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510(k) Data Aggregation

    K Number
    K122818
    Date Cleared
    2013-01-04

    (112 days)

    Product Code
    Regulation Number
    880.6850
    Reference & Predicate Devices
    Why did this record match?
    Reference Devices :

    K033222, K092682

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

    The Olympus MAJ-172 Instrument Tray for LTF Videoscope is intended to be used to enclose Olympus medical devices including hand instruments, trocars, camera heads, adapter, and endoscopes to be sterilized by a health care provider. It is intended to allow steam or ethylene oxide sterilization of the enclosed medical device. The Olympus MAJ-172 Instrument Tray for LTF Videoscope is a purpose designed transport and sterilization case indicated for use in medical facilities to accommodate an endoscope from the Olympus LTF range of videoscopes, plus certain identified accessories, for reprocessing by autoclaving (steam) or ETO sterilization (depending on the model). LTF Type 160 and VH videoscopes are compatible with Steam and ETO sterilization cycles. LTF Type V3 and VP are compatible only with ETO sterilization cycles.

    The Olympus MAJ-172 Instrument Tray for LTF Videoscope is designed to secure and store a single videoscope and its accessories for sterilization at a healthcare facility. Refer to the instrument tray instructions for use for the proper orientation of the videoscope and accessories within the instrument tray. The recommended sterilization cycles for the LTF videoscopes are as follows:

    ETO Sterilization .. . .. 100% ETO concentration: 735 mg/L Temp: 57 °C -------------Relative Humidity: 70% Processing (Hold) Time: 1 hour Aeration Time: 12 hours

    Steam Sterilization: Vacuum: 0.016 MPa minimum Pressure: 0.101 MPa minimum Temp: 135 °C Exposure Time: 3 minutes Drving Time: 20 minutes

    Device Description

    The Olympus MAJ-172 Instrument Tray for LTF Videoscope is a polymer tray with a perforated lid intended to secure an endoscope and accessories during exposure to gaseous sterilization methods.

    AI/ML Overview

    The provided document, K122818, is a 510(k) summary for the Olympus MAJ-172 Instrument Tray for LTF Videoscope. This document details the device's substantial equivalence to predicate devices based on non-clinical performance testing. It is important to note that this document is for a medical device tray used for sterilization, not an AI/ML-driven diagnostic or prognostic device, therefore many of the requested criteria regarding AI model evaluation (e.g., sample sizes for test/training sets, expert ground truth, MRMC studies) are not applicable.

    Here's an analysis based on the available information:

    1. Acceptance Criteria and Reported Device Performance

    The device is a non-measuring, non-analytical, and non-AI product. Its "performance" is determined by its ability to safely contain and allow sterilization of specific medical instruments without degradation or compromise. The acceptance criteria are implicitly derived from the design specifications and the tests conducted.

    Acceptance Criteria (Implicit from Testing)Reported Device Performance
    Maintain structural integrity during useMet requirements (simulated use, drop testing, resistance to chemicals)
    Be resistant to cleaning agentsMet requirements (resistance to chemicals, cleaning)
    Successfully allow steam sterilizationMet requirements (steam sterilization studies)
    Successfully allow ethylene oxide (ETO) sterilizationMet requirements (ethylene oxide sterilization studies)
    Ensure safekeeping of instruments during sterilization, storage, and transportationMet requirements (customized for specific instruments, simulated use)
    Have an expected useful life of five yearsDevice has an expected useful life of five years

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

    This is not applicable as the device is a physical instrument tray, not an AI model that processes data. The "test set" would refer to the physical units of the instrument tray used in the non-clinical studies. The document does not specify the exact number of trays tested.

    • Data Provenance: The (non-clinical) studies were conducted by KeyMed (Medical & Industrial) Ltd. in the United Kingdom, as indicated by the submitter's address. The studies are by nature prospective with respect to the testing of the specific MAJ-172 trays.

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

    This is not applicable for a physical device like a sterilization tray. "Ground truth" in this context would be established by validated engineering and microbiological testing methods, rather than expert interpretation of data.

    4. Adjudication Method for the Test Set

    This is not applicable. The performance was assessed through established laboratory and engineering testing protocols, not through expert adjudication of ambiguous cases.

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

    No, an MRMC study was not done as this is a physical medical device, not a diagnostic or prognostic AI/ML system.

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

    Yes, in a sense, the performance described is "standalone" in that it refers to the intrinsic capabilities of the physical device to withstand various sterilization processes and functional demands. There is no "algorithm" or "human-in-the-loop" concept applicable here. The device's performance was evaluated independently.

    7. The Type of Ground Truth Used

    The "ground truth" for the performance of the sterilization tray was established through:

    • Engineering and Physical Testing: Such as simulated use tests, drop testing, and resistance to chemical agents, which evaluate the physical integrity and durability of the tray.
    • Sterilization Efficacy Studies: These studies confirm that the tray allows effective sterilization of its contents without impeding the sterilant's penetration or compromising the sterility maintenance, as validated by microbiological assays in accordance with relevant standards. These would involve monitoring parameters like temperature, pressure, exposure time, and potentially biological indicators to confirm sterilization.

    8. The Sample Size for the Training Set

    This is not applicable. As a physical device, there is no "training set" in the context of machine learning. The design and manufacturing process would involve engineering specifications and quality control, not AI model training.

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

    This is not applicable for the reasons stated above. The "ground truth" for product development would be established through engineering design principles, material science, and regulatory standards for medical device manufacturing.

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    K Number
    K120474
    Manufacturer
    Date Cleared
    2012-07-10

    (145 days)

    Product Code
    Regulation Number
    880.6850
    Reference & Predicate Devices
    Why did this record match?
    Reference Devices :

    K092682

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

    The Gyrus ACMI Telescope Storage-Sterilization Tray (TEL-GT) is intended to be used to enclose and protect Gyrus ACMI telescopes during Steam Sterilization using the following parameters:

    STEAM Sterilization Parameters:

    PreVacuum
    Temp:275°F
    132°C
    Pressure26psigs
    Exposure3 minutes
    Dry Time20 minutes

    The trays are to be double wrapped with an FDA cleared sterilization wrap. The trays are optional accessories to the Gyrus ACMI telescopes. Telescopes without lumens up to 31 cm in length may be sterilized in the tray with a diameter between 2.7mm to 4mm. Two telescopes can be sterilized at one time.

    Maintenance of Sterility is dependent on the sterilization wrap shelf life and not the tray. User must follow the instructions for use supplied with the approved sterilization wrap and follow recommended storage conditions and timeframes for shelf life of the sterilization wrap.

    Device Description

    The Gyrus ACMI Telescope Storage-Sterilization Trav is a two-piece container made of a plastic lid containing 14 holes, and a plastic trav containing 18 holes that permit ready ingress of Steam. The tray provides protection to the telescopes during sterilization and storage.

    AI/ML Overview

    The provided document, K120474, describes the Gyrus ACMI Telescope Storage-Sterilization Tray. This is a medical device, and the information presented is for a 510(k) premarket notification. The document focuses on demonstrating substantial equivalence to a predicate device, rather than providing detailed acceptance criteria and a study report with performance metrics in the way one would for a diagnostic or AI-driven decision support system.

    Therefore, many of the requested categories (e.g., sample size for test set, number of experts for ground truth, MRMC study, training set details) are not applicable to this type of device submission. The "study" described is a validation of the sterilization process through parameters, not a clinical performance study.

    Here's an attempt to populate the table and answer the questions based on the available information:


    Acceptance Criteria and Device Performance for Gyrus ACMI Telescope Storage-Sterilization Tray (K120474)

    The Gyrus ACMI Telescope Storage-Sterilization Tray is intended for use in steam sterilization. The "acceptance criteria" for this device are fundamentally linked to its ability to facilitate effective steam sterilization and protect the enclosed telescopes. The "performance" is demonstrated by its compatibility with specific sterilization parameters and its design features that allow for proper steam ingress.

    1. Table of Acceptance Criteria and Reported Device Performance

    Acceptance Criteria CategorySpecific CriteriaReported Device Performance / Compliance
    Sterilization EffectivenessThe tray must permit steam sterilization of Gyrus ACMI telescopes using defined PreVacuum steam parameters (Temp: 275°F/132°C, Pressure: 26psigs, Exposure: 3 minutes, Dry Time: 20 minutes) when double-wrapped with FDA cleared sterilization wrap.Validation performed. The device was validated to sterilize Gyrus ACMI telescopes using Steam with the specified parameters. The plastic lid and tray contain 14 and 18 holes, respectively, "that permit ready ingress of Steam." The conclusion states "performance data" supports substantial equivalence.
    Device ProtectionThe tray must enclose and protect Gyrus ACMI telescopes (without lumens, up to 31 cm length, 2.7mm to 4mm diameter) during sterilization and storage.The tray provides "protection to the telescopes during sterilization and storage."
    BiocompatibilityMaterials must be compatible with testing identified in ISO10993-1."Materials are compatible with testing identified in ISO10993-1." The DEVICE does not come into contact with patients.
    Material EquivalenceMaterials used must be the same as the predicate devices, or other legally marketed devices by Gyrus ACMI."The Gyrus ACMI Telescope Storage-Sterilization Tray is composed of the same materials as the predicates..." as well as other legally marketed devices.
    Maintenance of SterilityMaintenance of sterility is dependent on the sterilization wrap shelf life, not the tray. Users must follow IFU for wrap.Explicitly stated: "Maintenance of Sterility is dependent on the sterilization wrap shelf life and not the tray. User must follow the instructions for use supplied with the approved sterilization wrap..."
    Compliance to StandardsDesign must comply with relevant voluntary standards."The design of the DEVICE complies with the following standards: ISO10993-1, AAMI/ANSI ST77, AAMI/ANSI ST79."
    Substantial EquivalenceThe device must be substantially equivalent to legally marketed predicate devices."In summary, based on intended use, technological characteristics and performance data, the Gyrus ACMI Telescope Storage-Sterilization Tray is substantially equivalent to previously cleared Gyrus ACMI storage-sterilization trays."

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

    The document does not specify a "test set" in the context of statistical analysis of a diagnostic or AI device. The validation described is for the sterilization process parameters using the tray. While specific numbers of sterilization cycles or tests are implied by "validation," the sample size and data provenance (country of origin, retrospective/prospective) are not detailed in this 510(k) summary. This is typical for a device like a sterilization tray where the focus is on process validation rather than clinical outcome studies.

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

    Not applicable. There is no mention of experts establishing a "ground truth" for a test set in the context of this device. The "ground truth" for sterilization effectiveness would be defined by standard microbiological testing and physical indicators during the validation process, which is established by established protocols and regulatory standards, not expert consensus on individual cases.

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

    Not applicable. There is no test set requiring expert adjudication for this type of device.

    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

    Not applicable. This is not a diagnostic device or an AI-assisted device.

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

    Not applicable. This is not an algorithmic device.

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

    For the sterilization effectiveness, the "ground truth" is established by adherence to validated sterilization parameters, successful inactivation of biological indicators if used, and sterility assurance levels as defined by relevant standards (e.g., AAMI/ANSI ST77, ST79). For biocompatibility, the ground truth is established by material testing against ISO10993-1. These are physical/microbiological truths, not expert consensus or pathology.

    8. The sample size for the training set

    Not applicable. This is not an AI/ML device requiring a training set.

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

    Not applicable. This is not an AI/ML device requiring a training set.

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