Intended Use / Indications for Use

EPIQ:

The intended use of Philips EPIQ series diagnostic ultrasound systems is diagnostic ultrasound imaging and fluid flow analysis of the human body, with the following indications for use:

Abdominal, Cardiac Adult, Cardiac other (Fetal), Cardiac Pediatric, Cerebral Vascular, Cephalic (Adult), Cephalic (Neonatal), Fetal/Obstetric, Gynecological, Intra-cardiac Echo, Intra-luminal, Intraoperative (Vascular), Intraoperative (Cardiac), Musculoskeletal (Conventional), Musculoskeletal (Superficial), Ophthalmic, Other: Urology, Pediatric, Peripheral Vessel, Small Organ (Breast, Thyroid, Testicle), Transesophageal (Cardiac), Transrectal, Transvaginal, Lung.

Modes of operation include: B Mode, M Mode, PW Doppler, CW Doppler, Color Doppler, Color M Mode, Power Doppler, and Harmonic Imaging.

The clinical environments where Philips EPIQ diagnostic ultrasound systems can be used include clinics, hospitals, and clinical point-of-care for diagnosis of patients.

When integrated with Philips EchoNavigator, the systems can assist the interventionalist and surgeon with image guidance during treatment of cardiovascular disease in which the procedure uses both live X-ray and live echo guidance.

The systems are intended to be installed, used, and operated only in accordance with the safety procedures and operating instructions given in the product user information. Systems are to be operated only by appropriately trained healthcare professionals for the purposes for which they were designed. However, nothing stated in the user information reduces your responsibility for sound clinical judgement and best clinical procedure.

Affiniti:

The intended use of the Affiniti Series Diagnostic Ultrasound Systems is diagnostic ultrasound imaging and fluid flow analysis of the human body with the following Indications for Use:

Abdominal, Cardiac Adult, Cardiac other (Fetal), Cardiac Pediatric, Cerebral Vascular, Cephalic (Adult), Cephalic (Neonatal), Fetal/Obstetric, Gynecological, Intraoperative (Vascular), Intraoperative (Cardiac), Musculoskeletal (Conventional), Musculoskeletal (Superficial), Other: Urology, Pediatric, Peripheral Vessel, Small Organ (Breast, Thyroid, Testicle), Transesophageal (Cardiac), Transrectal, Transvaginal, Lung.

Modes of operation include: B Mode, M Mode, PW Doppler, CW Doppler, Color Doppler, Color M Mode, Power Doppler, and Harmonic Imaging.

The clinical environments where the Affiniti Diagnostic Ultrasound Systems can be used include Clinics, Hospitals, and clinical point-of-care for diagnosis of patients.

The systems are intended to be installed, used, and operated only in accordance with the safety procedures and operating instructions given in the product user information. Systems are to be operated only by appropriately trained healthcare professionals for the purposes for which they were designed. However, nothing stated in the user information reduces your responsibility for sound clinical judgment and best clinical procedure.

The purpose of this Special 510(k) Pre-Market Notification is to expand the Smart View Select (SVS) software application onto the Affiniti Series Diagnostic Ultrasound Systems and to modify the Smart View Select software application onto both the EPIQ Series Diagnostic Ultrasound Systems.

Smart View Select is an automated software feature that assists the user in selection of images for analysis with the existing Philips AutoStrain LV or 2D Auto LV application in Adult Echo Transthoracic (TTE) examination. This feature automatically classifies each acquired image by view and selects an appropriate set of images for left ventricle (LV) analysis. The classification is based on a Deep Learning AI interface engine; the selection is a non-AI algorithm that considers the view classification and image depth to select the optimal set of images.

No hardware changes to the EPIQ or Affiniti systems are required when using SVS, and existing, cleared Philips TTE transducers are used with these software applications.

The SVS v2 feature is supported by all EPIQ models running software version 13.0 or higher including EPIQ CVx/CVxi, EPIQ Elite Advanced, EPIQ Elite, EPIQ 7, EPIQ 5. The SVS v2 feature is supported by the Affiniti models running software version VM13.0 or higher, including Affiniti CVx, Affiniti 70, Affiniti 50, and Affiniti 30. The SVS and SWM software features are associated with the cardiac adult indication.

The provided document details the 510(k) clearance for Philips Ultrasound's EPIQ and Affiniti Series Diagnostic Ultrasound Systems with the Smart View Select (SVS) v2 software. The SVS feature is an automated software that assists users in selecting images for Left Ventricle (LV) analysis using existing Philips AutoStrain LV or 2D Auto LV applications in Adult Echo Transthoracic (TTE) examinations. It classifies acquired images by view using a Deep Learning AI interface and then uses a non-AI algorithm to select an optimal set of images.

Here's an analysis of the acceptance criteria and the study that proves the device meets them:

1. Table of Acceptance Criteria and Reported Device Performance

The study aimed to demonstrate agreement between LV analysis outputs (Ejection Fraction - EF, and Global Longitudinal Strain - GLS) derived from manually selected clips (ground truth) and automatically selected clips by the SVS software.

2. Sample Size and Data Provenance

• Test Set Sample Size: The exact number of patients or cases in the test set is not explicitly stated as a single number. However, the demographic characteristics section indicates n=71 for various demographic variables like Sex, Age, Height, Weight, BMI, Race, LV systolic function, RWMA, Known CAD, Previous reported MI Location, and LV Hypertrophy, suggesting the test dataset comprised data from at least 71 unique patients.
• Data Provenance: The data was collected from a US-based medical center. The study was a retrospective data analysis.

3. Number of Experts and Qualifications for Ground Truth

• Number of Experts: Three (3) reviewers (clinical experts) participated in establishing the ground truth.
• Qualifications of Experts: They are referred to as "clinical experts." No further specific qualifications (e.g., years of experience, specific board certifications like radiologist/cardiologist) are provided in the document.

4. Adjudication Method for the Test Set

The adjudication method used to establish ground truth was consensus/averaging. For each output (GLS and EF), the average across the three reviewers was used as the ground truth.

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

No Multi-Reader Multi-Case (MRMC) comparative effectiveness study was described. The study focused on comparing the AI-selected clips' performance (GLS and EF) against the ground truth established by human experts using manually selected clips. There is no information provided regarding how much human readers improve with AI vs. without AI assistance. The study evaluates the AI's ability to select optimal clips, a step that precedes human analysis with AutoStrain LV.

6. Standalone Performance Study (Algorithm Only)

Yes, a standalone performance study was done. The performance of the SVS software was evaluated solely based on its ability to automatically select appropriate clips, and then the subsequent, un-edited evaluation of GLS and EF through AutoStrain LV using these SVS-selected clips was compared against the human-selected clips. This represents the algorithm's performance in its specific task (clip selection) without direct human intervention in the selection process.

7. Type of Ground Truth Used

The ground truth used was expert consensus. Specifically, it was the average of GLS and EF measurements obtained from clips manually selected and subsequently semi-automatically processed by three clinical experts using the AutoStrain LV software.

8. Sample Size for the Training Set

The document does not provide the sample size used for the training set of the deep learning AI model for image classification. It only states that "the neural network of the subject device was revised as described in attachment 002," implying updates to an existing model rather than a completely new one, but no training data details are given.

9. How Ground Truth for Training Set was Established

The document does not explicitly state how the ground truth for the training set was established. It mentions that the "classification is based on a Deep Learning AI interface engine," but details regarding the training data annotation and ground truth establishment are not provided within the excerpt.

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L Vivo platform is intended for non-invasive processing of ultrasound images to detect, measure, and calculate relevant medical parameters of structures and function of patients with suspected disease.

The LVivo System analyzes echocardiographic patient examination DICOM movies for Global ejection fraction (EF) evaluation. EF is evaluated using two orthogonal planes, four-chamber (4CH) and two-chamber (2CH) views, to provide fully automated analyses of LV function from the echo examination movies. It also has the ability to measure strain and to evaluate the Right Ventricle and well as to measure the bladder.

This document describes the acceptance criteria and study results for DiA Imaging Analysis Ltd's LVivo Software Application, specifically focusing on its LVivoRV (Right Ventricular) and LVivo Bladder modules.

1. Table of Acceptance Criteria and Reported Device Performance

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