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510(k) Data Aggregation

    K Number
    K170122
    Date Cleared
    2017-06-28

    (166 days)

    Product Code
    Regulation Number
    876.5990
    Reference & Predicate Devices
    Why did this record match?
    Reference Devices :

    K151298, K122234

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

    The Delta III Lithotripter is indicated for the fragmentation of urinary tract stones, i.e., renal calyceal stones, renal pelvic stones, and upper ureteral stones.

    Device Description

    The Delta III Lithotripter is a modular urological work station designed for extracorporeal shock wave lithotripsy ("ESWL") and for diagnostic and therapeutic procedures usual in urology. The Delta III Lithotripter is composed of the following modules: Basic Unit with integrated X-ray C-arm and Therapy Arm with camera for Shockwave Treatment; Patient Table; Control Desk Image Processing.

    AI/ML Overview

    The provided document is a 510(k) summary for the Dornier Delta III Lithotripter, detailing its substantial equivalence to predicate devices. It mentions a retrospective confirmatory clinical study, but it does not provide specific acceptance criteria or the study's detailed results in a format that allows for a table of acceptance criteria vs. device performance.

    Here's an analysis of the information available and what is not present in the document, structured according to your request:

    1. Table of Acceptance Criteria and Reported Device Performance

    The document states: "A retrospective confirmatory clinical study was performed using the Delta III Lithotripter. As compared to the currently cleared Dornier Lithotripters, the overall treatment results were comparable for the subject device. The complication rate was extremely low."

    However, specific numerical acceptance criteria (e.g., stone-free rate, fragmentation rate, complication rate thresholds) and precise reported device performance metrics against those criteria are not provided in this 510(k) summary. The summary only gives a qualitative statement of comparability and low complication rates.

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

    The document does not specify the sample size for the retrospective confirmatory clinical study. It is stated to be a "retrospective confirmatory clinical study." The country of origin of the data is not specified.

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

    This information is not provided in the document. The type of ground truth used (e.g., imaging, clinical outcomes) is also not detailed for the clinical study.

    4. Adjudication Method for the Test Set

    This information is not provided in the document.

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

    A multi-reader multi-case (MRMC) comparative effectiveness study is not mentioned in the document. The clinical study described is a "retrospective confirmatory clinical study" to compare overall treatment results and complication rates, not specifically to evaluate human reader improvement with or without AI assistance.

    6. Standalone (Algorithm Only) Performance Study

    The device is an extracorporeal shock wave lithotripter, not an AI algorithm. Therefore, a "standalone algorithm only" performance study is not applicable and not mentioned. The performance data section refers to compliance with standards for acoustic output, electrical safety, and electromagnetic compatibility for the hardware device itself.

    7. Type of Ground Truth Used

    For the retrospective clinical study, the document broadly refers to "overall treatment results" and "complication rate." It does not explicitly state the method by which ground truth for treatment success or stone fragmentation was established (e.g., follow-up imaging, clinical assessment, pathology).

    8. Sample Size for the Training Set

    The Delta III Lithotripter is a hardware device for lithotripsy, not a machine learning algorithm that requires a "training set" in the conventional sense of AI/ML. Therefore, this concept is not applicable and not provided. The device development involved design and verification testing, and compliance with standards.

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

    As above, the concept of a "training set" for an AI algorithm is not applicable to this device.

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