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The Apollo TMS Therapy System is indicated for the treatment of Major Depressive Disorder in adult patients who have failed to achieve satisfactory improvement from prior antidepressant medication in the current episode, as well as an adjunct for the treatment of adult patients suffering from Obsessive-Compulsive Disorder (OCD).

The Apollo TMS Therapy System is an electromagnetic device that non-invasively delivers a rapidly pulsed magnetic field to the cerebral cortex in order to activate neurons within a limited volume without inducing a seizure. This method of cortical stimulation by application of brief magnetic pulses to the head is known as Transcranial Magnetic Stimulation (TMS).

The Apollo TMS Therapy System is comprised of the following principal components:

• User Interface
• Main Unit (with or without housing)
• Stimulation Coil
• Coil Positioning System

The operator controls the Apollo TMS Therapy System via the user interface (application software "Stimware"). "Stimware" is a treatment and data management software that administrates treatment protocols and the patient´s individual stimulation dose determined by the patient´s individual motor threshold. Stimulation is applied via the stimulation coil. For the treatment of major depressive disorder, the stimulation coil is positioned to the left dorsolateral prefrontal cortex (DLPFC) by means of the coil positioning system. The observed and documented increase in cortical excitability after high frequency rTMS has been shown to persist beyond the duration of the train of stimulation. For treatment of OCD, the stimulation coil is positioned to the dorsomedial prefrontal cortex (DMPFC).

The provided FDA 510(k) clearance letter and summary for the Apollo TMS Therapy System (K243539) indicate that the device is substantially equivalent to predicate devices. This clearance is based on non-clinical performance data and a comparison to existing cleared devices rather than a de novo clinical comparative effectiveness study.

Here's an analysis of the acceptance criteria and the study that proves the device meets them, based on the provided text:

1. Table of Acceptance Criteria and Reported Device Performance

The acceptance criteria for this 510(k) submission are primarily based on demonstrating substantial equivalence to existing legally marketed predicate devices, particularly for the extended indication of Obsessive-Compulsive Disorder (OCD) treatment. The criteria are therefore focused on matching or being demonstrably similar to the predicate device's performance, especially for the OCD treatment parameters, and adhering to recognized safety and performance standards.

2. Sample size used for the test set and the data provenance

The submission does not detail a specific "test set" sample size with patient data for efficacy, as it claims substantial equivalence primarily through non-clinical performance testing and direct comparison of specifications and treatment parameters to already cleared devices.

The "study" relies on:

• Non-clinical performance testing: This would involve engineering and laboratory testing for electrical safety, EMC, usability, temperature, and stimulation intensity, rather than a sample size of patients.
• Leveraged data from prior clearances (K180313 and K232639): This indicates that data from previously cleared versions of the Apollo TMS Therapy System was used as a basis.
• Primary predicate device (HORIZON® 3.0 TMS Therapy System K222171): The effectiveness of the OCD treatment protocol is derived from the established effectiveness of this predicate device, which was itself cleared based on its own clinical or non-clinical data.

Data Provenance: Not specified in terms of country of origin or retrospective/prospective for patient data, as direct clinical effectiveness data for the subject device was not required for this 510(k) clearance due to the substantial equivalence claim. The non-clinical testing would have been conducted by the manufacturer (MAG & More GmbH, Germany).

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

This information is not applicable as the submission does not describe a clinical study where experts established ground truth for a test set of patient data. The clearance is based on comparison to a predicate device and non-clinical engineering tests.

4. Adjudication method for the test set

This information is not applicable as there was no clinical test set requiring expert adjudication.

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 applicable. The Apollo TMS Therapy System is a therapeutic device that directly applies magnetic stimulation, not an imaging analysis or diagnostic AI device that involves "human readers" or AI assistance in interpretation. No MRMC study was conducted or mentioned.

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

This information is not applicable in the context of an "algorithm only" performance study. The Apollo TMS Therapy System is a hardware device with controlling software. Its performance is always "standalone" in the sense that the device itself (hardware+software) delivers the therapy; there isn't a separate "human-in-the-loop" performance associated with its direct therapeutic action, but rather clinical oversight and operation by a healthcare professional. The software verification and validation are noted, but this is for the control system's reliability, not an "algorithm-only performance" in the diagnostic AI sense.

7. The type of ground truth used

For the effectiveness of the OCD treatment, the "ground truth" is essentially the established clinical efficacy of the primary predicate device (HORIZON® 3.0 TMS Therapy System K222171), whose OCD treatment protocol the Apollo TMS Therapy System replicates. The substantial equivalence claim means that because the subject device's treatment parameters are identical and its output stimulation is adequately similar, it can be expected to achieve the same therapeutic effect.

For the safety and performance of the device itself (e.g., electrical safety, temperature limits, consistent stimulus delivery), the "ground truth" is established through adherence to recognized consensus standards (e.g., IEC 60601-1) and successful non-clinical engineering tests.

8. The sample size for the training set

This information is not applicable. The Apollo TMS Therapy System is not an AI/ML device in the sense of requiring a large "training set" of patient data for its primary function. Its software (Stimware) manages protocols and patient data, but it's not "trained" on patient outcomes to learn or adapt therapeutic delivery in an AI sense.

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

This information is not applicable for the same reasons as point 8.

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The Apollo TMS Therapy System is indicated for the treatment of Major Depressive Disorder in adult patients who have failed to achieve satisfactory improvement from prior antidepressant medication in the current episode.

The Apollo TMS Therapy System is an electromagnetic device that non-invasively delivers a rapidly pulsed magnetic field to the cerebral cortex in order to activate neurons within a limited volume without inducing a seizure. This method of cortical stimulation by application of brief magnetic pulses to the head is known as Transcranial Magnetic Stimulation (TMS).

The Apollo TMS Therapy System is comprised of the following principal components:

• User Interface
• Main Unit (with or without housing)
• Stimulation Coil
• Coil Positioning System

The operator controls the Apollo TMS Therapy System via the user interface (application software "Stimware"). "Stimware" is a treatment and data management software that administrates treatment protocols and the patient´s individual stimulation dose determined by the patient´s individual motor threshold. Stimulation is applied via the stimulation coil which is positioned to the left dorsolateral prefrontal cortex (DLPFC) by means of a coil positioning system. The observed and documented increase in cortical excitability after high frequency (10Hz) rTMS has been shown to persist beyond the duration of the train of stimulation.

This document does not contain information about a study proving the device meets acceptance criteria. Instead, it is a 510(k) summary for the Apollo TMS Therapy System, demonstrating its substantial equivalence to previously cleared predicate devices for the treatment of Major Depressive Disorder.

Therefore, I cannot provide the requested information regarding:

• A table of acceptance criteria and reported device performance.
• Sample size used for the test set and data provenance.
• Number of experts and their qualifications for ground truth establishment.
• Adjudication method for the test set.
• MRMC comparative effectiveness study results.
• Standalone performance.
• Type of ground truth used.
• Sample size for the training set.
• How ground truth for the training set was established.

The document primarily focuses on:

• Intended Use and Device Description: The Apollo TMS Therapy System is an electromagnetic device for non-invasive stimulation of the cerebral cortex to treat Major Depressive Disorder.
• Compliance with Standards: Conforms to various ISO and IEC standards for medical devices, electrical safety, usability, software life cycle processes, and risk management.
• Non-Clinical and Clinical Performance Data: States that non-clinical testing was performed according to standards, and comparative testing for additional coils demonstrated substantial equivalence to predicate devices. It specifically mentions that clinical data on the treatment efficacy of the iTBS protocol was already demonstrated in a previous summary (K173620) and that verification testing confirmed constant intensity of individual stimuli.
• Software Verification and Validation: Conducted in accordance with IEC 62304, considered "basic documentation" as software failures are not likely to present high-risk situations.
• Risk Management: Applied throughout the product development life cycle, concluding no new hazards compared to predicate devices.
• Substantial Equivalence: The core of the submission, asserting that the Apollo TMS Therapy System is substantially equivalent to the HORIZON® TMS Therapy System (K182853) and an earlier version of the Apollo TMS Therapy System (K180313). This equivalence is based on identical intended use, indications for use, system components, operational procedures, and treatment protocols (especially iTBS).
• Comparative Table: Provides a detailed comparison of characteristics between the subject device and its predicates, highlighting similarities in indications for use, product code, classification, standard treatment stimulation parameters (e.g., area of brain stimulated, stimulation intensity, frequency, pulse train duration), output stimulation parameters, and coil parameters. It explicitly notes that the performance and clinical effectiveness are substantially equivalent.

In summary, this document is a regulatory submission demonstrating substantial equivalence rather than a clinical study report with specific acceptance criteria and performance data from a clinical trial.

Ask a specific question about this device

The Apollo TMS Therapy System is indicated for the treatment of Major Depressive Disorder in adult patients who have failed to achieve satisfactory improvement from prior antidepressant medication in the current episode.

The Apollo TMS Therapy System is an electromagnetic device that non-invasively delivers a rapidly pulsed magnetic field to the cerebral cortex in order to activate neurons within a limited volume without inducing a seizure. This method of cortical stimulation of brief magnetic pulses to the head is known as Transcranial Magnetic Stimulation. The Apollo TMS Therapy System is comprised of four principal components: User Interface, Main Unit, Stimulation Coil, and Coil Positioning System. The operator controls the system via the User Interface. The Treatment and Data Management Software administrates the treatment protocols and the patient´s individual stimulation dose determined by the patient´s individual motor threshold. The stimulation is applied via the Stimulation Coil which is positioned to the left dorsolateral prefrontal cortex (DLPFC) by means of the coil positioning system.

The provided text is a 510(k) summary for the Apollo TMS Therapy System, which is a medical device. This type of submission is for demonstrating substantial equivalence to a legally marketed predicate device, rather than proving novel effectiveness through a clinical study with detailed performance metrics.

Therefore, the document does not contain acceptance criteria and a study proving the device meets those criteria in the way one might expect for a new diagnostic or AI-driven interpretative device. Instead, it focuses on demonstrating substantial equivalence to existing, approved devices.

Here's an analysis based on your request, identifying what information is available and what is not:

1. Table of acceptance criteria and reported device performance:

The document doesn't explicitly define "acceptance criteria" for performance in the typical sense of a new clinical trial. Instead, it demonstrates how the Apollo TMS Therapy System is substantially equivalent to predicate devices. The "performance" here is related to mirroring the characteristics and functionality of those predicates.

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

This document describes non-clinical testing for substantial equivalence, not a clinical study on patient outcomes with a "test set" in the context of, for example, diagnostic accuracy. Therefore, this information is not applicable and not provided. The "testing" primarily involved engineering and safety assessments (electromagnetic field characteristics, electrical safety, EMC, software, risk management).

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

As no clinical test set for diagnostic or interpretative performance is described, this information is not applicable and not provided.

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

As no clinical test set requiring expert adjudication is described, this information is not applicable and not provided.

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 device is a therapeutic system (Repetitive Transcranial Magnetic Stimulation) for Major Depressive Disorder, not an AI-assisted diagnostic or interpretive tool that would involve human readers. Therefore, an MRMC comparative effectiveness study is not applicable and not mentioned.

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

The device is a therapeutic system, not an algorithm. Performance evaluation focuses on its physical and functional characteristics, and its equivalence to predicate devices, not on a standalone algorithm's performance. Therefore, this concept is not applicable.

7. The type of ground truth used:

For the non-clinical testing performed, the "ground truth" would be established by:

• Engineering standards and specifications: For electromagnetic field characteristics, pulse width, frequency accuracy, amplitude, etc.
• International safety standards: Such as IEC 60601-1 and IEC 60601-1-2 for electrical safety and EMC.
• FDA guidance documents: For software verification and validation, and special controls for rTMS systems.
• Risk management standards: ISO 14971.

8. The sample size for the training set:

As this is a 510(k) submission for a physical medical device, not a machine learning model, the concept of a "training set" is not applicable and not provided.

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

As the concept of a training set is not applicable, this information is not provided.

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