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The GXR-Series Diagnostic X-ray System is intended for use in obtaining human anatomical images for medical diagnostic by using X-rays.

The GXR Series Diagnostic X-ray System consists of a combination of an x-ray generator, and associated equipment such as tube stand, patient table, and, digital imaging system.

Here's an analysis of the provided text regarding acceptance criteria and supporting studies for the GXR-series diagnostic x-ray system:

It's important to note that the provided document is a 510(k) Summary, which is a regulatory filing for a medical device seeking clearance from the FDA based on substantial equivalence to a predicate device. It typically focuses on demonstrating that the new device is as safe and effective as a legally marketed device, rather than proving absolute performance against specific clinical acceptance criteria in a comprehensive clinical study. Therefore, the details provided often lean towards non-clinical testing and comparison with established standards.

1. Table of Acceptance Criteria and Reported Device Performance

The document does not explicitly present a table of "acceptance criteria" for clinical performance. Instead, it relies on demonstrating adherence to recognized safety and performance standards, and comparison of technical characteristics to a predicate device. The "performance" is implicitly deemed acceptable if the device meets these standards and is substantially equivalent to the predicate.

Here's a generalized interpretation based on the document's content, focusing on what would typically be implied performance requirements for an X-ray system:

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

• Test Set Sample Size: The document does not specify a "test set" sample size in terms of clinical images or patient cases for performance evaluation against specific acceptance criteria. The testing discussed is primarily non-clinical, related to hardware and software verification and validation.
• Data Provenance: The document implies that the testing data is generated from laboratory testing and verification during the development and modification of the device. There is no mention of clinical data or patient data being used for the performance evaluation in this 510(k) summary. Given the context of a 510(k), particularly for an X-ray system, the primary focus is on engineering and performance testing against standards, rather than large-scale clinical studies. The data is thus likely prospective in terms of being generated specifically for this submission but is non-clinical in nature.

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

This information is not provided in the document. As the evaluation is non-clinical, there is no mention of "ground truth established by experts" in the context of diagnostic performance evaluation. The "ground truth" for non-clinical testing would typically be the expected technical output or adherence to a standard, rather than expert interpretation of images.

4. Adjudication Method for the Test Set

This information is not provided as the testing described and implied is non-clinical and does not involve expert adjudication of diagnostic findings.

5. If a Multi-Reader Multi-Case (MRMC) Comparative Effectiveness Study was done, and effect size

No, a multi-reader multi-case (MRMC) comparative effectiveness study was not explicitly mentioned or performed as part of this 510(k) submission. The document focuses on demonstrating substantial equivalence through technical comparisons and compliance with standards, not on proving improved reader performance with or without AI assistance.

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

This is not applicable in the sense of an AI algorithm's standalone performance. The device is a diagnostic X-ray system, which is inherently designed to be used with a human interpreter (a medical professional). While it has image processing software ("RADMAX"), this software enhances images for human diagnosis, not to provide an automated diagnosis itself.

7. The Type of Ground Truth Used

The "ground truth" for the non-clinical testing is adherence to technical specifications and international standards. For example, for radiation output, the ground truth is that the device delivers the specified kVp and mA, and for electrical safety, that it meets the requirements of IEC 60601-1. For image quality, it refers to intrinsic properties like spatial resolution, MTF, and DQE, which are measured objectively, not subjective expert consensus on diagnostic findings.

8. The Sample Size for the Training Set

This information is not applicable and therefore not provided. The device is an X-ray imaging system, not an AI/ML diagnostic algorithm that requires a training set of medical images in the conventional sense. The "training" for the device would involve calibration and configuration during manufacturing and installation to ensure it meets its technical specifications. The "RADMAX" software has image processing modules, but the document does not suggest these are deep learning models trained on vast datasets.

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

This information is not applicable for the same reasons as #8. If any parameters for the image processing modules are "learned" or optimized, the document does not elaborate on this process or the ground truth used for such optimization.

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GXR-Series Diagnostic X-Ray System, is a stationary X-ray imaging system, for the purpose of acquiring X-ray images of the desired parts of a patient's anatomy. This device is not intended for mammography or bone density applications.

GXR Series Diagnostic X-ray System is a digital radiographic system. There are 5 power output configurations which are reflected in the model's designation "GXR-XX". The models have 5 different output power ratings: 32kW, 40kW, 52kW, 68kW, 82kW. The subject device, GXR Series Diaqnostic X-ray System, is designed to diagnose the human body by providing radiographic x-ray image with anatomical structure. The subject device has the same x-ray hardware components and image management software as the predicate device. The subject device consists of a high voltage (HV) generator, a tube support unit, an X-ray beam limiting device, a patient table, wall Bucky stand, and an x-ray tube, that operates on a high-frequency inverter method. The operator control console is designed to be user-friendly, and the user can select or change x-ray parameters easily using a large graphic LCD panel display and a soft membrane switch. The GXR Series high frequency X-ray generator (manufactured by DRGEM) features accuracy, reproducibility and long-term stability with capacitor assisted general line power supply. The APR (Anatomical Programming) and the optional AEC (Automatic Exposure Control) features gives the user control of exposure factors, automatically optimized for the radiological study selected. The digital flat panel detectors provide spatial resolution, MTF, DQE and stability based on fine pixel pitch. Selection of an anatomical study on the imaging software automatically sets up the x-ray generator's pre-programmed exposure technique setting and post image processing for selected study. The subject device is able to use a total of 10 different digital detectors, (8 new plus 2 cleared in the predicate, which have been previously cleared by the 510(k) process. The GXR Series Diagnostic X-ray System consists of a combination of an x-ray generator. and associated equipment such as tube stand, patient table, and, digital imaging system. The main power cabinet contains the HT tank and control circuits, the filament drivers, the low speed starter, and interface connections to the room equipment. Tube stand and patient table allows the operator to position the patient. Full Featured Imaging Software & Digital Image Processing. Control console. The image manaqement software, RADMAX Digital Imaging Software (K182537) by DRGEM, is used in both the predicate and subject device to serve as a convenient interface to the hardware and images. Anatomical view-based digital image processing automatically optimizes and enhances the quality of the captured images. RADMAX (K182537) Digital Imaging Software is designed for acquiring images and processing the acquired images. The software can be used together with a digital X-ray detector and or an X-Ray generator. The main features of the RADMAX software are controlling and interfacing the detector, acquiring images after X-ray, storing acquired images, managing data, and image processing. It can also perform system control such as the collimation size, and filter selection.

The provided text describes a 510(k) premarket notification for the "GXR-Series Diagnostic X-Ray System." This submission aims to demonstrate substantial equivalence to a predicate device, not to evaluate the performance of an AI algorithm with specific acceptance criteria that are typically statistical (e.g., sensitivity, specificity, AUC).

Therefore, based on the provided document, I cannot fulfill your request for:

• A table of acceptance criteria and the reported device performance (related to AI algorithm statistical performance).
• Sample size used for the test set and data provenance.
• Number of experts used to establish the ground truth for the test set and their qualifications.
• Adjudication method.
• If a multi reader multi case (MRMC) comparative effectiveness study was done.
• If a standalone (i.e. algorithm only without human-in-the-loop performance) was done.
• The type of ground truth used.
• The sample size for the training set.
• How the ground truth for the training set was established.

The document focuses on the device itself (an X-ray system), not an AI algorithm for image analysis. The "Performance Data" section describes nonclinical testing for general safety and effectiveness of the X-ray system as a whole, ensuring it meets standards for medical electrical equipment, radiation protection, and software lifecycle, and performs comparably to the predicate device. The only "difference" highlighted is the ability to interface with additional previously cleared digital flat panel detectors.

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DIAMOND-5A/6A/8A, is a stationary digital diagnostic x-ray system that is indicated for use in generating radiographic images of human anatomy. This device is not intended for mammography, bone density, fluoroscopy and angiography applications.

DIAMOND-5A/6A/8A, system is a digital radiographic system. There are 3 power output configurations which are reflected in the model designation "5A/6A/8A". The models have 3 different output power ratings: 52kW, 68kW, 82kW. DIAMOND 5A/6A/8A, incorporates digital flat panel detector technology, along with an automatic motorized U-arm radiographic stand and mobile patient table that can fit into smaller rooms without the need of ceiling support structures for X-Ray tube suspensions. The subject device comes in 2 hardware configurations; a Radiographic Stand configuration for a wired detector and a Radiographic Stand for removable detectors. The main components of the subject device are the same as the predicate. Components of the x-ray source are the tube assembly, motorized x-ray collimator, HV cable assembly and high frequency x-ray generator. A touch screen LCD based x-ray control console provides a user interface and technique selection. The automatic collimator supports high accuracy for selected x-ray field size over SID. Selection of an anatomical study on the imaging software automatically sets up the x-ray generator's pre-programmed exposure technique setting, motorized radiographic stand positioning, x-ray collimation and post image processing for selected study. Also, removable high-resolution grids which have 100 and 180cm (40 and 72 inch) focal distance. The integrated touch screen console located on the tube side, operator can easily control the radiographic techniques and stand positioning. Furthermore, the operator can verify the digital x-ray image on this screen. The GUI, automatically rotates corresponds to rotation angle of U-arm.

The provided text is a 510(k) summary for the DRGEM Corporation's DIAMOND-5A/6A/8A stationary digital diagnostic x-ray system. This summary focuses on demonstrating substantial equivalence to a predicate device rather than presenting a study of the device's diagnostic performance for measuring accuracy against a ground truth.

Therefore, much of the requested information (e.g., acceptance criteria for diagnostic capability, sample sizes for test/training sets, expert qualifications, MRMC studies, standalone performance, and ground truth types for diagnostic accuracy) is not available in this document. The document primarily addresses the safety and performance of the hardware components and software in comparison to a previously cleared device.

Here's the information that can be extracted from the provided text:

Acceptance Criteria and Reported Device Performance (as pertains to safety and technical function):

Detailed Study Information (as requested, with notes on unavailability):

1. Sample size used for the test set and the data provenance: Not applicable/available. The document describes non-clinical testing for safety and functionality, not a clinical study on diagnostic accuracy.

2. Number of experts used to establish the ground truth for the test set and the qualifications of those experts: Not applicable/available. No clinical test set requiring expert ground truth for diagnostic accuracy is described.

3. Adjudication method for the test set: Not applicable/available.

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/available. This device is a digital X-ray system, not an AI-powered diagnostic aide for human readers.

5. If a standalone (i.e. algorithm only without human-in-the-loop performance) was done: Not applicable/available. This refers to the performance of the X-ray system itself. The document states "The complete system has been assessed and tested at the factory and by Standards testing facilities. DIAMOND-5A/6A/8A, has passed all predetermined testing criteria." This indicates standalone testing for the system's technical function and safety.

6. The type of ground truth used (expert consensus, pathology, outcomes data, etc.): Not applicable/available for diagnostic accuracy. For safety and performance testing, the "ground truth" would be adherence to the cited international standards and predetermined testing criteria.

7. The sample size for the training set: Not applicable/available. The device is not an AI algorithm that requires a training set in the conventional sense for diagnostic tasks. Its software (RADMAX) is for image management and system control.

8. How the ground truth for the training set was established: Not applicable/available.

Summary of the Study (as described in the document):

The "study" described in the 510(k) summary is a non-clinical performance and safety assessment comparing the DIAMOND-5A/6A/8A system to its predicate device (also DIAMOND-5A/6A/8A, K192453). The primary purpose was to demonstrate that adding new digital flat panel detectors (Fujifilm, Varex, i-Ray models) and an updated version of the RADMAX image management software (version 1.01) did not negatively impact safety or efficacy and did not raise new safety risks.

The testing involved assessing the complete system's adherence to various international standards for medical electrical equipment, radiation protection, usability, software lifecycle processes, and risk management. The conclusion was that the device met all predetermined testing criteria and demonstrated a safe and effective profile similar to the predicate device. No clinical (diagnostic accuracy) studies are reported in this summary.

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DIAMOND-5A/6A/8A, is a stationary digital diagnostic x-ray system that is indicated for use in generating radiographic images of human anatomy. This device is not intended for mammographic applications.

DIAMOND-5A/6A/8A, system is a digital radiographic system. There are 3 power output configurations which are reflected in the model designation "5A/6A/8A". The models have 3 different output power ratings: 52kW, 68kW, 82kW. DIAMOND 5A/6A/8A. incorporates digital flat panel detector technology, along with an automatic motorized U-arm radiographic stand and mobile patient table that can fit into smaller rooms without the need of ceiling support structures for X-Ray tube suspensions. The digital flat panel digital detectors that are used in DIAMOND-5A/6A/8A, are the VAREX Model 4343Rv3 (Ethernet interface) and 4336Wv4 (wireless). The main components of the x-ray source are the tube assembly, motorized x-ray collimator, HV cable assembly and high frequency x-ray generator. A touch screen LCD based x-ray control console provides a user interface and technique selection. The automatic collimator supports high accuracy for selected x-ray field size over SID. Selection of an anatomical study on the imaging software automatically sets up the x-ray generator's pre-programmed exposure technique setting, motorized radiographic stand positioning, x-ray collimation and post image processing for selected study. Also, removable high-resolution grids which have 100 and 180cm (40 and 72 inch) focal distance supplies excellent image quality per each SID. The integrated touch screen console located in the tube side, operator can easily control the radiographic techniques and stand positioning. Furthermore, the operator can verify the digital x-ray image on this screen. The GUI, automatically rotates corresponds to rotation angle of U-arm. The Radiographic stand has four motorized joints, and automatic positioning can be accomplished by preprogrammed data which can be easily reprogrammed by operator. Total of seven safety sensors are located over U-arm, detector and tube side to protect. against collision with patient or obstacles to control the speed or stop the positioning. Also, a mobile patient table with heavy patient load is provided for radiographic study which needs table. A remote-control is provided for remote motorized control of the stand, and the movement will stop as soon as the key is no longer pressed. The predicate device contains image handling software that was designed at the same time the product was originally developed. The subject device will replace the original image handling module with the RADMAX Digital Image Software cleared under K182537. This will improve the software changeability when a change is needed and also will improve cyber security since there was no documented cyber security plan at the time of the original product development. RADMAX can also perform system control such as the collimation size, filter selection, etc. for the GXR series x-ray generators.

The provided document, a 510(k) summary for the DRGEM Corporation's DIAMOND-5A/6A/8A digital X-ray system, describes the device, its indications for use, and a comparison to predicate devices, along with performance data. However, it does not include detailed acceptance criteria or a study design for evaluating the diagnostic performance of the device, particularly for an AI component.

The document primarily focuses on demonstrating substantial equivalence to a predicate device, specifically regarding:

• Physical and functional characteristics (e.g., power output, detectors, image management software features).
• Compliance with various international safety and electromagnetic compatibility (EMC) standards for medical electrical equipment and software lifecycle processes.
• Risk management and usability engineering.

Therefore, I cannot extract specific information about acceptance criteria for diagnostic performance (e.g., sensitivity, specificity, or reader improvement with AI assistance) or a detailed diagnostic performance study (e.g., MRMC study, expert ground truth establishment) because that information is not present in the provided text.

The Performance Data section explicitly states: "The DIAMOND-5A/6A/8A system, has been assessed and tested and has passed predetermined testing criteria. The Validation Test Plan was designed to evaluate input functions, output functions, and actions performed by the subject device and followed the process documented in the System Validation Test Plan. Nonclinical testing results are provided in the 510(k). Validation testing indicated that as required by the risk analysis, designated individuals performed all verification and validation activities and that the results demonstrated that the predetermined acceptance criteria were met."

This phrasing suggests that the "testing criteria" and "acceptance criteria" referred to are for ensuring the functionality, safety, and compliance with standards of the X-ray system itself, and not necessarily for demonstrating specific diagnostic performance metrics (like the accuracy of an AI algorithm in detecting pathologies). The core of the submission seems to be the replacement of an older image handling module with "RADMAX Digital Image Software," and the impact of this change on the system's safety and efficacy, not the introduction of AI for diagnostic assistance.

Based on the provided text, the device is a stationary digital diagnostic x-ray system, and the "AI component" referred to in your prompt (if it were present) would likely be part of the "RADMAX Digital Image Software" if it contained any AI-driven diagnostic features beyond basic image processing. However, the document does not elaborate on such diagnostic AI features or their performance evaluation.

Hypothetical Answer (if the document had contained the requested information for an AI-powered diagnostic device):

(Please note: The following is a hypothetical answer structured as if the document provided details for an AI-powered diagnostic device, which it does not. I've used placeholder values where specific information about diagnostic performance would typically be found in such a submission.)

Acceptance Criteria and Study for AI-Powered Diagnostic Device (Hypothetical)

This document describes the validation of a stationary digital diagnostic X-ray system. While the submission primarily focuses on functional safety and feature equivalence, if it were an AI-powered diagnostic device, the following hypothetical information would be expected for a performance study.

1. Table of Acceptance Criteria and Reported Device Performance (Hypothetical)

4. Adjudication Method for Test Set (Hypothetical)

• Method: [e.g., 2+1 Adjudication: Each case was initially reviewed independently by two experts. In cases of disagreement, a third, senior expert reviewed the case to establish the final ground truth. Alternatively, 3-reader consensus.]

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

• Was an MRMC study done? [e.g., Yes]
• Effect Size of Human Reader Improvement: [e.g., The MRMC study demonstrated that human readers, when assisted by the AI algorithm, showed an average XX% improvement in sensitivity for detecting condition X (e.g., from 75% to 85%), while maintaining specificity. The study used methods such as observer performance studies (e.g., ROC analysis) to quantify this improvement.]

6. Standalone Algorithm Performance (Hypothetical)

• Was a standalone performance evaluation done? [e.g., Yes]
• Metrics: The algorithm demonstrated a standalone sensitivity of Y% and specificity of Z% for condition X on the test set. (As per the table above).

7. Type of Ground Truth Used (Hypothetical)

• Ground Truth Type: [e.g., Expert consensus (as described in point 4), confirmed by available clinical outcomes data and/or pathology reports where possible.]

8. Sample Size for Training Set (Hypothetical)

• Sample Size: [e.g., 10,000 cases]

9. How Ground Truth for Training Set was Established (Hypothetical)

• Method: [e.g., A combination of initial annotations by trained technicians or junior radiologists, followed by review and verification by a single or small panel of senior radiologists. Cases were sometimes cross-referenced with electronic health records for clinical context and pathology reports if available.]

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The GXR-Series Diagnostic X-Ray System, (Models GXR-SD, GXR-S, SGXR-S, FDR Smart FGXR-S), is a stationary X-ray imaging system, for the purpose of acquiring X-ray images of the desired parts of a patient's anatomy. This device is not intended for mammography or bone density applications.

The GXR-Series Diagnostic X-Ray System, (Models GXR-SD, GXR-S, SGXR-S, FDR Smart FGXR-S) is comprised of 2 main configurations: GXR-SD and GXR-S, with SGXR-S, FDR Smart FGXR-S being different brand names for GXR-S. Both configurations are designed to diagnose the human body by providing radiographic x-ray image with anatomical structure.

GXR-S, SGXR-S, FDR Smart FGXR-S (analog) and GXR-SD (digital) have the same xray hardware components. However, the GXR-SD model contains image management (PACS) software and a flat panel digital detector. Interoperability is defined in the DICOM Conformance Statement which is part of the device labeling and is based upon NEMA PS 3.1 - 3.20 (2016). Digital Imaging and Communications in Medicine (DICOM) Set DICOM Standard.

The GXR-S does not have image management software and does not have a digital detector.

The GXR-SD, GXR-S, SGXR-S, FDR Smart FGXR-S, models consist of a high voltage (HV) generator, a tube support unit, an X-ray beam limiting device, patient table, wall Bucky stand, and an x-ray tube, that operates on a high-frequency inverter method.

The operator control console is designed to be simple and user-friendly, and the user can select or change x-ray parameters easily using a large graphic LCD panel display and a soft membrane switch. The GXR Series, high frequency X-ray generator features accuracy, reproducibility and long-term stability with capacitor assisted general line power supply. The APR (Anatomical Programming) and the optional AEC (Automatic Exposure Control) features gives the user control of exposure factors, automatically optimized for the radiological study selected.

RADMAX Digital Imaging Software (K182537) by DRGEM, is used in the GXR-SD model to serve as an interface to the hardware and images. Anatomical view-based digital image processing automatically optimizes and enhances the quality of the captured images.

The provided document, a 510(k) Premarket Notification summary for the GXR-Series Diagnostic X-Ray System, does not contain the detailed information typically presented in a study proving a device meets acceptance criteria for an AI/CADe (Computer-Aided Detection/Diagnosis) system.

This document describes a traditional X-ray system, not an AI software. The performance data highlighted is primarily related to non-clinical testing, electrical safety, EMC (Electromagnetic Compatibility), and conformance to various medical device standards (e.g., IEC 60601 series, ISO 14971, NEMA PS 3.1 DICOM). These are standard requirements for X-ray hardware, not for AI software performance in diagnostic tasks.

Therefore, I cannot extract the requested information regarding acceptance criteria and study details for an AI/CADe system from this document. The sections you asked for, such as sample sizes for test and training sets, expert qualifications, and MRMC studies, would be found in a submission for an AI-powered diagnostic device, which this is not.

The "Performance Data" section in the document specifically mentions "Nonclinical Testing" and lists several international standards for electrical safety and electromagnetic compatibility (EMC), as well as software lifecycle processes (IEC 62304) and risk management (ISO 14971). It concludes that "Validation testing indicated that as required by the risk analysis, designated individuals performed all verification and validation activities and that the results demonstrated that the predetermined acceptance criteria were met." However, it does not specify what those acceptance criteria for clinical performance are, as it is a hardware device.

If you have a document describing an AI/CADe device, please provide that, and I will be able to answer your questions.

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