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Found 116 results
510(k) Data Aggregation
(104 days)
400059
India
Re: K251610
Trade/Device Name: qER-CTA (v1.0)
Regulation Number: 21 CFR 892.2080
computer-assisted triage and notification software
Regulatory Class: Class II
Regulation Number: 21 CFR 892.2080
Inc.
510(k) Number: K223042
Regulatory Class: Class II
Regulation Number: 21 CFR 892.2080
software | Radiological computer aided triage and notification software |
| Regulation Number | 21 CFR 892.2080
| 21 CFR 892.2080 |
| Product Code | QAS | QAS |
| Manufacturer | Viz.ai, Inc. | Qure.ai Technologies
qER-CTA is a notification-only, parallel workflow tool for use by hospital networks and trained clinicians to identify and communicate images of specific patients to a specialist, independent of the standard of care workflow. qER-CTA uses a deep learning algorithm to analyze images for findings suggestive of a pre-specified clinical condition and to notify an appropriate medical specialist in parallel to standard of care image interpretation. Identification of suspected findings is not for diagnostic use beyond notification. Specifically, the device analyses CT angiogram images of the brain acquired in the acute setting and sends notifications to a neurovascular specialist that a suspected large vessel occlusion has been identified, recommending review of those images. Images can be previewed through a mobile application. qER-CTA is intended to analyze the internal carotid artery (ICA) and M1 segment of the middle cerebral artery (MCA) for LVOs on CTA scans of adults (≥ 22 years of age). Images previewed through the mobile application are compressed and for informational purposes only, not intended for diagnostic use beyond notification. Notified clinicians are responsible for viewing non-compressed images on a diagnostic viewer, conducting appropriate patient evaluation, and engaging in relevant discussions with the treating physician before making care-related decisions or requests. qER-CTA is limited to the analysis of imaging data and should not be used as a substitute for full patient evaluation or relied upon to make or confirm a diagnosis.
qER-CTA is a radiological computer-aided triage and notification (CADt) software designed to assist trained clinicians and radiologists in analyzing and triaging head CTA scans for suspected LVO (Large Vessel Occlusion) in the anterior circulation.
The software uses a deep learning algorithm to analyze CTA images and provide a case-level output available in the PACS or workstation for worklist prioritization or triage. It does not alter the original image, change the worklist order, or send proactive alerts directly to the end user. Instead, the end user can sort the worklist based on the passive notification flag. Images can be previewed through a mobile application also. There are two alternatives' users can choose from engaging with qER-CTA.
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For de-identified CTA scans, they are sent to qER-CTA via transmission functions built within the user's PACS or workstation. Results are pushed back to the user's PACS or other user-specified radiology software database once the processing is complete.
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For the client system that does not have de-identification and re-identification capabilities, qER-CTA interacts with on-premises gateway rather than directly with the PACS.
qER-CTA is not intended to direct attention to specific portions of the image, rule out target conditions, or be used as a standalone tool for clinical decision-making. It operates as a parallel workflow tool, independent of the standard of care, to assist in identifying and communicating suspected LVO cases to appropriate medical specialists for further review. Images previewed through the mobile application are compressed and are for informational purposes only.
1. Acceptance Criteria and Reported Device Performance
| Abnormality | Acceptance Criteria | Reported Device Performance (95% CI) |
|---|---|---|
| Large Vessel Occlusion | Not explicitly stated in the provided text. Likely compared against predicate. | AUC: 0.959 (0.943 – 0.975) |
| Sensitivity: 91.35% (87.54%-94.07%) | ||
| Specificity: 91.86% (88.18% -94.47%) | ||
| Time to Notification | Not explicitly stated in the provided text. Likely compared against predicate. | Mean: 6.36 minutes (6.06-6.66) |
2. Sample Size for Test Set and Data Provenance
- Sample Size: 584 head CTA scans (289 LVO, 295 non-LVO).
- Data Provenance: Not explicitly stated in the provided text (e.g., country of origin, retrospective or prospective).
3. Number of Experts and Qualifications for Ground Truth Establishment (Test Set)
- Number of Experts: Three.
- Qualifications: U.S. board-certified neuroradiologists with at least 10 years of experience.
4. Adjudication Method for the Test Set
- The adjudication method is not explicitly mentioned. It states that "Three U.S. board certified neuroradiologists with at least 10 years of experience did the ground truthing," implying a consensus or majority vote might have been used, but specific details (e.g., 2+1, 3+1) are not provided.
5. Multi-Reader Multi-Case (MRMC) Comparative Effectiveness Study
- No, a MRMC comparative effectiveness study was not done. The document explicitly states that the performance was assessed using a "standalone study."
6. Standalone Performance (Algorithm Only) Study
- Yes, a standalone study was done. The performance of the qER-CTA device was assessed using a standalone study, evaluating its classification of large vessel occlusion.
7. Type of Ground Truth Used
- Expert Consensus: The ground truth was established by three U.S. board-certified neuroradiologists with at least 10 years of experience.
8. Sample Size for the Training Set
- The sample size for the training set is not provided in the given text.
9. How Ground Truth for the Training Set Was Established
- How the ground truth for the training set was established is not provided in the given text. The document only mentions the ground truthing for the clinical performance testing (test set).
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(108 days)
Trade/Device Name: Rapid Obstructive Hydrocephalus, Rapid OH
Regulation Number: 21 CFR 892.2080
processing system
Classification: II
Product Code: Primary: QAS
Regulation No: 21 C.F.R. §892.2080
------------------|---------------------------|
| Product Code | QAS | QAS |
| Regulation | 21 CFR §892.2080
| 21 CFR §892.2080 |
| Intended Use/ Indications for Use | Rapid SDH is a radiological computer aided
Rapid OH is a radiological computer aided triage and notification software indicated for suspicion of Obstructive Hydrocephalus (OH) in non-enhanced CT head images of adult patients. The device is intended to assist trained clinicians in workflow prioritization triage by providing notification of suspected findings in head CT images.
Rapid OH uses an artificial intelligence algorithm to analyze images and highlight cases with suspected OH on a server or standalone desktop application in parallel to the ongoing standard of care image interpretation. The user is presented with notifications for cases with suspected OH findings. Notifications include compressed preview images, that are meant for informational purposes only and not intended for diagnostic use beyond notification. The device does not alter the original medical image and is not intended to be used as a diagnostic device.
The results of Rapid OH are intended to be used in conjunction with other patient information and based on professional judgment, to assist with triage/prioritization of medical images. Notified clinicians are responsible for viewing full images per the standard of care.
Contraindications/Limitations/Exclusions:
- Rapid OH is intended for use for adult patients.
- Input data image series containing excessive patient motion or metal implants may impact module analysis accuracy, robustness and quality.
- Ventriculoperitoneal shunts are contraindicated
Exclusions:
- Series with missing slices or improperly ordered slices
- data acquired at x-ray tube voltage < 100kVp or > 140kVp.
- data not representing human head or head/neck anatomical regions
Rapid OH software device is a radiological computer-aided triage and notification software device using AI/ML. The Rapid OH device is a non-contrast CT (NCCT) processing module which operates within the integrated Rapid Platform to provide a notification of suspected findings of obstructive hydrocephalus (OH). The Rapid OH device is SaMD which analyzes input NCCT images that are provided in DICOM format for notification of suspected findings for workflow prioritization.
Here's a breakdown of the acceptance criteria and study details for the Rapid OH device, based on the provided FDA 510(k) clearance letter:
1. Table of Acceptance Criteria and Reported Device Performance
| Metric | Acceptance Criteria | Reported Device Performance |
|---|---|---|
| Primary Endpoint: Sensitivity (Se) | Not explicitly stated as a separate acceptance criterion, but the reported performance met the statistical confidence interval. | 89.5% (95% CI: 0.837-0.935) |
| Primary Endpoint: Specificity (Sp) | Not explicitly stated as a separate acceptance criterion, but the reported performance met the statistical confidence interval. | 97.6% (95% CI: 0.940-0.991) |
| Secondary Endpoint: Time to Notification | Not explicitly stated as a numerical acceptance criterion, but the reported performance indicates efficiency. | 30.3 seconds (range 10.5-55.5 seconds) |
Note: The document states "Standalone performance primary endpoint passed with sensitivity (Se) of 89.5% (95% CI:0.837-0.935) and specificity (Sp) of 97.6% (95% CI:0.940-0.991)". While explicit numerical acceptance criteria for sensitivity and specificity are not provided, the "passed" statement implies that the reported performance fell within pre-defined acceptable ranges or met a statistical hypothesis.
2. Sample Size for the Test Set and Data Provenance
- Sample Size for Test Set: 320 cases
- Data Provenance: The document mentions "diversity amongst demographics (M: 45%, F: 54%); Sites (and manufacturers (GE, Philips, Siemens, Toshiba) and confounders (ICH, Ischemic Stroke, Tumor, Cyst, Aqueductal stenosis, Mass effect, Brain atrophy and Communicating hydrocephalus)". While specific countries of origin are not explicitly stated, the mention of multiple manufacturers (Siemens, GE, Toshiba, Philips) and multiple sites (74 sites for algorithm development, and "Sites" for the validation set) suggests a diverse, likely multi-site, and potentially multi-country dataset, although this is not definitively confirmed for the test set itself. The dataset appears to be retrospective, as it's used for algorithm development and validation based on existing cases.
3. Number of Experts Used to Establish Ground Truth for the Test Set and Qualifications
- Number of Experts: 3 experts (implied from "Truthing was established using 2:3 experts.")
- Qualifications of Experts: Not explicitly stated in the provided text. They are referred to as "experts." In regulatory contexts, these would typically be radiologists or neuro-radiologists with significant experience in interpreting head CTs.
4. Adjudication Method for the Test Set
- Adjudication Method: "2:3 experts." This means that ground truth was established by agreement from at least 2 out of 3 experts.
5. Multi-Reader Multi-Case (MRMC) Comparative Effectiveness Study
- MRMC Study Done: No, an MRMC comparative effectiveness study was not explicitly mentioned for this device. The study described is a standalone performance validation of the algorithm.
6. Standalone Performance (Algorithm Only without Human-in-the-Loop) Done
- Standalone Performance Done: Yes, "Final device validation included standalone performance validation. This performance validation testing demonstrated the Rapid OH device provides accurate representation of key processing parameters under a range of clinically relevant conditions associated with the intended use of the software." The reported sensitivity and specificity values are for this standalone performance.
7. Type of Ground Truth Used
- Type of Ground Truth: Expert consensus ("Truthing was established using 2:3 experts.")
8. Sample Size for the Training Set
- Sample Size for Training Set: 3340 cases (This refers to "Algorithm development" which encompasses training and likely internal validation/development sets).
9. How the Ground Truth for the Training Set Was Established
- How Ground Truth Was Established (Training Set): The document states "Algorithm development was performed using 3340 cases... Truthing was established using 2:3 experts." This implies that the same expert consensus method (2 out of 3 experts) used for the test set was also used to establish ground truth for the cases used in algorithm development (which includes the training set).
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(60 days)
Kingdom
Re: K251983
Trade/Device Name: Brainomix 360 Triage Stroke
Regulation Number: 21 CFR 892.2080
Notification Software
Regulatory Class: Class II
Product Code: QAS
Regulation No: 21 C.F.R. §892.2080
Brainomix 360 Triage Stroke
Manufacturer: Brainomix Limited
Regulation Number: 21 C.F.R. §892.2080
-|-------------------------------------------|
| Product Code | QAS | QAS |
| Regulation | 21 CFR. §892.2080
| 21 CFR. §892.2080 |
| Indications for Use | Brainomix 360 Triage Stroke is a radiological computer
Brainomix 360 Triage Stroke is a radiological computer aided triage and notification software indicated for use in the analysis of non-contrast head CT (NCCT) images to assist hospital networks and trained clinicians in workflow triage by flagging and communicating suspected positive findings of head NCCT images for large vessel occlusion (LVO) of the intracranial ICA and M1 or intracranial hemorrhage (ICH). Specifically, the device is intended to be used for the triage of images acquired from adult patients in the acute setting, within 24 hours of the onset of the acute symptoms, or where this is unclear, since last known well (LKW) time. It is not intended to detect symmetrical bilateral MCA occlusions.
Brainomix 360 Triage Stroke uses an artificial intelligence algorithm to analyze images and highlight cases with detected NCCT LVO or ICH on the Brainomix server on premise or in the cloud in parallel to the ongoing standard of care image interpretation. The user is presented with notifications for cases with suspected LVO or ICH findings via a web user interface or mobile application. Notifications include compressed preview images that are meant for informational purposes only and are not intended for diagnostic use beyond notification.
The device does not alter the original medical image, and it is not intended to be used as a primary diagnostic device. The results of Brainomix 360 Triage Stroke are intended to be used in conjunction with other patient information and based on professional judgment to assist with triage/prioritization of medical images. Notified clinicians are ultimately responsible for reviewing full images per the standard of care.
Cautions:
- All patients should get adequate care for their symptoms, including angiography and/or other appropriate care per the standard clinical practice, irrespective of the output of Brainomix 360 Triage Stroke.
- Brainomix 360 Triage Stroke is not intended to be a rule-out device and for cases that have been processed by the device without notification for "Suspected LVO" should not be viewed as indicating that LVO is excluded. All cases should undergo angiography, per the standard stroke workup.
Limitations:
- Brainomix 360 Triage Stroke is not intended for mobile diagnostic use. Images viewed on a mobile platform are compressed preview images and not for diagnostic interpretation.
- Brainomix 360 Triage Stroke does not replace the need for angiography in ischemic stroke workup - it provides workflow prioritization and notification only.
- Brainomix 360 Triage Stroke has been validated and is intended to be used on Siemens, GE and Philips scanners.
- Brainomix 360 Triage Stroke is not intended to be used on patients with recent (within 6 weeks) neurosurgery or endovascular neurointervention or recent (within 4 weeks) previous diagnosis of stroke.
- Brainomix 360 Triage Stroke is not intended to detect symmetrical bilateral MCA occlusions.
Contraindications:
Brainomix 360 Triage Stroke is not suitable for use with scan data containing image features associated with:
- tumours or abscesses
- coils, shunts, embolization or movement artifacts
- intracranial vascular pathologies such as arterial aneurysms, arteriovenous malformations or venous thrombosis.
Brainomix 360 Triage Stroke (also referred to as Triage Stroke in this submission) is a radiological computer aided triage and notification software package compliant with the DICOM standard and running on an off-the-shelf physical or virtual server. Triage Stroke is a non-contrast CT processing software-only medical device which operates within the integrated Brainomix 360 Platform to provide triage and notification prioritization of suspected large vessel occlusion (LVO) or intracranial hemorrhage (ICH). The device uses machine learning algorithms such as advanced non adaptive imaging algorithms, artificial intelligence, and large data analytics.
Brainomix 360 Triage Stroke is available to users in three configurations, featuring three individual processing modules:
- Triage ICH Module, which can only flag positive findings of suspected ICH;
- Triage Stroke Module, which can flag positive findings of suspected ICH or LVO; And
- NCCT LVO Module, which can flag positive finding of suspected LVO
The Triage ICH Module automatically identifies suspected ICH, the NCCT LVO module automatically identifies suspected LVO, while the Triage Stroke Module automatically identifies suspected ICH or LVO on non-contrast CT (NCCT) imaging acquired from adult patients in the acute setting, within 24 hours of the onset of acute symptoms, or where this is unclear, since last known well (LKW) time. The output of the device is a priority notification to clinicians indicating the suspicion of just ICH for Triage ICH Module, the suspicion of just LVO for the NCCT LVO Module, and suspicion of ICH or LVO for Triage Stroke Module based on positive findings. Specifically, the ICH analysis algorithm is optimized to identify findings of hyperdense volume in the parenchyma typically associated with acute intracranial hemorrhage; and the NCCT LVO suspicion uses the combined analysis of the ASPECTS and hyperdense vessel sign (HDVS) algorithms to identify hyper attenuation in vessels and hypodense regions typically associated with a large vessel occlusion in a non-contrast CT scan.
Brainomix 360 Triage Stroke is not intended to detect symmetrical bilateral MCA occlusions. The device uses the basic services supplied by the Brainomix 360 Platform including DICOM processing, job management, imaging module execution and imaging output including notification and compressed image.
Brainomix 360 Triage Stroke notification capabilities enable clinicians to review and preview images via mobile app notification. Alternatively, intended users can also access the notification (a "Suspected LVO" or "Suspected hemorrhage" flag) and straightened images via the Brainomix 360 web user interface. Images that are previewed via mobile app are compressed, are for preview informational purposes only, and not intended for diagnostic use beyond notification.
The device is intended for use as an additional tool for assisting study triage within existing patient pathways. It does not replace any part of the current standard of care. It is designed to assist in prioritization of studies for reading within a worklist, in addition to any other pre-existing formal or informal methods of study prioritization in place. Specifically, it does not remove cases from a reading queue and operates in parallel to the standard of care. This device is not intended to replace the usual methods of communication and transfer of information in the current standard of care.
The Brainomix 360 Triage Stroke device is made available to the user through the Brainomix 360 Platform The Brainomix 360 Platform is a central control unit which coordinates the execution image processing modules which support various analysis methods used in clinical practice today:
The provided document describes the acceptance criteria and the study that proves the device meets those criteria for the Brainomix 360 Triage Stroke device.
Here's a breakdown of the requested information:
1. Table of Acceptance Criteria and Reported Device Performance
| Performance Metric | Acceptance Criteria (Pre-specified Goal) | Reported Device Performance |
|---|---|---|
| ICH Detection (Standalone Study) | Sensitivity > 80% | Sensitivity: 96.41% (95% CI: 92.65-98.65%) |
| Specificity > 80% | Specificity: 96.55% (95% CI: 92.94-98.70%) | |
| SAH Detection (Secondary Outcome) | Sensitivity > 80% | Sensitivity: 85.71% (CI: 60.99-97.67%) |
| Specificity > 80% | Specificity: 96.55% (CI: 80.60-98.87%) | |
| LVO Detection (Standalone Study) | (Not explicitly stated, but "exceeded pre-specified performance goals") | Sensitivity: 69.64% (CI: 60.65-77.70%) |
| (Not explicitly stated, but "exceeded pre-specified performance goals") | Specificity: 89.57% (CI: 82.92-94.36%) | |
| Combined Time-to-Notification | < 3.5 minutes | Minimum: 58.3 secondsMaximum: 150.7 seconds(Both met criterion) |
| LVO Detection (Reader Study) | Expert Non-Inferiority | Device Sensitivity: 69.64%All Readers Sensitivity: 47.94%Difference: 20.52% (8.26-32.78%) (Device demonstrated superiority, thus non-inferiority was met) |
| Non-Expert Superiority | Device Sensitivity: 69.64%Non-Expert Sensitivity: 47.18%Difference: 21.28% (5.84-36.72%) (Device demonstrated superiority) |
2. Sample Size Used for the Test Set and Data Provenance
- ICH Standalone Study Test Set: 341 cases (167 ICH positive; 174 ICH negative)
- LVO and ICH Standalone Study Test Set: 267 cases (112 LVO positive; 40 ICH positive; 115 Negative for ICH or LVO; 3 excluded due to technical inadequacy).
- Reader LVO Performance Study Test Set: The document does not explicitly state the number of cases used in the reader study. It refers to the same LVO and ICH Standalone Study data for performance metrics, suggesting the reader study was conducted on a subset or the entirety of that dataset.
- Data Provenance: Retrospective study. The document does not specify the country of origin of the data.
3. Number of Experts Used to Establish the Ground Truth for the Test Set and Qualifications of Those Experts
- Number of Experts: Three (3)
- Qualifications of Experts: Experienced US board-certified neuroradiologists.
4. Adjudication Method for the Test Set
- Method: Consensus of the three experienced US board-certified neuroradiologists.
5. If a Multi-Reader Multi-Case (MRMC) Comparative Effectiveness Study was done
- Yes, a reader study was conducted.
- Effect Size of Human Readers Improvement with AI vs. Without AI Assistance:
The study compared the device's standalone LVO sensitivity to that of human readers without AI assistance (the document does not describe human readers using AI assistance).- Device's LVO Sensitivity: 69.64%
- All Human Readers (Experts and Non-experts) LVO Sensitivity: 47.94%
- Difference (Effect Size): The device's sensitivity was 20.52% (CI: 8.26-32.78%) higher than that of all human readers.
- Non-expert Radiologists LVO Sensitivity: 47.18%
- Difference (Effect Size for Non-experts): The device's sensitivity was 21.28% (CI: 5.84-36.72%) higher than that of non-expert (general) radiologists.
- This indicates that the AI performs better than human readers alone for LVO detection in this study (i.e., human readers would need to improve significantly to match the AI's standalone performance, if this AI assistance was their only aid). The study primarily demonstrates the device's standalone performance in comparison to human unassisted performance rather than human improvement with AI.
6. If a Standalone (i.e., algorithm only without human-in-the-loop performance) was done
- Yes, standalone performance studies were conducted.
- A standalone study for ICH detection performance was conducted.
- A standalone study for LVO and ICH detection performance was conducted.
7. The Type of Ground Truth Used
- Type of Ground Truth: Expert Consensus (consensus of three experienced US board-certified neuroradiologists).
8. The Sample Size for the Training Set
- The document mentions that the improved ICH algorithm uses "a different deep learning framework, CNN architecture, training data and post-processing capabilities of the algorithm." However, it does not specify the sample size of the training set used for the AI models.
9. How the Ground Truth for the Training Set Was Established
- The document implies ground truth for the training data was established due to the mention of "training data." However, it does not explicitly detail the method for establishing ground truth for the training set, only for the test sets (expert consensus).
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(89 days)
08039
Spain
Re: K251590
Trade/Device Name: Methinks CTA Stroke
Regulation Number: 21 CFR 892.2080
software
Regulatory Class: Class II
Product Code: QAS
Regulation Number: 21 CFR §892.2080
Regulatory Class:** Class II Special Control
Product Code: QAS
Regulation Number: 21 CFR §892.2080
--------|-------------------------------------|
| Product Code | QAS | QAS |
| Regulation | 21 CFR §892.2080
| 21 CFR §892.2080 |
| Indications for Use | ContaCT is a notification-only, parallel workflow tool
Methinks CTA Stroke is a radiological computer aided triage and notification software, parallel workflow tool for use by hospital networks and trained clinicians to identify and communicate images of specific patients to a specialist, independent of standard of care workflow.
Methinks CTA Stroke uses an artificial intelligence algorithm to analyze images for findings suggestive of a pre-specified clinical condition and to notify an appropriate medical specialist of these findings in parallel to standard of care image interpretation.
Identification of suspected findings is not for diagnostic use beyond notification.
Specifically, the device analyzes CT angiogram images of the brain acquired in the acute setting and sends to PACS and/or notifications to a neurovascular specialist that a suspected large vessel occlusion has been identified and recommends review of those images. Images can be previewed through an image viewer. Methinks CTA Stroke is intended to analyze terminal ICA, MCA-M1 and MCA-M2 vessels for LVOs.
Images that are previewed are for informational purposes only and not intended for diagnostic use beyond notification. Notified clinicians are responsible for viewing non-compressed images on a diagnostic viewer and engaging in appropriate patient evaluation and relevant discussion with a treating physician before making care-related decisions or requests. Methinks CTA Stroke is limited to analysis of imaging data and should not be used in-lieu of full patient evaluation or relied upon to make or confirm diagnosis.
Methinks CTA Stroke is a software-only device which is intended to be used by trained physicians involved in the management of Acute Stroke (AS) patients at emergency settings or other departments across the stroke care pyramid model. They include trained physicians such as emergency physicians, neurologists, general radiologists, neurovascular interventionists, neuroradiologists and any trained stroke professionals.
The target patients (intended patient population) are male and female in the adult population (above 21 years old) with suspected Acute Stroke.
The Methinks CTA Stroke device analyzes Computed Tomography Angiography (CTA) images from the intended patient population to identify suspected Large Vessel Occlusions (LVO). This information is to be used in conjunction with other patient information by a professional to assist with triage/prioritization of medical images.
The input of the software is Computed Tomography Angiography (CTA) in DICOM format from patients suspected of Acute Stroke. The outputs of the software are notifications sent to the trained physicians intended to be used in conjunction with other patient information for professional judgment to assist with triage/prioritization.
Here is a comprehensive breakdown of the acceptance criteria and the study proving the Methinks CTA Stroke device meets those criteria, based on the provided FDA 510(k) clearance letter:
Acceptance Criteria and Study Details for Methinks CTA Stroke
Context: The Methinks CTA Stroke device is a radiological computer-aided triage and notification software that uses an AI algorithm to analyze CT angiogram images for findings suggestive of a Large Vessel Occlusion (LVO) and notifies a neurovascular specialist.
1. Table of Acceptance Criteria and Reported Device Performance
The direct acceptance criteria (pre-specified performance goals) are explicitly stated in the document for Sensitivity and Specificity. The time to notification is also presented as a performance metric.
| Performance Metric | Acceptance Criteria (Pre-specified Goal) | Reported Device Performance (95% CI) |
|---|---|---|
| Sensitivity for LVO | Exceeds (unspecified threshold) | 98.2% (93.6% - 99.8%) |
| Specificity for LVO | Exceeds (unspecified threshold) | 91.6% (87.2% - 94.9%) |
| Time to Notification | Not explicitly stated as an acceptance criteria threshold, but documented. | Mean: 3.30 minutes (3.23 - 3.36 minutes) |
Note: While the document states "Sensitivity and specificity exceed the pre-specified performance goals for LVO," the specific numerical thresholds for these goals are not provided in the extract.
2. Sample Size Used for the Test Set and Data Provenance
- Test Set Sample Size: 336 cases
- LVO Positive: 110 cases
- LVO Negative: 226 cases
- Data Provenance: Retrospective, blinded, multicenter, multinational study. Institutions included in the validation study were different from institutions included in training, ensuring separation and representativity. This was verified by checking countries, states, and ZIP codes. The specific countries are not mentioned beyond "multinational."
3. Number of Experts Used to Establish Ground Truth and Qualifications
- Number of Experts: Two primary readers, with a third expert for adjudication. (Total of 3 experts involved in establishing ground truth for any given case of disagreement)
- Qualifications of Experts: US board-certified neuroradiologists. (No years of experience are specified).
4. Adjudication Method for the Test Set
- Method: Majority vote (2+1 adjudication). Ground truth was established by two US board-certified neuroradiologists. If they disagreed regarding LVO findings, a third ground truther established the final ground truth based on the majority vote.
5. Multi-Reader Multi-Case (MRMC) Comparative Effectiveness Study
- The provided document does not indicate that an MRMC comparative effectiveness study was done looking at how human readers improve with AI vs. without AI assistance. The study focuses solely on the standalone performance of the AI algorithm.
6. Standalone Performance (Algorithm Only)
- Yes, a standalone performance study was done. The reported Sensitivity and Specificity values (98.2% and 91.6% respectively) represent the performance of the AI algorithm itself in identifying LVOs, without human-in-the-loop assistance for the core performance metrics.
7. Type of Ground Truth Used
- Ground Truth Type: Expert consensus. Specifically, it was established by two US board-certified neuroradiologists, with a third neuroradiologist for adjudication in case of disagreement.
8. Sample Size for the Training Set
- The document does not explicitly state the sample size used for the training set. It only mentions that "Institutions included in the validation study were different from institutions included in training," but the training dataset size is not provided.
9. How Ground Truth for the Training Set Was Established
- The document does not explicitly describe how ground truth for the training set was established. It only details the ground truth establishment process for the test set. It is implied that similar expert review would have been used, but no specific methodology or number of readers are provided for the training data.
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(93 days)
80401
USA
Re: K251151
Trade/Device Name: Rapid CTA 360
Regulation Number: 21 CFR 892.2080
Software
Classification: II
Product Code: Primary: QAS
Regulation No: 21 C.F.R. §892.2080
---------------|------------------------------|
| Product Code | QAS | QAS |
| Regulation | 21 CFR §892.2080
| 21 CFR §892.2080 |
| Intended Use/ Indications for Use | Rapid LVO is a radiological computer aided
Rapid CTA 360 is a radiological computer aided triage and notification software indicated for use in the analysis of CTA adult head images. The device is intended to assist hospital networks and trained clinicians in workflow triage by flagging and communication of suspected positive Large and Medium Vessel Occlusion findings in head CTA images including the ICA (C1-C5), MCA (M1-M3), ACA, PCA, Basilar and Vertebral vascular segments.
Rapid CTA 360 uses an AI software algorithm to analyze images and highlight cases with suspected occlusion on a server or standalone desktop application in parallel to the ongoing standard of care image interpretation. The user is presented with notifications for cases with suspected LVO and MVO findings. Notifications include compressed preview images. These are meant for informational purposes only and are not intended for diagnostic use beyond notification. The device does not alter the original medical image and is not intended to be used as a diagnostic device.
The results of Rapid CTA 360 are intended to be used in conjunction with other patient information and based on professional judgment, to assist with triage/prioritization of medical images. Notified clinicians are responsible for viewing full images per the standard of care.
Rapid CTA 360 device is a radiological computer-assisted Triage and Notification Software device using AI/ML. The Rapid CTA 360 processing module operates within the integrated Rapid Platform to provide triage and notification of suspected large and medium vessel neuro-occlusions. The Rapid CTA 360 software analyzes input Head and Neck CTA images that are provided in DICOM format and provides notification of suspected positive results. The device does not alter the original medical image and is not intended to be used as a diagnostic device.
Here's a breakdown of the acceptance criteria and the study proving the device meets them, based on the provided FDA 510(k) Clearance Letter:
1. Table of Acceptance Criteria and Reported Device Performance
| Acceptance Criterion | Description | Reported Device Performance |
|---|---|---|
| Primary Endpoint: Sensitivity | Ability of the device to correctly identify true positive cases of Large and Medium Vessel Occlusion (LVO and MVO). | 0.921 (95% CI: 0.880, 0.949) |
| Primary Endpoint: Specificity | Ability of the device to correctly identify true negative cases (no LVO or MVO). | 0.890 (95% CI: 0.832, 0.929) |
| Secondary Endpoint: Time to Notification | The time taken by the device to provide a notification of suspected occlusion. | 3.2 minutes (min: 1.92 min to 5.35 min) |
| Sensitivity Analysis (High Grade Stenosis) | Sensitivity specifically for cases involving high grade stenosis (a potential confounder). | 87.4% (95% CI: 0.829-0.908) |
| Specificity Analysis (High Grade Stenosis) | Specificity specifically for cases involving high grade stenosis (a potential confounder). | 89.0% (95% CI: 0.832-0.929) |
2. Sample size used for the test set and the data provenance
- Test Set Sample Size: 403 CTA cases
- Data Provenance: The data was collected from multiple sites (not explicitly stated which countries, but the training data was primarily US, which might suggest a similar distribution for the test set or at least a representative one). The cases were selected to cover patient demographics (age, gender), manufacturer distributions (GE, Toshiba, Siemens, Philips scanners), and confounders. The data was "collected and blinded prior to use, per internal data management procedures which includes isolation of development and product validation cohorts," implying a retrospective collection, but carefully separated from the training data.
3. Number of experts used to establish the ground truth for the test set and the qualifications of those experts
- Number of Experts: 3 experts
- Qualifications of Experts: Not explicitly stated beyond "experts."
4. Adjudication method for the test set
- Adjudication Method: 2 out of 3 (2:3 concurrence). This means that for a case to be considered positive or negative for ground truth, at least two of the three experts had to agree on the finding.
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
- No MRMC comparative effectiveness study involving human readers with and without AI assistance was mentioned in the provided text. The study focused on the standalone performance of the AI device.
6. If a standalone (i.e. algorithm only without human-in-the-loop performance) was done
- Yes, a standalone performance validation was explicitly stated as being conducted: "Final device validation included standalone performance validation, per the special controls."
7. The type of ground truth used
- Ground Truth Type: Expert consensus. The document states, "ground truth established by 3 experts (2:3 concurrence)."
8. The sample size for the training set
- Training Set Sample Size: 6264 cases
9. How the ground truth for the training set was established
- The document implies that the ground truth for the training set was established through expert review and annotation, as the cases were used for "Algorithm development, including training and testing." It mentions the selection criteria for cases (demographics, scanner manufacturers, confounders) which would likely lead to expert-verified labels as ground truth, but the exact method (e.g., specific number of experts, adjudication) for the training set is not detailed in the same way as for the test set.
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(102 days)
Spain
Re: K250685
Trade/Device Name: Methinks NCCT Stroke
Regulation Number: 21 CFR 892.2080
Spain
Re: K250685
Trade/Device Name: Methinks NCCT Stroke
Regulation Number: 21 CFR 892.2080
software
Regulatory Class: Class II
Product Code: QAS
Regulation Number: 21 CFR §892.2080
software
Regulatory Class: Class II
Product Code: QAS
Regulation Number: 21 CFR §892.2080
| 21 CFR §892.2080 |
| Indications for Use | Rapid NCCT Stroke is a radiological computer aided triage
Methinks NCCT Stroke is a radiological computer aided triage and notification software indicated for use in the analysis of (1) non-contrast head CT (NCCT) images. The device is intended to assist hospital networks and trained physicians in workflow triage by flagging and communicating suspected positive findings of (1) Intracranial Hemorrhage (ICH) and (2) Large Vessel Occlusion (LVO) of the ICA, MCA-M1 and MCA-M2.
Methinks NCCT Stroke uses an artificial intelligence algorithm to analyze images and highlight cases with suspected (1) ICH and (2) LVO in the cloud in parallel to the ongoing standard of care image interpretation. The user is presented with notifications for cases with suspected ICH or LVO findings via PACS and/or notifications. Notifications include preview images that are meant for informational purposes only, and are not intended for diagnostic use beyond notification.
The device does not alter the original medical image, and it is not intended to be used as a primary diagnostic device. The results of Methinks NCCT Stroke are intended to be used in conjunction with other patient information and based on professional judgment to assist with triage/prioritization of medical images. Notified clinicians are ultimately responsible for reviewing full images per the standard of care. Methinks NCCT Stroke is for adults only.
Methinks NCCT Stroke is a radiological computer-assisted triage and notification software device. The device receives Non-Contrast Computed Tomography (NCCT) images and processes them to provide triage and notification prioritization of suspected Intracranial Hemorrhage (ICH) and Large Vessel Occlusion (LVO) of the ICA, MCA-M1 and MCA-M2. The Methinks NCCT Stroke device is an AI/ML Software as a Medical Device. The outputs of the device are intended to be used by trained clinicians in the prioritization of patients with suspected ICH and/or LVO.
The provided FDA 510(k) clearance letter for the Methinks NCCT Stroke device details the acceptance criteria and the study that proves the device meets these criteria. Here's a breakdown of the requested information:
Acceptance Criteria and Reported Device Performance
Table of Acceptance Criteria and Reported Device Performance
The acceptance criteria are implied by the reported performance metrics, primarily sensitivity (Se) and specificity (Sp), for both Intracranial Hemorrhage (ICH) and Large Vessel Occlusion (LVO) detection. The document states that "Sensitivity and specificity exceed the pre-specified performance goals for ICH and LVO," although the exact numerical "goals" are not explicitly stated. The performance of the device against human readers is also an implicit acceptance criterion.
| Metric | Condition | Pre-specified Performance Goal (Implied Minimum) | Reported Device Performance | 95% Confidence Interval |
|---|---|---|---|---|
| ICH Detection | Sensitivity (Se) | > 89.3% | 94.7% | 89.3% - 97.8% |
| Specificity (Sp) | > 97.5% | 99.5% | 97.5% - 99.9% | |
| LVO Detection | Sensitivity (Se) | > 67.3% | 76.4% | 67.3% - 83.9% |
| Specificity (Sp) | > 86.6% | 91.1% | 86.6% - 94.5% | |
| LVO Reader Study (Versus Experts) | Sensitivity (Se) - Superiority | N/A (Device Se > Expert Se) | Device: 73.6% | 59.7% - 84.7% |
| Experts: 50.0% | 40.1% - 59.9% | |||
| LVO Reader Study (Versus Non-Experts) | Sensitivity (Se) - Superiority | N/A (Device Se > Non-Expert Se) | Device: 73.6% | 59.7% - 84.7% |
| Non-Experts: 37.7% | 28.5% - 47.7% | |||
| Time to Notification | NCCT-ICH | N/A | 1.43 minutes | 1.36 - 1.50 minutes |
| NCCT-LVO | N/A | 1.42 minutes | 1.36 - 1.48 minutes |
Study Information
-
Sample sizes used for the test set and the data provenance:
- ICH Test Set: 358 cases (132 ICH Positive, 226 ICH Negative)
- LVO Test Set: 335 cases (110 LVO Positive, 225 LVO Negative)
- Data Provenance: Retrospective, blinded, multicenter, multinational study.
-
Number of experts used to establish the ground truth for the test set and the qualifications of those experts:
- The document implies that ground truth for the initial performance evaluation (Se and Sp for ICH and LVO) was established through "expert reader truthing of the data." The number and qualifications of these specific experts for ground truth establishment are not explicitly stated beyond "expert reader."
- For the reader study, there were 4 readers involved: 2 "expert neuroradiologists" and 2 "general radiologists (non-experts)." Their specific years of experience or other detailed qualifications are not provided beyond these labels.
-
Adjudication method for the test set:
- The document mentions "expert reader truthing of the data" for establishing ground truth but does not specify a detailed adjudication method (e.g., 2+1, 3+1). For the reader study, the individual performance of the readers is provided, implying that their interpretations were compared against the established ground truth, but not that they formally adjudicated for the ground truth itself within the study.
-
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:
- A MRMC comparative study was done comparing the device's performance to human readers (radiologists) without AI assistance.
- Effect Size of AI vs. Human Readers (Standalone AI vs. Human Alone):
- LVO Sensitivity:
- Methinks NCCT-LVO: 73.6%
- Expert Neuroradiologists (R1 + R2): 50.0%
- General Radiologists (R3 + R4): 37.7%
- Difference in Sensitivity (Effect Size):
- Methinks NCCT-LVO vs. Experts: 23.6% (95%CI: 8.5% - 38.7%), showing superiority of the device.
- Methinks NCCT-LVO vs. Non-experts: 35.9% (95%CI: 16.0% - 42.9%), also showing superiority of the device.
- LVO Sensitivity:
- The study does not report how much human readers improve with AI assistance (i.e., human-in-the-loop performance). It focuses on the standalone performance of the AI compared to human readers working without AI.
-
If a standalone (i.e. algorithm only without human-in-the-loop performance) was done:
- Yes, a standalone performance evaluation of the Methinks NCCT Stroke algorithm was done for both ICH and LVO detection. The reported sensitivity and specificity metrics (e.g., ICH Se: 94.7%, Sp: 99.5%; LVO Se: 76.4%, Sp: 91.1%) are for the algorithm only.
-
The type of ground truth used:
- The ground truth for the test set was established by "expert reader truthing of the data." This implies a consensus of medical experts, likely radiologists or neuroradiologists, reviewing the images. It is not explicitly stated if pathology, surgical findings, or long-term clinical outcomes were used to confirm the ground truth.
-
The sample size for the training set:
- The document does not specify the sample size for the training set. It only mentions the test set sizes.
-
How the ground truth for the training set was established:
- The document does not specify how the ground truth for the training set was established. It only mentions the "expert reader truthing of the data" in the context of the performance validation (test set).
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(24 days)
of Columbia 20004
Re: K251406
Trade/Device Name: BriefCase-Triage
Regulation Number: 21 CFR 892.2080
Classification Name:** Radiological computer-assisted triage and notification software device (21 CFR 892.2080
BriefCase-Triage is a radiological computer aided triage and notification software indicated for use in the analysis of CT chest, abdomen, or chest/abdomen exams with contrast (CTA and CT with contrast) in adults or transitional adolescents aged 18 and older. The device is intended to assist hospital networks and appropriately trained medical specialists in workflow triage by flagging and communication of suspected positive findings of Aortic Dissection (AD) pathology.
BriefCase-Triage uses an artificial intelligence algorithm to analyze images and highlight cases with detected findings on a standalone desktop application in parallel to the ongoing standard of care image interpretation. The user is presented with notifications for cases with suspected findings. Notifications include compressed preview images that are meant for informational purposes only and not intended for diagnostic use beyond notification. The device does not alter the original medical image and is not intended to be used as a diagnostic device.
The results of BriefCase-Triage are intended to be used in conjunction with other patient information and based on their professional judgment, to assist with triage/ prioritization.
Briefcase-Triage is a radiological computer-assisted triage and notification software device. The software is based on an algorithm programmed component and is intended to run on a linux-based server in a cloud environment.
The Briefcase-Triage receives filtered DICOM Images, and processes them chronologically by running the algorithms on each series to detect suspected cases. Following the AI processing, the output of the algorithm analysis is transferred to an image review software (desktop application). When a suspected case is detected, the user receives a pop-up notification and is presented with a compressed, low-quality, grayscale image that is captioned "not for diagnostic use, for prioritization only" which is displayed as a preview function. This preview is meant for informational purposes only, does not contain any marking of the findings, and is not intended for primary diagnosis beyond notification.
Presenting the users with worklist prioritization facilitates efficient triage by prompting the user to assess the relevant original images in the PACS. Thus, the suspect case receives attention earlier than would have been the case in the standard of care practice alone.
Here's a detailed breakdown of the acceptance criteria and study findings for BriefCase-Triage, based on the provided FDA 510(k) clearance letter:
1. Table of Acceptance Criteria and Reported Device Performance
| Parameter | Acceptance Criteria | Reported Device Performance |
|---|---|---|
| Primary Endpoints | A lower bound 95% Confidence Interval (CI) of 80% for Sensitivity and Specificity at the default operating point. | Default Operating Point: - Sensitivity: 92.7% (95% CI: 88.2%, 95.8%). The lower bound (88.2%) is > 80%. - Specificity: 92.8% (95% CI: 89.2%, 95.4%). The lower bound (89.2%) is > 80%. Additional Operating Points (AOPs) meeting criteria: - AOP1: Sensitivity 95.6% (95% CI: 91.8%-98.0%), Specificity 88.2% (95% CI: 84.0%-91.6%) - AOP2: Sensitivity 94.1% (95% CI: 90.0%-96.9%), Specificity 89.8% (95% CI: 85.8%-93.0%) - AOP3: Sensitivity 89.3% (95% CI: 84.2%-93.2%), Specificity 94.7% (95% CI: 91.6%-97.0%) - AOP4: Sensitivity 86.3% (95% CI: 80.9%-90.7%), Specificity 97.7% (95% CI: 95.3%-99.1%) |
| Secondary Endpoints (Comparability with Predicate) | Time-to-notification metric for the Briefcase-Triage software should demonstrate comparability with the predicate device. | Briefcase-Triage (Subject Device): Mean time-to-notification = 10.7 seconds (95% CI: 10.5-10.9) Predicate AD: Mean time-to-notification = 38.0 seconds (95% CI: 35.5-40.4) The subject device's time-to-notification is faster than the predicate, demonstrating comparability and improvement in time savings. |
2. Sample Size Used for the Test Set and Data Provenance
- Sample Size: 509 cases.
- Data Provenance:
- Country of origin: 5 US-based clinical sites.
- Retrospective or Prospective: Retrospective.
- Data Sequestration: Cases collected for the pivotal dataset were "all distinct in time or center from the cases used to train the algorithm," and "Test pivotal study data was sequestered from algorithm development activities."
3. Number of Experts Used to Establish the Ground Truth for the Test Set and Their Qualifications
- Number of Experts: Three (3) senior board-certified radiologists.
- Qualifications: "Senior board-certified radiologists." (Specific years of experience are not provided.)
4. Adjudication Method for the Test Set
- The text states "the ground truth, as determined by three senior board-certified radiologists." This implies a consensus-based adjudication, likely 3-0 or 2-1 (majority vote), but the exact method (e.g., 2+1, 3+1) is not explicitly detailed.
5. Multi-Reader Multi-Case (MRMC) Comparative Effectiveness Study
- Was it done? No.
- The study primarily focused on the standalone performance of the AI algorithm compared to ground truth and a secondary comparison of time-to-notification with a predicate device. It did not evaluate human reader performance with and without AI assistance.
6. Standalone Performance Study
- Was it done? Yes.
- The study evaluated the algorithm's performance (sensitivity, specificity, PPV, NPV, PLR, NLR) in identifying AD pathology without human intervention as a primary and secondary endpoint. The device's output is "flagging and communication of suspected positive findings" and "notifications include compressed preview images that are meant for informational purposes only and not intended for diagnostic use beyond notification," confirming a standalone function.
7. Type of Ground Truth Used
- Ground Truth: Expert Consensus, specifically "as determined by three senior board-certified radiologists."
8. Sample Size for the Training Set
- The document states, "The algorithm was trained during software development on images of the pathology." However, it does not specify the sample size for the training set. It only mentions that the pivotal test data was "distinct in time or center" from the training data.
9. How the Ground Truth for the Training Set Was Established
- "As is customary in the field of machine learning, deep learning algorithm development consisted of training on labeled ("tagged") images. In that process, each image in the training dataset was tagged based on the presence of the critical finding."
- While it indicates images were "labeled ("tagged")" based on the "presence of the critical finding," it does not explicitly state who established this ground truth for the training set (e.g., experts, pathology, etc.). It's implied that medical professionals were involved in the labeling process, but no specific number or qualification is provided for the training set.
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(35 days)
Australia
Re: K250831
Trade/Device Name: Annalise Enterprise
Regulation Number: 21 CFR 892.2080
Annalise Enterprise is a device designed to be used in the medical care environment to aid in triage and prioritization of studies with features suggestive of the following findings:
- pleural effusion* [1]
- pneumoperitoneum* [2]
- pneumothorax
- tension pneumothorax
- vertebral compression fracture* [3]
*See additional information below.
The device analyzes studies using an artificial intelligence algorithm to identify findings. It makes study-level output available to an order and imaging management system for worklist prioritization or triage.
The device is not intended to direct attention to specific portions of an image and only provides notification for suspected findings.
Its results are not intended:
- to be used on a standalone basis for clinical decision making
- to rule out specific findings, or otherwise preclude clinical assessment of chest X-ray studies
Intended modality:
Annalise Enterprise identifies suspected findings in digitized (CR) or digital (DX) chest X-ray studies.
Intended user:
The device is intended to be used by trained clinicians who are qualified to interpret chest X-ray studies as part of their scope of practice.
Intended patient population:
The intended population is patients who are 22 years or older.
Additional information:
The following additional information relates to the findings listed above:
[1] Pleural effusion
- specificity may be reduced in the presence of scarring and/or pleural thickening
- standalone performance evaluation was performed on a dataset that included supine and erect positioning
- use of this device with prone positioning may result in differences in performance
[2] Pneumoperitoneum
- standalone performance evaluation was performed on a dataset that included supine and erect positioning where most cases were of unilateral right-sided and bilateral pneumoperitoneum
- use of this device with prone positioning and for unilateral left-sided pneumoperitoneum may result in differences in performance
[3] Vertebral compression fracture
- intended for prioritization or triage of worklists of Bone Health and Fracture Liaison Service program clinicians
- standalone performance evaluation was performed on a dataset that included only erect positioning
- use of this device with supine positioning may result in differences in performance
Annalise Enterprise is a software workflow tool which uses an artificial intelligence (AI) algorithm to identify suspected findings on chest X-ray studies in the medical care environment. The findings identified by the device include pneumothorax, tension pneumothorax, pleural effusion, pneumoperitoneum and vertebral compression fracture.
Radiological findings are identified by the device using an AI algorithm – a convolutional neural network trained using deep-learning techniques. Images used to train the algorithm were sourced from datasets that included a range of equipment manufacturers including. This dataset, which contained over 750,000 chest X-ray imaging studies, was labelled by trained radiologists regarding the presence of the findings of interest.
The performance of the device's AI algorithm was validated in a standalone performance evaluation, in which the case-level output from the device was compared with a reference standard ('ground truth'). This was determined by two ground truthers, with a third truther used in the event of disagreement. All truthers were US board-certified radiologists.
The device interfaces with image and order management systems (such as PACS/RIS) to obtain chest X-ray studies for processing by the AI algorithm. Following processing, if any of the clinical findings of interest are identified in the study, the device provides a notification to the image and order management system for prioritization of that study in the worklist. This enables users to review the studies containing features suggestive of these clinical findings earlier than in the standard clinical workflow. It is important to note that the device will never decrease a study's existing priority in the worklist. This ensures that worklist items will never have their priorities downgraded based on AI results.
The device workflow is performed parallel to and in conjunction with the standard clinical workflow for interpretation of chest X-ray studies. The device is intended to aid in prioritization and triage of radiological medical images only.
The Annalise Enterprise device is designed to aid in the triage and prioritization of chest X-ray studies by identifying features suggestive of several findings. The following outlines the acceptance criteria and the study conducted to prove the device meets these criteria.
1. Table of Acceptance Criteria and Reported Device Performance
The acceptance criteria for each finding are implicitly demonstrated by the reported Area Under the Curve (AUC), Sensitivity, and Specificity values, aiming for high performance in triaging positive cases while minimizing false positives. The reported device performance for each finding at various operating points is:
| Finding | Product Code | AUC (95% CI) | Operating Point (Threshold) | Sensitivity % (Se) (95% CI) | Specificity % (Sp) (95% CI) |
|---|---|---|---|---|---|
| Pneumothorax | QFM | 0.984 (0.976, 0.990) | 0.200 | 97.1 (95.5, 98.6) | 88.2 (85.4, 90.8) |
| 0.250 | 96.2 (94.3, 98.1) | 91.9 (89.5, 94.1) | |||
| 0.300 | 95.0 (92.8, 97.1) | 94.1 (91.9, 95.9) | |||
| 0.350 | 93.1 (90.7, 95.5) | 95.6 (93.7, 97.2) | |||
| 0.400 | 90.7 (88.0, 93.3) | 96.7 (95.0, 98.2) | |||
| Tension Pneumothorax | QFM | 0.989 (0.984, 0.994) | 0.225 | 96.0 (92.0, 99.2) | 94.0 (92.3, 95.6) |
| 0.250 | 95.2 (91.2, 98.4) | 94.6 (93.1, 96.2) | |||
| 0.300 | 93.6 (88.8, 97.6) | 95.6 (94.1, 96.9) | |||
| 0.350 | 89.6 (84.0, 94.4) | 96.6 (95.3, 97.8) | |||
| 0.400 | 87.2 (80.8, 92.8) | 97.5 (96.4, 98.6) | |||
| Pneumoperitoneum | QAS | 0.987 (0.976, 0.994) | 0.250 | 96.2 (92.4, 99.0) | 87.9 (83.2, 92.1) |
| 0.300 | 94.3 (89.5, 98.1) | 90.5 (86.3, 94.2) | |||
| 0.350 | 92.4 (86.7, 97.1) | 93.7 (90.0, 96.8) | |||
| 0.400 | 91.4 (85.7, 96.2) | 95.8 (92.6, 98.4) | |||
| 0.450 | 87.6 (81.0, 93.3) | 98.4 (96.3, 100.0) | |||
| Pleural Effusion | QFM | 0.977 (0.969, 0.984) | 0.380 | 96.7 (95.0, 98.1) | 86.8 (83.6, 89.5) |
| 0.425 | 94.4 (92.3, 96.5) | 89.5 (86.8, 92.1) | |||
| 0.450 | 92.9 (90.7, 95.0) | 91.3 (88.6, 93.7) | |||
| 0.475 | 89.8 (87.1, 92.3) | 93.7 (91.5, 95.9) | |||
| 0.500 | 87.6 (84.6, 90.5) | 95.5 (93.5, 97.0) | |||
| Vertebral Compression Fx | QFM | 0.972 (0.960, 0.982) | 0.460 | 93.4 (90.1, 96.0) | 85.8 (82.1, 89.6) |
| 0.500 | 92.6 (89.3, 95.6) | 90.9 (87.7, 93.7) | |||
| 0.550 | 87.1 (83.1, 90.8) | 94.7 (91.8, 96.9) |
2. Sample Size Used for the Test Set and Data Provenance
- Test Set Sample Size: The standalone performance evaluation was conducted on a total dataset of 3,252 cases.
- Data Provenance: The data was collected retrospectively and anonymized. Cases were collected consecutively from four US hospital network sites. The datasets included a variety of patient demographics (gender, age, ethnicity, race) and technical parameters (imaging equipment make, model), indicating a diverse geographic (US) and technical (various scanner manufacturers: Agfa, Carestream, Fujifilm, GE Healthcare, Kodak, Konica Minolta, McKesson, Philips, Siemens, Varian) origin.
3. Number of Experts Used to Establish the Ground Truth for the Test Set and Their Qualifications
- Number of Experts: At least two ABR-certified radiologists were used for each de-identified case. A third radiologist was used in the event of disagreement.
- Qualifications: All truthers were US board-certified radiologists who interpret chest X-rays as part of their regular clinical practice and were protocol-trained.
4. Adjudication Method for the Test Set
The adjudication method used was 2+1 consensus. Each deidentified case was annotated by at least two ground truthers (radiologists), and consensus was determined by these two. In the event of disagreement between the first two, a third ground truther was used to resolve the discrepancy and establish the final ground truth.
5. Multi-Reader Multi-Case (MRMC) Comparative Effectiveness Study
The provided information does not indicate that a Multi-Reader Multi-Case (MRMC) comparative effectiveness study was done to assess how human readers improve with AI vs. without AI assistance. The study focuses on the standalone performance of the AI algorithm and its impact on triage effectiveness (turn-around time).
6. Standalone Performance (Algorithm Only without Human-in-the-Loop Performance)
Yes, a standalone performance evaluation was done. The key results table and associated metrics (AUC, Sensitivity, Specificity) are specifically for the device's AI algorithm independent of human intervention. The study describes "case-level output from the device was compared with a reference standard ('ground truth')", confirming a standalone evaluation.
7. Type of Ground Truth Used
The ground truth used was expert consensus, established by multiple US board-certified radiologists using a 2+1 adjudication method.
8. Sample Size for the Training Set
The training dataset used to train the Convolutional Neural Network (CNN) algorithm contained over 750,000 chest X-ray imaging studies.
9. How the Ground Truth for the Training Set was Established
The studies in the training dataset were labelled by trained radiologists regarding the presence of the findings of interest. The document does not specify the exact number of radiologists or the specific consensus or adjudication method used for the training set, only that they were "trained radiologists".
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(192 days)
Tennessee 37932
Re: K243145
Trade/Device Name: syngo.CT LVO Detection
Regulation Number: 21 CFR 892.2080
Tennessee 37932
Re: K243145
Trade/Device Name: syngo.CT LVO Detection
Regulation Number: 21 CFR 892.2080
Computer-Assisted Triage and Notification Software
Classification Panel: Radiology
CFR Section: 21 CFR §892.2080
Computer-Assisted Triage and Notification Software
Classification Panel: Radiology
CFR Section: 21 CFR §892.2080
Computer-Assisted Triage and Notification Software
Classification Panel: Radiology
CFR Section: 21 CFR §892.2080
syngo.CT LVO Detection is a radiological post-processing application for the analysis of CT angiography (CTA) head images. syngo.CT LVO Detection supports computer-aided triage, and it addresses vascular abortions in the CTA of the brain, commonly referred to as large vessel occlusion (LVO), in the ICA, M1, and M2 segment. It is intended for all patient populations of age ≥ 22 years, without any of the following contraindications: old infarcts or other diseases impacting the brain vasculature (for example, brain tumors), metal artifacts (for example, coils), surgical signs in the images. The output for triage is intended for informational purposes only. It is not intended for diagnostic use and does not alter the original medical image.
The subject device syngo.CT LVO Detection is an image processing software that utilizes artificial intelligence learning algorithms to support qualified clinicians (Radiologists, Neuroradiologists, Neurologists) in prioritization of CT-angiography images by algorithmically identifying findings suspicious of a large vessel occlusion and providing notification to the user. syngo.CT LVO Detection provides a reproducible detection of large vessel occlusions (LVO) on contrast-enhanced CT examinations of the head for detection of ICA, M1, and M2 vessel occlusions in patients suspected of having stroke related circulation occlusion. syngo.CT LVO Detection analyses CT-angiography (CTA) images of the head. The subject device provides a pipeline for the analysis and identification of potential LVO The output which can be send to an external notification device does not highlight or direct attention of the reading physician to any portion of the image.
Here's a detailed breakdown of the acceptance criteria and the study that proves the device meets them, based on the provided FDA 510(k) clearance letter for syngo.CT LVO Detection:
Acceptance Criteria and Reported Device Performance
| Acceptance Criteria | Reported Device Performance | Comments |
|---|---|---|
| Sensitivity > 80% | 90.6% [86.8% - 93.3%] (95% CI) | Exceeds the predefined acceptance threshold. |
| Specificity > 80% | 88.8% [84.7% – 91.9%] (95% CI) | Exceeds the predefined acceptance threshold. |
| Processing Time | < 110 seconds for all cases; Median of 42 seconds | Meets the implicit criteria for timely triage support. |
Study Details
2. Sample size used for the test set and the data provenance
- Sample Size: 602 retrospective CT data sets from 602 individual patients.
- Data Provenance:
- Country of origin: US (from 4 different clinical sites).
- Retrospective or prospective: Retrospective.
- Demographics (for known cases): Median patient age 66 years (IQR: [54 years, 76 years]), 51.9% female. Ethnicity known for 290 cases (48.2%): 66.2% White, 26.9% Black/African American, 4.1% Hispanic, 2.8% Others. NIHSS score known for 296 cases (49.2%) with median 10 (IQR: [4,19]).
3. Number of experts used to establish the ground truth for the test set and the qualifications of those experts
- Number of experts: Three.
- Qualifications of experts: US-board certified neuroradiologists.
4. Adjudication method for the test set
- Adjudication method: Two experts independently assessed the cases. In case of disagreement, a third expert performed adjudication. (This is a 2+1 adjudication method).
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
- The provided document does not indicate that a multi-reader multi-case (MRMC) comparative effectiveness study was done to assess human reader improvement with AI assistance. The study focuses purely on the standalone performance of the AI algorithm for triage.
6. If a standalone (i.e. algorithm only without human-in-the loop performance) was done
- Yes, a standalone performance study was done. The study evaluated the syngo.CT LVO Detection algorithm's performance (sensitivity and specificity) in identifying LVOs on CT angiography images without human intervention in the initial detection or triage decision.
7. The type of ground truth used
- Type of ground truth: Expert consensus (established by US-board certified neuroradiologists). Specifically, it was based on the independent assessment and subsequent adjudication by these experts.
8. The sample size for the training set
- The document does not explicitly state the sample size used for the training set. It only describes the test set.
9. How the ground truth for the training set was established
- The document does not explicitly state how the ground truth for the training set was established. It only details the ground truth establishment for the test set.
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(100 days)
d'Uzès Paris, 75002 France
Re: K243808
Trade/Device Name: Rayvolve PTX-PE Regulation Number: 21 CFR 892.2080
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| RayvolvePTX-PE | Rayvolve | 21 CFR892.2080
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| RegulationNumber | 21 CFR 892.2080
| 21 CFR 892.2080
Rayvolve PTX-PE is a radiological computer-assisted triage and notification software that analyzes chest x-ray images (Postero-Anterior (PA) or Antero-Posterior (AP)) of patients 18 years of age or older for the presence of pre-specified suspected critical findings (pleural effusion and/or pneumothorax).
Rayvolve PTX-PE uses an artificial intelligence algorithm to analyze the images for features suggestive of critical findings and provides study-level output available in DICOM node servers for worklist prioritization or triage.
As a passive notification for prioritization-only software tool within the standard of care workflow, Rayvolve PTX-PE does not send a proactive alert directly to a trained medical specialist.
Rayvolve PTX-PE is not intended to direct attention to specific portions of an image. Its results are not intended to be used on a stand-alone basis for clinical decision-making.
Rayvolve PTX-PE is a software-only device designed to help healthcare professionals. It's a radiological computer-assisted triage and notification software that analyzes chest x-ray imaqes (Postero-Anterior (PA) or Antero-Posterior (AP)) of patients of 18 years of age or older for the presence of pre-specified suspected critical findings (pleural effusion and/or pneumothorax). It is intended to work in combination with DICOM node servers.
Rayvolve PTX-PE has been developed to use the current edition of the DICOM image standard. DICOM is the international standard for transmitting, storing, retrieving, printing, processing, and displaying medical imaging.
Using the DICOM standard allows Rayvolve PTX-PE to interact with existing DICOM node servers (eg .: PACS), and clinical-grade image viewers. The device is designed to run on a cloud platform and be connected to the radiology center's local network. It can also interact with the DICOM Node server.
When remotely connected to a medical center DICOM Node server, the software utilizes Al-based analysis algorithms to analyze chest X-rays for features suggestive of critical findings and provide study-level outputs to the DICOM node server for worklist prioritization. Following receipt of chest X-rays, the software device automatically analyzes each image to detect features suggestive of pneumothorax and/or pleural effusion.
Rayvolve PTX-PE filters and downloads only X-rays with organs determined from the DICOM Node server.
As a passive notification for prioritization-only software tool within the standard of care workflow, Rayvolve PTX-PE does not send a proactive alert directly to a trained health professional. Rayvolve PTX-PE is not intended to direct attention to a specific portion of an image. Its results are not intended to be used on a stand-alone basis for clinical decision-making.
Rayvolve PTX-PE does not intend to replace medical doctors. The instructions for use are strictly and systematically transmitted to each user and used to train them on Rayvolve's use.
AZmed's Rayvolve PTX-PE is a radiological computer-assisted triage and notification software designed to analyze chest x-ray images for the presence of suspected pleural effusion and/or pneumothorax. The device's performance was evaluated through a standalone study to demonstrate its effectiveness and substantial equivalence to a predicate device (Lunit INSIGHT CXR Triage, K211733).
Here's a breakdown of the acceptance criteria and the study proving the device meets them:
1. Table of Acceptance Criteria and Reported Device Performance
The acceptance criteria for Rayvolve PTX-PE are implicitly derived from demonstrating performance comparable to or better than the predicate device, especially regarding AUC, sensitivity, and specificity for detecting pleural effusion and pneumothorax, as well as notification time. The predicate's performance metrics are used as a benchmark.
| Metric (Disease) | Acceptance Criteria (Implicit, based on Predicate K211733) | Reported Device Performance (Rayvolve PTX-PE) |
|---|---|---|
| Pleural Effusion | ||
| ROC AUC | > 0.95 (Predicate: 0.9686) | 0.9830 (95% CI: [0.9778, 0.9880]) |
| Sensitivity | 89.86% (Predicate) | 0.9134 (95% CI: [0.8874, 0.9339]) |
| Specificity | 93.48% (Predicate) | 0.9448 (95% CI: [0.9239, 0.9339]) |
| Performance Time | 20.76 seconds (Predicate) | 19.56 seconds (95% CI: [19.49 - 19.58]) |
| Pneumothorax | ||
| ROC AUC | > 0.95 (Predicate: 0.9630) | 0.9857 (95% CI: [0.9809, 0.9901]) |
| Sensitivity | 88.92% (Predicate) | 0.9379 (95% CI: [0.9127, 0.9561]) |
| Specificity | 90.51% (Predicate) | 0.9178 (95% CI: [0.8911, 0.9561]) |
| Performance Time | 20.45 seconds (Predicate) | 19.43 seconds (95% CI: [19.42 - 19.45]) |
2. Sample Size Used for the Test Set and Data Provenance
- Sample Size: The test set for the standalone study consisted of 1000 radiographs for the Pneumothorax group and 1000 radiographs for the Pleural Effusion group. For each group, positive and negative images represented approximately 50%.
- Data Provenance: The document does not explicitly state the country of origin of the data or whether it was retrospective or prospective.
3. Number of Experts Used to Establish the Ground Truth for the Test Set and Their Qualifications
The document does not provide details on the number of experts or their specific qualifications (e.g., years of experience as a radiologist) used to establish the ground truth for the test set.
4. Adjudication Method for the Test Set
The document does not describe the adjudication method used for the test set (e.g., 2+1, 3+1, none).
5. If a Multi Reader Multi Case (MRMC) Comparative Effectiveness Study Was Done
No, a Multi Reader Multi Case (MRMC) comparative effectiveness study was not conducted. The performance assessment was a standalone study evaluating the algorithm's performance only. The document explicitly states: "AZmed conducted a standalone performance assessment for Pneumothorax and Pleural Effusion in worklist prioritization and triage." Therefore, there is no effect size of how much human readers improve with AI vs. without AI assistance reported in this document.
6. If a Standalone (i.e., algorithm only without human-in-the-loop performance) Was Done
Yes, a standalone performance assessment (algorithm only without human-in-the-loop) was performed. The results presented in the table above and in the "Bench Testing" section are from this standalone evaluation.
7. The Type of Ground Truth Used
The document does not explicitly state the type of ground truth used (e.g., expert consensus, pathology, outcomes data). However, for a diagnostic AI device, it is standard practice to establish ground truth through a panel of qualified medical experts (e.g., radiologists) providing consensus reads, often with access to additional clinical information or follow-up. Given the nature of the findings (pleural effusion and pneumothorax on X-ray), it is highly likely that expert interpretations served as the ground truth.
8. The Sample Size for the Training Set
The document does not specify the sample size used for the training set of the AI model. The provided information focuses on the performance evaluation using an independent test set.
9. How the Ground Truth for the Training Set Was Established
The document does not detail how the ground truth for the training set was established. This information is typically proprietary to the developer's internal development process and is not always fully disclosed in 510(k) summaries.
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