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The ACUSON Sequoia and Sequoia Select ultrasound imaging systems are intended to provide images of, or signals from, inside the body by an appropriately trained healthcare professional in a clinical setting for the following applications: Fetal, Abdominal, Pediatric, Neonatal Cephalic, Small Parts, OB/GYN (useful for visualization of the ovaries, follicles, uterus and other pelvic structures), Cardiac, Transesophageal, Pelvic, Vascular, Adult Cephalic, Musculoskeletal and Peripheral Vascular applications.

The system supports the Ultrasonically-Derived Fat Fraction (UDFF) measurement tool to report an index that can be useful as an aid to a physician managing adult and pediatric patients with hepatic steatosis.

The system also provides the ability to measure anatomical structures for fetal, abdominal, pediatric, small organ, cardiac, transrectal, transvaginal, peripheral vessel, musculoskeletal and calculation packages that provide information to the clinician that may be used adjunctively with other medical data obtained by a physician for clinical diagnosis purposes.

The ACUSON Origin and Origin ICE ultrasound imaging systems are intended to provide images of, or signals from, inside the body by an appropriately trained healthcare professional in a clinical setting for the following applications: Fetal, Abdominal, Pediatric, OB/GYN (useful for visualization of the ovaries, follicles, uterus and other pelvic structures), Cardiac, Transesophageal, Intracardiac, Vascular, Adult Cephalic, and Peripheral Vascular applications.

The catheter is intended for intracardiac and intra-luminal visualization of cardiac and great vessel anatomy and physiology as well as visualization of other devices in the heart of adult and pediatric patients. The catheter is intended for imaging guidance only, not treatment delivery, during cardiac interventional percutaneous procedures.

The system also provides the ability to measure anatomical structures for fetal, abdominal, pediatric, cardiac, peripheral vessel, and calculation packages that provide information to the clinician that may be used adjunctively with other medical data obtained by a physician for clinical diagnosis purposes.

The ACUSON Sequoia, Sequoia Select, Origin, and Origin ICE Diagnostic Ultrasound Systems (software version VC10) are multi-purpose, mobile, software-controlled, diagnostic ultrasound systems with an on-screen display of thermal and mechanical indices related to potential bio- effect mechanisms. The function of these ultrasound systems is to transmit, receive, process ultrasound echo data (distance and intensities information about body tissue) in various modes of operation and display it as ultrasound imaging, anatomical and quantitative measurements, calculations, analysis of the human body and fluid flow, etc. These ultrasound systems use a variety of transducers to provide imaging in all standard acquisition modes and also have comprehensive networking and DICOM capabilities.

The provided FDA 510(k) clearance letter and summary discuss the ACUSON Sequoia, Sequoia Select, Origin, and Origin ICE Diagnostic Ultrasound Systems. This document indicates a submission for software feature enhancements and workflow improvements, including an "AI Measure and AI Assist workflow efficiency feature" and "Liver Elastography optimization."

Here's an analysis of the acceptance criteria and the study information provided:

Acceptance Criteria and Reported Device Performance

The submission focuses on enhancements to existing cleared devices rather than a de novo AI device. Therefore, the "acceptance criteria" discussed are primarily related to the performance of the Liver Elastography optimization using phantom testing.

Study Details for Liver Elastography Optimization (SWE Performance Testing)

The primary study mentioned in the document for performance evaluation is related to the Liver Elastography optimization.

1. Sample Size Used for the Test Set and the Data Provenance:

   • Test Set: Calibrated elasticity phantoms. The specific number of phantoms used is not stated beyond "calibrated elasticity phantoms."
   • Data Provenance: Not explicitly stated, but implies laboratory testing using commercially available or manufacturer-certified phantoms. Transducers listed were DAX, 5C1, 9C2, 4V1, and 10L4.

2. Number of Experts Used to Establish the Ground Truth for the Test Set and the Qualifications of those Experts:

   • Ground Truth Establishment: The ground truth for the test set (phantom stiffness) was established by the phantom manufacturer, as they were "calibrated elasticity phantoms certified by the phantom manufacturer."
   • Number/Qualifications of Experts: The document does not specify the number or qualifications of experts involved in the phantom's certification process or in the actual testing of the Siemens device. The testing appears to be objective, relying on the calibrated properties of the phantoms.

3. Adjudication Method for the Test Set:

   • Adjudication Method: Not applicable. Phantom testing typically relies on quantitative measurements against known phantom properties, not human adjudication of results.

4. If a Multi-Reader Multi-Case (MRMC) Comparative Effectiveness Study was done:

   • MRMC Study: No, an MRMC comparative effectiveness study was not conducted according to this document. The submission focuses on technical enhancements and phantom validation for elastography, and system safety/effectiveness.

5. If a Standalone (i.e., algorithm only without human-in-the-loop performance) was done:

   • Standalone Performance: The "SWE Performance Testing" with phantoms could be considered a form of standalone performance assessment as it evaluates the device's measurement capabilities against a known standard. However, the AI Measure and AI Assist features are described as "workflow efficiency features" where measurements are "automatically launched" after classification, implying an interaction with a human user rather than a fully standalone diagnostic output. No specific standalone performance metrics for the AI Measure/Assist components are provided.

6. The Type of Ground Truth Used:

   • Ground Truth: For the elastography testing, the ground truth was the known stiffness values of the calibrated elasticity phantoms.

7. The Sample Size for the Training Set:

   • Training Set Sample Size: The document does not provide information about a training set size for the AI Measure and AI Assist features or the elastography optimization. This type of 510(k) submission typically focuses on validation and verification of changes to an already cleared product, rather than detailing the initial development or training data for AI algorithms.

8. How the Ground Truth for the Training Set Was Established:

   • Training Set Ground Truth: Not applicable, as information on a specific training set is not provided in this document.

Summary regarding AI components:

While the document mentions "AI Measure" and "AI Assist" as workflow efficiency features (e.g., launching relevant measurements after cardiac view classification), it does not provide detailed performance metrics, test set sizes, ground truth establishment, or clinical study information specifically for these AI components. The 510(k) emphasizes that these are "software feature enhancements and workflow improvements" that, along with other changes, do not raise new questions of safety and effectiveness, leading to substantial equivalence with the predicate device. The only detailed "performance testing" described is for the Liver Elastography optimization using phantoms. This suggests that the AI features themselves might have been validated through internal software verification and validation activities that are not detailed in this public summary, or their impact on diagnostic performance was considered incremental and not requiring specific clinical comparative studies for this particular submission.

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The Siemens PET/CT systems are combined X-Ray Computed Tomography (CT) and Positron Emission Tomography (PET) scanners that provide registration and fusion of high resolution physiologic and anatomic information.

The CT component produces cross-sectional images of the body by computer reconstruction of X-Ray transmission data from either the same axial plane taken at different angles or spiral planes taken at different angles. The PET subsystem images and measures the distribution of PET radiopharmaceuticals in humans for the purpose of determining various metabolic (molecular) and physiologic functions within the human body and utilizes the CT for fast attenuation correction maps for PET studies and precise anatomical reference for the fused PET and CT images.

The system maintains independent functionality of the CT and PET devices, allowing for single modality CT and/or PET diagnostic imaging.

These systems are intended to be utilized by appropriately trained health care professionals to aid in detecting, localizing, diagnosing, staging and restaging of lesions, tumors, disease and organ function for the evaluation of diseases and disorders such as, but not limited to, cardiovascular disease, neurological disorders and cancer. The images produced by the system can also be used by the physician to aid in radiotherapy treatment planning and interventional radiology procedures.

This system can be used for low dose lung cancer screening in high risk populations.*

*As defined by professional medical societies. Please refer to clinical literature, including the results of the National Lung Screening Trial (N Engl J Med 2011; 365:395-409) and subsequent literature, for further information.

Biograph Trinion PET/CT systems are combined multi-slice X-Ray Computed Tomography and Positron Emission Tomography scanners. This system is designed for whole body oncology, neurology and cardiology examinations. Biograph Trinion PET/CT systems provide registration and fusion of high-resolution metabolic and anatomic information from the two major components of each system (PET and CT). Additional components of the system include a patient handling system and acquisition and processing workstations with associated software.

Biograph Trinion VK20 software is a command-based program used for patient management, data management, scan control, image reconstruction and image archival and evaluation. All images conform to DICOM imaging format requirements.

Biograph PET/CT systems, which are the subject of this application, are substantially equivalent to the commercially available Biograph Trinion VK10 family of PET/CT systems (K233677). Differences compared to the commercially available Biograph Trinion systems include:

• The commercially available SOMATOM go.All and go.Top systems with VB10 (K233650) software have been incorporated into the Biograph Trinion VK20 systems, including commercially available CT features.

• Additional PET axial field of view (FoV) systems allowing for more scalability.

• Additional patient communication and comfort features.

• PET respiratory gating with an external gating device has been implemented.

The Biograph Trinion models may also use the names Biograph Mission, Biograph Wonder, Biograph Ambition and Biograph Devotion for marketing purposes.

The provided FDA 510(k) clearance letter for the Biograph Trinion PET/CT system primarily focuses on demonstrating substantial equivalence to a predicate device and adherence to recognized performance standards. It indicates that "all performance testing met the predetermined acceptance values," but does not provide specific numerical acceptance criteria or reported device performance for an AI/algorithm component, nor does it detail a study proving the device meets AI-specific acceptance criteria. The context suggests the "performance testing" refers to general PET/CT system performance, not AI-driven diagnostic assistance.

Therefore, many of the requested details, particularly those related to a standalone AI algorithm's performance, human-in-the-loop studies, dataset characteristics (sample size, provenance), and ground truth establishment methods for an AI component, are not available in the provided text.

Based on the information available in the document, here's what can be extracted and inferred, with explicit notes where information is missing or not applicable in the context of an AI study.

Acceptance Criteria and Reported Device Performance

The document states that "all performance testing met the predetermined acceptance values." However, it does not specify what those acceptance values were or the precise reported performance metrics beyond this general statement. The tests conducted were primarily related to the physical performance of the PET/CT system as per NEMA NU 2:2024 and NEMA XR 25:2019 standards, not specifically an AI component for diagnostic aid.

Table of Acceptance Criteria and Reported Device Performance (Based on available information for the PET/CT system):

Study Details (Focusing on AI-related aspects where applicable, and general system testing otherwise)

1. Sample size used for the test set and the data provenance:

   • For System Performance (NEMA tests): The document does not specify a "test set" in terms of patient data. NEMA tests typically involve phantom studies rather than patient data. Thus, sample size and data provenance are not applicable in the traditional sense for these tests.
   • For AI Component: The document does not provide any information on a test set (patient cases, images) or data provenance (e.g., country of origin, retrospective/prospective) for validating an AI component for diagnostic assistance. The descriptions are entirely about the physical PET/CT system.

2. Number of experts used to establish the ground truth for the test set and the qualifications of those experts:

   • For System Performance: Ground truth for NEMA tests is established by physical measurements and calibration standards, not human experts.
   • For AI Component: This information is not provided in the document as there's no mention of an AI-driven diagnostic aid requiring expert-established ground truth.

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

   • For System Performance: Not applicable.
   • For AI Component: This information is not provided in the document.

4. 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:

   • The document does not indicate that an MRMC study was performed for an AI component. The focus is on the substantial equivalence of the PET/CT hardware and software to a predicate device, and compliance with performance standards for the imaging system itself.

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

   • The document does not detail any standalone algorithm performance testing. The performance testing described is for the integrated PET/CT system's physical and functional characteristics.

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

   • For System Performance: Ground truth for NEMA tests involves physical phantoms and established measurement protocols.
   • For AI Component: This information is not provided in the document.

7. The sample size for the training set:

   • This information is not provided in the document, as there is no mention of an AI model that undergoes a separate training process requiring a distinct training set.

8. How the ground truth for the training set was established:

   • This information is not provided in the document, as there is no mention of an AI model's training set.

Summary of Device and Performance Information from Document:

The provided 510(k) clearance letter for the Biograph Trinion is for a PET/CT imaging system, not an AI-based diagnostic software. The "performance testing" described in the document pertains to the physical and functional aspects of the PET/CT scanner (e.g., spatial resolution, sensitivity, image quality) as measured against industry standards (NEMA NU 2:2024). The clearance is based on proving substantial equivalence to a predicate device and adherence to these well-established performance standards for imaging hardware.

Therefore, the detailed questions regarding AI acceptance criteria, AI test set characteristics, human-in-the-loop studies, and AI ground truth establishment are not addressed in this document because the device being cleared is the imaging system itself, not an AI software component for image analysis or diagnostic support. The document implies that the system can be used for certain clinical applications (like lung cancer screening), but it doesn't describe an automated AI system within the device that requires separate clinical validation with reader studies or large patient datasets.

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The Cios Spin is a mobile X-ray system designed to provide X-ray imaging of the anatomical structures of patients during clinical applications. Clinical applications may include but are not limited to interventional fluoroscopic, gastro-intestinal, endoscopic, urologic, pain management, orthopedic, neurologic, vascular, cardiac, critical care, and emergency room procedures. The patient population may include pediatric patients.

The Cios Spin (VA31A) mobile fluoroscopic C-arm X-ray System is designed for the surgical environment. The Cios Spin provides comprehensive image acquisition modes to support orthopedic and vascular procedures. The system consists of two major components:
a. The C-arm with X-ray source on one side and the flat panel detector on the opposite side. The c-arm can be angulated in both planes and be lifted vertically, shifted to the side and move forward/backward by an operator.
b. The second unit is the image display station with a moveable trolley for the image processing and storage system, image display and documentation. Both units are connected to each other with a cable.

The following modifications were made to the Predicate Device the Cios Spin Mobile X-ray System cleared under Premarket Notification K210054 on February 5, 2021. Siemens Medical Solutions USA, Inc. submits this Traditional 510(k) to request clearance for the Subject Device Cios Spin (VA31A). The following modification is incorporated in the Predicate Device to create the Subject Device, for which Siemens is seeking 510(k) clearance:

1. Software updated from VA30 to VA31A to support the below software features
   A. Updated Retina 3D for optional enlarged 3D Volume of 25cm x 25cm x 16cm
   B. Introduction of NaviLink 3D Lite
   C. Universal Navigation Interface (UNI)
   D. Updated InstantLink with Extended NXS Interface
2. Updated Collimator
3. Updated FLC Imaging system PC with new PC hardware Updated AppHost PC with High Performance Graphic Card
4. New Eaton UPS 5P 850i G2 as successor of UPS 5P 850i due to obsolescense

Based on the provided FDA 510(k) clearance letter for the Siemens Cios Spin (VA31A), here's an analysis of the acceptance criteria and the study proving the device meets them:

Important Note: The provided document is a 510(k) summary, which often summarizes testing without providing granular details on study design, sample sizes, and ground truth establishment to the same extent as a full clinical study report. Therefore, some information requested (e.g., specific number of experts for ground truth, adjudication methods) may not be explicitly stated in this summary. The focus of this 510(k) is primarily on demonstrating substantial equivalence to a predicate device, especially for software and hardware modifications, rather than a de novo effectiveness study.

Acceptance Criteria and Reported Device Performance

The 510(k) summary primarily focuses on demonstrating that the modifications to the Cios Spin (VA31A) do not introduce new safety or effectiveness concerns compared to its predicate device (Cios Spin VA30) and a reference device (CIARTIC Move VB10A) that incorporates some of the new features. The acceptance criteria are implicitly tied to meeting various industry standards and demonstrating functionality and safety through non-clinical performance testing.

Table 1: Acceptance Criteria and Reported Device Performance

Study Details Proving Device Meets Acceptance Criteria

The study described is primarily a non-clinical performance testing and software verification and validation effort rather than a traditional clinical trial.

1. Sample sizes used for the test set and data provenance:

   • Test Set Sample Size: Not explicitly stated as a "sample size" in the context of patients or images for performance evaluation. The testing described is "Unit, Subsystem, and System Integration testing" and "software verification and regression testing." This type of testing uses a diverse set of test cases designed to cover functionality, performance, and safety requirements. For the "Enlarged Volume Field of View," it's a non-clinical test, likely using phantoms or simulated data.
   • Data Provenance: Not applicable in terms of patient data provenance for the non-clinical and software testing described. This is bench testing and software validation. Customer reports and feedback forms are mentioned for human factors, but specific details on their origin (country, etc.) are not provided. The manufacturing site is Kemnath, Germany.

2. Number of experts used to establish the ground truth for the test set and qualifications of those experts:

   • Not explicitly stated. For non-clinical performance and software testing, "ground truth" is typically established by engineering specifications, known correct outputs for given inputs, and compliance with industry standards. If clinical use tests involved subjective evaluation, the number and qualifications of experts are not detailed, but they are implied to be "healthcare professionals" (operators are "adequately trained").

3. Adjudication method for the test set:

   • Not applicable/Not explicitly stated. For software and bench testing, adjudication usually refers to a process of resolving discrepancies in ratings or measurements. Given the nature of this submission (software/hardware modifications and non-clinical testing), formal clinical adjudication methods (like 2+1, 3+1 for image reviews) are not described as part of the primary evidence. Acceptance is based on test cases meeting predefined engineering requirements.

4. 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. An MRMC study was not conducted. This 510(k) is for a mobile X-ray system with software and hardware updates, not an AI-assisted diagnostic device where evaluating human reader performance with and without AI would be relevant. The "AI" mentioned (Retina 3D, NaviLink 3D) refers to advanced imaging/navigation features, not machine learning for diagnostic interpretation.

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

   • Yes, implicitly. The "non-clinical test 'Enlarged Volume Field of View' testing" and other "Unit, Subsystem, and System Integration testing" for functionality and performance are essentially standalone tests of the device's components and software without immediate human interpretation in a diagnostic loop. The acceptance criteria for these tests refer to technical performance endpoints, not diagnostic accuracy.

6. The type of ground truth used:

   • Engineering Specifications and Standard Compliance: For the performance and safety testing, the "ground truth" is adherence to predefined engineering requirements (e.g., image dimensions, system response times, electrical safety limits) and compliance with national and international industry standards (e.g., IEC 60601 series, ISO 14971, NEMA PS 3.1).
   • For the Human Factors Usability Validation, "customer reports and feedback forms" serve as a form of "ground truth" regarding user experience and usability.

7. The sample size for the training set:

   • Not applicable. This submission describes modifications to an X-ray imaging system, not the development of a machine learning algorithm that requires a separate training set. The existing software (VA30) was updated to VA31A. The "training" for the software itself would have occurred during its initial development, not for this specific 510(k) submission.

8. How the ground truth for the training set was established:

   • Not applicable. As above, this information is not relevant to this specific 510(k) submission, as it focuses on modifications to an existing device rather than the development of a new AI/ML algorithm requiring a training set and its associated ground truth.

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This computed tomography system is intended to generate and process cross-sectional images of patients by computer reconstruction of x-ray transmission data.

The images delivered by the system can be used by a trained staff as an aid in diagnosis, treatment and radiation therapy planning as well as for diagnostic and therapeutic interventions.

This CT system can be used for low dose lung cancer screening in high risk populations*.

*As defined by professional medical societies. Please refer to clinical literature, including the results of the National Lung Screening Trial (N Engl J Med 2011; 365:395-409) and subsequent literature, for further information.

Siemens intends to update the software version syngo CT VB20 (update) for the following NAEOTOM Alpha class CT systems:

Dual Source NAEOTOM CT scanner systems:

• NAEOTOM Alpha (trade name ex-factory CT systems: NAEOTOM Alpha.Peak; trade name installed base CT systems with SW upgrade only: NAEOTOM Alpha)

For simplicity, the product name of NAEOTOM Alpha will be used throughout this submission instead of the trade name NAEOTOM Alpha.Peak.

• NAEOTOM Alpha.Pro

Single Source NAEOTOM CT scanner system:

• NAEOTOM Alpha.Prime

The subject devices NAEOTOM Alpha (trade name ex-factory CT systems: NAEOTOM Alpha.Peak) and NAEOTOM Alpha.Pro with software version SOMARIS/10 syngo CT VB20 (update) are Computed Tomography X-ray systems which feature two continuously rotating tube-detector systems, denominated as A- and B-systems respectively (dual source NAEOTOM CT scanner system).

The subject device NAEOTOM Alpha.Prime with software version SOMARIS/10 syngo CT VB20 (update) is a Computed Tomography X-ray system which features one continuously rotating tube-detector systems, denominated as A-system (single source NAEOTOM CT scanner system).

The detectors' function is based on photon-counting technology.

In this submission, the above-mentioned CT scanner systems are jointly referred to as subject devices by "NAEOTOM Alpha class CT scanner systems".

The NAEOTOM Alpha class CT scanner systems with SOMARIS/10 syngo CT VB20 (update) produce CT images in DICOM format, which can be used by trained staff for post-processing applications commercially distributed by Siemens and other vendors. The CT images can be used by a trained staff as an aid in diagnosis, treatment and radiation therapy planning as well as for diagnostic and therapeutic interventions. The radiation therapy planning support includes, but is not limited to, Brachytherapy, Particle Therapy including Proton Therapy, External Beam Radiation Therapy, Surgery. The computer system delivered with the CT scanner is able to run optional post-processing applications.

Only trained and qualified users, certified in accordance with country-specific regulations, are authorized to operate the system. For example, physicians, radiologists, or technologists. The user must have the necessary U.S. qualifications in order to diagnose or treat the patient with the use of the images delivered by the system.

The platform software for the NAEOTOM Alpha class CT scanner systems is syngo CT VB20 (update) (SOMARIS/10 syngo CT VB20 (update)). It is a command-based program used for patient management, data management, X-ray scan control, image reconstruction, and image archive/evaluation. The software platform provides plugin software interfaces that allow for the use of specific commercially available post-processing software algorithms in an unmodified form from the cleared stand-alone post-processing version.

Software version syngo CT VB20 (update) (SOMARIS/10 syngo CT VB20 (update)) shall support additional software features compared to the software version of the predicate devices NAEOTOM Alpha class CT systems with syngo CT VB20 (SOMARIS/10 syngo CT VB20) cleared in K243523.

Software version SOMARIS/10 syngo CT VB20 (update) will be offered ex-factory and as optional upgrade for the existing NAEOTOM Alpha class systems.

The bundle approach is feasible for this submission since the subject devices have similar technological characteristics, software operating platform, and supported software characteristics. All subject devices will support previously cleared software and hardware features in addition to the applicable modifications as described within this submission. The intended use remains unchanged compared to the predicate devices.

The provided document describes the acceptance criteria and a study that proves the device meets those criteria for the NAEOTOM Alpha CT Scanner Systems. However, the document primarily focuses on demonstrating substantial equivalence to a predicate device and safety and effectiveness based on non-clinical testing and adherence to standards, rather than detailing a specific clinical performance study with defined acceptance criteria for a diagnostic aid.

Here's a breakdown of the requested information based on the provided text:

1. Table of Acceptance Criteria and Reported Device Performance

The document does not provide a specific table of acceptance criteria with corresponding performance metrics in the way one would typically find for a diagnostic AI device (e.g., sensitivity, specificity, AUC). Instead, it states that:

• Acceptance Criteria for Software: "The test specification and acceptance criteria are related to the corresponding requirements." and "The test results show that all of the software specifications have met the acceptance criteria."
• Acceptance Criteria for Features: "Test results show that the subject devices...is comparable to the predicate devices in terms of technological characteristics and safety and effectiveness and therefore are substantially equivalent to the predicate devices."
• Performance Claim: "The conclusions drawn from the non-clinical and clinical tests demonstrate that the subject devices are as safe, as effective, and perform as well as or better than the predicate devices."

The closest the document comes to defining and reporting on "performance criteria" for a specific feature, beyond basic safety and technical functionality, are for the HD FoV 5.0 and ZeeFree RT algorithms.

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

The document mentions "physical and anthropomorphic phantoms" for HD FoV 5.0 and "homogeneous water phantom" and "phantom with tissue-equivalent inserts," and "dynamic thorax phantom" for ZeeFree RT. It also refers to "retrospective blinded rater studies of respiratory 4D CT examinations performed at two institutions" for ZeeFree RT, but does not specify the sample size (number of cases/patients) or the country of origin for these real-world examination datasets. The data provenance (retrospective/prospective) is stated for the rater study for ZeeFree RT as retrospective, but not for the HD FoV 5.0 rater study (though implied by "retrospective blinded rater study").

3. Number of Experts and Qualifications for Ground Truth

For the HD FoV 5.0 and ZeeFree RT rater studies, the experts were "board-approved radio-oncologists and medical physicists." The number of experts is not specified, nor is their specific years of experience.

4. Adjudication Method for the Test Set

The document explicitly states "retrospective blinded rater study" for HD FoV 5.0 and ZeeFree RT. However, it does not specify the adjudication method (e.g., 2+1, 3+1, none) if there were multiple raters and disagreements.

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

The document states that for HD FoV 5.0 and ZeeFree RT, "the performance of the algorithm was evaluated by board-approved radio-oncologists and medical physicists by means of retrospective blinded rater study." This indicates a reader study, which is often a component of an MRMC study.

However, the study described does not appear to be comparing human readers with AI assistance vs. without AI assistance. Instead, for HD FoV 5.0, it's comparing the new algorithm's results to its predecessor, HD FoV 4.0. For ZeeFree RT, it's comparing the reconstruction to "Standard reconstruction" and assessing if it introduces errors or new artifacts. It's an evaluation of the algorithm's output, not necessarily a direct measure of human reader improvement with AI assistance. Therefore, no effect size for human reader improvement with AI vs. without AI assistance is reported because this specific type of comparative effectiveness study was not described.

6. Standalone (Algorithm Only) Performance Study

Yes, standalone (algorithm only) performance was conducted. The bench testing described for both HD FoV 5.0 and ZeeFree RT involves detailed evaluations of the algorithms' outputs using phantoms and comparing them to established standards or previous versions. For example, for ZeeFree RT, the bench test objectives include demonstrating that it "introduces no relevant errors in terms of CT values and noise levels measured in a homogeneous water phantom" and "does not introduce relevant new artefacts." This is an assessment of the algorithm's direct output.

7. Type of Ground Truth Used

The ground truth used primarily appears to be:

• Phantom-based measurements: For HD FoV 5.0 (physical and anthropomorphic phantoms) and ZeeFree RT (homogeneous water phantom, tissue-equivalent inserts, static torso phantom, dynamic thorax phantom). These phantoms have known properties which serve as ground truth for evaluating image quality metrics.
• Expert Consensus/Interpretation: For HD FoV 5.0 and ZeeFree RT, it involved "board-approved radio-oncologists and medical physicists" in "retrospective blinded rater studies." This suggests the experts' interpretations (potentially comparing image features or diagnostic quality) formed a part of the ground truth or served as the primary evaluation method. The text doesn't specify if there was a pre-established "true" diagnosis or condition for these clinical cases, or if the experts were rating image quality or agreement with a reference standard.

8. Sample Size for the Training Set

The document does not specify the sample size for the training set for any of the algorithms or software features. This document is a 510(k) summary, which generally focuses on justification for substantial equivalence rather than detailed algorithm development specifics.

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

The document does not describe how the ground truth for the training set was established, as it does not provide information about the training set itself.

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The Cios Alpha is a mobile X-Ray system designed to provide X-ray imaging of the anatomical structures of patient during clinical applications. Clinical applications may include, but are not limited to: interventional fluoroscopic, gastro-intestinal, endoscopic, urologic, pain management, orthopedic, neurologic, vascular, cardiac, critical care, and emergency room procedures. The patient population may include pediatric patients.

The Cios Flow is a mobile X-Ray system designed to provide X-ray imaging of the anatomical structures of patient during clinical applications. Clinical applications may include, but are not limited to: interventional fluoroscopic, gastro-intestinal, endoscopic, urologic, pain management, orthopedic, neurologic, vascular, cardiac, critical care and emergency room procedures. The patient population may include pediatric patients.

The Cios Alpha and Cios Flow (VA31A) mobile fluoroscopic C-arm X-ray System is designed for the surgical environment. The Cios Alpha and Cios Flow provide comprehensive image acquisition modes to support orthopedic and vascular procedures. The system consists of two major components:

a) The C-arm with X-ray source on one side and the flat panel detector on the opposite side. The C-arm can be angulated in both planes and lifted vertically, shifted to the side, and moved forward/backward by an operator.

b) The second unit is the image display station with a movable trolley for the image processing and storage system, image display, and documentation. Both units are connected with a cable.

The main unit is connected to the main power outlet, and the trolley is connected to a data network.

The following modifications were made to the predicate device Cios Alpha and Cios Flow. Siemens Medical Solutions USA, Inc. submits this Bundled Traditional 510k to request clearance for Subject Devices Cios Alpha and Cios Flow (VA31A) for the following device modifications made to the Predicates Device Cios Alpha and Cios Flow (VA30).

This 510k submission, Subject Devices "Cios Alpha" and "Cios Flow" with software version VA31A, will support the following categories of modifications made to the Subject Devices in comparison to the Predicate Devices:

1. Software updated from VA30 to VA31A to support the following software features: A. Updated InstantLink with Extended NXS Interface
2. Updated Collimator
3. New optional flat detector Trixell Pixium 3131SOD with IGZO (Indium Gallium Zinc Oxide) technology
4. Updated FLC imaging system with new PC hardware Updated the High Performance Graphic Card on the Apphost PC
5. Updated Eaton UPS 5P 850i G2 as successor of UPS 5P 850i due to obsolescense
6. The Cios Alpha is also known as "Cios Alpha.neo" The Cios Flow is also known as Cios Flow.neo

The provided 510(k) clearance letter details modifications to an existing fluoroscopic X-ray system, Cios Alpha and Cios Flow, specifically focusing on software updates and hardware changes (e.g., a new flat detector).

However, the provided text does not contain explicit acceptance criteria tables for performance metrics (such as image quality, diagnostic accuracy, sensitivity, specificity, or AUC) or the results of a statistically powered, pre-specified study proving the device meets these criteria in a comparative effectiveness setting (e.g., MRMC study).

The document primarily focuses on bench testing, software validation, and compliance with recognized standards to demonstrate the substantial equivalence of the modified device to its predicate. It states that "All test results met all acceptance criteria" for software modifications and that a "Clinical Cadaver Report" was conducted to assess the non-inferiority of a new flat panel detector's subjective image quality. This suggests acceptance criteria were established internally for these tests, but they are not detailed in the provided document.

Therefore, many of the requested details about acceptance criteria, study design, and performance metrics for clinical effectiveness are not present in this 510(k) clearance letter summary. The document's purpose is to justify substantial equivalence based on safety, hardware/software changes, and compliance with standards, rather than proving enhanced clinical effectiveness through a comparative study.

Here's an attempt to answer based on the available information, noting what is not provided:

Acceptance Criteria and Device Performance

No explicit quantitative acceptance criteria table for clinical performance (e.g., diagnostic accuracy metrics like sensitivity, specificity, AUC) is provided in the document. The document discusses "acceptance criteria" in the context of:

• Software Validation: "The testing results show that all the software specifications have met the acceptance criteria." (Page 14)
• Non-clinical Testing: "All test results met all acceptance criteria." (Page 10)
• Clinical Cadaver Report (Subjective Image Quality): The IGZO detector was considered "non-inferior (equal or better) concerning the subjective image quality for four anatomical regions that have been investigated in the ortho-trauma setting." (Page 14) This implies a qualitative acceptance criterion of non-inferiority for subjective image quality, but no numerical thresholds are given.

Since no specific performance metrics with numerical acceptance criteria are provided for clinical use, a table demonstrating reported device performance against such criteria cannot be created from this text. The document refers broadly to testing results meeting "acceptance criteria" but does not define them publicly.

Study Details Proving Device Meets Acceptance Criteria

The primary "study" mentioned for clinical relevance is a Clinical Cadaver Report.

1. Sample Size and Data Provenance:

   • Test Set Sample Size: Not specified for the Clinical Cadaver Report.
   • Data Provenance: The study was a "Clinical Cadaver Report." This implies an experimental, non-human, pre-clinical study. The country of origin is not specified but given the manufacturing site in Germany, it's possible the testing was conducted there or at Siemens facilities elsewhere. It is inherently prospective as it's a pre-market development activity.

2. Number of Experts and Qualifications:

   • Number of Experts: Not specified.
   • Qualifications: Not specified.

3. Adjudication Method:

   • Adjudication Method: Not specified. Given it was a "subjective image quality" assessment, it would likely involve multiple readers, but the method (e.g., 2+1, 3+1) is not disclosed.

4. Multi-Reader Multi-Case (MRMC) Comparative Effectiveness Study:

   • Was an MRMC study done? The document does not indicate that a formal MRMC comparative effectiveness study was done to show human readers improve with AI vs. without AI assistance. The "Clinical Cadaver Report" focused on the subjective image quality of the new detector, not human performance with AI. The device described primarily appears to be an imaging system, not an AI-assisted diagnostic tool that would typically undergo MRMC studies for improved human interpretation.

5. Standalone Performance:

   • Was a standalone (algorithm only without human-in-the-loop performance) done? Not explicitly stated in the context of clinical performance. The "software functional, verification, and System validation testing" (Page 11) and "software validation data" (Page 14) refer to the algorithm's internal performance against specifications, not its standalone diagnostic accuracy on clinical images.

6. Type of Ground Truth Used:

   • Ground Truth for Clinical Cadaver Report: In the context of "subjective image quality," the "ground truth" would be the consensus assessment of the evaluating experts regarding the quality of the images generated by the new IGZO detector compared to the a-Si detector. It is not pathology or outcomes data.

7. Training Set (if applicable for AI/Software components):

   • Sample Size for Training Set: The document does not mention an AI component that would require a distinct "training set" in the common understanding of machine learning. The "software" referred to is control software for the X-ray system, not a diagnostic AI algorithm.

8. Ground Truth for Training Set:

   • How ground truth was established for training set: Not applicable, as there's no indication of machine learning model training. The software modifications are described as updates to system control, interfaces, and hardware support.

In summary: The provided 510(k) clearance letter demonstrates that the modified Cios Alpha and Cios Flow systems meet regulatory requirements for substantial equivalence, primarily through non-clinical testing, compliance with safety standards, and software validation against internal acceptance criteria. A "Clinical Cadaver Report" assessed the subjective image quality of a new detector, finding it non-inferior. However, the document does not contain the specific details of clinical performance acceptance criteria, sample sizes for such studies, or a multi-reader comparative effectiveness study as would be seen for AI-enabled diagnostic tools.

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syngo.via molecular imaging (MI) workflows comprise medical diagnostic applications for viewing, manipulation, quantification, analysis and comparison of medical images from single or multiple imaging modalities with one or more time-points. These workflows support functional data, such as positron emission tomography (PET) or nuclear medicine (NM), as well as anatomical datasets, such as computed tomography (CT) or magnetic resonance (MR). syngo.via MI workflows can perform harmonization of SUV (PET) across different PET systems or different PET reconstruction methods.

syngo.via MI workflows are intended to be utilized by appropriately trained health care professionals to aid in the management of diseases, including those associated with oncology, cardiology, neurology, and organ function. The images and results produced by the syngo.via MI workflows can also be used by the physician to aid in radiotherapy treatment planning.

syngo.via MI Workflows (including Scenium and syngo MBF applications) is a multi-modality post-processing software only medical device intended to aid in the management of diseases, including those associated with oncology, cardiology, neurology, and organ function. The syngo.via MI Workflows applications are part of a larger syngo.via client/server system which is intended to be installed on common IT hardware. The hardware itself is not seen as part of the syngo.via MI Workflows medical device.

The syngo.via MI Workflows software addresses the needs of the following typical users of the product:

• Reading Physician / Radiologist – Reading physicians are doctors who are trained in interpreting patient scans from PET, SPECT and other modality scanners. They are highly detail oriented and analyze the acquired images for abnormalities, enabling ordering physicians to accurately diagnose and treat scanned patients. Reading physicians serve as a liaison between the ordering physician and the technologists, working closely with both.
• Technologist – Nuclear medicine technologists operate nuclear medicine scanners such as PET and SPECT to produce images of specific areas and states of a patient's anatomy by administering radiopharmaceuticals to patients orally or via injection. In addition to administering the scan, the technologist must properly select the scan protocol, keep the patient calm and relaxed, monitor the patient's physical health during the protocol and evaluate the quality of the images. Technologists work very closely with physicians, providing them with quality-checked scan images.

The software has been designed to integrate the clinical workflow for the above users into a server-based system that is consistent in design and look with the base syngo.via platform and other syngo.via software applications. This ensures a similar look and feel for radiologists that may review multiple types of studies from imaging modalities other than Molecular Imaging, such as MR.

The syngo.via MI workflows software supports integration through DICOM transfers of positron emission tomography (PET) or nuclear medicine (NM) data, as well as anatomical datasets, such as computed tomography (CT) or magnetic resonance (MR).

Although data is automatically imported into the server based on predefined configurations through the hospital IT system, data can also be manually imported from external media, including CD, external mass storage devices, etc.

The Siemens syngo.via platform and the applications that reside on it, including syngo.via MI Workflows, are distributed via electronic medium. The Instructions for Use is also delivered via electronic medium.

syngo.via MI Workflows includes 2 workflows (syngo.MM Oncology and syngo.MI General) as well as the Scenium neurology software application and the syngo MBF cardiology software application which are launched from the OpenApps framework within the MI General workflow.

Here's a breakdown of the acceptance criteria and study details for the syngo.via MI Workflows, Scenium, and syngo MBF devices:

Acceptance Criteria and Reported Device Performance

For Lung and Lung Lobe Segmentation:

For PERCIST Liver Reference Region Placement (Binary Liver Mask, input to the algorithm):

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The Siemens Biograph systems are combined X-Ray Computed Tomography (CT) and Positron Emission Tomography (PET) scanners that provide registration and fusion of high resolution physiologic and anatomic information.

The CT component produces cross-sectional images of the body by computer reconstruction of X-Ray transmission data from either the same axial plane taken at different angles or spiral planes taken at different angles. The PET subsystem images and measures the distribution of PET radiopharmaceuticals in humans for the purpose of determining various metabolic (molecular) and physiologic functions within the human body and utilizes the CT for fast attenuation correction maps for PET studies and precise anatomical reference for the fused PET and CT images.

The system maintains independent functionality of the CT and PET devices, allowing for single modality CT and/or PET diagnostic imaging.

These systems are intended to be utilized by appropriately trained health care professionals to aid in detecting, localizing, diagnosing, staging, and restaging of lesions, tumors, disease, and organ function for the evaluation of diseases and disorders such as, but not limited to, cardiovascular disease, neurological disorders, and cancer. The images produced by the system can also be used by the physician to aid in radiotherapy treatment planning and interventional radiology procedures.

This CT system can be used for low dose lung cancer screening in high risk populations. *

• As defined by professional medical societies. Please refer to clinical literature, including the results of the National Lung Screening Trial (N Engl J Med 2011; 365; 395-409) and subsequent literature, for further information.

The Biograph Vision and Biograph mCT PET/CT systems are combined multi-slice X-Ray Computed Tomography and Positron Emission Tomography scanners. These systems are designed for whole-body oncology, neurology and cardiology examinations. The Biograph Vision and Biograph mCT systems provide registration and fusion of high-resolution metabolic and anatomic information from the two major components of each system (PET and CT). Additional components of the system include a patient handling system and acquisition and processing workstations with associated software.

Biograph Vision and Biograph mCT software is a command-based program used for patient management, data management, scan control, image reconstruction and image archival and evaluation. All images conform to DICOM imaging format requirements.

The software for the Biograph Vision and Biograph mCT systems, which are the subject of this application, is substantially equivalent to the commercially available Biograph Vision and Biograph mCT software.

• Somaris Software (cleared in K230421)
  • Upgrade to the latest revision of Somaris Software (Somaris/7 syngo CT VB30) with modified software features:
    • FAST Bolus
    • FAST 4D
    • FAST Applications (FAST Spine, FAST Planning)
    • Automatic Patient Instructions
    • Additional default exam protocols
    • Additional kV setting for Tin Filtration
• PETsyngo software
  • SMART Image Framer (available for Vision 600 and X models only – cleared in K223547)
• Updated computer hardware due to obsolescence issues (cleared in K230421). These changes do not affect system performance characteristics and have no impact on safety or effectiveness.

The Biograph Vision may also use the names Biograph Vision Quantum and Peak for marketing purposes.

Here's an analysis of the provided FDA 510(k) clearance letter for Siemens Biograph Vision and mCT PET/CT Systems, focusing on acceptance criteria and the study that proves the device meets them:

1. Table of Acceptance Criteria and Reported Device Performance

The provided document describes the performance of the updated software (VG85) for the Siemens Biograph Vision and Biograph mCT PET/CT Systems, comparing it to the predicate device (VG80). The "Acceptance Criteria" for the subject device are explicitly stated as "Same" as the predicate device's performance values. This implies that the updated system must perform at least as well as the predicate device across all tested metrics.

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This computed tomography system is intended to generate and process cross-sectional images of patients by computer reconstruction of X-ray transmission data.

The images delivered by the system can be used by a trained staff as an aid in diagnosis, treatment, and radiation therapy planning as well as for diagnostic and therapeutic interventions.

This CT system can be used for low dose lung cancer screening in high risk populations*.

*As defined by professional medical societies. Please refer to clinical literature, including the results of the National Lung Screening Trial (N Engl J Med 2011; 365:395-409) and subsequent literature, for further information.

Siemens intends to market a new software version, SOMARIS/10 syngo CT VB20 for the following SOMATOM Computed Tomography (CT) Scanner Systems:

a) Single Source CT Scanner systems (SOMATOM go. Platform):

• SOMATOM go.Now
• SOMATOM go.Up
• SOMATOM go.All
• SOMATOM go.Top
• SOMATOM go.Sim
• SOMATOM go.Open Pro

In this submission, the above listed CT scanner systems are jointly referred to as subject devices by "SOMATOM go. Platform" CT scanner systems.

b) Dual Source CT Scanner system:

• SOMATOM Pro.Pulse

The above listed subject devices with SOMARIS/10 syngo CT VB20 are Computed Tomography X-ray Systems which feature one (Single Source) or two (Dual Source) continuously rotating tube-detector system and function according to the fan beam principle. The SOMATOM go. Platform and the SOMATOM Pro.Pulse with software SOMARIS/10 syngo CT VB20 produce CT images in DICOM format, which can be used by trained staff for software applications, e.g. post-processing applications, commercially distributed by Siemens Healthcare and other vendors as an aid in diagnosis, treatment preparation and therapy planning support (including, but not limited to, Brachytherapy, Particle including Proton Therapy, External Beam Radiation Therapy, Surgery). The computer system delivered with the CT scanner is able to run optional post processing applications.

The provided FDA 510(k) Clearance Letter for the SOMATOM CT Systems focuses heavily on establishing substantial equivalence to predicate devices through comparisons of technological characteristics, hardware, and software. It generally asserts that the device has met performance criteria through verification and validation testing, but it does not provide a detailed "Acceptance Criteria Table" with specific quantitative metrics and reported device performance. Similarly, it describes the types of studies performed (e.g., bench testing, retrospective blinded rater study), but it lacks the specific details requested regarding sample sizes, data provenance, expert qualifications, and effect sizes that would typically be found in a detailed study report.

Therefore, I will extract and synthesize the information that is available in the document and explicitly state where the requested information is not provided.

Understanding the Device and its Changes

The devices under review are Siemens SOMATOM CT Systems (SOMATOM go.Now, SOMATOM go.Up, SOMATOM go.All, SOMATOM go.Top, SOMATOM go.Sim, SOMATOM go.Open Pro, and SOMATOM Pro.Pulse) with a new software version, SOMARIS/10 syngo CT VB20. This new software version builds upon the previous VB10 version cleared in K233650 and K232206.

The submission focuses on modifications and new features introduced with VB20, including:

• Eco Power Mode: New feature for reduced energy consumption during idle times (not supported on go.Now and go.Up).
• Oncology Exchange: New feature for transferring prescription information from ARIA Oncology Information System.
• myExam Contrast: New feature for exchanging contrast injection parameters.
• FAST 3D Camera/FAST Integrated Workflow: Modifications including retrained algorithms, collision indication, and Centerline/Grid Overlay.
• FAST Planning: Extended to detect additional body regions.
• myExam Companion (myExam Compass/myExam Cockpit): Clinical decision trees now available for child protocols.
• HD FoV 5.0: New extended field of view reconstruction algorithm (for go.Sim and go.Open Pro only).
• CT guided intervention – myAblation Guide interface: New interface.
• Flex 4D Spiral: Modifications regarding dynamic tube current modulation.
• ZeeFree RT: New stack artifact reduced reconstruction for respiratory-related examinations (for go.Open Pro only).
• DirectDensity: Modified to include stopping-power ratio (Kernel St).
• DirectLaser: Patient Marking workflow improvement.
• Respiratory Motion management - Open Online Interface: New interface for respiratory gating.
• DirectSetup Notes: Enabled for certain SOMATOM go. Platform systems.

The core argument for clearance is substantial equivalence to predicate devices. This means that, despite modifications, the device is as safe and effective as a legally marketed device (the predicates).

1. Table of Acceptance Criteria and Reported Device Performance

The provided document does not contain a specific table of quantitative acceptance criteria with corresponding reported device performance values. Instead, it describes general acceptance criteria related to verification and validation tests and then provides qualitative statements about the test results demonstrating comparability or improvement over predicate devices.

Here's a summary of the described performance evaluations:

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

The document provides very limited, qualitative information:

• FAST 3D Camera: Optimized using "additional data from adults and adolescence patients." No specific number of patients or images mentioned.
• FAST Planning: Evaluated on "patient data." No specific number of patients or images mentioned.
• HD FoV 5.0: Evaluated with "physical and anthropomorphic phantoms."
• Flex 4D Spiral: No specific sample size or data type mentioned for performance assessment.
• ZeeFree RT: Evaluated with "homogeneous water phantom," "phantom with tissue-equivalent inserts," "static torso phantom," and "dynamic thorax phantom." Also, "retrospective blinded rater studies of respiratory 4D CT examinations performed at two institutions." No specific number of phantoms, images per phantom, or patient cases mentioned.
• DirectDensity: Evaluated on "SOMATOM CT scanner models." No specific sample size or data type mentioned.

Data Provenance:

• Country of Origin: Not specified for the patient data used for algorithm optimization/validation.
• Retrospective or Prospective:
  • FAST 3D Camera: Implied retrospective as it uses "additional data."
  • FAST Planning: Implied retrospective as it uses "patient data."
  • HD FoV 5.0: Retrospective for the blinded rater study.
  • ZeeFree RT: Retrospective for the blinded rater study of clinical cases. The phantom tests are by nature not retrospective/prospective.

3. Number of Experts and Qualifications for Ground Truth

• HD FoV 5.0: "board-approved radio-oncologists and medical physicists." The number of experts is not specified.
• ZeeFree RT: "board-approved radio-oncologists and medical physicists." The number of experts is not specified.

For other tests, ground truth appears to be established by phantom measurements or internal engineering verification, rather than human expert reads validating clinical ground truth.

4. Adjudication Method for the Test Set

The document mentions "retrospective blinded rater study" for HD FoV 5.0 and ZeeFree RT. However, it does not specify the adjudication method used (e.g., 2+1, 3+1, none) for these studies. It only states they were "blinded."

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

• A Multi-Reader Multi-Case (MRMC) comparative effectiveness study was mentioned for HD FoV 5.0 and ZeeFree RT. Both were "retrospective blinded rater studies."
• Effect Size: The document does not report specific effect sizes (e.g., how much human readers improve with AI vs. without AI assistance). It only states that the purpose of the comparison was to "demonstrate that the HD FoV 5.0 algorithm is as safe and effective as the HD FoV 4.0 algorithm" and for ZeeFree RT that it "enables the optional reconstruction of stack artefact corrected images, which reduce the strength of misalignment artefacts." This implies an assessment of non-inferiority or improvement in image quality, but specific quantitative results for reader performance are not provided in this excerpt.

6. Standalone (Algorithm Only) Performance

The document describes tests for several algorithms (FAST 3D Camera, FAST Planning, HD FoV 5.0, Flex 4D Spiral, ZeeFree RT, DirectDensity) using phantoms and "patient data." These evaluations seem to be focused on the algorithm's performance in generating images or calculations, independent of human interpretation in some cases (e.g., accuracy of FAST 3D Camera, correctness percentage of FAST Planning).

However, it does not explicitly use the term "standalone performance" to differentiate these from human-in-the-loop assessments. The mention of "retrospective blinded rater studies" for HD FoV 5.0 and ZeeFree RT indicates a human-in-the-loop component for that specific evaluation, but the phantom testing mentioned alongside them would be considered standalone.

7. Type of Ground Truth Used

• Phantom Data: For HD FoV 5.0, Flex 4D Spiral, ZeeFree RT, and DirectDensity, physical and/or anthropomorphic phantoms were used, implying the ground truth is precisely known physical characteristics or pre-defined phantom configurations.
• Expert Consensus/Reads: For HD FoV 5.0 and ZeeFree RT, board-approved radio-oncologists and medical physicists performed retrospective blinded rater studies, implying their interpretations/ratings served as a form of ground truth or evaluation metric. It's not explicitly stated if this was against a clinical gold standard (e.g., pathology) or if it was a comparative assessment of image quality and clinical utility.
• Internal Verification: For FAST 3D Camera, FAST Planning, accuracy was assessed, likely against internal system metrics or pre-defined ideal outcomes.

8. Sample Size for the Training Set

The document does not provide any specific information about the sample size used for training the algorithms (e.g., for FAST 3D Camera, FAST Planning, HD FoV 5.0, ZeeFree RT). It only states that FAST 3D Camera was "optimized using additional data" and FAST Planning's algorithm had "product development, validation, and verification on patient data."

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

The document does not provide any specific information on how the ground truth for the training set was established. It only mentions the data types used for validation/verification (phantoms, patient data from two institutions, expert raters).

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syngo.CT LVO Detection is a radiological post-processing application for the analysis of CT angiography (CTA) head images. syngo.CT LVO Detection supports computer-aided triage, and it addresses vascular abortions in the CTA of the brain, commonly referred to as large vessel occlusion (LVO), in the ICA, M1, and M2 segment. It is intended for all patient populations of age ≥ 22 years, without any of the following contraindications: old infarcts or other diseases impacting the brain vasculature (for example, brain tumors), metal artifacts (for example, coils), surgical signs in the images. The output for triage is intended for informational purposes only. It is not intended for diagnostic use and does not alter the original medical image.

The subject device syngo.CT LVO Detection is an image processing software that utilizes artificial intelligence learning algorithms to support qualified clinicians (Radiologists, Neuroradiologists, Neurologists) in prioritization of CT-angiography images by algorithmically identifying findings suspicious of a large vessel occlusion and providing notification to the user. syngo.CT LVO Detection provides a reproducible detection of large vessel occlusions (LVO) on contrast-enhanced CT examinations of the head for detection of ICA, M1, and M2 vessel occlusions in patients suspected of having stroke related circulation occlusion. syngo.CT LVO Detection analyses CT-angiography (CTA) images of the head. The subject device provides a pipeline for the analysis and identification of potential LVO The output which can be send to an external notification device does not highlight or direct attention of the reading physician to any portion of the image.

Here's a detailed breakdown of the acceptance criteria and the study that proves the device meets them, based on the provided FDA 510(k) clearance letter for syngo.CT LVO Detection:

Acceptance Criteria and Reported Device Performance

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This computed tomography system is intended to generate and process cross-sectional images of patients by computer reconstruction of x-ray transmission data.

The images delivered by the system can be used by a trained staff as an aid in diagnosis, treatment and radiation therapy planning as well as for diagnostic and therapeutic interventions.

This CT system can be used for low dose lung cancer screening in high risk populations*.

• As defined by professional medical societies. Please refer to clinical literature, including the results of the National Lung Screening Trial (N Engl J Med 2011; 365:395-409) and subsequent literature, for further information.

Siemens intends to market a new Single source CT system NAEOTOM Alpha.Prime and a new Dual Source CT system NAEOTOM Alpha.Pro based on the SOMARIS/10 software platform.

Siemens also intends to market updated software version, SOMARIS/10 syngo CT VB20, for the new NAEOTOM CT scanner systems and for the NAEOTOM Alpha cleared in K233657 (clearance date March 28th, 2024). The updated software version SOMARIS/10 syngo CT VB20 incorporates mainly features for radiotherapy planning support.

With the new software version SOMARIS/10 syngo CT VB20, the trade name of NAEOTOM Alpha cleared in K233657 has been changed to NAEOTOM Alpha.Peak for ex-factory systems. Systems already installed will receive the software update without change of the trade name. The system label keeps the product name NAEOTOM Alpha. System label information and UDI are not changed and remain the same as the original submitted.

For simplicity, the product name of NAEOTOM Alpha will be used throughout this submission instead of the trade name NAEOTOM Alpha.Peak.

The subject devices NAEOTOM Alpha (trade name ex-factory CT systems: NAEOTOM Alpha.Peak) and NAEOTOM Alpha.Pro with software version SOMARIS/10 syngo CT VB20 are Computed Tomography X-ray systems which feature two continuously rotating tube-detector systems, denominated as Aand B-systems respectively (dual source NAEOTOM CT scanner system).

The subject device NAEOTOM Alpha.Prime with software version SOMARIS/10 syngo CT VB20 is a Computed Tomography X-ray system which features one continuously rotating tube-detector systems, denominated as A-system (single source NAEOTOM Alpha CT scanner system).

The detectors' function is based on photon-counting technology.

In this submission, the above-mentioned CT scanner systems are jointly referred to as subject devices by "NAEOTOM CT scanner systems".

The NAEOTOM CT scanner systems with SOMARIS/10 syngo CT VB20 produce CT images in DICOM format, which can be used by trained staff for post-processing applications commercially distributed by Siemens and other vendors. The CT images can be used by a trained staff as an aid in diagnosis, treatment and radiation therapy planning as well as for diagnostic and therapeutic interventions. The radiation therapy planning support includes, but not limited to, Brachytherapy, Particle including Proton Therapy, External Beam Radiation Therapy, Surgery. The computer system delivered with the CT scanner is able to run optional post-processing applications.

Only trained and qualified users, certified in accordance with country-specific regulations, are authorized to operate the system. For example, physicians, radiologists, or technologists. The user must have the necessary U.S. qualifications in order to diagnose or treat the patient with the use of the images delivered by the system.

The platform software for the NAEOTOM CT scanner systems is syngo CT VB20 (SOMARIS/10 syngo CT VB20). It is a command-based program used for patient management, data management, X-ray scan control, image reconstruction, and image archive/evaluation. The software platform provides plugin software interfaces that allow for the use of specific commercially available post-processing software algorithms in an unmodified form from the cleared stand-alone post-processing version.

Software version syngo CT VB20 (SOMARIS/10 syngo CT VB20) is a modified software version of the primary predicate device NAEOTOM Alpha, syngo CT VB10 (SOMARIS/10 syngo CT VB10) cleared in K233657.

Software version SOMARIS/10 syngo CT VB20 will be offered ex-factory and as optional upgrade for the existing NAEOTOM Alpha systems.

The bundle approach is feasible for this submission since the subject devices have similar technological characteristics, software operating platform, and supported software characteristics. All subject devices will support previously cleared software and hardware features in addition to the applicable modifications as described within this submission. The intended use remains unchanged compared to the predicate devices.

The provided document is a 510(k) summary for the Siemens NAEOTOM CT Scanner Systems, specifically addressing the updated software version SOMARIS/10 syngo CT VB20 and new system configurations (NAEOTOM Alpha.Pro and NAEOTOM Alpha.Prime).

The document does not contain a multi-reader, multi-case (MRMC) comparative effectiveness study with human readers improving with AI vs. without AI assistance. The device described is a Computed Tomography (CT) X-ray system, which is a medical imaging hardware device, not an AI software intended for image interpretation assistance to human readers in the way an MRMC study would typically evaluate. The software features described primarily relate to system control, image reconstruction, and workflow efficiency, some of which are automated ("FAST" technologies) but do not indicate an "AI assistance" that augments a human reader's diagnostic performance in a comparative study design. Therefore, the questions related to MRMC studies and human reader improvement are not applicable to the information provided in this 510(k) summary.

Additionally, the document describes non-clinical performance testing (bench testing), which evaluates the technical performance of the device and its features, rather than a clinical study evaluating diagnostic accuracy against a ground truth from expert readers or pathology. The performance data presented is based on phantom tests and technical assessments rather than a clinical study. Therefore, several of the requested elements (number of experts, adjudication methods, type of ground truth for test sets/training sets, sample sizes for training/test sets as they pertain to clinical data) are not directly addressed in the context of a clinical performance study as typically understood for AI/CADe devices.

The acceptance criteria and reported device performance are generally stated in terms of comparable or improved accuracy to predicate devices and successful completion of verification and validation testing against internal specifications and recognized standards.

Here's an attempt to answer the questions based on the provided document, noting the limitations regarding the type of device and performance data presented:

Acceptance Criteria and Device Performance Study Summary

The device in question is a Computed Tomography (CT) X-ray System (NAEOTOM CT Scanner Systems) with software version SOMARIS/10 syngo CT VB20. The performance data provided are primarily from non-clinical bench testing to demonstrate the device's technical capabilities and comparability to predicate devices. The focus is on functionality verification and image quality evaluation, particularly for new and modified features.

1. Table of Acceptance Criteria and Reported Device Performance

The document does not provide a specific, quantifiable table of "acceptance criteria" for features in the typical sense of a clinical trial (e.g., sensitivity/specificity thresholds). Instead, "acceptance criteria" are referenced as being "related to the corresponding requirements" for various verification and validation tests. The reported performance is generally qualitative, stating that features meet expectations or are comparable/improved to predicate devices.

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

The "test set" in this context refers to phantom test data used for non-clinical bench testing.

• Sample Size: Not explicitly quantified as a number of "cases" or "patients" in the way a clinical study would. The descriptions indicate testing was performed on "a dynamic phantom" for Direct i4D, and "additional data from adults and adolescence patients" for FAST 3D Camera accuracy (though this data was for optimizing the feature, not for an independent test set as typically understood for a clinical performance evaluation). For FAST Planning, testing was done on "patient data" but no sample size is given. For Low-Dose Lung Cancer Screening, "technical parameters" were compared, implying phantom or engineering data. The overall testing framework includes "System Validation test" and "System Verification test" with various activities, but no specific human subject test set is detailed.
• Data Provenance: The data is from non-clinical bench testing and internal verification/validation activities. There is no mention of data origin in terms of "country of origin" as it is not a clinical study involving patient data from specific geographical locations. The testing is described as part of product development, implying internal company testing. It is inherently retrospective in the sense that it's testing a developed product against its specifications.

3. Number of Experts Used to Establish the Ground Truth for the Test Set and Qualifications of Those Experts

This information is not provided as the performance data is from non-clinical bench testing, not from a clinical study with a ground truth established by medical experts interpreting images. The "ground truth" for these tests would be the pre-defined technical specifications and expected physical behavior of the system, verified by engineering and quality assurance personnel.

4. Adjudication Method for the Test Set

Since there is no clinical test set involving human expert interpretations and potential discrepancies, an "adjudication method" is not applicable. The "acceptance criteria" for the non-clinical tests are against internal requirements and performance metrics (e.g., accuracy against a known phantom truth, successful triggering of functions).

5. If a Multi-Reader Multi-Case (MRMC) Comparative Effectiveness Study was done

No, an MRMC comparative effectiveness study was not done according to the provided information. This submission is for a CT scanner system (hardware and associated control/reconstruction software), not an AI software intended to assist human readers in image interpretation. The performance data focuses on the technical capabilities of the CT system itself.

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

The "performance data" section describes the technical performance and functionality of various software and hardware features, which can be considered "standalone" in the sense of evaluating the algorithm/system's output against a known input (e.g., phantom data). For instance:

• Direct i4D: Performance evaluated based on data acquisition and artifact avoidance.
• FAST Planning: Assessed the algorithm's ability to calculate ranges correctly and its speed.
• Low-Dose Lung Cancer Screening: Compared technical parameters.

However, this is not a "standalone performance" measure for diagnostic accuracy of an AI algorithm in the context of interpreting medical images compared to a clinical ground truth, but rather the technical performance of the imaging device and its embedded functionalities.

7. The Type of Ground Truth Used

For the non-clinical testing, the "ground truth" is technical/physical ground truth based on phantom properties, defined test conditions, and engineering specifications. For instance:

• For Direct i4D, the ground truth is the "breathing pattern of a thorax phantom."
• For FAST 3D Camera, the ground truth for accuracy would be the known physical position/orientation relative to the scanner.
• For FAST Planning, the ground truth involves "correct" calculated ranges based on anatomical rules or system design.

There is no mention of ground truth established via expert consensus, pathology, or outcomes data, as these are non-clinical hardware/software performance tests.

8. The Sample Size for the Training Set

The document does not provide information on a "training set" in the context of machine learning or AI models with labelled clinical data. The software features described are primarily rule-based or optimized algorithms, not deep learning models that require large labelled training datasets. While some features like FAST 3D camera were "optimized using additional data," this refers to data used for algorithm refinement (development/internal testing) and not a distinct "training set" for an AI model that would then be tested on an independent "test set."

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

Since no explicit "training set" for AI/ML algorithms is described in the provided context, this question is not applicable. The development and optimization of the system's features rely on engineering specifications, physical models, and potentially iterative refinement using internal test data (phantoms, potentially anonymized patient data for feature optimization) where the "truth" is either known by design or derived from highly controlled measurements.

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