Medical electrical equipment - Part 2-85: Particular requirements for the basic safety and essential performance of cerebral tissue oximeter equipment (ISO 80601-2-85:2021)

This particular standard applies to basic safety and essential performance of cerebral tissue oximeter equipment (t-NIRS), which is a unique application of NIRS in that it employs multiple wavelengths of light energy and time-resolved (frequency or time domain) and/or spatially resolved methods to derive a quantitative measure of tissue oxygen saturation of haemoglobin within the field of the NIRS sensor. This particular standard applies to ME EQUIPMENT used in a hospital environment as well as when used outside the hospital environment, such as in ambulances and air transport. Additional standards may apply to ME EQUIPMENT for those environments of use.
Not included within the scope of this particular standard are:
a) Invasive tissue or vascular oximeters
b) Device measuring dissolved oxygen
c) Functional NIRS device covered by IEC 80601-2-71, where not intended for obtaining cerebral tissue oximeter signals for monitoring purposes
d) Pulse oximeter covered by ISO 80601-2-61, where not intended for obtaining cerebral tissue oximeter signals for monitoring purposes; however, manufacturers should consider using relevant clauses of this standard as appropriate for their intended use.
NOTE: a manufacturer may claim monitoring of tissue other than cerebral, which is not covered
by this standard.

Medizinische elektrische Geräte - Teil 2-85: Besondere Anforderungen für die Sicherheit einschließlich der wesentlichen Leistungsmerkmale von Geräten für die zerebrale Oxymetrie (ISO 80601-2-85:2021)

Dieses Dokument ist anzuwenden für die Basissicherheit und wesentlichen Leistungsmerkmale von zerebralen Gewebeoximetriegeräten, die Licht verschiedener Wellenlänge zur quantitativen Messung der Sauerstoffsättigung des Hämoglobins innerhalb des unter dem am Kopf befestigten Sensor befindlichen Gewebevolumens nutzen. Die Technologie des zerebralen Gewebeoximetriegeräts kann auf Dauerlicht, dem Frequenzbereich oder dem Zeitbereich basieren. Dieses Dokument ist anzuwenden für in einer Klinikumgebung verwendete ME Geräte, sowie wenn diese außerhalb der Klinikumgebung z. B. in Rettungsdienstfahrzeugen oder beim Lufttransport verwendet werden. Weitere Normen für diese Einsatzbedingungen können auf ME Geräte anwendbar sein.
ANMERKUNG 1 Zerebrale Gewebeoximetriegeräte werden in der medizinischen Literatur manchmal auch als Nahinfrarotspektroskopiegeräte bezeichnet.
Nicht im Anwendungsbereich dieses Dokuments enthalten sind:
- invasive Gewebe  oder Gefäßoximeter;
- Oximeter, die eine Blutprobe des Patienten erfordern;
- Geräte zur Messung von Gelöstsauerstoff;
- ME Geräte, oder Teile davon, die weglängenabhängige Hämoglobinänderungen messen. Die Anforderungen an funktionelle Nahinfrarotspektroskopiegeräte sind in ISO 80601-2-71 [4] zu finden;
- ME Geräte, oder Teile davon, die die arterielle Sättigung anhand pulsatiler Änderungen der optischen Eigenschaften des Gewebes (SpO2) messen. Die Anforderungen an Pulsoximetriegeräte sind in ISO 80601-2-61 [3] zu finden;
- ME Geräte, oder jegliche Teile davon, die den Anspruch erheben, Gewebe in anderen Körperteilen als dem Kopf zu überwachen.
Dieses Dokument ist auch anzuwenden für zerebrale Gewebeoximetriegeräte, einschließlich zerebraler Gewebeoximetriemonitore, zerebraler Gewebeoximetriesensoren und Sensorverlängerungskabel, die wiederaufbereitet wurden.
Wenn ein Abschnitt oder Unterabschnitt speziell nur auf ME Geräte oder ME Systeme angewendet werden soll, wird dies aus der Überschrift und dem Inhalt des jeweiligen Abschnitts oder Unterabschnitts deutlich. In den übrigen Fällen gilt der Abschnitt oder Unterabschnitt je nach Zutreffen für sowohl ME Geräte als auch ME Systeme.
Gefährdungen, die sich aus der vorgesehenen physiologischen Funktion von ME Geräten oder ME Systemen im Anwendungsbereich dieses Dokuments ergeben, sind nicht durch besondere Anforderungen in diesem Dokument erfasst, ausgenommen in 201.11 und in 201.7.2.13 und 201.8.4.1 der allgemeinen Norm.
ANMERKUNG 2 Siehe auch 4.2 der allgemeinen Norm.
Dieses Dokument kann auch auf ME Geräte und deren Zubehör angewendet werden, die für die Kompensation oder Linderung bei Krankheiten, Verletzungen oder Behinderungen verwendet werden.
Dieses Dokument ist nicht anzuwenden für entfernt aufgestellte oder gekoppelte (sekundäre) Geräte, die StO2 Werte anzeigen und die sich außerhalb der Patientenumgebung befinden.
ANMERKUNG 3 Von ME Geräten, bei denen die Auswahl zwischen einer Diagnose  und einer Überwachungsfunktion möglich ist, wird erwartet, dass sie die Anforderungen des entsprechenden Dokuments erfüllen, wenn sie für die jeweilige Funktion konfiguriert sind.

Appareils électromédicaux - Partie 2-85: Exigences particulières pour la sécurité de base et les performances essentielles des oxymètres pour tissu cérébral (ISO 80601-2-85:2021)

Medicinska električna oprema - 2-85. del: Posebne zahteve za osnovno varnost in bistvene lastnosti opreme za cerebralno oksimetrijo (ISO 80601-2-85:2021)

General Information

Status
Published
Current Stage
6060 - Definitive text made available (DAV) - Publishing
Due Date
14-Apr-2021
Completion Date
14-Apr-2021

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SLOVENSKI STANDARD
SIST EN ISO 80601-2-85:2021
01-julij-2021
Medicinska električna oprema - 2-85. del: Posebne zahteve za osnovno varnost in
bistvene lastnosti opreme za cerebralno oksimetrijo (ISO 80601-2-85:2021)

Medical electrical equipment - Part 2-85: Particular requirements for the basic safety and

essential performance of cerebral tissue oximeter equipment (ISO 80601-2-85:2021)

Medizinische elektrische Geräte - Teil 2-85: Besondere Anforderungen für die Sicherheit

einschließlich der wesentlichen Leistungsmerkmale von Geräten für die nicht-invasive

zerebrale Oxymetrie (ISO 80601-2-85:2021)

Appareils électromédicaux - Partie 2-85: Exigences particulières pour la sécurité de base

et les performances essentielles des oxymètres pour tissu cérébral (ISO 80601-2-
85:2021)
Ta slovenski standard je istoveten z: EN ISO 80601-2-85:2021
ICS:
11.040.10 Anestezijska, respiratorna in Anaesthetic, respiratory and
reanimacijska oprema reanimation equipment
SIST EN ISO 80601-2-85:2021 en

2003-01.Slovenski inštitut za standardizacijo. Razmnoževanje celote ali delov tega standarda ni dovoljeno.

---------------------- Page: 1 ----------------------
SIST EN ISO 80601-2-85:2021
---------------------- Page: 2 ----------------------
SIST EN ISO 80601-2-85:2021
EN ISO 80601-2-85
EUROPEAN STANDARD
NORME EUROPÉENNE
April 2021
EUROPÄISCHE NORM
ICS 11.040.10
English Version
Medical electrical equipment - Part 2-85: Particular
requirements for the basic safety and essential
performance of cerebral tissue oximeter equipment (ISO
80601-2-85:2021)

Appareils électromédicaux - Partie 2-85: Exigences Medizinische elektrische Geräte - Teil 2-85: Besondere

particulières pour la sécurité de base et les Anforderungen für die Sicherheit einschließlich der

performances essentielles des oxymètres pour tissu wesentlichen Leistungsmerkmale von Geräten für die

cérébral (ISO 80601-2-85:2021) nicht-invasive zerebrale Oxymetrie (ISO 80601-2-
85:2021)
This European Standard was approved by CEN on 21 January 2021.

CEN members are bound to comply with the CEN/CENELEC Internal Regulations which stipulate the conditions for giving this

European Standard the status of a national standard without any alteration. Up-to-date lists and bibliographical references

concerning such national standards may be obtained on application to the CEN-CENELEC Management Centre or to any CEN

member.

This European Standard exists in three official versions (English, French, German). A version in any other language made by

translation under the responsibility of a CEN member into its own language and notified to the CEN-CENELEC Management

Centre has the same status as the official versions.

CEN members are the national standards bodies of Austria, Belgium, Bulgaria, Croatia, Cyprus, Czech Republic, Denmark, Estonia,

Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, Netherlands, Norway,

Poland, Portugal, Republic of North Macedonia, Romania, Serbia, Slovakia, Slovenia, Spain, Sweden, Switzerland, Turkey and

United Kingdom.
EUROPEAN COMMITTEE FOR STANDARDIZATION
COMITÉ EUROPÉEN DE NORMALISATION
EUROPÄISCHES KOMITEE FÜR NORMUNG
CEN-CENELEC Management Centre: Rue de la Science 23, B-1040 Brussels

© 2021 CEN All rights of exploitation in any form and by any means reserved Ref. No. EN ISO 80601-2-85:2021 E

worldwide for CEN national Members.
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SIST EN ISO 80601-2-85:2021
EN ISO 80601-2-85:2021 (E)
Contents Page

European foreword ....................................................................................................................................................... 3

---------------------- Page: 4 ----------------------
SIST EN ISO 80601-2-85:2021
EN ISO 80601-2-85:2021 (E)
European foreword

This document (EN ISO 80601-2-85:2021) has been prepared by Technical Committee ISO/TC 121

"Anaesthetic and respiratory equipment" in collaboration with Technical Committee CEN/TC 215

“Respiratory and anaesthetic equipment” the secretariat of which is held by BSI.

This European Standard shall be given the status of a national standard, either by publication of an

identical text or by endorsement, at the latest by October 2021, and conflicting national standards shall

be withdrawn at the latest by April 2024.

Attention is drawn to the possibility that some of the elements of this document may be the subject of

patent rights. CEN shall not be held responsible for identifying any or all such patent rights.

According to the CEN-CENELEC Internal Regulations, the national standards organizations of the

following countries are bound to implement this European Standard: Austria, Belgium, Bulgaria,

Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland,

Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, Netherlands, Norway, Poland, Portugal, Republic of

North Macedonia, Romania, Serbia, Slovakia, Slovenia, Spain, Sweden, Switzerland, Turkey and the

United Kingdom.
Endorsement notice

The text of ISO 80601-2-85:2021 has been approved by CEN as EN ISO 80601-2-85:2021 without any

modification.
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SIST EN ISO 80601-2-85:2021
---------------------- Page: 6 ----------------------
SIST EN ISO 80601-2-85:2021
INTERNATIONAL ISO
STANDARD 80601-2-85
First edition
2021-03
Medical electrical equipment —
Part 2-85:
Particular requirements for the basic
safety and essential performance of
cerebral tissue oximeter equipment
Appareils électromédicaux —
Partie 2-85: Exigences particulières pour la sécurité de base et les
performances essentielles des oxymètres pour tissu cérébral
Reference number
ISO 80601-2-85:2021(E)
ISO 2021
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SIST EN ISO 80601-2-85:2021
ISO 80601-2-85:2021(E)
COPYRIGHT PROTECTED DOCUMENT
© ISO 2021

All rights reserved. Unless otherwise specified, or required in the context of its implementation, no part of this publication may

be reproduced or utilized otherwise in any form or by any means, electronic or mechanical, including photocopying, or posting

on the internet or an intranet, without prior written permission. Permission can be requested from either ISO at the address

below or ISO’s member body in the country of the requester.
ISO copyright office
CP 401 • Ch. de Blandonnet 8
CH-1214 Vernier, Geneva
Phone: +41 22 749 01 11
Email: copyright@iso.org
Website: www.iso.org
Published in Switzerland
ii © ISO 2021 – All rights reserved
---------------------- Page: 8 ----------------------
SIST EN ISO 80601-2-85:2021
ISO 80601-2-85:2021(E)
Contents Page

Foreword ......................................................................................................................................................................... vi

Introduction .................................................................................................................................................................. vii

201.1 Scope, object and related standards .......................................................................................................... 1

201.1.1 * Scope ............................................................................................................................................................... 1

201.1.2 Object ................................................................................................................................................................. 2

201.1.3 Collateral standards ..................................................................................................................................... 2

201.1.4 Particular standards .................................................................................................................................... 3

201.2 Normative references ..................................................................................................................................... 4

201.3 Terms and definitions ..................................................................................................................................... 5

201.4 General requirements .................................................................................................................................. 10

201.4.3.101 * Additional requirements for essential performance ......................................................... 11

201.4.102 Additional requirements for acceptance criteria .................................................................... 11

201.4.103 Additional requirements for cerebral tissue oximeter equipment, parts and

accessories ....................................................................................................................................................... 11

201.5 General requirements for testing of ME equipment .......................................................................... 12

201.6 Classification of ME equipment and ME systems ................................................................................. 12

201.7 ME equipment identification, marking and documents ................................................................... 12

201.7.1.101 Information to be supplied by the manufacturer .................................................................... 12

201.7.2.3 Consult accompanying documents .................................................................................................... 12

201.7.2.9.101 IP classification ............................................................................................................................... 12

201.7.2.101 Additional requirements for marking on the outside of ME equipment parts ............ 13

201.7.4.3 Units of measurement ........................................................................................................................... 13

201.7.9.2 Instructions for use ................................................................................................................................ 13

201.7.9.2.1.101 Additional general requirements......................................................................................... 13

201.7.9.2.2.101 Additional requirements for warnings and safety notices ......................................... 15

201.7.9.2.9.101 Additional requirements for operating instructions .................................................... 15

201.7.9.2.14.101 Additional requirements for accessories, supplementary equipment, used

material ............................................................................................................................................................ 15

201.7.9.3.1.101 * Additional general requirements ...................................................................................... 16

201.8 Protection against electrical hazards from ME equipment ............................................................. 16

201.8.3.101 Additional requirements for classification of applied parts .............................................. 16

201.8.5.5.1.101 Defibrillation protection ........................................................................................................ 16

201.8.7.4.7.101 Additional requirements for measurement of the patient leakage current ........ 16

201.9 Protection against mechanical hazards of ME equipment and ME systems ............................... 17

201.10 Protection against unwanted and excessive radiation hazards ................................................ 17

201.10.4 Lasers ........................................................................................................................................................... 17

201.11 Protection against excessive temperatures and other hazards ................................................. 17

201.11.1.2.2 Applied parts not intended to supply heat to a patient ...................................................... 17

201.11.6.5.101 * Additional requirements for ingress of water or particulate matter into

the ME equipment or ME system............................................................................................................... 18

201.11.6.7 Sterilization of ME equipment or ME system ............................................................................... 18

201.11.8.101 Additional requirements for interruption of the power supply/supply mains

to ME equipment ............................................................................................................................................ 18

© ISO 2021 – All rights reserved iii
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SIST EN ISO 80601-2-85:2021
ISO 80601-2-85:2021(E)

201.11.8.101.1 Technical alarm condition for power supply failure ...................................................... 18

201.11.8.101.2 Settings and data storage following short interruptions or automatic

switchover ...................................................................................................................................................... 19

201.11.8.101.3 Operation following long interruptions ............................................................................. 19

201.12 Accuracy of controls and instruments and protection against hazardous outputs............ 19

201.12.1.101 * StO accuracy of cerebral tissue oximeter equipment ..................................................... 19

201.12.1.101.1 * Specification .............................................................................................................................. 19

201.12.1.101.2 * Data collection for determination of StO accuracy .................................................... 21

201.12.1.101.3 * Data analysis for determination of StO accuracy ........................................................ 22

201.12.1.101.4 Characteristics of the study used for determination of StO accuracy .................... 23

201.12.4 Protection against hazardous output .............................................................................................. 23

201.12.4.101 * Data update period ..................................................................................................................... 23

201.12.4.102 * Signal inadequacy ...................................................................................................................... 23

201.13 Hazardous situations and fault conditions for ME equipment .................................................... 24

201.13.101 Detection of probe faults and probe cable extender faults .................................................. 24

201.14 Programmable electrical medical systems (PEMS) .......................................................................... 24

201.15 Construction of ME equipment ............................................................................................................... 24

201.15.3.5.101 * Additional requirements for rough handling ................................................................ 25

201.15.3.5.101.1 * Shock and vibration (robustness) .................................................................................. 25

201.15.3.5.101.2 * Shock and vibration for a transit-operable cerebral tissue oximeter

during operation .......................................................................................................................................... 26

201.15.101 Mode of operation.............................................................................................................................. 27

201.16 ME systems..................................................................................................................................................... 27

201.17 Electromagnetic compatibility of ME equipment and ME systems............................................. 27

201.101 * Cerebral tissue oximeter probes and probe cable extenders ................................................... 27

201.101.1 General ..................................................................................................................................................... 27

201.101.2 Labelling .................................................................................................................................................. 28

201.102 Functional connection ............................................................................................................................. 28

201.102.1 General ..................................................................................................................................................... 28

201.102.2 * Connection to an electronic health record or integrated clinical environment .......... 28

201.102.3 Connection to a distributed alarm system ................................................................................... 28

202 Electromagnetic disturbances — Requirements and tests ................................................................ 29

202.4.3.1 Configurations ......................................................................................................................................... 29

202.5.2.2.1 Requirements applicable to all ME equipment and ME systems ........................................ 29

202.8.1.101 Additional general requirements ............................................................................................... 29

202.8.2 Patient physiological simulation .......................................................................................................... 29

206 Usability ........................................................................................................................................................... 30

208 General requirements, tests and guidance for alarm systems in medical electrical

equipment and medical electrical systems......................................................................................... 30

208.6.1.2.101 * Additional requirements for alarm condition priority ................................................. 30

208.6.5.4.101 * Additional requirements for default alarm preset ......................................................... 31

208.6.8.5.101 Additional requirements for alarm signal inactivation states, indication and

access ................................................................................................................................................................ 31

211 Requirements for medical electrical equipment and medical electrical systems used

in the home healthcare environment ................................................................................................... 31

212 Requirements for medical electrical equipment and medical electrical systems used

in the emergency medical services environment ............................................................................. 31

iv © ISO 2021 – All rights reserved
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SIST EN ISO 80601-2-85:2021
ISO 80601-2-85:2021(E)

Annex C (informative) Guide to marking and labelling requirements for ME equipment and

ME systems ....................................................................................................................................................... 32

Annex D (informative) Symbols on marking...................................................................................................... 36

Annex AA (informative) Particular guidance and rationale ........................................................................ 37

Annex BB (informative) Skin temperature at the cerebral tissue oximeter probe ............................... 48

Annex CC (informative) Determination of accuracy ....................................................................................... 50

Annex DD (informative) Characteristics of a tissue haemoglobin phantom for the verification

of the accuracy of cerebral tissue oximeter equipment .................................................................... 56

Annex EE (informative) Guideline for evaluating and documenting StO accuracy in human

subjects ............................................................................................................................................................. 66

Annex FF (informative) Functional testers for cerebral tissue oximeter equipment ............................ 72

Annex GG (informative) Concepts of ME equipment response time .......................................................... 75

Annex HH (normative) Data interface requirements ..................................................................................... 80

Annex II (informative) Comparison of methods of performance evaluation ......................................... 84

Annex JJ (informative) Reference to the IMDRF essential principles and labelling guidances ........ 89

Annex KK (informative) Reference to the essential principles .................................................................... 92

Annex LL (informative) Reference to the general safety and performance requirements ............... 95

Annex MM (informative) Terminology — alphabetized index of defined terms .................................. 98

Bibliography .............................................................................................................................................................. 102

© ISO 2021 – All rights reserved v
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SIST EN ISO 80601-2-85:2021
ISO 80601-2-85:2021(E)
Foreword

ISO (the International Organization for Standardization) is a worldwide federation of national

standards bodies (ISO member bodies). The work of preparing International Standards is normally

carried out through ISO technical committees. Each member body interested in a subject for which a

technical committee has been established has the right to be represented on that committee.

International organizations, governmental and non-governmental, in liaison with ISO, also take part in

the work. ISO collaborates closely with the International Electrotechnical Commission (IEC) on all

matters of electrotechnical standardization.

The procedures used to develop this document and those intended for its further maintenance are

described in the ISO/IEC Directives, Part 1. In particular, the different approval criteria needed for the

different types of ISO documents should be noted. This document was drafted in accordance with the

editorial rules of the ISO/IEC Directives, Part 2 (see www.iso.org/directives).

Attention is drawn to the possibility that some of the elements of this document may be the subject of

patent rights. ISO shall not be held responsible for identifying any or all such patent rights. Details of

any patent rights identified during the development of the document will be in the Introduction and/or

on the ISO list of patent declarations received (see www.iso.org/patents).

Any trade name used in this document is information given for the convenience of users and does not

constitute an endorsement.

For an explanation of the voluntary nature of standards, the meaning of ISO specific terms and

expressions related to conformity assessment, as well as information about ISO's adherence to the

World Trade Organization (WTO) principles in the Technical Barriers to Trade (TBT), see

www.iso.org/iso/foreword.html.

This document was prepared jointly by Technical Committee ISO/TC 121, Anaesthetic and respiratory

equipment, Subcommittee SC 3, Respiratory devices and related equipment used for patient care, and

Technical Committee IEC/TC 62, Electrical equipment in medical practice, Subcommittee 62D,

Electromedical equipment, in collaboration with the European Committee for Standardization (CEN)

Technical Committee CEN/TC 215, Respiratory and anaesthetic equipment, in accordance with the

Agreement on technical cooperation between ISO and CEN (Vienna Agreement).

A list of all parts in the ISO and IEC 80601 series can be found on the ISO and IEC websites.

Any feedback or questions on this document should be directed to the user’s national standards body. A

complete listing of these bodies can be found at www.iso.org/members.html.
vi © ISO 2021 – All rights reserved
---------------------- Page: 12 ----------------------
SIST EN ISO 80601-2-85:2021
ISO 80601-2-85:2021(E)
Introduction

The estimation of blood oxygen saturation in the brain tissue by cerebral tissue oximetry equipment is

increasingly used in many areas of medicine. This document covers basic safety and essential

performance requirements achievable within the limits of existing technology.

Annex AA contains a rationale for some of the requirements. It is included to provide additional insight

into the reasoning of the committees that led to a requirement and into the hazards that the

requirement addresses.

Annex BB is a literature review and provides recommendations relevant to determining the maximum

safe temperature of the interface between a cerebral tissue oximeter probe and a patient's tissue.

Annex CC discusses both the formulae used to evaluate the StO accuracy of cerebral tissue oximeter

equipment measurements, and the names that are assigned to those formulae.

Annex DD presents guidance on using in-vitro methods (phantoms) for verification of StO accuracy of

cerebral tissue oximeter equipment.

Annex EE presents a guideline for an in-vivo (human subjects) controlled desaturation study for the

verification of StO accuracy of cerebral tissue oximeter equipment.

Annex FF is a description of functional testers for use with cerebral tissue oximeter equipment.

Annex GG describes concepts of cerebral tissue oximeter equipment response time.
Annex HH describes data interface requirements.

Annex II is a comparison between human desaturations (in-vivo) and tissue haemoglobin phantom

desaturations (in-vitro) for assessing StO accuracy.
In this document, the following print types are used:
— requirements and definitions: roman type;

— Instructions, test specifications and terms defined in Clause 3 of the general standard, in this document

or as noted: italic type;

— informative material appearing outside of tables, such as notes, examples and references: in smaller

type; normative text of tables is also in a smaller type.
In referring to the structure of this document, the term

— “clause” means one of the numbered divisions within the table of contents, inclusive of all

subdivisions (e.g. Clause 201.7 includes subclauses 201.7.1, 201.7.2) and

— “subclause” means a numbered subdivision of a clause (e.g. 201.7.1, 7.2 and 201.7.2.1 are all

subclauses of Clause 201.7).

References to clauses within this document are preceded by the term “Clause” followed by the clause

number. References to subclauses within this document are by number only.
© ISO 2021 – All rights reserved vii
---------------------- Page: 13 ----------------------
SIST EN ISO 80601-2-85:2021
ISO 80601-2-85:2021(E)

In this document, the conjunctive “or” is used as an “inclusive or” so a statement is true if any

combination of the conditions is true.
For the purposes of this document, the auxiliary verb:

— “shall” means that conformance with a requirement or a test is mandatory for conformance with

this document;

— “should” means that conformance with a requirement or a test is recommended but is not

mandatory for conformance with this document; and

— “may” is used to describe permission (e.g. a permissible way to achieve conformance with a

requirement or test);
— "can" is used to describe a possibility or capability; and
— "must" is used to express an external constraint.

Annex C contains a guide to the marking and labelling requirements in this document.

Annex D contains a summary of the symbols referenced in this document.

An asterisk (*) as the first character of a title or at the beginning of a paragraph or table title indicates

that there is guidance or rationale related to that item in AA.
viii © ISO 2021 – All rights reserved
---------------------- Page: 14 ----------------------
SIST EN ISO 80601-2-85:2021
INTERNATIONAL STANDARD ISO 80601-2-85:2021(E)
Medical electrical equipment —
Part 2-85:
Particular requirements for the basic safety and essential
performance of cerebral tissue oximeter equipment
201.1 Scope, object and related standards
Clause 1 of the general standard applies, except as follows.
NOTE The general standard is IEC 60601-1:2005+AMD1:2012+AMD2:2020.
201.1.1 * Scope
Replacement:

This document applies to basic safety and essential performance of cerebral tissue oximeter equipment,

that employs light at multiple wavelengths to derive a quantitative measure of oxygen saturation of

haemoglobin within the volume of tissue sampled under the probe attached to the head. The cerebral

tissue oximeter equipment can be based on continuous light, frequency domain or time domain

technologies. This document applies to ME equipment used in a hospital environment as well as when

used outside the hospital environment, such as in ambulances and air transport. Additional standards

may apply to ME equipment for those environments of use.

NOTE 1 Cerebral tissue oximeters are sometimes referred to as near infrared spectroscopy equipment in medical

literature.
Not included within the scope of this document
...

SLOVENSKI STANDARD
oSIST prEN ISO 80601-2-85:2020
01-maj-2020
Medicinska električna oprema - 2-85. del: Posebne zahteve za osnovno varnost in
bistvene lastnosti opreme za cerebralno oksimetrijo (ISO/DIS 80601-2-85:2020)

Medical electrical equipment - Part 2-85: Particular requirements for basic safety and

essential performance of cerebral tissue oximeter equipment (ISO/DIS 80601-2-85:2020)

Medizinische elektrische Geräte - Teil 2-85: Besondere Anforderungen für die Sicherheit

einschließlich der wesentlichen Leistungsmerkmale von Geräten für die zerebrale
Oxymetrie (ISO/DIS 80601-2-85:2020)

Appareils électromédicaux - Partie 2-85: Exigences particulières pour la sécurité de base

et les performances essentielles des oxymètres pour tissu cérébral (ISO/DIS 80601-2-

85:2020)
Ta slovenski standard je istoveten z: prEN ISO 80601-2-85
ICS:
11.040.10 Anestezijska, respiratorna in Anaesthetic, respiratory and
reanimacijska oprema reanimation equipment
oSIST prEN ISO 80601-2-85:2020 en

2003-01.Slovenski inštitut za standardizacijo. Razmnoževanje celote ali delov tega standarda ni dovoljeno.

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oSIST prEN ISO 80601-2-85:2020
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oSIST prEN ISO 80601-2-85:2020
DRAFT INTERNATIONAL STANDARD
ISO/DIS 80601-2-85
ISO/TC 121/SC 3 Secretariat: ANSI
Voting begins on: Voting terminates on:
2020-03-09 2020-06-01
Medical electrical equipment —
Part 2-85:
Particular requirements for basic safety and essential
performance of cerebral tissue oximeter equipment
ICS: 11.040.10
This document is circulated as received from the committee secretariat.
THIS DOCUMENT IS A DRAFT CIRCULATED
This draft is submitted to a parallel vote in ISO and in IEC.
FOR COMMENT AND APPROVAL. IT IS
THEREFORE SUBJECT TO CHANGE AND MAY
NOT BE REFERRED TO AS AN INTERNATIONAL
STANDARD UNTIL PUBLISHED AS SUCH.
IN ADDITION TO THEIR EVALUATION AS
ISO/CEN PARALLEL PROCESSING
BEING ACCEPTABLE FOR INDUSTRIAL,
TECHNOLOGICAL, COMMERCIAL AND
USER PURPOSES, DRAFT INTERNATIONAL
STANDARDS MAY ON OCCASION HAVE TO
BE CONSIDERED IN THE LIGHT OF THEIR
POTENTIAL TO BECOME STANDARDS TO
WHICH REFERENCE MAY BE MADE IN
Reference number
NATIONAL REGULATIONS.
ISO/DIS 80601-2-85:2020(E)
RECIPIENTS OF THIS DRAFT ARE INVITED
TO SUBMIT, WITH THEIR COMMENTS,
NOTIFICATION OF ANY RELEVANT PATENT
RIGHTS OF WHICH THEY ARE AWARE AND TO
PROVIDE SUPPORTING DOCUMENTATION. ISO 2020
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oSIST prEN ISO 80601-2-85:2020
ISO/DIS 80601-2-85:2020(E)
COPYRIGHT PROTECTED DOCUMENT
© ISO 2020

All rights reserved. Unless otherwise specified, or required in the context of its implementation, no part of this publication may

be reproduced or utilized otherwise in any form or by any means, electronic or mechanical, including photocopying, or posting

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36 CONTENTS

37 201.1 Scope, object and related standards ....................................................................................... 1

38 201.2 Normative references .................................................................................................................. 3

39 201.3 Terms and definitions .................................................................................................................. 5

40 201.4 General requirements .............................................................................................................. 10

41 201.5 General requirements for testing of ME equipment ....................................................... 12

42 201.6 Classification of ME equipment and ME systems .............................................................. 12

43 201.7 ME equipment identification, marking and documents ................................................ 12

44 201.8 Protection against electrical hazards from ME equipment .......................................... 16

45 201.9 Protection against mechanical hazards of ME equipment and ME systems ........... 17

46 201.10 Protection against unwanted and excessive radiation hazards ................................ 17

47 201.11 Protection against excessive temperatures and other hazards ................................ 17

48 201.12 Accuracy of controls and instruments and protection against hazardous outputs

49 ........................................................................................................................................................... 21

50 201.13 Hazardous situations and fault conditions for ME equipment .................................... 25

51 201.14 Programmable electrical medical systems (PEMS) ......................................................... 26

52 201.15 Construction of ME equipment ............................................................................................... 26

53 201.16 ME systems .................................................................................................................................... 28

54 201.17 Electromagnetic compatibility of ME equipment and ME systems ............................ 28

55 201.101 Cerebral tissue oximeter probes and probe cable extenders ........................................ 28

56 201.102 Functional connection................................................................................................................ 29

57 202 Electromagnetic disturbances – Requirements and tests ........................................... 29

58 206 Usability ......................................................................................................................................... 31

59 208 General requirements, tests and guidance for alarm systems in medical

60 electrical equipment and medical electrical systems ................................................... 31

61 211 Requirements for medical electrical equipment and medical

62 electrical systems used in the home healthcare environment .................................. 32

63 212 Requirements for medical electrical equipment and medical

64 electrical systems used in the emergency medical services environment ............ 32

65 Annex C (informative) Guide to marking and labelling requirements for

66 ME equipment and ME systems ............................................................................................... 33

67 Annex D (informative) Symbols on marking ......................................................................................... 37

68 Annex AA (informative) Particular guidance and rationale ............................................................ 39

69 Annex BB (informative) Skin temperature at the cerebral tissue oximeter probe ................... 50

70 Annex CC (informative) Determination of accuracy ........................................................................... 52

71 Annex DD (informative) Characteristics of a tissue haemoglobin phantom for the

72 verification of the accuracy of cerebral tissue oximeter equipment .......................... 58

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73 Annex EE (informative) Guideline for evaluating and documenting StO accuracy

74 in human subjects .......................................................................................................................68

75 Annex FF (informative) Functional testers for cerebral tissue oximeter equipment ................74

76 Annex GG (informative) Concepts of ME equipment response time ...............................................78

77 Annex HH (normative) Data interface requirements..........................................................................83

78 Annex II (informative) Comparison of methods of performance evaluation .............................87

79 Annex JJ (informative) Reference to the essential principles ...........................................................92

80 Annex KK (informative) Terminology — alphabetized index of defined terms ........................96

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83 Foreword

84 ISO (the International Organization for Standardization) is a worldwide federation of national standards

85 bodies (ISO member bodies). The work of preparing International Standards is normally carried out

86 through ISO technical committees. Each member body interested in a subject for which a technical

87 committee has been established has the right to be represented on that committee. International

88 organizations, governmental and non-governmental, in liaison with ISO, also take part in the work. ISO

89 collaborates closely with the International Electrotechnical Commission (IEC) on all matters of

90 electrotechnical standardization.

91 The procedures used to develop this document and those intended for its further maintenance are

92 described in the ISO/IEC Directives, Part 1. In particular, the different approval criteria needed for the

93 different types of ISO documents should be noted. This document was drafted in accordance with the

94 editorial rules of the ISO/IEC Directives, Part 2 (see www.iso.org/directives).

95 Attention is drawn to the possibility that some of the elements of this document may be the subject of

96 patent rights. ISO shall not be held responsible for identifying any or all such patent rights. Details of any

97 patent rights identified during the development of the document will be in the Introduction and/or on

98 the ISO list of patent declarations received (see www.iso.org/patents).

99 Any trade name used in this document is information given for the convenience of users and does not

100 constitute an endorsement.

101 For an explanation on the voluntary nature of standards, the meaning of ISO specific terms and

102 expressions related to conformity assessment, as well as information about ISO's adherence to the World

103 Trade Organization (WTO) principles in the Technical Barriers to Trade (TBT) see the following URL:

104 www.iso.org/iso/foreword.html.

105 This document was prepared jointly by Technical Committee ISO/TC 121, Anaesthetic and respiratory

106 equipment, Subcommittee SC 3, Respiratory devices and related equipment used for patient care, and

107 Technical Committee IEC/TC 62, Electrical equipment in medical practice, Subcommittee SC 62D,

108 Electromedical equipment. The draft was circulated for voting to the national bodies of both ISO and IEC.

109 This first edition of ISO 80601-2-85 includes an alignment with Amendment 1 of both the third edition of

110 IEC 60601-1 and the second edition of IEC 60601-1-8, as well as the fourth edition of IEC 60601-1-2, the

111 third edition of IEC 60601-1-6, the second edition of IEC 60601-1-11 and IEC 60601-1-12.

112 A list of all the parts of the ISO/IEC 80601 series is available on the ISO website.

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113 Introduction

114 The approximation of cerebral tissue oximetry is increasingly used in many areas of medicine. This

115 document covers basic safety and essential performance requirements achievable within the limits of

116 existing technology.

117 Annex AA contains a rationale for some of the requirements. It is included to provide additional insight

118 into the reasoning of the committees that led to a requirement and identifying the hazards that the

119 requirement addresses.

120 Annex BB is a literature survey relevant to the determination of the maximum safe temperature of the

121 interface between a cerebral tissue oximeter probe and a patient's tissue.

122 Annex CC discusses both the formulae used to evaluate the StO accuracy of cerebral tissue oximeter

123 equipment measurements, and the names that are assigned to those formulae.

124 Annex DD presents guidance on using in-vitro methods for assessing the performance of cerebral tissue

125 oximeter equipment.

126 Annex EE presents a guideline for a controlled desaturation study for the verification of cerebral tissue

127 oximeter equipment.

128 Annex FF is a description of functional testers for use with cerebral tissue oximeter equipment.

129 Annex GG describes concepts of cerebral tissue oximeter equipment response time.

130 Annex HH describes data interface requirements.

131 Annex II is a comparison between human desaturations (in-vivo) and tissue haemoglobin phantom

132 desaturations (in-vitro) for assessing StO accuracy.
133 Annex JJ contains Reference to the essential principles.

134 This publication has been drafted in accordance with the ISO/IEC Directives, Part 2.

135 In this document, the following print types are used:
136 – requirements and definitions: roman type;

137 – Instructions, test specifications and terms defined in Clause 3 of the general standard, in this document

138 or as noted: italic type;

139 – informative material appearing outside of tables, such as notes, examples and references: in smaller

140 type; normative text of tables is also in a smaller type;
141 In referring to the structure of this document, the term

142 – “clause” means one of the numbered divisions within the table of contents, inclusive of all

143 subdivisions (e.g. Clause 201.7 includes subclauses 201.7.1, 201.7.2) and

144 – “subclause” means a numbered subdivision of a clause (e.g. 201.7.1, 7.2 and 201.7.2.1 are all

145 subclauses of Clause 201.7).
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146 References to clauses within this document are preceded by the term “Clause” followed by the clause

147 number. References to subclauses within this document are by number only.

148 In this document, the conjunctive “or” is used as an “inclusive or” so a statement is true if any combination

149 of the conditions is true.

150 The verbal forms used in this document conform to usage described in Annex H of the ISO/IEC Directives,

151 Part 2. For the purposes of this document, the auxiliary verb:

152 – “shall” means that compliance with a requirement or a test is mandatory for compliance with this

153 document;

154 – “should” means that compliance with a requirement or a test is recommended but is not mandatory

155 for compliance with this document; and

156 – “may” is used to describe permission (e.g. a permissible way to achieve compliance with a

157 requirement or test);
158 – "can" is used to describe a possibility or capability; and
159 – "must" is used to express an external constraint.

160 An asterisk (*) as the first character of a title or at the beginning of a paragraph or table title indicates

161 that there is guidance or rationale related to that item in AA.
162
163
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164 Medical electrical equipment — Part 2-85: Particular
165 requirements for basic safety and essential performance of
166 cerebral tissue oximeter equipment
167 201.1 Scope, object and related standards
168 Clause 1 of the general standard applies, except as follows:
169 201.1.1 * Scope
170 Replacement:

171 This document applies to basic safety and essential performance of cerebral tissue oximeter equipment,

172 that employs light at multiple wavelengths to derive a quantitative measure of oxygen saturation of

173 haemoglobin within the volume of tissue sampled under the probe attached to the head. The cerebral

174 tissue oximeter equipment can be based on continuous light, frequency domain or time domain

175 technologies. This document applies to ME equipment used in a hospital environment as well as when

176 used outside the hospital environment, such as in ambulances and air transport. Additional standards

177 may apply to ME equipment for those environments of use.

178 NOTE 1 Cerebral tissue oximeters are sometimes referred to as near infrared spectroscopy equipment in medical

179 literature.
180 Not included within the scope of this document are:
181 ⎯ invasive tissue or vascular oximeters;
182 ⎯ oximeters that require a blood sample from the patient;
183 ⎯ equipment measuring dissolved oxygen;

184 ⎯ ME equipment, or part thereof, that measures path-length-dependent haemoglobin change. The

[2]

185 requirements for functional near-infrared spectroscopy equipment are found in ISO 80601-2-71 ;

186 ⎯ ME equipment, or part thereof, that measures arterial saturation based on pulsatile changes in tissue

187 optical properties (SpO ). The requirements for pulse oximeter equipment are found in

[2]
188 ISO 80601-2-61 ;

189 ⎯ ME equipment, or part thereof, that claims to monitor tissue in other parts of the body other than the

190 head.

191 These requirements also apply to cerebral tissue oximeter equipment, including cerebral tissue oximeter

192 monitors, cerebral tissue oximeter probes and probe cable extenders, which have been remanufactured.

193 If a clause or subclause is specifically intended to be applicable to ME equipment only, or to ME systems

194 only, the title and content of that clause or subclause will say so. If that is not the case, the clause or

195 subclause applies both to ME equipment and to ME systems, as relevant.
The general standard is IEC 60601-1:2005+AMD1:2012.
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196 Hazards inherent in the intended physiological function of ME equipment or ME systems within the scope

197 of this document are not covered by specific requirements in this document except in 201.11 and in

198 201.7.2.13 and 201.8.4.1 of the general standard.

199 NOTE 2 See also 4.2 of the general standard. “The general standard” is IEC 60601-1:2005+AMD1:2012, Medical

200 electrical equipment – Part 1: General requirements for basic safety and essential performance.

201 This document can also be applied to ME equipment and their accessories used for compensation or

202 alleviation of disease, injury or disability.

203 This document is not applicable to remote or slave (secondary) equipment that displays StO values that

204 are located outside of the patient environment.

205 NOTE 3 ME equipment that provides selection between diagnostic and monitoring functions is expected to meet

206 the requirements of the appropriate document when configured for that function.

207 This document is a particular standard in the IEC 60601-1 and ISO/IEC 80601 series of standards.

208 201.1.2 Object
209 Replacement:

210 The object of this document is to establish particular basic safety and essential performance requirements

211 for cerebral tissue oximeter equipment [as defined in 201.3.202] and its accessories.

212 NOTE Accessories are included because the combination of the cerebral tissue oximeter monitor and the

213 accessories needs to be adequately safe. Accessories can have a significant impact on the basic safety or essential

214 performance of cerebral tissue oximeter equipment.
215 201.1.3 Collateral standards
216 Amendment (add after existing text):

217 This document refers to those applicable collateral standards that are listed in Clause 2 of the general

218 standard and Clause 201.2 of this document.

219 IEC 60601-1-2, IEC 60601-1-6, IEC 60601-1-8, IEC 60601-1-11 and IEC 60601-1-12 apply as modified in

[4]

220 Clauses 202, 206, 208, 211 and 212 respectively. IEC 60601-1-3 does not apply. All other published

221 collateral standards in the IEC 60601-1 series apply as published.
222 201.1.4 Particular standards
223 Replacement:

224 In the IEC 60601 series, particular standards may modify, replace or delete requirements contained in

225 the general standard, including the collateral standards, as appropriate for the particular ME equipment

226 under consideration, and may add other basic safety or essential performance requirements.

227 A requirement of a particular standard takes priority over the general standard or the collateral

228 standards.

229 For brevity, IEC 60601-1:2005+AMD1:2012 is referred to in this document as the general standard.

230 Collateral standards are referred to by their document number.

231 The numbering of clauses and subclauses of this document corresponds to those of the general standard

232 with the prefix “201” (e.g. 201.1 in this document addresses the content of Clause 1 of the general

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233 standard) or applicable collateral standard with the prefix “2xx” where xx is the final digits of the

234 collateral standard document number (e.g. 202.4 in this document addresses the content of Clause 4 of

235 the IEC 60601-1-2 collateral standard, 208.4 in this document addresses the content of Clause 4 of the

236 IEC 60601-1-8 collateral standard, etc.). The changes to the text of the general standard are specified by

237 the use of the following words:

238 "Replacement" means that the clause or subclause of the general standard or applicable collateral

239 standard is replaced completely by the text of this document.

240 "Addition" means that the text of this document is additional to the requirements of the general standard

241 or applicable collateral standard.

242 "Amendment" means that the clause or subclause of the general standard or applicable collateral

243 standard is amended as indicated by the text of this document.

244 Subclauses or figures that are additional to those of the general standard are numbered starting from

245 201.101, additional annexes are lettered AA, BB, etc., and additional items aa), bb), etc.

246 Subclauses or figures that are additional to those of a collateral standard are numbered starting from 2xx,

247 where “x” is the number of the collateral standard, e.g. 202 for IEC 60601-1-2, 203 for IEC 60601-1-3, etc.

248 The term "this document" is used to make reference to the general standard, any applicable collateral

249 standards and this particular document taken together.

250 Where there is no corresponding clause or subclause in this document, the section, clause or subclause

251 of the general standard or applicable collateral standard, although possibly not relevant, applies without

252 modification; where it is intended that any part of the general standard or applicable collateral standard,

253 although possibly relevant, is not to be applied, a statement to that effect is given in this particular

254 document.
255 201.2 Normative references

256 The following documents are referred to in the text in such a way that some or all of their content

257 constitutes requirements of this document. For dated references, only the edition cited applies. For

258 undated references, the latest edition of the referenced document (including any amendments) applies.

259 NOTE 1 The way in which these referenced documents are cited in normative requirements determines the extent

260 (in whole or in part) to which they apply.
261 NOTE 2 Informative references are listed in the Bibliography.
262 Clause 2 of the general standard applies, except as follows:
263 Replacement:
264 ISO 7000:2019, Graphical symbols for use on equipment — Registered symbols

265 ISO 7010:2019, Graphical symbols — Safety colours and safety signs — Registered safety signs

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266 ISO 15223-1:— , Medical devices — Symbols to be used with medical device labels, labelling and

267 information to be supplied — Part 1: General requirements
268 IEC 60529:2013, Degrees of protection provided by enclosures (IP code)

269 IEC 60601-1-2:2014, Medical electrical equipment — Part 1-2: General requirements for basic safety and

270 essential performance — Collateral Standard: Electromagnetic disturbances — Requirements and tests

271 IEC 60601-1-6:2010+AMD1:2013, Medical electrical equipment — Part 1-6: General requirements for

272 basic safety and essential performance —Collateral standard: Usability

273 IEC 60601-1-8:2006+AMD1:2012, Medical electrical equipment — Part 1-8: General requirements for

274 basic safety and essential performance — Collateral Standard: General requirements, tests and guidance for

275 alarm systems in medical electrical equipment and medical electrical systems

276 IEC 60825-1:2014, Safety of laser products - Part 1: Equipment classification and requirements

277 Addition:

278 ISO 14155:2011, Clinical investigation of medical devices for human subjects — Good clinical practice

279 ISO 14937:2009, Sterilization of health care products — General requirements for characterization of a

280 sterilizing agent and the development, validation and routine control of a sterilization process for medical

281 devices

282 ISO 16142-1:2016, Medical devices — Recognized essential principles of safety and performance of medical

283 devices — Part 1: General essential principles and additional specific essential principles for all non-IVD

284 medical devices and guidance on the selection of standards

285 ISO 17664:2017, Processing of health care products — Information to be provided by the medical device

286 manufacturer for the processing of medical devices

287 IEC 60068-2-27:2008+AMD1:2013, Environmental testing — Part 2-27: Tests — Test Ea and guidance:

288 Shock

289 IEC 60068-2-31:2008, Environmental testing — Part 2-31: Tests — Test Ec: Rough handling shocks,

290 primarily for equipment-type specimens

291 IEC 60068-2-64:2008, Environmental testing — Part 2-64: Tests — Test Fh: Vibration, broadband random

292 and guidance

293 IEC 60601-1-11:2015, Medical electrical equipment — Part 1-11: General requirements for basic safety and

294 essential performance — Collateral Standard: Requirements for medical electrical equipment and medical

295 electrical systems used in the home healthcare environment

296 IEC 60601-1-12:2014, Medical electrical equipment — Part 1-12: General requirements for basic safety and

297 essential performance — Collateral Standard: Requirements for medical electrical equipment and medical

298 electrical systems used in the emergency medical services environment
Under preparation. Stage at the time of publication: ISO DIS 15223-1:2020.
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299 IEC 62366-1:2015, Medical devices — Part 1: Application of usability engineering to medical devices

300 IEC 60601-2-2:2009, Medical electrical equipment - Part 2-2: Particular requirements for the basic safety

301 and essential performance of high frequency surgical equipment and high frequency surgical accessories

302 IEC 62471:2006, Photobiological safety of lamps and lamp systems

303 AAMI 2700-1:2019 (formerly ASTM F2761-09), Medical devices and medical systems — Essential safety

304 requirements for equipment comprising the patient-centric integrated clinical environment (ICE) — Part 1:

305 General requirements and conceptual model
306 201.3 Terms and definitions

307 For the purposes of this document, the terms and definitions given in ISO 16142-1:2016, ISO 17664:2017,

308 IEC 60601-1:2005+AMD 1:2012, IEC 60601-1-2:2014, IEC 60601-1-6:2010+AMD 1:2013,

309 IEC 60601-1-8:2006+AMD 1:2012, IEC 60601-1-11:2015, IEC 60601-1-12:2014, IEC 62366-1:2015,

310 IEC 60601-2-2:2009, AAMI 2700-1:2019 and the following apply.

311 ISO and IEC maintain terminological databases for use in standardization at the following addresses:

312 – IEC Electropedia: available at http://www.electropedia.org/
313 – ISO Online browsing platform: available at http://www.iso.org/obp
314 NOTE An alphabetized index of defined terms is found in Annex KK.
315 201.3.201
316 accuracy
317 A
rms
318 closeness of agreement between a test result and the true value

319 Note 1 to entry: 201.12.1.101.2 contains methods for estimating the StO2 accuracy of cerebral tissue oximeter

320 equipment.

321 Note 2 to entry: Additional information is found in Annexes CC, DD, EE and II.

322 Note 3 to entry: In this document, accuracy (A ) is stated in terms of the root mean square difference. See

rms
323 201.12.1.101.3.
[5]
324 [SOURCE: ISO 3534-2:2006 3.3.1, modified, with Notes to entry replaced]
325 201.3.202
326 cerebral tissue oximeter
327 cerebral tissue oximeter equipment

328 ME equipment for the noninvasive estimation of functional oxygen saturation of haemoglobin in cerebral

329 tissue below the probe (StO or rSO ), based on light interacting with tissue
2 2
330 N
...

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