syngo.CT Brain Hemorrhage is designed to assist the radiologist in prioritizing cases of suspected intracranial hemorrhage, also in the subarachnoid space, on non-contrast CT examinations of the head. It makes case-level output available to a CT scanner or other PACS system for worklist prioritization. The output is intended for informational purposes only and is not intended for diagnostic use. The device does not alter the original medical image and is not intended to be used as a standalone diagnostic device.

Device Description

The subject device syngo.CT Brain Hemorrhage is an image-processing software that uses an artificial intelligence algorithm to support qualified clinicians in the analysis and prioritization of non-contrast head CT images. It is a notification-only processing application that algorithmically identifies findings suspicious of acute intracranial hemorrhage (ICH) and acute subarachnoid hemorrhage (SAH). The subject device facilitates a parallel workflow, where cases suspected of presence of ICH or SAH are flagged. The device does not mark, highlight, or direct users' attention to a specific location in the original image. The device does not remove cases from a reading queue.

AI/ML Overview

Here's a breakdown of the acceptance criteria and study details for the syngo.CT Brain Hemorrhage device, based on the provided text:

Acceptance Criteria and Device Performance

Acceptance Criteria (Performance Goal)	Reported Device Performance (Intracranial Hemorrhage)	Reported Device Performance (Subarachnoid Hemorrhage)
Sensitivity ≥ 80%	95.0% (95% CI: 92.5%-96.7%)	86.1% (95% CI: 81.1%-90.0%)
Specificity ≥ 80%	93.1% (95% CI: 90.5%-95.1%)	85.2% (95% CI: 82.3%-87.7%)

Study Details

Sample size used for the test set and the data provenance:
- Sample Size: 900 anonymized head CT cases.
- Data Provenance: From 5 sites in the US and Europe. The distribution of positive (case with ICH) and negative (case without ICH) cases was approximately equal.
- Type: Retrospective (implied by "anonymized head CT cases from 5 sites").
Number of experts used to establish the ground truth for the test set and the qualifications of those experts:
- Number of Experts: 3
- Qualifications: US board-certified neuroradiologists with more than 10 years of experience.
Adjudication method for the test set:
- Method: Majority read (e.g., 2 out of 3 experts agreed).
If a multi-reader multi-case (MRMC) comparative effectiveness study was done: No, a multi-reader multi-case (MRMC) comparative effectiveness study was not explicitly mentioned. The study described is a standalone performance study.
If a standalone (i.e., algorithm only without human-in-the-loop performance) was done: Yes, the document explicitly states: "The performance of the syngo.CT Brain Hemorrhage device has been va alone performance study."
The type of ground truth used: Expert consensus, established by the majority read of 3 US board-certified neuroradiologists.
The sample size for the training set: 29,713 cases.
How the ground truth for the training set was established: The document does not explicitly state how the ground truth for the training set was established. It only mentions the training data size.

Summary

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Image /page/0/Picture/0 description: The image shows the logo of the U.S. Food and Drug Administration (FDA). On the left is the Department of Health & Human Services logo. To the right of that is a blue square with the letters "FDA" in white. To the right of the blue square is the text "U.S. FOOD & DRUG ADMINISTRATION" in blue.

Siemens Medical Solutions USA, Inc. Monsuru Bello Regulatory Affairs Specialist 810 Innovation Drive Knoxville, TN 37932

Re: K232431

March 22, 2024

Trade/Device Name: syngo.CT Brain Hemorrhage Regulation Number: 21 CFR 892.2080 Regulation Name: Radiological computer aided triage and notification software Regulatory Class: Class II Product Code: QAS Dated: February 21, 2024 Received: February 21, 2024

Dear Monsuru Bello:

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 (the 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. Although this letter refers to your product as a device, please be aware that some cleared products may instead be combination products. The 510(k) Premarket Notification Database available at https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm identifies combination product submissions. 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. Please note: CDRH does not evaluate information related to contract liability warranties. We remind you, however, that device labeling must be truthful and not misleading.

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 may publish further announcements concerning your device in the Federal Register.

Additional information about changes that may require a new premarket notification are provided in the FDA guidance documents entitled "Deciding When to Submit a 510(k) for a Change to an Existing Device" (https://www.fda.gov/media/99812/download) and "Deciding When to Submit a 510(k) for a Software Change to an Existing Device" (https://www.fda.gov/media/99785/download).

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Your device is also subject to, among other requirements, the Quality System (QS) regulation (21 CFR Part 820), which includes, but is not limited to, 21 CFR 820.30, Design controls; 21 CFR 820.90, Nonconforming product; and 21 CFR 820.100, Corrective and preventive action. Please note that regardless of whether a change requires premarket review, the QS regulation requires device manufacturers to review and approve changes to device design and production (21 CFR 820.30 and 21 CFR 820.70) and document changes and approvals in the device master record (21 CFR 820.181).

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); medical device reporting of medical device-related adverse events) (21 CFR Part 803) for devices or postmarketing safety reporting (21 CFR Part 4, Subpart B) for combination products (see https://www.fda.gov/combination-products/guidance-regulatory-information/postmarketing-safety-reportingcombination-products); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820) for devices or current good manufacturing practices (21 CFR Part 4, Subpart A) for combination products; and, if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR Parts 1000-1050.

Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR 807.97). For questions regarding the reporting of adverse events under the MDR regulation (21 CFR Part 803), please go to https://www.fda.gov/medical-device-safety/medical-device-reportingmdr-how-report-medical-device-problems.

For comprehensive regulatory information about medical devices and radiation-emitting products, including information about labeling regulations, please see Device Advice (https://www.fda.gov/medicaldevices/device-advice-comprehensive-regulatory-assistance) and CDRH Learn (https://www.fda.gov/training-and-continuing-education/cdrh-learn). Additionally, you may contact the Division of Industry and Consumer Education (DICE) to ask a question about a specific regulatory topic. See the DICE website (https://www.fda.gov/medical-device-advice-comprehensive-regulatoryassistance/contact-us-division-industry-and-consumer-education-dice) for more information or contact DICE by email (DICE@fda.hhs.gov) or phone (1-800-638-2041 or 301-796-7100).

Sincerely.

Jessica Lamb

Jessica Lamb. Ph.D. Assistant Director Imaging Software Team DHT8B: Division of Radiological Imaging Devices and Electronic Products OHT8: Office of Radiological Health Office of Product Evaluation and Quality Center for Devices and Radiological Health

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Indications for Use

Submission Number (if known)

K232431

Device Name

syngo.CT Brain Hemorrhage

Indications for Use (Describe)

Type of Use (Select one or both, as applicable)

Prescription Use (Part 21 CFR 801 Subpart D)

Over-The-Counter Use (21 CFR 801 Subpart C)

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Image /page/3/Picture/1 description: The image contains the logo for Siemens Healthineers. The word "SIEMENS" is written in teal, and the word "Healthineers" is written in orange below it. To the right of the word "Healthineers" is a graphic of orange dots.

510(k) Summary

1. Identification of the Submitter

Submitter / Primary Contact Person	Monsuru (Kenny) BelloRegulatory Affairsmonsuru.bello@siemens-healthineers.com+1(240) 601-3848
Secondary Contact Person	Clayton GinnRegulatory Affairsclayton.ginn@siemens-healthineers.com+1 (865) 898-2692
Submitter Address	Siemens Medical Solutions, Inc. USAMolecular Imaging810 Innovation DriveKnoxville, TN 37932Establishment Registration Number: 1034973
Legal Manufacturer	Siemens Healthcare GmbHSIEMENSSTRASSE 1 -OR-Rittigfeld 1FORCHHEIM Bavaria, DE 91301Establishment Registration Number: 3004977335
Importer/Distributor	Siemens Medical Solutions USA, Inc.40 Liberty BoulevardMalvern, PA 19355Establishment Registration Number: 2240869

2. Device Name and Classification

Product Name:	syngo.CT Brain Hemorrhage
Propriety Trade Name:	syngo.CT Brain Hemorrhage
Classification Name:	Radiological Computer-Assisted Triage and Notification Software
Classification Panel:	Radiology
CFR Section:	21 CFR §892.2080
Device Class:	Class II
Product Code:	QAS

3. Predicate Device

Trade Name:	syngo.CT Brain Hemorrhage
510(k) Number:	K203260
Clearance Date:	01/28/2022
Classification Name:	Radiological Computer-Assisted Triage and Notification Software
Classification Panel:	Radiology
CFR Section:	21 CFR §892.2080
Device Class:	Class II
Product Code:	QAS

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Image /page/4/Picture/0 description: The image contains the logo for Siemens Healthineers. The word "SIEMENS" is written in teal, and the word "Healthineers" is written in orange below it. To the right of the words is a graphic of orange dots arranged in a circular pattern.

4. Device Description

The subject device syngo.CT Brain Hemorrhage is an improved and extended version of the predicate device (syngo.CT Brain Hemorrhage, K203260, clearance date 01/28/2022). The differences to the predicate device can be summarized as:

. Improved algorithm model for the triage of intracranial hemorrhage (ICH), targeting a higher sensitivity for cases with smaller hemorrhages.
. Extension of the device output to the triage of subarachnoid hemorrhages (SAH), a subtype of intracranial hemorrhages (ICH).
. Support of DICOM conformant head CT reconstructions fulfilling diagnostic quality for the identification of ICH, without restriction to be acquired with a Siemens CT scanner
. Additional deployment compatibility with the syngo.via host system.

5. Indications for Use

6. Comparison of Technological Characteristics with the Predicate Device

The differences and similarities between the above referenced predicate device are listed at a high-level in the following table:

Feature	Subject Device	Predicate Device	Comparison Table
	syngo.CT Brain Hemorrhage(SOMARIS/8 VB80)	syngo.CT Brain Hemorrhage(SOMARIS/8 VB60)
Notification-only, parallelworkflow tool	Yes	Yes	Same
Intended User	Radiologists and clinical administrators	Radiologists and clinical administrators	Same
Setting	Acute Care	Acute Care	Same

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Image /page/5/Picture/0 description: The image contains the logo for Siemens Healthineers. The word "SIEMENS" is in teal, and the word "Healthineers" is in orange. To the right of the word "Healthineers" is a graphic of orange dots.

Feature	Subject Device	Predicate Device	ComparisonTable
	syngo.CT Brain Hemorrhage(SOMARIS/8 VB80)	syngo.CT Brain Hemorrhage(SOMARIS/8 VB60)
Identify patients with aprespecified clinicalcondition	Yes	Yes	Same
Clinical condition	Intracranial hemorrhage,Subarachnoid hemorrhage	Intracranial hemorrhage	Extended
Alert to finding	Yes; flagged for review	Yes; flagged for review	Same
Independent of standardof care workflow	Yes; No cases are removed fromworklist	Yes; No cases are removed fromworklist	Same
Modality	Non-contrast CT	Non-contrast CT	Same
Body Part	Head	Head	Same
Artificial Intelligencealgorithm	Yes	Yes	Same
Training Data	29 713 cases	28 814 cases	Improved
Limited to analysis ofimaging data	Yes	Yes	Same
Scanner Manufacturer ofInput Data	Siemens and other vendors	Siemens	Extended
Output	Suspected hemorrhage / Suspectedhemorrhage including thesubarachnoid space / Processingfinished	Suspected hemorrhage / Processingfinished	Extended
Deployment Compatibility	SOMARIS-X platform,syngo.via platform	SOMARIS-X platform	Extended

The subject device syngo.CT Brain Hemorrhage does not have changes in fundamental scientific technology compared to the predicate device. The post-processing software functionality remains unchanged from the subject device and the predicate device. The operating principle and the scientific technology are the same; therefore, Siemens believes that syngo.CT Brain Hemorrhage application is substantially equivalent to the predicate device.

7. Performance Data

The following performance data were provided in support of the substantial equivalence determination.

Non-Clinical Testing

This submission contains performance tests (Non-clinical test reports) to demonstrate continued conformance with special controls for medical devices containing software. Non-clinical tests (integration and functional) were conducted for syngo.CT Brain Hemorrhage during product development. These tests have been performed to test the ability of the included features of the subject device. The results of these tests demonstrate that the subject device performs as intended. The results of all conducted testing were found acceptable to support the claim of substantial equivalence.

Performance Evaluation of the Algorithm

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Image /page/6/Picture/0 description: The image contains the logo for Siemens Healthineers. The word "SIEMENS" is written in teal, and the word "Healthineers" is written in orange below it. To the right of the word "Healthineers" is a graphic of orange dots arranged in a circular pattern.

The performance of the syngo.CT Brain Hemorrhage device has been va alone performance study. Sensitivity and specificity of syngo.CT Brain Hemorrhage in processing of noncontrast head CT have been analyzed by comparison to a ground truth established by majority read of 3 US board certified neuroradiologists with more than 10 years of experience. The data cohort consisted of 900 anonymized head CT cases from 5 sites in US and Europe with approximately equal distribution of positive (case with ICH) and negative (case without ICH) cases.

For the triage of intracranial hemorrhage, the sensitivity was 95.0% (95% Cl: 92.5%-96.7%) and the specificity was 93.1% (95% Cl: 90.5%-95.1%). Thus, sensitivity and specificity exceeded the 80% performance goal.

For the triage of subarachnoid hemorrhage, the sensitivity was 86.1% (95% Cl: 81.1%-90.0%) and the specificity was 85.2% (95% Cl: 82.3%-87.7%). Thus, sensitivity and specificity exceeded the 80% performance goal.

The average per-case processing time was 13.34 seconds (95% Cl: 9.16-17.51 seconds). This is comparable to the predicate device (13.67 seconds, 95% Cl: 7.48-19.86).

To conclude, syngo.CT Brain Hemorrhage is a safe and effective triage and notification device for intracranial hemorrhages which is substantially equivalent to the predicate device.

Siemens hereby certifies that syngo.CT Brain Hemorrhage will meet the following voluntary standards covering electrical and mechanical safety listed below, prior to introduction into interstate commerce:

Standard	Version	Content	FDA RecognitionNumber(if applicable)
ANSI AAMI IEC 62304	:62304:2006/A1:2016	Medical device software - Software life cycle processes[Including Amendment 1 (2016)]	13-79
NEMA PS 3.1 - 3.202022d	:2022	Digital Imaging and Communications in Medicine(DICOM) Set	12-349
ISO 14971	:2019	Application of Risk Management to Medical Devices	5-125
IEC 62366-1	Edition 1.1 2020-06CONSOLIDATEDVERSION	Medical devices - Part 1: Application of usabilityengineering to medical devices	5-129
ISO 15223-1	Fourth edition2021-07	Medical devices - Symbols to be used with informationto be supplied by the manufacturer - Part 1: Generalrequirements	5-134
ISO 20417:2021	First edition 2021-04 Correctedversion 2021-12	Medical devices - Information to be supplied by themanufacturer	5-135

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8. Conclusion

syngo.CT Brain Hemorrhage has the same intended use and similar indication for use as the predicate device. The result of all testing conducted was found acceptable to support the claim of substantial equivalence. The comparison of technological characteristics, clinical and non-clinical performance data, and software validation demonstrates that the subject device is as safe and effective when compared to the predicate device that is currently marketed for the same intended use. Siemens considers syngo.CT Brain Hemorrhage to be as safe, as effective and with performance substantially equivalent to the commercially available predicate device.

Regulation Number and Section

§ 892.2080 Radiological computer aided triage and notification software.

(a)
Identification. Radiological computer aided triage and notification software is an image processing prescription device intended to aid in prioritization and triage of radiological medical images. The device notifies a designated list of clinicians of the availability of time sensitive radiological medical images for review based on computer aided image analysis of those images performed by the device. The device does not mark, highlight, or direct users' attention to a specific location in the original image. The device does not remove cases from a reading queue. The device operates in parallel with the standard of care, which remains the default option for all cases.(b)
Classification. Class II (special controls). The special controls for this device are:(1) Design verification and validation must include:
(i) A detailed description of the notification and triage algorithms and all underlying image analysis algorithms including, but not limited to, a detailed description of the algorithm inputs and outputs, each major component or block, how the algorithm affects or relates to clinical practice or patient care, and any algorithm limitations.
(ii) A detailed description of pre-specified performance testing protocols and dataset(s) used to assess whether the device will provide effective triage (
e.g., improved time to review of prioritized images for pre-specified clinicians).(iii) Results from performance testing that demonstrate that the device will provide effective triage. The performance assessment must be based on an appropriate measure to estimate the clinical effectiveness. The test dataset must contain sufficient numbers of cases from important cohorts (
e.g., subsets defined by clinically relevant confounders, effect modifiers, associated diseases, and subsets defined by image acquisition characteristics) such that the performance estimates and confidence intervals for these individual subsets can be characterized with the device for the intended use population and imaging equipment.(iv) Stand-alone performance testing protocols and results of the device.
(v) Appropriate software documentation (
e.g., device hazard analysis; software requirements specification document; software design specification document; traceability analysis; description of verification and validation activities including system level test protocol, pass/fail criteria, and results).(2) Labeling must include the following:
(i) A detailed description of the patient population for which the device is indicated for use;
(ii) A detailed description of the intended user and user training that addresses appropriate use protocols for the device;
(iii) Discussion of warnings, precautions, and limitations must include situations in which the device may fail or may not operate at its expected performance level (
e.g., poor image quality for certain subpopulations), as applicable;(iv) A detailed description of compatible imaging hardware, imaging protocols, and requirements for input images;
(v) Device operating instructions; and
(vi) A detailed summary of the performance testing, including: test methods, dataset characteristics, triage effectiveness (
e.g., improved time to review of prioritized images for pre-specified clinicians), diagnostic accuracy of algorithms informing triage decision, and results with associated statistical uncertainty (e.g., confidence intervals), including a summary of subanalyses on case distributions stratified by relevant confounders, such as lesion and organ characteristics, disease stages, and imaging equipment.