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510(k) Data Aggregation

    K Number
    K161724
    Date Cleared
    2017-04-28

    (310 days)

    Product Code
    Regulation Number
    892.5050
    Reference & Predicate Devices
    Why did this record match?
    Applicant Name (Manufacturer) :

    RadioMed Corporation

    AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
    Intended Use

    The Visicoil MR Marker and the Pre-Loaded Visicoil MR Marker are indicated for use to radiographically mark soft tissue for future therapeutic procedures.

    Device Description

    Device Identification: the Visicoil MR is a helically wound coil of platinum wire. The product is available on a carrier for user-loaded implantation or pre-loaded in a needle.
    Device Characteristics: The Visicoil MR is a linear fiducial marker. It is used for marking soft tissue for future therapeutic procedures.
    Environment for Use: The Visicoil MR and Pre-Loaded Visicoil MR may be implanted in a healthcare facility, free standing clinic or physician's office.
    Description of Device: The Visicoil MR Marker and the Pre-loaded Visicoil MR Marker is a sterile device, in the form of a platinum coil. Visicoil MR comes on a delivery system, packaged in a Mylar/Tyvek pouch, sterilized by gamma sterilization. The Pre-Loaded Visicoil MR comes in a 18, 19, 20, 21, or 22g 304 stainless steel needle and stylet with a beeswax plug at the tip, packaged in a Mylar/Tyvek pouch sterilized by EO sterilization.
    The coils ranges in length from 0.3cm to 2cm and have an outside diameter that ranges between 0.3mm and 1.0mm. Platinum has a dense mass which allows for imaging in all x-ray based imaging devices and other electro-magnetic properties help to enhance visibility within Magnetic Resonance Imaging (MRI).
    The device is a passive device and is permanently implanted in the patient.

    AI/ML Overview

    This document describes a 510(k) premarket notification for the Visicoil MR Marker. It demonstrates substantial equivalence to predicate devices, but it does not contain information about an AI-powered device or a study proving that an AI device meets acceptance criteria.

    The document is for a physical medical device (a radiographically visible marker for soft tissue) and focuses on changes in material composition (from gold to platinum) and its visibility under MRI, as well as biocompatibility and functional testing of the physical marker.

    Therefore, I cannot provide an answer based on the prompt's requirements for acceptance criteria, study details, sample sizes, expert involvement, or AI performance, as this information is not present in the provided text.

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    K Number
    K120859
    Date Cleared
    2012-04-19

    (28 days)

    Product Code
    Regulation Number
    892.5730
    Reference & Predicate Devices
    Why did this record match?
    Applicant Name (Manufacturer) :

    RADIOMED CORPORATION

    AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
    Intended Use

    Pre-Loaded CK Visicoil Gold Marker is indicated for use to radiographically mark soft tissue for future therapeutic procedures.

    Device Description

    The Pre-Loaded CK Visicoil a sterile device, in the form of two gold coils and a PGLA spacer loaded into a 17, 18 or 19g needle. The coil ranges in OD between 0.35mm and 1.2mm.

    The Pre-Loaded CK Visicoil is packaged sterile, for single use. Sterilization is achieved by a validated EO sterilization method.

    The Pre-Loaded CK Visicoil will be manufactured, labeled, and packaged in accordance with the current FDA QSR. To ensure compliance to specifications, upon completion of the manufacturing process the device will be inspected and tested in accordance with RadioMed standard operating procedures.

    Depending on the coil size (0.35mm, 0.50mm, 0.75mm, or 1.2mm), the Pre-Loaded Visicoil Marker will be delivered using either a 17, 18 or 19 gauge needle. The coils and spacer are supplied loaded and ready for use in the applicable needle.

    AI/ML Overview

    The provided text describes the 510(k) submission for the RadioMed™ Pre-Loaded CK Visicoil Marker. It focuses on establishing substantial equivalence to predicate devices rather than presenting a study of the device's performance against specific acceptance criteria.

    Therefore, many of the requested details about acceptance criteria, study design, and performance metrics are not available in the provided document. The 510(k) process primarily relies on demonstrating that a new device is as safe and effective as a legally marketed predicate device, often through comparison of technological characteristics and compliance with recognized standards.

    Here's an attempt to answer the questions based on the provided text, indicating when information is not present:


    1. A table of acceptance criteria and the reported device performance

    This information is not provided in the document. The submission focuses on demonstrating substantial equivalence to predicate devices through comparisons of technological characteristics and compliance with general medical device standards. No specific acceptance criteria or quantitative performance metrics for the device itself are reported in this text.

    2. Sample size used for the test set and the data provenance (e.g. country of origin of the data, retrospective or prospective)

    This information is not provided. The document does not describe a clinical performance study with a distinct test set.

    3. Number of experts used to establish the ground truth for the test set and the qualifications of those experts (e.g. radiologist with 10 years of experience)

    This information is not provided. As there's no described performance study or test set, there's no mention of experts establishing ground truth for such a set.

    4. Adjudication method (e.g. 2+1, 3+1, none) for the test set

    This information is not provided. No adjudication method is mentioned for a test set.

    5. If a multi reader multi case (MRMC) comparative effectiveness study was done, If so, what was the effect size of how much human readers improve with AI vs without AI assistance

    This information is not provided. The device is a physical marker and not an AI or imaging system, so an MRMC study related to AI assistance would not be applicable.

    6. If a standalone (i.e. algorithm only without human-in-the-loop performance) was done

    This information is not provided. The device is a physical marker; it does not involve algorithms or human-in-the-loop performance in the context of an AI system.

    7. The type of ground truth used (expert consensus, pathology, outcomes data, etc)

    This information is not provided. The document does not describe a study that would require establishing a ground truth for device performance in the sense of diagnostic accuracy or efficacy. The "ground truth" for this type of device would likely be its physical properties and functionality.

    8. The sample size for the training set

    This information is not provided. There is no mention of a training set as this is a physical medical device, not a machine learning model.

    9. How the ground truth for the training set was established

    This information is not provided. No training set is mentioned.


    Summary of available "Performance Testing" information:

    The document mentions "Performance Testing" in Section 7, but it refers to compliance with general standards rather than specific device performance criteria:

    • Standards Achieved:
      • ISO 10993: Biological Evaluation of Medical Devices (This indicates biocompatibility testing was performed, but specific results are not detailed).
      • FDA QSR 21 CFR Part 820: Good Manufacturing Practices (This indicates compliance with manufacturing processes and quality systems).

    The submission relies on demonstrating that the new device (Pre-Loaded CK Visicoil Gold Marker) shares the "fundamental scientific technology" with and is "identical" in certain design aspects to its predicate devices:

    • Visicoil™ Pre-Loaded Visicoil Marker (K070305)
    • Brachy Needles/Sleeves/Spacers/Markers (K103449)

    The key modification described is the configuration of loading two gold coils and a PGLA spacer into a needle, which is stated to be identical to one of the predicate products (K103449). The intended use is also stated as "has not changed."

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    K Number
    K070305
    Date Cleared
    2007-03-07

    (34 days)

    Product Code
    Regulation Number
    892.5050
    Reference & Predicate Devices
    Why did this record match?
    Applicant Name (Manufacturer) :

    RADIOMED CORPORATION

    AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
    Intended Use

    The Pre-Loaded Visicoil is indicated for use to radiographically mark soft tissue for future therapeutic procedures.

    Device Description

    The Pre-Loaded Visicoil a sterile device, in the form of a gold coil loaded into a 17, 18 or 19g needle. The coil ranges in OD between 0.35mm and 1.2mm. The Pre-Loaded Visicoil is packaged sterile, for single use. Sterilization is achieved by a validated EO sterilization method. Depending on the coil size (0.35mm, 0.75mm, or 1.2mm), the Pre-Loaded Visicoil Marker will be delivered using either a 17, 18 or 19 gauge needle. The coil is supplied loaded and ready for use in the applicable needle.

    AI/ML Overview

    This 510(k) submission (K070305) for the RadioMed™ Soft Tissue Marker (Pre-Loaded Visicoil Marker) is a Special 510(k), which implies that the fundamental scientific technology and the intended use of the modified device have not changed from the predicate device (Visicoil™ Marker, K031206). Therefore, the performance testing focuses on demonstrating that the device continues to meet established safety and effectiveness criteria, particularly considering the changes introduced (pre-loading in the needle and sterilization method change).

    The provided document does not contain a detailed study report with specific quantitative acceptance criteria or a comprehensive clinical study. Instead, the submission relies on the established substantial equivalence to the predicate device and adherence to regulatory standards.

    Here's a breakdown based on the available information:

    1. Table of Acceptance Criteria and Reported Device Performance

    The submission does not explicitly state quantitative acceptance criteria or a "reported device performance" section with metrics like sensitivity, specificity, accuracy, etc., as typically seen in submissions for AI/diagnostic devices.
    Instead, it indicates that the device has passed adherence to regulatory and manufacturing standards.

    Acceptance Criteria CategorySpecific Criteria (Implicit/Explicit)Reported Device Performance
    Functional EquivalenceThe modified device (Pre-Loaded Visicoil) maintains the same fundamental scientific technology and intended use as the predicate device (Visicoil™ Marker). This implies that its radiographic marking capabilities remain unchanged.The "Comparison of Technological Characteristics" states: "The fundamental scientific technology of the modified device has not changed." and "The design of the predicate Visicoil Marker is identical to the Pre-Loaded Marker." The "Intended Use" and "Indications for Use" are also stated as unchanged. This indirectly confirms that the performance in marking soft tissue for future therapeutic procedures is maintained.
    Sterilization EfficacyThe new sterilization method (Ethylene Oxide - EO) must effectively sterilize the device to ensure patient safety. This implies meeting industry standards for sterility assurance."Sterilization is achieved by a validated EO sterilization method." While specific validation data (e.g., Sterility Assurance Level - SAL) is not provided in this summary, the statement indicates that a validated method is used, implying successful performance against sterility criteria.
    BiocompatibilityThe materials used for the device must be biocompatible with human tissue, especially since the change involves pre-loading in a delivery needle. The gold coil material is assumed to be biocompatible, as it's identical to the predicate. The new needle and any associated components must also be biocompatible. (Not explicitly mentioned as a new test but implicitly covered by relying on predicate and QSR).Not explicitly detailed in the provided text. However, adherence to FDA QSR Part 820 ("Good Manufacturing Practices") implicitly covers material and process controls that ensure biocompatibility. Since the core gold coil material is identical to the predicate, and the needle type (CP Medical, Class I exempt) is standard, new biocompatibility testing might not have been deemed necessary beyond standard QSR compliance.
    Device Integrity/StabilityThe pre-loading of the coil within the needle must not compromise the integrity of the coil (e.g., kinking, damage) or its ability to be deployed effectively. The device must also remain stable throughout its shelf life under the new sterilization and packaging. (Not explicitly mentioned as a new test but implicitly covered by relying on predicate and QSR)."Pre-Loaded Visicoil is packaged sterile, for single use." "To ensure compliance to specifications, upon completion of the manufacturing process the device will be inspected and tested in accordance with RadioMed standard operating procedures." This implies that the device integrity and functionality for deployment are verified at manufacturing.
    Manufacturing QualityCompliance with the FDA Quality System Regulation (QSR) 21 CFR Part 820."The Pre-Loaded Visicoil will be manufactured, labeled, and packaged in accordance with the current FDA QSR." "Summary of standards achieved: FDA QSR 21 CFR Part 820 Good Manufacturing Practices." This indicates adherence to established quality and control procedures for manufacturing.

    2. Sample Size Used for the Test Set and Data Provenance

    • Test Set Sample Size: The document does not specify a sample size for a separate "test set" in the context of clinical performance or human reader studies. This submission is for a modified device and relies on showing substantial equivalence, rather than new clinical efficacy data.
    • Data Provenance: Not applicable in the context of a new clinical study. The data provenance implicitly stems from the predicate device's established performance and the manufacturer's internal validation of manufacturing and sterilization processes.

    3. Number of Experts and Qualifications for Ground Truth

    • Number of Experts: Not applicable. The document does not describe a study involving expert readers or the establishment of ground truth by experts for a new diagnostic or interpretative purpose.
    • Qualifications of Experts: Not applicable.

    4. Adjudication Method

    • Adjudication Method: Not applicable. There is no mention of a study involving human interpretation or a need for adjudication.

    5. Multi-Reader Multi-Case (MRMC) Comparative Effectiveness Study

    • MRMC Study: No, an MRMC comparative effectiveness study was not conducted or described in this document. This is not a study about human readers improving with or without AI assistance but rather a device modification submission.

    6. Standalone (Algorithm Only) Performance Study

    • Standalone Study: No, a standalone performance study (algorithm only) was not conducted or described. This device is a physical marker, not a diagnostic algorithm.

    7. Type of Ground Truth Used

    • Type of Ground Truth: For the purposes of this submission, the "ground truth" is implicitly the established safety and effectiveness of the predicate device and the validated performance of the manufacturing and sterilization processes. There is no new "ground truth" established as part of a diagnostic accuracy study.

    8. Sample Size for the Training Set

    • Training Set Sample Size: Not applicable. This document is not describing an AI/machine learning device that would require a training set.

    9. How the Ground Truth for the Training Set Was Established

    • Training Set Ground Truth: Not applicable for the reasons stated above.
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    K Number
    K022326
    Device Name
    RADIOMED MARKER
    Date Cleared
    2003-01-31

    (197 days)

    Product Code
    Regulation Number
    892.1750
    Reference & Predicate Devices
    Why did this record match?
    Applicant Name (Manufacturer) :

    RADIOMED CORPORATION

    AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
    Intended Use

    RadioMed™ Marker is indicated for use to radiographically mark soft tissue for future therapeutic procedures.

    Device Description

    The RadioMed™ Marker is a non-sterile, disposable device in the form of a rhodium coil that is 0.35mm in diameter.

    AI/ML Overview

    The provided text is a 510(k) summary for the RadioMed™ Marker, a medical device. This type of document is a premarket notification to the FDA, demonstrating substantial equivalence to a legally marketed predicate device. It primarily focuses on device description, intended use, and comparison to predicates, along with a summary of performance testing and adherence to standards.

    However, the provided text does not contain the detailed information required to fill out all aspects of your request regarding acceptance criteria and the study that proves the device meets them.

    Specifically, the document mentions "Visibility Testing (see section V)" and refers to various standards (FDA QSR, ISO 10993-1, AAMI Standard 11134-1994) but does not detail the specific performance acceptance criteria for visibility, a quantitative measure of performance, or the results of the visibility study. It also lacks information on the sample sizes, data provenance, ground truth establishment, or specific details of a comparative effectiveness study.

    Therefore, I can only populate the table and answer the questions based on the limited information available in the provided text. Many fields will be marked as "Not provided in the text."

    Here's the breakdown of what can and cannot be extracted:

    1. Table of Acceptance Criteria and Reported Device Performance

    Acceptance CriteriaReported Device Performance
    VisibilityVisible under fluoroscopy, ultrasound, CT, and x-ray. (No quantitative criteria or specific performance metrics provided in this document excerpt)
    BiocompatibilityPasses biocompatibility testing per ISO 10993-1
    Material (Chemical Composition)Rhodium (Stated to be identical to a predicate device's material)
    Manufacturing StandardsComplies with FDA QSR 21 CFR Part 820 Good Manufacturing Practices, AAMI Standard 11134-1994 Recommended Practice for Steam Autoclave

    2. Sample size used for the test set and the data provenance (e.g. country of origin of the data, retrospective or prospective)

    • Sample size for test set: Not provided in the text. The document refers to "Visibility Testing" and "animal and bench studies" but no sample sizes are mentioned.
    • Data Provenance: Not provided in the text.
    • Retrospective/Prospective: Not provided in the text.

    3. Number of experts used to establish the ground truth for the test set and the qualifications of those experts (e.g. radiologist with 10 years of experience)

    • Not provided in the text.

    4. Adjudication method (e.g. 2+1, 3+1, none) for the test set

    • Not provided in the text.

    5. If a multi reader multi case (MRMC) comparative effectiveness study was done, If so, what was the effect size of how much human readers improve with AI vs without AI assistance

    • No MRMC comparative effectiveness study is described for this device, nor is it an AI-based device. The device is a physical marker.

    6. If a standalone (i.e. algorithm only without human-in-the-loop performance) was done

    • Not applicable. This is a physical marker, not an algorithm.

    7. The type of ground truth used (expert consensus, pathology, outcomes data, etc)

    • For "Visibility Testing," the ground truth likely involved direct visual confirmation on imaging modalities, possibly by a human observer or sensor, but the specific method (e.g., expert consensus on image quality, quantitative measurement) is not detailed.
    • For "Biocompatibility," the ground truth would be established by the results of standardized biological tests as per ISO 10993-1.

    8. The sample size for the training set

    • Not applicable. This is a physical marker, not a machine learning model requiring a training set.

    9. How the ground truth for the training set was established

    • Not applicable. This is a physical marker, not a machine learning model.
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    K Number
    K013660
    Device Name
    GENETRA
    Date Cleared
    2001-12-05

    (29 days)

    Product Code
    Regulation Number
    892.5730
    Reference & Predicate Devices
    Why did this record match?
    Applicant Name (Manufacturer) :

    RADIOMED CORPORATION

    AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
    Intended Use

    GENETRA ™ with activities from 0.1 to 5.0 mCi per centimeter length is indicated for temporary or permanent interstitial implantation or surface application to treat selected localized tumors. They can be used as either primary treatment or as treatment for residual disease after excision of primary or recurrent turnors. GENETRA may be used concurrently with or following treatment with other interventions, such as external beam therapy, hyperthermia, or chemotherapy. Tumors of the head, neck, lung, pancreas, prostate and other accessible tumors are commonly treated.

    Device Description

    GENETRA ™ utilizes Pd-103 as the radionuclide for brachytherapy. GENETRA™ exists in the form of a coiled rhodium wire. The rhodium matrix also provides the radiopacity of the device. GENETRA™ is a naturally sealed source in the form of a wire. GENETRA™ is packaged non-sterile, single use, and is to be sterilized by the end user in accordance with a validated sterilization process. Sterilization is accomplished by exposure to steam autoclave. GENETRA™ will be manufactured, labeled and packaged under GMP controls. Upon completion of the manufacturing and assembly process the device will be inspected to assure compliance to specifications. The devices will be tested in accordance with Standard Operating Procedures. The sources are delivered using a 19 gauge needle and stylet.

    AI/ML Overview

    The provided document describes the GENETRA™ brachytherapy radionuclide source and its submission for 510(k) clearance. However, it does not contain a detailed study report with specific acceptance criteria and performance data for a device in the context of diagnostic AI or image analysis.

    The document focuses on comparing GENETRA™ to its predicate device (RadioMed™ Source K001070) based on shared technological characteristics and compliance with manufacturing and safety standards. The "Performance Testing" section lists categories of tests but provides no numerical acceptance criteria or performance results.

    Therefore, I cannot directly answer most of your detailed questions regarding acceptance criteria, study design, sample sizes, expert qualifications, or comparative effectiveness with AI. The device described is a medical implant (radioactive source), not a diagnostic AI or imaging device that would typically involve such studies.

    Here's a breakdown of what can be extracted or inferred from the provided text, addressing your points where possible, and noting where information is missing:


    Acceptance Criteria and Device Performance for GENETRA™

    The document does not explicitly state numerical acceptance criteria or specific performance results for the GENETRA™ device in the format typically used for diagnostic or AI-based devices. Instead, performance is framed in terms of meeting established industry standards for radioactive sources and being identical in fundamental design and characteristics to a legally marketed predicate device.

    1. Table of Acceptance Criteria and Reported Device Performance

    CategoryAcceptance Criteria (Inferred from standards and predicate comparison)Reported Device Performance (Inferred from "Summary of standards achieved" and "identical to predicate")
    Material CompositionIdentical to predicate RadioMed™ Source (rhodium matrix). Radionuclide: Palladium - 103, identical to predicate. Packaging: modified from original stainless steel cartridge to utilize a glass barrel, but fundamentally similar.GENETRA™ uses rhodium as did the predicate RadioMed™ Source. Radionuclide for GENETRA™ is Palladium - 103, which is the same as the predicate.
    Energy EmissionIdentical to predicate RadioMed™ Source (20-23 keV x-rays).Energy emitted for GENETRA™ and the RadioMed™ Source is identical: 20-23 keV x-rays.
    Physical DesignIdentical to predicate RadioMed™ Source. "Sealed source in the form of a wire from which to deliver a therapeutic dosage of radioactive energy."The design of the predicate RadioMed™ Source is identical to GENETRA™.
    SterilizationTo be sterilized by the end-user in accordance with a validated sterilization process (exposure to steam autoclave). Complies with AAMI Standard 11134-1994 (Recommended practice for Steam Autoclave).Device is packaged non-sterile, single use, and is to be sterilized by the end user via steam autoclave. Compliance with AAMI 11134-1994 is listed.
    Manufacturing QualityCompliance with FDA QSR 21 CFR Part 820 Good Manufacturing Practices. Devices inspected to assure compliance to specifications and tested in accordance with Standard Operating Procedures.Manufactured, labeled, and packaged under GMP controls. Inspected to assure compliance to specifications. Tested in accordance with Standard Operating Procedures.
    Biological EvaluationCompliance with ISO 10993-1 1992 (E) Biological Evaluation of Medical Devices.Compliance with ISO 10993-1 1992 (E) listed.
    Sealed Source TestingCompliance with ANSI N43.6-1997 (Classification of sealed radioactive sources), ANSI N44.1-1973 (Integrity and Test Specifications for selected Brachytherapy Sources), ANSI N44.2-1973 (Leak testing radioactive brachytherapy sources), and ISO 9978: 1992(E) ("Radiation protection - Sealed radioactive sources - Leakage test methods").Compliance with ANSI N43.6-1997, ANSI N44.1-1973, ANSI N44.2-1973, and ISO 9978: 1992(E) listed under "Summary of standards achieved." "Sealed Source Testing" is one of the four performance categories.
    Needle GaugeDelivery through a 19 gauge needle and stylet. (Predicate uses 17 or 18 gauge).GENETRA™ sources are delivered using a 19 gauge needle and stylet. (This is a design modification from the predicate, but is a stated characteristic of GENETRA™).
    Activity Range0.1 to 5.0 mCi per centimeter length.GENETRA™ produced with activities from 0.1 to 5.0 mCi per centimeter length.
    Radiation EnergyNo specific numerical acceptance criteria provided in the text beyond "identical to predicate"."Radiation Energy" is listed as a performance category. The energy emitted is 20-23 keV x-rays, identical to the predicate.
    Source Strength Measurement: Calibration and Calibration AccuracyNo specific numerical acceptance criteria provided in the text."Source Strength Measurement: Calibration and Calibration Accuracy" is listed as a performance category. No specific results are reported.
    Dose ComparisonNo specific numerical acceptance criteria provided in the text."Dose Comparison" is listed as a performance category. No specific results are reported, but given the identical radionuclide and energy, the dose characteristics are implied to be clinically comparable to the predicate.

    Missing Information (Not applicable or not typically included for this type of device)

    • Sample size used for the test set and the data provenance (e.g. country of origin of the data, retrospective or prospective): No test set of clinical cases or patient data is mentioned as this is a device clearance for a radiation source based on substantial equivalence and engineering standards, not a clinical trial of its efficacy with patient outcomes in a diagnostic context.
    • Number of experts used to establish the ground truth for the test set and the qualifications of those experts: Not applicable. Ground truth for a clinical diagnosis or image interpretation is not relevant for this type of device submission.
    • Adjudication method (e.g. 2+1, 3+1, none) for the test set: Not applicable.
    • If a multi-reader multi-case (MRMC) comparative effectiveness study was done, If so, what was the effect size of how much human readers improve with AI vs without AI assistance: Not applicable. This is not an AI or diagnostic imaging device.
    • If a standalone (i.e. algorithm only without human-in-the-loop performance) was done: Not applicable.
    • The type of ground truth used (expert consensus, pathology, outcomes data, etc.): Not applicable for a device quality and safety submission based on substantial equivalence. The "ground truth" here is compliance with engineering, manufacturing, and safety standards for radioactive sources.
    • The sample size for the training set: Not applicable. This is not an AI device that requires a training set.
    • How the ground truth for the training set was established: Not applicable.
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