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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, Intraoperative (Vascular), Intraoperative (Cardiac), Intra-luminal, Intra-cardiac Echo, Musculoskeletal (Conventional), Musculoskeletal (Superficial), Ophthalmic, Other: Urology, Pediatric, Peripheral Vessel, Small Organ (Breast, Thyroid, Testicle), Transesophageal (Cardiac), Transrectal, Transvaginal, Lung.

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.

The purpose of this Special 510(k) Pre-Market Notification is to modify the Segmental Wall Motion and introduce Auto EF with contrast software application onto the Philips EPIQ Series Diagnostic Ultrasound System and Affiniti Series Diagnostic Ultrasound Systems. SWM algorithm was previously cleared (K243862) and Auto EF contrast algorithm(K243235) was also previously cleared. The current software release version VM 13, replaces the previous version of the segmental wall motion algorithm included in version 11 of the software release with the current cleared version (K243862) without any modifications, and integrates Auto EF contrast algorithm(K243235) without any modifications into one software release.

The SWM v2 software automatically evaluates the segmental (regional) function of the left ventricle (LV) from adult TTE echo examinations. For input, the SWM algorithm uses 3 apical views (A4C, A2C and A3C) and performs border detection and tracking to identify each of the LV segments based on the three views. The SWM v2 software is a semi-automated quantitative imaging algorithm, as users are generally expected to review and concur with the initial and generated results. The users can also manually edit algorithm-generated segmental wall motion scores for individual segments based on their clinical expertise.

Auto EF with contrast is an AI based automated software feature that assists clinicians with assessing Left Ventricular Ejection Fraction (LVEF) from images acquired with contrast agent as part of an adult transthoracic echo (TTE) examination. The feature is located within the Philips Auto EF Adv application. Auto EF with contrast uses 2 apical views (Apical four chamber view (A4C), Apical two chamber (A2C)) and provides EF for each view and a biplane Simpsons EF.

No hardware changes to the EPIQ or Affiniti systems were made due to the SWM v2 and Auto EF with contrast, and existing, cleared Philips TTE transducers are used with these software applications.

This FDA 510(k) clearance (K251110) modifies the Segmental Wall Motion (SWM) algorithm and integrates an existing Auto EF with contrast software into Philips EPIQ and Affiniti Series Diagnostic Ultrasound Systems. The study details for each software component are primarily based on retrospective data analyses.

Here's a breakdown of the acceptance criteria and study information for each feature:

SWM v2 (Segmental Wall Motion v2)

1. Comparison of the average WMSI from ground truthers to the SWM v2 software's WMSI.
2. Majority agreement: A minimum of 2 out of 3 ground truthers were required to agree on WMSI = 1 (normal) or WMSI > 1 (abnormal) for the exam, which was then compared to the software's WMSI. |
   | 5. Multi-Reader Multi-Case (MRMC) Study | No, an MRMC comparative effectiveness study was not explicitly described. The study compared the algorithm's performance to expert visual estimation as the ground truth. |
   | 6. Standalone Performance | Yes, this was a standalone (algorithm only) performance evaluation against an expert-established ground truth. Although it is a "semi-automated quantitative imaging algorithm" where "users are generally expected to review and concur," the performance assessment described here focuses on the algorithm's output prior to user editing. |
   | 7. Type of Ground Truth Used | Expert consensus/visual estimation by 3 expert cardiologists. |
   | 8. Training Set Sample Size | Not provided in this document. This clearance refers to a previous clearance (K243862) for the SWM v2 algorithm. |
   | 9. Training Set Ground Truth Establishment | Not provided in this document. This clearance refers to a previous clearance (K243862). |

Auto EF with Contrast

1. Manual selection of clips by an experienced sonographer.
2. Manual EF assessment using Simpson's method of disks by 3 qualified sonographers.
3. "Shoulder to shoulder" consensus meetings among the 3 sonographers to review manual measurements, jointly select best traced images ("Best Trace"), and adjust traces if needed.
4. A cardiologist specializing in echo subsequently reviewed the selected A4C and A2C clips with "Best Trace" and the resulting LV EF measurements, performing manual adjustments if needed. These final measurements were used as ground truth. |
   | 5. Multi-Reader Multi-Case (MRMC) Study | No, an MRMC comparative effectiveness study was not explicitly described. This was a direct comparison of the algorithm's standalone performance against a consensus-derived ground truth. |
   | 6. Standalone Performance | Yes, the study describes the "Contrast EF application to an EF output" in an automated fashion, and "The ground truth EF measurements were compared to the Contrast EF automated results for EF (biplane)." This indicates a standalone performance evaluation. |
   | 7. Type of Ground Truth Used | Expert consensus (between 3 sonographers and 1 cardiologist) using manual EF assessment via Simpson's method of disks. |
   | 8. Training Set Sample Size | Not provided. This clearance refers to a previous clearance (K243235) for the Contrast EF algorithm. |
   | 9. Training Set Ground Truth Establishment | Not provided. This clearance refers to a previous clearance (K243235). |

Overall Context:

It's important to note that this 510(k) is a Special 510(k). This type of submission is usually for modifications to a currently cleared device where the changed device does not raise new questions of safety and effectiveness. Both SWM v2 and Auto EF with contrast were previously cleared as standalone applications (K243862 and K243235, respectively). This clearance focuses on integrating these previously cleared algorithms into the Philips EPIQ and Affiniti ultrasound systems and replacing an older SWM algorithm. Therefore, the performance studies described here are primarily to demonstrate that the algorithms maintain their previously established performance when integrated into the new platform, or to provide updated performance data for the newer version of the SWM algorithm.

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