(80 days)
The Monaco system is used to create treatment plans for any cancer patient for whom external beam intensity modulated radiation therapy (IMRT) has been prescribed. The system will calculate and display, both on-screen and in hard-copy, either two- or three-dimensional radiation dose distributions within a patient for a given treatment plan set-up.
The Monaco product line is intended for use in radiation treatment planning using generally accepted methods for contouring, image manipulation, simulation, image fusion, plan optimization and QA and plan review.
Monaco uses local biological measures for optimization to create intensity modulated radiation therapy (IMRT) plans using Multileaf Collimators.
The provided text describes the Monaco RTP System, a radiation treatment planning system, and its non-clinical testing for substantial equivalence. It does not contain information about clinical trials or the specific acceptance criteria and performance metrics typically found in studies involving AI performance for diagnosis or image interpretation.
Based on the provided text, here is an analysis of the acceptance criteria and study information:
1. Table of Acceptance Criteria and Reported Device Performance:
The document does not provide a table with specific quantitative acceptance criteria or detailed performance metrics. Instead, it states:
| Acceptance Criteria Category | Reported Device Performance |
|---|---|
| Verification Testing | "The verification testing performed on Monaco incorporated the same pass/fail criteria and the same algorithm accuracy requirements as those used to evaluate the XiO RTP System and the Focal Workstation." |
| Algorithm Testing | "Monaco successfully passed both verification and algorithm testing." |
| Clinical Use Fitness | "Monaco was deemed fit for clinical use." |
2. Sample Sizes Used for Test Set and Data Provenance:
The document explicitly states that clinical trials were not performed. Therefore, there isn't a "test set" in the traditional sense involving patient data for an effectiveness study.
- Test Set Sample Size: Not applicable, as no clinical test set was used for effectiveness.
- Data Provenance: Not applicable for effectiveness testing. However, for "On-site validation testing," it mentions "a small group of customers, using actual patient data." The origin of this patient data (country, retrospective/prospective) is not specified. This validation was not a formal clinical trial for effectiveness.
3. Number of Experts and Qualifications for Ground Truth:
- Number of Experts: Not specified.
- Qualifications of Experts: For the "on-site validation testing," it mentions "qualified clinicians" who review and approve plans and "a small group of customers." Specific qualifications (e.g., radiologist with X years of experience) are not provided. The document highlights that "qualified clinicians" review plans and may subject them to quality assurance before treatment, implying their role in validating the plans generated by the system.
4. Adjudication Method for Test Set:
Not applicable, as no formal clinical test set or adjudication process for a diagnostic outcome was performed. The document mentions "qualified clinicians" review and approve plans, but this isn't an adjudication method for a test set in the context of an effectiveness study.
5. Multi-Reader Multi-Case (MRMC) Comparative Effectiveness Study:
No. The document explicitly states: "Clinical trials were not performed as part of the development of this feature." Therefore, an MRMC comparative effectiveness study was not conducted.
6. Standalone (Algorithm Only) Performance Study:
Yes, in a non-clinical context. The document refers to "Verification tests, including algorithm test cases," and "algorithm accuracy requirements." It states that "Monaco successfully passed both verification and algorithm testing," suggesting a standalone evaluation of the algorithms.
7. Type of Ground Truth Used:
For the non-clinical "verification tests" and "algorithm test cases," the ground truth would likely be established through:
- Pre-defined Pass/Fail Criteria: These would be based on engineering specifications and expected output from the algorithms.
- Comparison to Known Analytical Solutions/Benchmarks: For specific algorithm calculations (e.g., dose distribution), "ground truth" would be established by comparing the software's output to mathematically derived solutions or outputs from trusted reference calculators.
- Outputs from Predicate Devices: The text mentions "the same algorithm accuracy requirements as those used to evaluate the XiO RTP System and the Focal Workstation," implying that the performance of predicate devices might serve as a benchmark or a form of 'ground truth' for comparison during testing.
For the "on-site validation testing using actual patient data," the "ground truth" for clinical fitness would likely involve:
- Clinical Acceptability: Expert opinion from the "small group of customers" (clinicians) on whether the generated plans were clinically appropriate and safe.
- Quality Assurance (QA) Practices: Comparison against established QA standards for radiation oncology treatment plans.
8. Sample Size for the Training Set:
Not specified. The document does not provide details on the training methodology or the datasets used to develop the algorithms within the Monaco RTP System.
9. How Ground Truth for Training Set Was Established:
Not specified. Since details about the training set are not provided, how its ground truth was established is also not mentioned.
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| K07193pg. 1 | ||
|---|---|---|
| 510(k) Summary of Safety & Efficacy & Level of Concern StatementMonaco 510(k) | ||
| Submitter Name: | Computerized Medical Systems, Inc. | |
| Submitter Address: | 1145 Corporate Lake DriveSt. Louis, MO 63132-1716 | OCT 1 2007 |
| Submitter Phone: | 314 993 0003 | |
| Submitter Fax: | 314 993 0075 | |
| Contact Person: | Kathryn Stinson - Regulatory Affairs Associate orMichael A. Parsons - Director - Regulatory Affairs | |
| Date Summary Prepared: | July 12, 2007 | |
| Device Trade Name: | Monaco RTP System | |
| Device Common Name: | Radiation Treatment Planning System | |
| Device Classification: | Medical charged-particle radiation therapy systemper 21CFR892.5050 | |
| Substantial Equivalence: | Pinnacle 3 RTP System (K041577); XiO RTP System (K032762);Focal Workstation (K013112);Peregrine RTP System (K993675);Nulcetron Oncentra Masterplan (K031349) |
Level of Concern & Rationale*: Major
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*Per FDA document "Guidance for the Content of Premarket Submissions for Software Contained in Medical Devices," issued May 11, 2005.
4b of Table 1, "Does the Software Device control the delivery of potentially harmful energy that could result in death or serious injury, such as radiation treatment systems ... " Monaco does not directly control the linear accelerator that delivers the radiation. Once completed, plans are reviewed and approved by qualified clinicians and may be subject to quality assurance practices before treatment actually takes place. There is no automatic link between the Monaco software and the linear accelerator. However, should a flaw in the treatment plan escape the notice of the qualified professionals using the Monaco system, serious injury or death could result. Therefore, we believe Monaco to be of major level of concern.
Monaco RTP System 510(k) Computerized Medical Systems, Inc.
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K071438
pg 2 of 2
Device Description: Monaco uses local biological measures for optimization to create intensity modulated radiation therapy (IMRT) plans using Multileaf Collimators.
Device Intended Use: The Monaco system is used to create treatment plans for any cancer patient for whom external beam intensity modulated radiation therapy (IMRT) has been prescribed. The system will calculate and display, both on-screen and in hard-copy, either two- or three-dimensional radiation dose distributions within a patient for a given treatment plan set-up.
The Monaco product line is intended for use in radiation treatment planning using generally accepted methods for contouring, image manipulation, simulation, image fusion, plan optimization and QA and plan review.
Summary of Technological Characteristics Compared to Predicate Devices: Like Pinnacle, Monaco uses biological-based optimization in addition to dose-to-volume optimization and supports MLCs. The Monaco system also includes all functionality found in our Focal Workstation, which is used as an accessory to RTP systems and includes CT simulation and image fusion capabilities. Monaco uses Monte Carlo and Pencil Beam algorithms like those used in the predicate devices. The primary distinguishing characteristic of Monaco is that it is limited to IMRT planning using MLCs.
The verification testing performed on Monaco incorporated the same pass/fail criteria and the same algorithm accuracy requirements as those used to evaluate the XiO RTP System and the Focal Workstation.
A detailed comparison can be found in section 12 of this submittal.
Summary of Clinical Testing: Clinical trials were not performed as part of the development of this feature. Clinical testing is not advantageous in demonstrating substantial equivalence or safety and effectiveness of the device since measured data can be used for testing such that no human subjects are exposed to risk. Clinically oriented validation test cases were written and executed in-house by CMS customer support personnel. On-site validation testing was also performed by a small group of customers, using actual patient data. Monaco was deemed fit for clinical use.
Summary of Non-Clinical Testing: Verification tests, including algorithm test cases, were written and executed to ensure that the system is working as designed. Pass/fail requirements and results of this testing can be found in the Monaco Verification Test Report and the Algorithm Test Report, both of which are included in section 18 of this submittal. Monaco successfully passed both verification and algorithm testing.
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Image /page/2/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo features a stylized caduceus symbol, which is a staff with two snakes coiled around it. The words "DEPARTMENT OF HEALTH & HUMAN SERVICES. USA" are arranged in a circular pattern around the caduceus symbol.
Public Health Service
NOV 2 4 2008
ood and Drug Administration 9200 Corporate Boulevard Rockville MD 20850
Mr. Michael A. Parsons Regulatory Affairs Associate Computerized Medical Systems 1145 Corporate Lake Drive ST. LOUIS MO 63132
Re: K071938
Trade/Device Name: Monaco RTP System Regulation Number: 21 CFR 892.5050 Regulation Name: Medical charged-particle radiation therapy system Regulatory Class: II Product Code: MUJ Dated: July 12, 2007 Received: July 13, 2007
Dear Mr. Parsons:
This letter corrects our substantially equivalent letter of October 1, 2007.
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 (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 either class II (Special Controls) or class III (PMA), it may be subject to additional controls. Existing major regulations affecting your device can be found in the Code of Federal Regulations, Title 21, Parts 800 to 898. In addition, FDA mav 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 your 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 Part 801); good manufacturing practice requirements as set
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Page 2 - Mr. Parsons
forth in the quality systems (QS) regulation (21 CFR Part 820); and if applicable, the electronic product radiation control provisions (sections 531-542 of the Act); 21 CFR 1000-1050.
This letter will allow you to continue 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 Part 801), please contact the Office of Compliance at (240) 276-0100. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97). 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 (240) 276-3150 or at its Internet address http://www.fda.gov/cdrh/dsma/dsmamain.html
Sincerely yours,
Joyce M. Whang, Ph.D. Acting Director, Division of Reproductive, Abdominal, and Radiological Devices Office of Device Evaluation Center for Devices and Radiological Health
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K07/938
Statement of Indication for Use Monaco 510(k)
The Monaco system is used to create treatment plans for any cancer patient for whom external beam intensity modulated radiation therapy (IMRT) has been prescribed. The system will calculate and display, both on-screen and in hard-copy, either two- or threedimensional radiation dose distributions within a patient for a given treatment plan setup.
The Monaco product line is intended for use in radiation treatment planning using generally accepted methods for contouring, image manipulation, simulation, image fusion, plan optimization and QA and plan review.
Concurrence of the Center for Devices and Radiological Health, Office of Device Evaluation (ODE)
Prescription Use X
OR per 21 CFR 801.109
Over the Counter Use _
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(Division Sign-Off) Division of Reproductive, Abdominal and Radiological Devices 510(k) Number
Monaco RTP System 510(k) Computerized Medical Systems, Inc.
4-1
§ 892.5050 Medical charged-particle radiation therapy system.
(a)
Identification. A medical charged-particle radiation therapy system is a device that produces by acceleration high energy charged particles (e.g., electrons and protons) intended for use in radiation therapy. This generic type of device may include signal analysis and display equipment, patient and equipment supports, treatment planning computer programs, component parts, and accessories.(b)
Classification. Class II. When intended for use as a quality control system, the film dosimetry system (film scanning system) included as an accessory to the device described in paragraph (a) of this section, is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 892.9.