
A lot of people predicated them for a reason. Clicking a node traces parents and children, and selections from search carry over pre-selected.
10. Embeddings: the galaxy map
The Embeddings tab plots every matching document in a 2-D "galaxy map" where semantically similar devices cluster together. Hover or click clusters to explore, and let AI label the clusters for you. Embeddings beat product codes for grouping: two devices can carry different product codes (LLZ vs. QIH) yet do the same thing — the embedding captures the meaning of the intended use and device story. This is also exactly how retrieval-augmented generation (RAG) works under the hood, and it makes a great visual on client calls.
Try it yourself
Head to the search page and work through a few of these AI/ML fuzzy searches to build intuition: perivascular fat on CT · aortic valve calcification opportunistic screening on noncontrast CT · breast cancer prediction on digital pathology slides · autism detection · gestational age prediction · a hearing aid that can also detect a pulse · foundation model based analysis of ECG · large language models · penetration test. Watch how the relevance scores, intended use, and AI Performance tables tell you when results stop being meaningful.