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510(k) Data Aggregation

    K Number
    K241987
    Date Cleared
    2024-08-02

    (25 days)

    Product Code
    Regulation Number
    884.1690
    Reference & Predicate Devices
    Why did this record match?
    Reference Devices :

    K232003

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

    Single-Use Video Hysteroscope is intended to be used for viewing of the adult cervical canal and uterine cavity for the purpose of performing diagnostic and operative procedures.

    The device is suitable for professional healthcare facility environments such as hospitals and clinics.

    Device Description

    The subject device, Single-Use Video Hysteroscope is intended to be used for viewing of the adult cervical canal and uterine cavity for the purpose of performing diagnostic and operative procedures.

    The device is suitable for professional healthcare facility environments such as hospitals and clinics.

    The subject device consists of an endoscope (a hysteroscope) which includes an insertion portion and handle, and the following accessories: 2 pieces of two-way valves and 1 piece of silicone cap.

    AI/ML Overview

    The provided document, K241987, describes a 510(k) premarket notification for a medical device and does not contain information about acceptance criteria and a study that proves the device meets those criteria from an AI/algorithm performance perspective.

    The document is a K241987 submission for a Single-Use Video Hysteroscope (RP-G-C24, RP-G-C0101). This device is a traditional medical instrument used for viewing the cervical canal and uterine cavity. It is not an AI/algorithm-based device.

    Therefore, many of the requested fields related to AI/algorithm performance, such as sample size for test sets, data provenance, number of experts, adjudication methods, MRMC studies, standalone performance, and training set details, are not applicable to this submission.

    The "Performance" section within the document refers to non-clinical performance testing of the physical device, such as mechanical, optical, and biocompatibility tests, not an algorithm's performance.

    Here's a breakdown of the information that is available in the document, framed against your request:

    Acceptance Criteria and Device Performance for Single-Use Video Hysteroscope (RP-G-C24, RP-G-C0101)

    As this is a physical medical device (a hysteroscope) and not an AI or algorithm, the acceptance criteria and performance data relate to its physical and functional attributes. The document states that "Verification testing including performance testing using previously submitted methods and acceptance criteria cleared under K232003... were conducted to evaluate the modifications. The subject device passed all the testing in accordance with internal requirements and applicable standards."

    Due to the nature of the device, many of the requested fields are not relevant.

    1. A table of acceptance criteria and the reported device performance

    The document lists performance tests conducted but does not explicitly detail the quantitative acceptance criteria or the specific reported device performance values beyond stating that the "subject device passed all the testing." The acceptance criteria are implicitly those established for the predicate device (K232003) and internal requirements/applicable standards.

    Test categoryTest ItemAcceptance Criteria (from K232003 / applicable standards)Reported Device Performance
    Mechanical PerformanceSurface and Edges Visual AssessmentPassedPassed
    Water Delivery System (Flow Rate and Leakage Testing)PassedPassed
    Basic Size (Dimensional Analysis and Compatibility Testing of the Two-way Valve)PassedPassed
    Comprehensive Performance of Luer Taper per ISO 80369-7:2021 and ISO 80369-20:2015PassedPassed
    Pullout Force of Silicone CapPassedPassed
    Compatibility with Accessories When Installing Silicone CapPassedPassed
    Sealing Test after Installing the Two-way Valve (Leakage Testing under Pressure)PassedPassed
    Optical PerformanceDepth of field (Note: RP-G-C0101 changed from 5 mm50 mm to 3 mm50 mm, which implies this new range is the acceptance criteria for the modified device).3 mm ~ 50 mm (for RP-G-C0101)Met
    BiocompatibilityCytotoxicity test per ISO 10993-5:2009PassedPassed
    Sensitization test per ISO 10993-10:2011PassedPassed
    Intracutaneous Reactivity test per ISO 10993-23:2021PassedPassed
    Acute Systemic Toxicity test per ISO 10993-11:2017PassedPassed
    Material-Mediated Pyrogenicity test per USPPassedPassed
    SterilizationEO/ethylene chlorohydrin (ECH) residual testing per ISO 10993-7:2008Below stated residual limitsMet
    Shelf Life & PackagingASTM F1980-21, ISO 11607-1:2019, ISO 11607-2:2019, ASTM F 1929-15, ASTM F88/F88M-23, ASTM F1886/F1886M-16, ASTM D4169-23PassedPassed

    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 for individual performance tests. The testing refers to "subject device" and implies a representative number of units were tested.
    • Data Provenance: Not specified. Testing was conducted internally by Guangzhou Red Pine Medical Instrument Co., Ltd.

    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. This relates to human expert review for AI/algorithm performance. The device is a physical hysteroscope. The "truth" for physical performance tests (e.g., leakage, dimensions, biocompatibility) is determined by objective measurements against established standards, not expert consensus on medical images or diagnoses.

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

    • Not applicable. See point 3.

    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 a physical medical device, not an AI system. No MRMC study was conducted.

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

    • Not applicable. This is a physical medical device, not an algorithm.

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

    • For Biocompatibility: "Ground truth" is established by adherence to recognized international standards (e.g., ISO 10993 series, USP ) and observable biological responses in tests.
    • For Mechanical/Optical Performance: "Ground truth" is based on engineer specifications, physical measurements, and conformity to applicable industry standards (e.g., ISO 80369-7:2021).
    • For Sterilization/Shelf Life: "Ground truth" is based on validated methods (e.g., ISO 11135:2014) demonstrating sterility assurance levels and packaging integrity per standards (e.g., ISO 11607).

    8. The sample size for the training set

    • Not applicable. This device does not involve a training set as it's not an AI/algorithm-based device.

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

    • Not applicable. See point 8.
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