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The EPIONE device is a user controlled, stereotactic accessory intended to assist in the planning and manual advancement of one or more instruments, as well as in verification of instrument position, during Computed Tomography (CT) guided percutaneous ablation procedures in the abdomen, performed by physicians trained for CT procedures and performed under general anesthesia with rigid straight instruments such as needles and probes of diameters ranging from 11G to 19G. During the planning phase, the desired instrument and performance is defined relative to the target anatomy. During the guidance phase, the device enables to monitor respiratory patient position prior to instrument advancement. During the assessment phase, the achieved instrument placement and performance are displayed relative to the previously defined plan through an overlay of the pre- and post-treatment image data.

The proposed Epione v1.0.2 is a modified version of the Epione predicate device as was cleared under 510(k) K211645. Aside from the modifications that are summarized further below, the Epione v1.0.2 is the same as the predicate as follows.

The EPIONE device v1.0.2 is a user controlled, stereotactic accessory device intended to assist in the planning and manual advancement of one or more instruments, as well as in verification of instrument position during Computed Tomography (CT) quided percutaneous procedures.

During the planning phase, the desired instrument placement and performance is defined relative to the tarqet anatomy. During the quidance phase, the device enables to monitor respiratory levels and verify patient position prior to instrument. During the assessment phase, the achieved instrument placement and performance are displayed relative to the previously defined plan through an overlay of the pre- and post-treatment image data.

The device is indicated for use with rigid straight instruments such as needles, and applicators (cryoprobes, electrodes, and antennas), used in CT-guided interventional procedures performed by physicians trained for CT procedures on organs and anatomical structures in the abdomen.

The EPIONE device v1.0.2 consists in the following components: Robot cart, Display cart, Navigation cart, EPIONE software, EPIONE instruments (Needle guide, Patient reference, Short Navigation probe).

The modifications include:

• expanding its ablation procedure indications to organs in the abdomen as compared to ablation procedures only on the liver in the Epione predicate,
• the addition of a new software functionalities to facilitate multi-needle planning that include configurable multiple needle array configurations for simultaneous needle group planning as compared to the planning of one needle at a time in a sequential manner in the Epione predicate,
• the addition of post-procedure imaging software tools to measure the post-procedure ablated zones as compared to only visual assessment in the Epione predicate, and
• the addition of an alternate shortened version of the navigation probe as compared to original longer version in the Epione predicate. This short navigation probe replaces the longer original navigation probe.

Here's a breakdown of the acceptance criteria and the study details for the Epione v1.0.2 device, based on the provided FDA 510(k) summary:

Acceptance Criteria and Reported Device Performance

The provided document primarily focuses on demonstrating substantial equivalence to predicate devices rather than setting explicit numerical acceptance criteria for a new, unique performance claim. However, the non-clinical tests re-performed from the predicate and the clinical study aim to demonstrate that the device performs equivalently to the predicates.

The implied acceptance criterion is that the device should be as safe and effective in achieving its intended use as in the predicates. The reported device performance is that it meets this implied criterion based on the conducted studies.

Study Information:

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

• Test Set Sample Size:
  • Non-Clinical (Bench) Testing: The document does not specify a numerical sample size for the "Overall System Accuracy Tests," "Respiratory Monitoring Effectiveness Tests," or "positional accuracy testing." It states these were "re-performed" from the predicate.
  • Usability Testing: Not specified, but re-performed.
  • Clinical Study: 33 patients (interim data).
• Data Provenance:
  • Non-Clinical Tests: In-vitro (bench testing).
  • Usability Testing: Re-performed.
  • Clinical Study: Ongoing clinical study in France (prospective data).

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

• The document does not specify the number of experts or their qualifications for establishing ground truth in the non-clinical or usability testing. These tests likely rely on standardized measurements and expert evaluation of safety and effectiveness, but specific details are not provided.
• For the clinical study, the ground truth for "in-vivo equivalence in safety and effectiveness" is established through physician-performed procedures and patient outcomes, but the number of adjudicating experts or their detailed qualifications for assessing the clinical data are not explicitly mentioned. The study is non-interventional, investigating device performance in procedures performed by "physicians trained for CT procedures."

4. Adjudication Method for the Test Set

• The document does not specify an explicit adjudication method (e.g., 2+1, 3+1, none) for any of the tests, including the clinical study. It states that the clinical study investigated the performance of the device.

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

• A MRMC comparative effectiveness study is not explicitly mentioned or described in the provided text. The clinical study is a non-interventional study investigating the performance of the device itself, not comparing human readers with and without AI assistance.

6. Standalone (Algorithm Only) Performance Study

• The device is described as a "user-controlled, stereotactic accessory" with a robotic arm and software components, indicating a human-in-the-loop system. While software verification and validation were performed, a standalone (algorithm only) performance study in the sense of an independent diagnostic algorithm without human interaction is not described. The software functions assist the physician.

7. Type of Ground Truth Used

• Non-Clinical Tests:
  • Overall System Accuracy & Positional Accuracy: Likely based on objective physical measurements and comparisons to known standards or established predicate device performance.
  • Respiratory Monitoring Effectiveness: Likely based on objective physiological measurements.
• Usability Testing: Based on user interaction, feedback, and demonstration of safe and effective use by intended users.
• Clinical Study: "In-vivo equivalence in safety and effectiveness" is the ground truth assessed. This would involve clinical outcomes, procedure success rates, safety endpoints, and potentially expert assessment of procedural metrics, though details are not provided.

8. Sample Size for the Training Set

• The document does not provide information about a specific training set size. The EPIONE device is a robotic surgical assistance system, and while it has software, it's not primarily an AI/ML image interpretation algorithm that would typically have a distinct image-based training set described in this context. The software development likely involved extensive internal testing and refinement, but a dedicated "training set" in the context of machine learning model development is not detailed here.

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

• As a training set is not explicitly identified or described in the context of AI/ML model training, the method for establishing its ground truth is also not provided.

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The EPIONE device is a user controlled, stereotactic accessory intended to assist in the planning and manual advancement of one or more instruments, as well as in verification of instrument position during Computed Tomography (CT) guided percutaneous procedures.

During the planning phase, the desired instrument placement and performance is defined relative to the target anatomy. During the guidance phase, the device enables to monitor respiratory levels and verify patient position prior to instrument advancement. During the assessment phase, the achieved instrument placement and performance are displayed relative to the previously defined plan through an overlay of the pre- and post-treatment image data.

The device is indicated for use in liver ablation procedures under general anesthesia with rigid straight instruments such as needles and probes of diameters ranging from 11G to 19G by physicians trained for CT procedures.

The EPIONE device is a user controlled, stereotactic accessory intended to assist in the planning and manual advancement of one or more instruments, as well as in verification of instrument position during Computed Tomography (CT) guided percutaneous procedures.

During the planning phase, the desired instrument placement and performance is defined relative to the target anatomy. During the guidance phase, the device enables to monitor respiratory levels and verify patient position prior to instrument. During the assessment phase, the achieved instrument placement and performance are displayed relative to the previously defined plan through an overlay of the pre- and post-treatment image data.

The device is indicated for use in liver ablation procedures under general anesthesia with rigid straight instruments such as needles and probes of diameters ranging from 11G to 19G by physicians trained for CT procedures.

The EPIONE device consists in the following components:
Robot cart: This mobile equipment can be moved in and out of the intervention room and is positioned next to the patient. The cart carries a robotic arm including a force sensor assembly allowing handguiding of the robotic arm by the user. The robotic arm movements are enabled by the user using a footswitch. The robot cart also embeds the electronic systems required to power and operate the robot arm.
Display cart: This mobile equipment can be moved in and out of the intervention room and is positioned next to the operator. The cart carries a touchscreen to operate the system.
Navigation cart: This mobile equipment can be moved in and out of the intervention room and is positioned next to the table. The cart carries a navigation camera.
EPIONET software: A software provides the step-by-step workflow assistance for intervention planning and intraoperative positioning of the robotic arm for instruments placement and post-operative assessment.
EPIONE instruments: Needle guide, Patient reference, Navigation probe

The provided document describes the Quantum Surgical EPIONE device and its FDA 510(k) summary, which includes non-clinical and clinical performance data to demonstrate substantial equivalence to a predicate device. This information will be used to answer your questions about acceptance criteria and the study proving the device meets them.

1. Table of acceptance criteria and the reported device performance

Based on the "Summary of Non-Clinical Performance Data" and "Clinical study" sections, the primary acceptance criteria revolve around the device's accuracy, safety, and effectiveness. A specific quantitative acceptance criterion for accuracy is hinted at by the mention of "average accuracy" being demonstrated as safe and effective, but the numerical value of this criterion is not explicitly stated. The performance is reported as meeting these general standards.

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

• Test set sample size:
  • Non-clinical (Animal Study): 36 needle placements were performed in a preclinical animal study (porcine models).
  • Clinical Study: 21 patients were enrolled in a multi-center, prospective, and interventional clinical study.
• Data Provenance:
  • Animal Study: The document states "preclinical animal study on the liver was conducted on porcine models". It does not specify the country of origin.
  • Clinical Study: The document mentions a "multi-center, prospective and interventional clinical study." It does not specify the country of origin, but given the sponsor (Quantum Surgical SAS) is based in France, it is likely the study involved sites in France or other European countries. The study is described as "prospective," indicating data was collected specifically for this study.

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

The document does not specify the number of experts used to establish ground truth or their qualifications for either the animal or clinical studies. The clinical study design focuses on the device's safety and effectiveness in guiding procedures performed by trained physicians, but it does not detail an independent ground truth establishment process by experts for, e.g., diagnostic accuracy or outcome evaluation separate from the performing physicians.

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

The document does not describe an adjudication method for the test set. Given that the clinical study focuses on the device's use in procedures and observed outcomes (safety and effectiveness of the procedure itself), rather than an image-based diagnostic evaluation requiring consensus reads, an adjudication process as typically understood for diagnostic AI might not have been applied in the same way.

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

A multi-reader multi-case (MRMC) comparative effectiveness study comparing human readers with and without AI assistance was not reported. The studies described are focused on the device's performance in assisting physicians with CT-guided percutaneous procedures, rather than on improving human reader performance in image interpretation. The EPIONE is a surgical assistance system, not primarily an image interpretation AI.

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

The EPIONE device is explicitly described as a "user controlled, stereotactic accessory intended to assist in the planning and manual advancement of one or more instruments, as well as in verification of instrument position during Computed Tomography (CT) guided percutaneous procedures." It involves a robotic arm, software, and instruments that are operated by a human. Therefore, a standalone (algorithm only without human-in-the-loop) performance study was not applicable or performed, as the device's function inherently requires human interaction.

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

• Animal Study: The "accuracy" and "feasibility" were evaluated by observing the results of the 36 needle placements in porcine livers. The ground truth for accuracy would likely be the actual vs. planned needle tip position, measured perhaps by post-procedure imaging or dissection, though the specific measurement method is not detailed.
• Clinical Study: The ground truth for the clinical study was primarily outcomes data regarding the safety and performance of the liver ablation procedures. Safety was assessed by the absence of adverse events, and effectiveness (performance) was confirmed by the successful execution of the CT-guided percutaneous procedures for liver ablations using the device.

8. The sample size for the training set

The document does not mention the sample size used for the training set for the EPIONE software or system. This information is typically found in details about the AI/algorithm development, which may not be fully disclosed in a 510(k) summary focused on substantial equivalence.

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

The document does not provide details on how the ground truth for the training set (if any specific training data was used for AI/ML components within the software) was established. The software development and validation were conducted in compliance with FDA guidance and IEC standards, which would cover verification and validation methods, but not necessarily the detailed ground truth establishment for a training dataset.

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