The US Food and Drug Administration regulates the import of medical devices into the US to ensure compliance. Foreign manufacturers must register, list their devices, have a quality system, submit premarket notifications or approvals, and comply with labeling, reporting, and other requirements. They must also designate a US agent and are subject to FDA enforcement. Imported radiation devices have additional radiation safety standards. All imports must also meet Customs and Border Protection requirements to clear customs, or they may be detained. Companies importing without understanding the full process risk financial penalties.