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Use of the Fukuda Denshi DynaScope Model DS-7000 Series Patient Monitor (Model: DS-7000/7000M/7210/7210M) is indicated in those situations where observation of one or more of the following parameters on an individual patient may be required. ECG (waveform, heart rate, ST-Level and ventricular arrhythmias), respiration, non-invasive blood pressure (NIBP), pulse rate, arterial oxygen saturation (SpO2), pulse wave, temperature, invasive blood pressure (IBP), cardiac output, carbon dioxide concentration (CO2), nitrous oxide concentration (N20), oxygen concentration (O2), and anesthetic agent concentration (AG). The target populations of the system are adult, pediatric, and neonatal patients with the exception of the ST segment and arrhythmia analysis, for which the target populations are adult and pediatric only. These observations can include an audible and visual alarm if any of these parameters exceed values that are established by the clinician. The observations may include the individual or comparative trending of one or more of these parameters over a period of up to 24 hours. The DS-7000 Series Patient Monitor is indicated in situations where an instantaneous display of waveform, numeric and trended values is desired. The DS-7000 Series Patient Monitor is also indicated where a hard copy record of the physiological parameters, the alarms conditions or the trended values may be required.

The Fukuda Denshi DynaScope Model DS-7000 Series Patient Monitor (Model: DS-7000/7000M/7210/7210M) is meant to acquire and monitor physiological signals from patients. The system is design to be used in ICU, CCU, OR, ER, or Recovery areas of the hospital or clinic. An optional Battery Pack operation allows the DS-7210/7210M to be used to monitor patients during intra-hospital transport. Patient ages from neonates to adults can all be monitored. Waveforms, numeric and trend data from these patients are available to the clinician on the systems display or may be printed on the system's recorder.

The DS-7000 Series Patient Monitor allows for the monitoring of ECG, heart rate, respiration, non-invasive blood pressure (NIBP), pulse rate, arterial oxygen saturation (SpO2), plethysmograph, temperature, invasive blood pressure (IBP), and cardiac output. This subject modified DS-7000 Series Patient Monitor extended the NIBP measurement target populations from adult and pediatric to adult. pediatric, and neonatal and the DS-7210/7210M of the DS-7000 Series includes ECG 12 Lead monitoring.

The DS-7000/7000M of the DS-7000 Series Patient Monitor allows for the monitoring of carbon dioxide concentration (CO2), nitrous oxide concentration (N2O), oxygen concentration (O2), and anesthetic agent concentration (AG), which utilizes Criticare Systems technology (K012059), by using the option Multigas Unit (MGU-701/MGU-702) . And, by using the option Unit (HU-71/HU-72/HU-73), invasive blood pressure (up to 6 channels), cardiac output, temperature (up to 3 channels) can be additionally monitored. No new functions for the options are being added and are not the subject of this submission for the DS-7000/7000M.

This subject modified DS-7210/7210M of the DS-7000 series Patient Monitor allows for the monitoring of carbon dioxide concentration (CO2), which utilizes Oridion Medical 1987 Ltd. technology "Microstream"" (K060065), by using the option CO2 measurement unit (MGU-722). Or, by using the option Mainstream CO2 interface Unit (MGU-721), the Capnostat 5 Mainstream CO2 Sensor (K042601) manufactured by Respironics Novametrix, LLC. is allowed to connect to the DS-7210/7210M with serial communication protocol for CO2 monitoring. And, by using the option Unit (HU-71/HU-72/HU-73), invasive blood pressure (up to 5 channels), cardiac output, temperature (up to 3 channels) can be additionally monitored.

For the SpO2 measurement monitoring, the DS-7000 utilizes Nellcor technology (K021090) and the DS-7000M utilizes Masimo one (K033296). No new functions for SpO2 measurement are being added and are not the subject of this submission. This subject modified DS-7210/7210M has the same feature.

The DS-7000 Series Patient Monitor is a self contained monitor which includes a 12.1 inch TFT color LCD display which can display up to 12 (for DS-7000/7000M) or 14 (for DS-7210/7210M) waveforms and up to 20 (for DS-7000/7000M) or 16 (for DS-7210/7210M) numeric displays. Input operation is performed by the touch screen panel, 5 fixed keys (only DS-7000/7000M), or infrared remote-control command (optional). Additional standard features of the DS-7000 Series Patient Monitor include the DS-LAN II connection, which is a proprietary network system based on an Ethernet LAN (K970585), through either a built in Ethernet LAN or external telemetry transmitter (the Fukuda Denshi DS-5000 series telemetry model HLX-501/561, K980728) connection for connection to the Fukuda Denshi Central Station Monitors, a built- in dot matrix thermal printer that can print up to 3 wave forms simultaneously, and an alarm indicator feature on the top of device that alerts to alarm conditions.

The DS-7000/7000M of the DS-7000 Series is small and lightweight at 9.0 kg. The physical dimensions of the device are 324mm (W) x 260mm (H) x 179mm (D). The option Multigas Unit (MGU-701/MGU-702) weight is 1.8 kg. The physical dimensions of the device are 248mm (W) x 138mm (H) x 82mm (D). No weight and physical dimensions are being changed and are not the subject of this submission for the DS-7000/7000M.

The subject modified DS-7210/7210M weight is 9.9 kg. The physical dimensions of the device are 310mm (W) x 351mm (H) x 245mm (D). The option CO2 measurement Unit (MGU-722) weight is 260g and Mainstream CO2 interface unit (MGU-721) weight is 200g. The both physical dimensions of the device are 141.5mm (W) x 41mm (H) x 79mm (D).

For the DS-7000 Series option Unit (HU-71/HU-72/HU-73) weight is 180g. The physical dimensions of the device are 37mm (W) x 99 mm (H) x 90 mm (D). No weight and physical dimensions are being changed and are not the subject of this submission.

The provided text describes the Fukuda Denshi DynaScope Model DS-7000 Series Patient Monitor and its substantial equivalence to predicate devices, but it does not contain a detailed study with specific acceptance criteria and reported device performance in the format requested.

The document primarily focuses on:

• Description of the device: Its features, monitored parameters, and intended use.
• Predicate device comparison: Stating that it incorporates identical technology and is substantially equivalent.
• Safety and environmental testing: Mentioning compliance with various general and individual safety standards, and EMC standards.
• Conclusion: Reiterating that it's as safe and effective as predicate devices based on laboratory testing, validation, and risk analysis.

However, it lacks the specific quantitative data, sample sizes, ground truth establishment methods, or expert qualifications that would be detailed in a robust clinical or performance study report.

Therefore, I cannot populate the requested table and answer many of the specific questions directly from the provided text.

Here's a breakdown of what can be extracted or inferred, and what is missing:

1. Table of Acceptance Criteria and Reported Device Performance:

Detailed Answers to Specific Questions:

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

• Sample size: Not specified. The document only mentions "various performance tests" and "final testing."
• Data provenance: Not specified. The text indicates "laboratory testing" and testing at an "OEM engineering test facility." This suggests internal testing, but no details on patient data, if any, are provided. It does not mention if the data was retrospective or prospective.

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

• Not applicable. The document describes compliance with technical standards and performance specifications, not diagnostic accuracy requiring expert ground truth in a clinical setting.

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

• Not applicable. This type of adjudication is typically for subjective assessments or discrepancy resolution in clinical studies, which is not described here.

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

• No, an MRMC comparative effectiveness study was not done. This device is a patient monitor, not an AI-assisted diagnostic tool. The submission focuses on device safety and performance as a monitoring system.

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

• Not applicable in the context of an "algorithm only" study. The performance testing mentioned is for the integrated patient monitor system.

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

• For a patient monitor, the "ground truth" for performance testing typically refers to validated reference standards or simulated physiological signals that mimic real patient data with known values (e.g., a calibrated simulator for vital signs, or direct physical measurement for electrical safety parameters). The document does not explicitly state the specific type of ground truth used, but it would be based on these established engineering and physiological reference systems.

8. The sample size for the training set

• Not applicable. This is not a machine learning or AI device that would have a separate "training set."

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

• Not applicable, as there is no mention of a training set for an AI/ML algorithm.

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The T-105 Series Vital Signs Monitor is intended to monitor a single patient's vital signs in the hospital, acute care settings, outpatient surgery, healthcare practitioner facilities or in an environment where patient care is provided by qualified healthcare personnel who will determine when use of this device is indicated, based upon their professional assessment of the patient's medical condition. The patient populations include adult, pediatric and neonatal. The device is capable of monitoring:

• . Pulse rate (via oximetry data)
• . Non-invasive pressure (systolic, diastolic and mean oscillometric (NIBP)
• . Temperature
• . Blood Oxygen Saturation (SpO2 via finger oximeter)
  This device is intended for use by qualified healthcare personnel trained in its use.

The Omron HBP T-105 Series is a modification of the Colin Press-Mate PM-2100 and is intended to monitor a single patient's vital signs. The device is capable of monitoring:

• . Pulse rate (via oximetry data):
• Non-invasive pressure (systolic, diastolic and mean oscillometric (NIBP); .
• . Temperature; and
• . Blood Oxygen Saturation (SpO2 via finger oximeter)

The provided document is a 510(k) premarket notification for the Omron HBP T-105 Series Vital Signs monitor. This type of submission relies on demonstrating substantial equivalence to pre-existing legally marketed predicate devices, rather than presenting a full de novo study with detailed acceptance criteria and performance data as might be found in a clinical trial report for a novel AI device.

Therefore, the requested information, particularly regarding acceptance criteria, study design, sample sizes, ground truth establishment, expert involvement, and comparative effectiveness studies (especially for AI systems), is largely not present in this document. The document focuses on demonstrating that the new device's specifications are similar to or the same as those of the predicate devices.

However, I can extract what is available and highlight what is missing based on your request.

Acceptance Criteria and Reported Device Performance

The "Acceptance Criteria" here are implicitly the specifications of the predicate devices, as the new device claims "same as predicate device" for most performance metrics. The "Reported Device Performance" is also stated in relation to these predicate device specifications.

Missing Information from the Document:

1. Sample sizes used for the test set and the data provenance: This information is not provided. A 510(k) submission for a vital signs monitor often relies on performance data collected during design verification and validation, but detailed sample sizes and population demographics are not routinely included in the public summary. Given the device is a technical modification of existing technology, the "testing" would likely involve demonstrating compliance with recognized standards (e.g., ISO 81060-1 for NIBP, ISO 80601-2-61 for Pulse Oximetry) rather than a novel clinical study for equivalence, and the results are summarized as "same as predicate."

2. Number of experts used to establish the ground truth for the test set and the qualifications of those experts: Not applicable/not provided. For device performance, the "ground truth" would be established by reference measurement devices or established clinical protocols, not by expert consensus on, for example, image interpretation.

3. Adjudication method for the test set: Not applicable/not provided. Adjudication is typically relevant for subjective assessments, which is not the primary mode of evaluation for a vital signs monitor.

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: Not applicable. This device is a vital signs monitor, not an AI-powered diagnostic imaging system. There are no "human readers" or "AI assistance" in the context of interpretation of complex medical cases.

5. If a standalone (i.e., algorithm only without human-in-the-loop performance) was done: Not applicable in the context of AI. The device's algorithms (e.g., for oscillometric NIBP, SpO2) operate intrinsically. Performance is assessed against reference standards.

6. The type of ground truth used: For vital signs monitors, the ground truth is typically established using independent, highly accurate reference measurement equipment/methods. For example, for NIBP, this might involve simultaneous intra-arterial pressure measurements, or non-invasive methods validated against such standards. For SpO2, it might involve co-oximetry measurements from arterial blood samples. This document does not detail the specific ground truth methods employed in its validation studies, but it is implied that standard validation procedures were followed for each parameter.

7. The sample size for the training set: Not applicable. This device does not employ machine learning/AI in a way that requires a distinct "training set" in the context of general-purpose vital signs monitoring. Its algorithms are based on established physiological principles.

8. How the ground truth for the training set was established: Not applicable, as no AI training set is described.

Summary of Study that Proves the Device Meets Acceptance Criteria

The document states that the Omron HBP T-105 Series is a modification of the Colin Press-Mate PM-2100. The primary method for proving the device meets acceptance criteria in a 510(k) submission like this is demonstrating substantial equivalence to a previously cleared predicate device.

The "study" in this context is not a standalone clinical trial in the sense of a drug or novel AI device, but rather a series of verification and validation (V&V) tests to confirm that the modified device performs according to its specifications and is at least as safe and effective as the predicate.

The provided table itself serves as the core of this proof, by showing that:

• Many key specifications (measurement method, patient target, accuracy of pressure indicator, accuracy of pulse rate for NIBP, SpO2 measurement method and accuracy for Nellcor, temperature measurement method and accuracy) are "same as predicate device."
• Where changes exist (e.g., power source, display, operating/storage conditions, dimensions, weight, BP module, SpO2 module, addition of Masimo sensors, use of an Omron algorithm for quick BP measurement), these changes are either presented as minor design updates (e.g., battery type, display technology) or by referencing other legally marketed predicate devices for the specific component/feature (e.g., Omron HEM907 for Air Control Valve/Applicable Cuff, Omron HEM-757 for Quick BP algorithm, Nellcor N-595 and Masimo RAD-5 with their respective sensors for SpO2).

The conclusion of the FDA (as shown in pages 4-6) is that the device is "substantially equivalent" to the predicate devices, which signifies that the manufacturer successfully demonstrated that the changes do not raise new questions of safety or effectiveness and that the performance meets acceptable standards, usually through bench testing, engineering analysis, and potentially limited clinical testing if deemed necessary for specific changes (though not detailed here).

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