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--- electronrt:instructions_for_use:instructions_for_use [2020/09/15 15:28] – [File Security] kerhart
+++ electronrt:instructions_for_use:instructions_for_use [2022/09/27 17:27] (current) – [Account Permissions] dpatenaude
@@ Line 49: / Line 49: @@
 The decimal ElectronRT software communicates with other radiation oncology software generally by sending & receiving files in various DICOM RT formats. Since the accuracy of information computed and displayed by an application such as this is very important to the proper treatment of patients, it is critical that users have the appropriate educational and clinical experience backgrounds to adequately understand and use the product. Additionally, since each radiotherapy treatment machine produces a unique beam of radiation, there is much responsibility on the end users to adequately commission and test this software over the full range of expected treatment conditions before the system is utilized for patient treatment. It is this area that provides opportunity for the most likely misuses of the software, which would be incorrect or inadequate commissioning of the application (note many other cases of potential misuse will be designed out of the system by limiting user interactions, providing warnings, and preventing unsafe or incompatible operations). This main misuse is mitigated by requiring that users perform appropriate quality assurance measurements for each patient plan prior to treatment, which should independently confirm that the treatment plan displayed within the decimal eRT app adequately matches the actual to be delivered plan. Please note that such testing is a safety and regulatory requirement in most territories.
+{{page>electronrt:userguide:userguide#common_planning_tasks}}
 ==== Data Management (Storage and Caching) ====
@@ Line 69: / Line 70: @@
 The decimal eRT app allows for centralized patient data that is shared between multiple clients (<imgref data_overview>). The patient storage folder includes an SQLite database for maintaining data records and modification events. By placing this directory on a network location users can share the database across multiple workstations and users.
-Patient files are stored in a folder structure that represents the organizational hierarchy of the patient data model. All patient identifying information is encrypted, using AES-256, in the database and patient data files to prevent unauthorized access to patient data. Files also include 32bit checksums that are linked to encrypted database entries to ensure they are not substituted or modified in an unauthorized manner. Refer to [[electronrt:instructions_for_use:instructions_for_use#data_integrity|Data Integrity]] for further details on how data is prevented from modification and changes.
+Patient files are stored in a folder structure that represents the organizational hierarchy of the patient data model. All patient identifying information is encrypted, refer to [[electronrt:instructions_for_use:instructions_for_use#file_security|File Security]] for more details, in the database and patient data files to prevent unauthorized access to patient data. Files also include 32bit checksums that are linked to encrypted database entries to ensure they are not substituted or modified in an unauthorized manner. Refer to [[electronrt:instructions_for_use:instructions_for_use#data_integrity|Data Integrity]] for further details on how data is prevented from modification and changes.
 === Network & Local Data Cache ===
-The decimal eRT app uses calculation data caching to improve the user experience by loading results from disk rather than recomputing on demand. This results in speedier load times of patient/plan data, beam dose, and hardware devices without having to utilize the processing power of the computer each time a plan is opened. If a calculation result is not found in the calculation cache, the calculation will be performed and the results stored in the cache. The calculation cache is comprised of a local disk cache and an optional network cache (refer to <imgref data_caching>).
+The decimal eRT app uses calculation data caching to improve the user experience by loading results from disk rather than recomputing on demand. The calculation disk cache files are comprised of proprietary compressed binary files that represent a completed calculation result. Storing and using the cached calculations results in speedier load times of patient/plan data, beam dose, and hardware devices without having to utilize the processing power of the computer each time a plan is opened. If a calculation result is not found in the calculation cache, the calculation will be performed and the results stored in the cache. The calculation cache is comprised of a local disk cache and an optional network cache (refer to <imgref data_caching>).
-Using the local cache allows for the caching of calculation results to the individual user’s workstation and the network cache allows users to share calculation results among all users using the centralized patient database (e.g.: user 1 saves a plan and user 2 opens the plan on a different computer; by saving to the network cache, user 2 automatically loads in user 1’s results without having to recompute them). Reading data from the local cache allows for the fastest data load time for the end user. Refer to <imgref internet_data_transfer> for the cache saving mechanics between the local and network caches.
+Using the local cache allows for the caching of calculation results to the individual user’s workstation and the network cache allows users to share calculation results among all users using the centralized patient database (e.g.: user 1 saves a plan and user 2 opens the plan on a different computer; by saving to the network cache, user 2 automatically loads in user 1’s results without having to recompute them). Reading data from the local cache allows for the fastest data load time for the end user. Refer to <imgref data_caching> for the cache saving mechanics between the local and network caches.
 By default when decimal eRT is installed the cache locations are set to the following:
@@ Line 99: / Line 100: @@
 As with any software application there is always concern with system and data integrity. decimal eRT makes use of caching at various system levels to improve performance and mitigate some of these concerns. Refer to [[electronrt:instructions_for_use:instructions_for_use#data_management_storage_and_caching|Data Management (Storage and Caching)]] for details on decimal eRT data caching. While decimal eRT has been designed with security in mind, users should understand that it is still their responsibility to ensure the system is accessed and controlled properly. Following international standards for IT risk management, such as IEC 80001-1, is therefore highly recommended.
-Since data integrity is a critical feature for application such as this, the decimal eRT app automatically and continuously saves both the state of the application and the working record data on a timer (triggering every minute or less) as well as on exit of any create or edit event in the application. Additionally, each "save" event creates a new entry in the record's history log in the local database, which provides a log file for editing of all records and ensures that patient records are saved securely on an independent medium so they are not lost in the event of a local system failure or crash. FIXME : The above really doesn't ensure data is saved on an independent medium...
+Since data integrity is a critical feature for application such as this, the decimal eRT app automatically and continuously saves both the state of the application and the working record data on a timer (triggering every minute or less) as well as on exit of any create or edit event in the application. Additionally, each "save" event creates a new entry in the record's history log in the local database, which provides a log file for editing of all records and ensures that patient records are saved securely. Note it is highly recommended that the application database is hosted on a separate server containing independent, redundant storage drives so that data is not lost in the event of a local system failure or crash.
 === File Security ===
-decimal eRT data files (including but not limited to: organization, beam model, patients, course data, plans, etc) are encrypted using AES-256 when stored to disk and secured with a checksum stored as an encrypted field in the application database. When files are read from disk, the contents are checked against the corresponding encrypted checksum to ensure the file contents have not been changed, manipulated, or substituted.
+The following table describes the file security methods used for decimal eRT data. The subsequent paragraphs provide supplemental details for each item.
-**Note**: The [[electronrt:instructions_for_use:instructions_for_use#network_local_data_cache|local calculation cache]] may contain unencrypted patient identifying information. The local cache is purged as it fills with data, so exposure to long term data is limited. However, workstation level disk encryption (e.g.: bitlocker) is recommended to protect against unauthorized access to file storage and calculation caches by providing encryption at rest.
+^  Item              ^  Storage Type                      ^   Encryption Type   ^
+| Patient Database   | SQLite Database                    | AES-256             |
+| :::                | Fields Containing PHI/PII          | AES-256             |
+| Patient/Data Files | Local/Network File System          | AES-256             |
+All PHI/PII data (including data files and database fields) is encrypted using AES-256 with an encryption key that is unique for each organization/patient storage location.
+  * **decimal eRT data files:** (includes but is not limited to: organization, beam model, patients, course data, plans, etc) Files are encrypted using AES-256 when stored to disk and secured with a checksum stored as an encrypted field in the application database. When files are read from disk, the contents are checked against the corresponding encrypted checksum to ensure the file contents have not been changed, manipulated, or substituted.
+  * **decimal eRT patient database:** Database is encrypted using AES-256. Additionally, the patient identifying fields within the database are further encrypted using separate AES-256 encryption, adding an additional level of security for patient data within the application database.
+**Note**: The [[electronrt:instructions_for_use:instructions_for_use#network_local_data_cache|local calculation cache]] files are a non-human readable, proprietary compressed binary format. These files may contain unencrypted patient identifying information. The local cache is purged as the cache fills with data, so exposure to long term data is limited. Workstation level disk encryption (e.g.: bitlocker) is recommended to protect against unauthorized access to calculation caches by providing encryption at rest.
 === Data Import/Export ===
 Patient data is imported and exported using the DICOM NEMA 2020 standard to ensure the data is transferred error free and securely. Refer to the decimal eRT {{:electronrt:usr-013_dicom_conformance_statement.pdf|Dicom Conformance Statement}} for the supported DICOM tags.
 === Data Backup Recommendations ===
-Since the ElectronRT app stores data on local file storage on each customer's servers we recommend frequent periodic backups of the file-system in which the patient database and file store are kept.
+Since the decimal eRT app stores data on local file storage on each customer's servers we recommend frequent periodic backups of the file-system in which the patient database and file store are kept.
-There are 4 major components for the ElectronRT app that should be considered for data backup following the [[electronrt:instructions_for_use:instructions_for_use#data_duplication_or_backup|Data Duplication or Backup Process]]. Refer to [[electronrt:instructions_for_use:instructions_for_use#data_management_storage_and_caching|Data Management (Storage and Caching)]] for a full detailed explanation of each item.
+There are 4 major components for the decimal eRT app that should be considered for data backup using the following [[electronrt:instructions_for_use:instructions_for_use#data_duplication_or_backup|Data Duplication or Backup Process]]. Refer to [[electronrt:instructions_for_use:instructions_for_use#data_management_storage_and_caching|Data Management (Storage and Caching)]] for a full detailed explanation of each item.
 ^ Data                          ^  Severity of Data Loss  ^  Recommended Frequency  ^
@@ Line 120: / Line 130: @@
 | 4. Local (client) Data Cache  |  Low                   |  N/A  |
-.decimal recommends Patient Database [1] and Patient File Storage [2] backups as frequent as possible, at least nightly, to ensure there is no substantial dataloss or interruption of software use. If the [4] Local Data Cache is lost on each workstation the [3] Network Data Cache will be fallen back to by the ElectronRT app. So backup of this data is not necessary. Refer to [[electronrt:instructions_for_use:instructions_for_use#network_local_data_cache|Network & Local Caching]] for a overview of the caching mechanic.
+.decimal recommends Patient Database [1] and Patient File Storage [2] backups as frequent as possible, at least nightly, to ensure there is no substantial dataloss or interruption of software use. If the [4] Local Data Cache is lost on each workstation the [3] Network Data Cache will be fallen back to by the decimal eRT app. So backup of this data is not necessary. Refer to [[electronrt:instructions_for_use:instructions_for_use#network_local_data_cache|Network & Local Caching]] for a overview of the caching mechanic.
-It's also recommended that prior to testing/deploying a new release version to a site a full [[electronrt:instructions_for_use:instructions_for_use#data_duplication_or_backup||data backup]] is performed. While this step should be unnecessary, it's recommended to all sites as a precaution in case there are problems from the version upgrade.
+It's also recommended that prior to deploying a new release version, a full [[electronrt:instructions_for_use:instructions_for_use#data_duplication_or_backup|data backup]] is performed. While this step should be unnecessary, it's recommended as a precaution in case there are problems with the version upgrade.
 === Internet Data Transfer ===
-Since the primary purpose of using the decimal eRT app is to design and order devices for patients, there is a necessity to transmit device manufacturing parameters and information to .decimal servers so that we can fabricate the custom devices. In order to protect patient privacy, our proprietary order file format contains only the minimal data necessary to manufacture the requested device. .decimal values   the   privacy   of   patients   and   security   of   your   sensitive information and we believe the best safeguard to protect critical data is to ensure it doesn’t leave your facility. As such, no PHI, PII, or any sensitive customer billing/payment information is contained in the order files sent to .decimal.
+Since electron therapy generally requires frequent use of patient-specific devices that are often not fabricated in-house, there is a necessity to transmit device manufacturing parameters and information to .decimal servers to all for fabrication of the custom devices. In order to protect patient privacy, .decimal's proprietary order file format contains only the minimal data necessary to manufacture each requested device. .decimal values the privacy of patients and security of our customer's sensitive information and we believe the best safeguard to protect critical data is to ensure it doesn’t leave your facility. As such, no PHI, PII, or any sensitive customer billing/payment information is contained in the order files sent to .decimal.
 <imgcaption internet_data_transfer|Internet Data Transfer>{{ :electronrt:instructions_for_use:decimal_ert_internet_transmission.png?direct&400 |}}</imgcaption>
-Data is transferred to and from the decimal Direct services using secure HTTPS transfer protocols, that guarantee error-free of transfer using common industry standard techniques. All data passed to and from .decimal's ordering servers is encrypted during transit and does not contain patient identifying data.
+Data is transferred to and from the decimal Direct servers using secure HTTPS transfer protocols that guarantee error-free transfer using common industry standard techniques. All data passed to and from .decimal's ordering servers is encrypted during transit and does not contain patient identifying data.
+=== Simultaneous Plan Access ===
+Treatment plans are protected against simultaneous record access and data loss by ensuring an attempted update to plan data is not based on an outdated base file. If the local plan record has been accessed simultaneously by another user and has been modified (committed to the database) by another user, the outdated local plan record will be unable to commit the change until the plan has been updated locally.
 ==== Coordinates and Units of Measure ====
 The following is a list of several important items that users should understand in regards to the information displays in the decimal eRT application:
-  * decimal eRT exclusively uses DICOM coordinate systems for display information (machine based coordinates are NOT available)
+  * decimal eRT exclusively uses the DICOM patient coordinate system for position display information (equipment based coordinates are NOT available)
+  * Local equipment coordinates are available for machine rotational axes (i.e. gantry, couch, and collimator) and users should configure each treatment room to match their actual equipment using decimal eRT site level settings at the time of commissioning
   * All linear dimensions are shown in centimeters (cm)
   * All angular dimensions are shown in degrees (deg)
   * All radiation dose quantities will be shown with their corresponding units within the application (e.g. Gy or %)
-  * All date/time values are provided in a // dd/mm/yyyy h:m:s // format using local time on a 24 hour clock
+  * All date/time values are provided in a // yyyy-mm-dd h:m:s // format using local time on a 24 hour clock
   * All date and time notifications in decimal eRT should match current Windows OS date and time, including proper use of daylight savings time where appropriate (note: decimal eRT will display in 24 hour format, while Windows may display in am/pm depending on local settings)
@@ Line 144: / Line 160: @@
 ==== Data Validation and Limits ====
-Users are responsible for inputting a lot of data into the decimal eRT to develop clinical treatment plans. In the course of entering such data, there are opportunities for users to enter incorrect information. Although users are responsible for checking for such errors before clinical treatment, decimal eRT does provide some assistance in ensuring data limitations are met by a plan. Machine energy limits, beam treatment angle collision detection, SSD limits, as well as electron block sizes and availability are all explicitly limited to user configured levels within the decimal eRT controls. Additionally, certain incompatible settings, negative prescriptions, are also explicitly prevented within the decimal eRT user interface.
+Users are responsible for inputting a lot of data into decimal eRT to develop clinical treatment plans. In the course of entering such data, there are opportunities for users to enter incorrect information. Although users are responsible for checking for such errors before clinical treatment, decimal eRT does provide some assistance in ensuring data limitations are met by a plan. Machine energy, beam treatment angle limits, applicator collision detection, SSD limits, as well as electron block sizes and availability are all explicitly limited to user configured ranges within the decimal eRT controls. Additionally, certain incompatible settings, e.g. negative prescription doses, are also explicitly prevented within the decimal eRT user interface.
-Despite these many data validation checks, some entries, are not validated within the decimal eRT user interface and users should include appropriate checks and warnings in their custom treatment plan reports to ensure such concerns are brought to the attention of all responsible parties before patient treatment begins.
+Despite these many data validation checks, some entries are not able to be validated within the decimal eRT user interface and users should include appropriate checks and warnings in their custom treatment plan reports to ensure such concerns are brought to the attention of all responsible parties before patient treatment begins. Additionally, some checks are implemented as warnings and can be overridden by users. In such cases, treatment plan reports will include a statement such as this (or similar): "CAUTION: SOME DATA ELEMENTS USED WERE OUTSIDE NORMAL RANGE".
-Such warnings should include a statement such as this (or similar): "CAUTION: SOME DATA ELEMENTS USED WERE OUTSIDE NORMAL RANGE".
 === Max number of Supported beams ===
@@ Line 156: / Line 170: @@
 === Commissioning Data Field Sizes ===
-The decimal eRT app UI will provide a warning to the user if a beam's field size is larger or smaller than the allowable field sizes listed in the commissioning data for the selected beam energy. The warning will appear in the Beams Block next to each beam and as a warning on the Treatment Plan PDF report.
+The decimal eRT app UI and plan reports will provide a warning to the user if a beam's field size is larger or smaller than the allowable field sizes listed in the commissioning data for the selected beam energy. The warning will appear in the Beams Block next to each beam and as a warning on the Treatment Plan PDF report.
 ==== Data Displays and Interpretation ====
-<WRAP center round todo 60%>
-KEVIN FIXME
+The decimal eRT app is a complex treatment planning system and as such it contains many different displays throughout the plan creation process. The provided [[http://apps.dotdecimal.com/doku.php?id=electronrt:userguide:tutorials:all_tutorials|User Guide Tutorials]] provide detailed descriptions of each task and display present in the system.
-Do this section
-</WRAP>
-Astroid contains many displays throughout the plan creation process. Please refer to [[http://apps.dotdecimal.com/doku.php?id=planning:userguide:tutorials:all_tutorials#astroid_optimization|the Astroid Tutorials]].
 ==== Unauthorized Use ====
-The decimal eRT application will contain sensitive patient information that is protected under various governmental regulations, therefore users must ensure they adequately follow all appropriate and applicable rules regarding how, where, and when their staff may access the application and its data. In order to facilitate proper usage and protections, decimal eRT has a [[electronrt:instructions_for_use:instructions_for_use#user_authentication_management|robust user authentication]] and permissioning system. Since all application and data access requires user login credentials, it is important that strong a strong password policy is used and that all users understand the importance of maintaining secrecy of their password (i.e. passwords should never be shared among more than one user). It is these user credentials that protect the system and its data from unauthorized access and replication.
+The decimal eRT application will contain sensitive patient information that is protected under various governmental regulations, therefore users must ensure they adequately follow all appropriate and applicable rules regarding how, where, and when their staff may access the application and its data. In order to facilitate proper usage and protections, decimal eRT has a [[electronrt:instructions_for_use:instructions_for_use#user_authentication_management|robust user authentication]] and permissioning system. Since all application and data access requires user login credentials, it is important that a strong password policy is used and that all users understand the importance of maintaining secrecy of their password (i.e. passwords should never be shared among more than one user). It is these user credentials that protect the system and its data from unauthorized access and replication.
-Currently the password policy requires passwords to have:
+Currently the .decimal authentication systems requires passwords to have:
-  * At least 1 special character
+  * At least 1 special character (!@#$%^&*)
   * Lower case (a-z), upper case (A-Z) and numbers (0-9)
-  * Must have 10 characters in length
+  * Must be at least 10 characters in length
 ==== Access Control ====
-decimal eRT uses [[https://auth0.com/security|Auth0]] as an Identity as a Service provider for user account management. All user accounts and credentials are managed by the Auth0 service including user creation, password policies, password resets, and secure authentication.
+decimal eRT uses [[https://auth0.com/security|Auth0]] as an Identity-as-a-Service provider for user account management. All user accounts and credentials are managed by the Auth0 service including user creation, password policies, password resets, and secure authentication.
-Idle workstation locking is recommended for all workstations with access to decimal eRT. While there are inactivity and session timeouts built into the application, workstation idle locking will mitigate unauthorized access in-between session timeouts.
+As decimal eRT is deployed on customer workstations the site administrator will be responsible for the installation of the software on the appropriate workstations and the account management of all users at the facility. Each employee should have an individual login and password to access the decimal eRT application that prevents unauthorized access, and account sharing should be strictly prohibited.
 === User Authentication ===
 Users authenticate and launch the decimal eRT application using the [[decimalauncher:decimallauncher#authentication | decimal Launcher]].
-== User Sessions ==
+=== User Sessions ===
-When decimal eRT is launched from the decimal Launcher, decimal eRT is given an JWT authentication token for the logged in user. This token is used to authenticate and perform [[https://direct.dotdecimal.com|decimal Direct API]] requests. This JWT token is issued by decimal Direct and Auth0 and has a built in expiration. When this token expires the user will be logged out of the application and be forced to re-authenticate and relaunch the application using the decimal Launcher. Refer to [[decimalauncher:decimallauncher#inactivity_and_session_timeout|decimal Launcher's User Guide]] for details on this authentication token and it's expiration.
+When decimal eRT is launched from the decimal Launcher, decimal eRT is given an JWT authentication token for the logged in user. This token is used to authenticate and perform [[https://direct.dotdecimal.com|decimal Direct API]] requests. This JWT token is issued by decimal Direct and Auth0 and has a built in expiration. When this token expires the user will be logged out of the application and be forced to re-authenticate and relaunch the application using the decimal Launcher. Refer to [[decimalauncher:decimallauncher#inactivity_and_session_timeout|decimal Launcher's User Guide]] for details on this authentication token and its expiration.
-== Inactivity Timeout ==
+Auth0 user credentials are authenticated and validated using the decimal Direct API by decimal eRT each time a user logs in and on recurring timer events. If user credentials are invalid or expired, users will automatically be logged out of the application and prevented from using or accessing any data within the application/system.
-decimal eRT has a built in inactivity timeout that will automatically log the user out if no mouse/keyboard activity has occurred. The timeout setting can be changed in the [[electronrt:userguide:tutorials:app_settings#app_settings|decimal eRT application settings]].
+=== Inactivity Timeout ===
+decimal eRT has a built in inactivity timeout that will automatically log the user out if no mouse/keyboard activity has occurred. The timeout setting can be changed in the [[electronrt:userguide:tutorials:app_settings#app_settings|decimal eRT application settings]]. Idle workstation locking at the OS level is also recommended for all workstations with access to decimal eRT. While there are inactivity and session timeouts built into the application, workstation idle locking will further protect the system from unauthorized access in-between session timeouts.
 === Account Management ===
-decimal eRT uses [[https://auth0.com/security|Auth0]] as an Identity as a Service provider for user account management. All user accounts and credentials are managed by the Auth0 service including user creation, password policies, password resets, and secure authentication.
+decimal eRT site managers have the ability to [[https://direct.dotdecimal.com/guide#site-management|add and remove users]] to their site. When adding a new user an Auth0 account will be created for the new user and automatically linked to the site. The user will then be notified to set their password following the Auth0 password reset process. Removing a user from a site does not delete the user's Auth0/.decimal account, but removes the account from the site, effectively removing all access to the site's apps, data, and device order history. Refer to the [[https://direct.dotdecimal.com/guide#site-management|decimal Direct User Guide]] for more information.
-Auth0 user credentials are authenticated and validated using the decimal Direct API by decimal eRT each time a user logs in and on recurring timer events. If user credentials are invalid or expired users will automatically be logged out of the application and prevented from using or accessing any data within the application/system.
+=== Account Permissions ===
-decimal eRT site managers have the ability to [[https://direct.dotdecimal.com/guide#site-management|add and remove users]] to their site. When adding a new user an Auth0 account will be created for the new user and automatically linked to the site. The user will then be notified to set their password following Auth0 password reset process. Removing a user from a site does not delete the user Auth0/.decimal account, but removes account from the site effectively removing all access to the site's apps, data, and device order history. Refer to the [[https://direct.dotdecimal.com/guide|decimal Direct User Guide]] for more information.
+Account permissions are able to be set by the Site Administrator within [[direct:userguide#app_specific_permissions|decimal Direct's App Permissions page]]. eRT has two levels of account permissions:
+  - **User Levels**: A high level generic group for the user that provides general access levels
+  - **Feature Permissions**: A feature by feature granular permission for the user
-=== Account Permissions ===
+== User Levels ==
-decimal eRT limits the features available to users based on their .decimal account permission level:
+decimal eRT limits the features available to users based on their .decimal account user permission level. The following user permission levels are available:
 ^ Permission Level ^ Available Permissions ^
 | **Default     ** | A default user with normal treatment planning permissions \\ - Recommended permission level for all dosimetry personnel |
 | **Research    ** | Not applicable for decimal eRT |
-| **Physics     ** | Elevated user with physics access \\ - Organization Configuration \\ - Machine Commissioning \\ - Plan Approval \\ - Sandbox configuration/user|
+| **Elevated    ** | Elevated user with physics access \\ - Sandbox configuration/user|
+== Feature Permissions ==
+In addition, eRT also provides user based permissions for specific features within the application.
+^ Permission    ^ Permission Level ^ Description ^
+| **IM Device** | Site Wide        | Allows the user to use the Electron Intensity Modulator devices when making a beam. \\ //This permission is granted by .decimal staff on the purchase of the Electron Intensity Modulator module//  |
+| **Plan Approval** | User Account | Allows the user to approve and lock treatment plans required to order hardware devices for fabrication |
+| **Facility Configuration** | User Account | Allows the user to edit the Organization and Treatment machines, including commissioning data |
-As decimal eRT is deployed on customer work stations the site administrator will be responsible for the installation of the software on the appropriate workstations and the account management of all users at the facility. Each employee should have an individual login and password to access the decimal eRT application that prevents authorized access, and account sharing is strictly prohibited.
 ==== Known Limitations ====
@@ Line 220: / Line 244: @@
   - Ensures that the local app client stays in sync with the latest release version (as set via decimal Direct)
   - Provides user authentication and password management
-  - Provides binary file security to ensure that the application files are not tampered with on .decimal's server or on client work stations (via hashes and checksums). Refer to [[decimalauncher:decimallauncher#application_security|decimal Launcher's Application Security]] page for further details.
+  - Provides binary file security to ensure that the application files are not tampered with on .decimal's server or on client workstations (via hashes and checksums). Refer to [[decimalauncher:decimallauncher#application_security|decimal Launcher's Application Security]] page for further details.
 When an application update is available via the decimal Launcher, the users will be required to install the app in the Launcher. This is accomplished by selecting the //Download// button for the specific app. Within a few minutes, the app should be downloaded and installed locally for the current user account. The user will then be able to launch the released app version from the Launcher.
@@ Line 227: / Line 251: @@
 === Releasing a new App Version ===
-When a new application version of decimal eRT is released users will be notified in the [[decimalauncher:decimallauncher#updating_applications|decimal Launcher]]. This notification serves only to notify users of a newer version of the application and does not result in a newer version being installed for use.
+When a new application version of decimal eRT is released, users will be notified in the [[decimalauncher:decimallauncher#updating_applications|decimal Launcher]]. This notification serves only to notify users of a newer version of the application and does not result in a newer version being installed for use.
 New release versions of the decimal eRT application should be tested prior to clinical deployment following the [[electronrt:instructions_for_use:instructions_for_use#testing_new_releases|Testing New Releases]] guide.
-Once an app version has been reviewed and approved for release at a site, the application will be deployed to the decimal Launcher clinical environment using the [[decimalauncher:decimallauncher#updating_applications|Updating Applications]] guide. This will immediately push the app update to all decimal eRT users (via the decimal Launcher) and all users will be required to update to the released version to continue using the software.
+Once an app version has been reviewed and approved for release at a site, the application will be deployed to the decimal Launcher clinical environment following the [[decimalauncher:decimallauncher#updating_applications|Updating Applications]] guide. This will immediately push the app update to all decimal eRT users (via the decimal Launcher) and all users will be required to update to the released version to continue using the software.
 === Release Notes ===
@@ Line 243: / Line 267: @@
   * Test the final dose calculations of matching patients between the two app versions to ensure the final doses exactly match (unless the app release notes has been otherwise indicated that the dose calculations have changed).
-Prior to releasing a new app version into a site, it is imperative to ensure that the data is compatible between the existing version installed in the clinical environment and the new version that is intended to be installed is tested according to the [[electronrt:instructions_for_use:instructions_for_use#clinical_safety|Clinical Safety]] guide for your site.
+Prior to releasing a new app version into a site, it is imperative to ensure that the data is compatible between the existing version installed in the clinical environment and the new version that is intended to be installed. This should be tested according to the [[electronrt:instructions_for_use:instructions_for_use#clinical_safety|Clinical Safety Guide]] for your site.
 === Testing New Releases ===
@@ Line 250: / Line 274: @@
 The following procedure shall be followed in order to safely release new versions of an application:
-  - Perform [[electronrt:instructions_for_use:instructions_for_use#data_duplication_or_backup|Data Backup]] of all clinical patient data
+  - Perform [[electronrt:instructions_for_use:instructions_for_use#data_duplication_or_backup|Data Backup]] of all clinical patient data.
-    - While this step should be unnecessary, it's recommended to all sites as a precaution in case there are problems from the version upgrade
+    - While this step should be unnecessary, it is recommended as a precaution in case problems arise during the version upgrade.
-  - Review the release notes for the new version and ensure you understand the changes and acknowledge any risks of deployment of the new version to your site
+  - Review the release notes for the new version and ensure you understand the changes and acknowledge any risks of deployment of the new version to your site.
-  - Install the release candidate version of the application to the [[decimalauncher:decimallauncher#sandbox_mode|decimal Launcher Sandbox environment]] and use the decimal eRT [[electronrt:userguide:tutorials:all_tutorials#sandbox_testing|Sandbox Testing]] process to open clinical data in the isolated sandbox mode
+  - Install the release candidate version of the application to the [[decimalauncher:decimallauncher#sandbox_mode|decimal Launcher Sandbox environment]] and use the decimal eRT [[electronrt:userguide:tutorials:all_tutorials#sandbox_testing|Sandbox Testing]] process to open clinical data in the isolated sandbox mode.
   - Open existing patients in the Sandbox environment. You should ensure each of the following for the existing patients and plans in the sandbox testing:
     - The patients and plans all open without errors.
     - The final dose result is the same as the previous version. Note: for unapproved plans the dose results may recompute. For approved plans the dose and device results should be exactly the same.
-    - Perform any testing deemed appropriate in regards to the changes outlined in the release notes and required by regulatory guidelines for treatment planning system upgrades.
+    - **Perform any testing deemed appropriate in regards to the changes outlined in the release notes and required by regulatory guidelines for treatment planning system upgrades**.
-  - Once the release candidate has been thoroughly tested and is ready for release, notify all users at your site of the pending release and set an appropriate date and time for the release (it is generally good practice to stop all active clinical use during the upgrade so choose a time outside of normal clinical operating hours). At the designated date/time  [[electronrt:instructions_for_use:instructions_for_use#data_duplication_or_backup|back up the clinical data]]  (data may have changed since the previous copy was made, so do not skip this step). **Keeping the latest backup of data is important as it provides the ability to roll back to a working clinical state should the release process fail.**
+  - Once the release candidate has been thoroughly tested and is ready for release, notify all users at your site of the pending release and set an appropriate date and time for the release (it is generally good practice to stop all active clinical use during the upgrade, so it is best to choose a time outside of normal clinical operating hours). At the designated date/time  [[electronrt:instructions_for_use:instructions_for_use#data_duplication_or_backup|back up the clinical data]]  (data may have changed since the previous copy was made, so do not skip this step). **Keeping the latest backup of data is important as it provides the ability to roll back to a working clinical state should the release process fail.**
-  - Using the decimal Launcher [[decimalauncher:decimallauncher#updating_applications|Updating Applications]] guide release the new version of decimal eRT to your site for the Clinical environment
+  - Using the decimal Launcher [[decimalauncher:decimallauncher#updating_applications|Updating Applications]] guide, release the new version of decimal eRT to your site for the Clinical environment.
 ==== Data Duplication or Backup ====
@@ Line 268: / Line 292: @@
 === Copying Data ===
-The current data storage locations are set in the decimal eRT [[electronrt:userguide:tutorials:all_tutorials#decimal_ert_settings|application settings]] page. By copying the folders linked from these settings the application data is fully captured and backed up.
+The current data storage locations are set in the decimal eRT [[electronrt:userguide:tutorials:all_tutorials#decimal_ert_settings|application settings]] page. By copying the folders linked from these settings, the application data is fully captured and backed up.
 === Linking to New Data Storage ===
-To restore or link to a different data store open the decimal eRT [[electronrt:userguide:tutorials:all_tutorials#decimal_ert_settings|application settings]] page and update each setting to the new file storage location.
+To restore or link to a different data store, open the decimal eRT [[electronrt:userguide:tutorials:all_tutorials#decimal_ert_settings|application settings]] page and update each setting to the new file storage location.
 ===== decimal eRT Patient Data Model =====
@@ Line 286: / Line 310: @@
     - Contains the physician's orders for treating this Course and contains information about the prescription and other clinical goals for the Course.
   - **Plan(s)**
-    - A detailed model of a electron therapy treatment. Most aspects of the patient planning information are stored here (e.g. Beams, Devices, Dose). A Plan will implement all of the Course prescription and physicians will approve a Plan to indicate it is ready to proceed to QA and (if successful) on to actual patient treatment.
+    - A detailed model of an electron therapy treatment. Most aspects of the patient planning information are stored here (e.g. Beams, Devices, Dose). A Plan will implement all of the Course prescription and physicians will approve a Plan to indicate it is ready to proceed to QA and (if successful) on to actual patient treatment.
-    - A Plan also contains a QA record (once the plan is approved) that allows plan dose QA and device QA.
+    - A Plan also contains a QA record (once the plan is approved) that facilitates completion of plan dose QA and device QA.
 ==== Hierarchy ====
@@ Line 312: / Line 336: @@
 ===== System Requirements =====
-Details regarding the specific requirements for computers on which the decimal Launcher and decimal eRT client applications will be installed can be found on the [[decimalauncher:decimallauncher#system_requirements|decimal Launcher System Requirements]] and [[electronrt:userguide:systemrequirements|decimal eRT System Requirements]] page.
+Details regarding the specific requirements for computers on which the decimal Launcher and decimal eRT client applications will be installed can be found on the [[decimalauncher:decimallauncher#system_requirements|decimal Launcher System Requirements]] and [[electronrt:userguide:systemrequirements|decimal eRT System Requirements]] pages.
+----
+<WRAP centeralign>Copyright © 2020 - 2022 .decimal, LLC. All Rights Reserved. \\
+//decimal eRT® is a trademark of .decimal, LLC.// \\
+Central Park Place, Sanford, FL 32771 \\ 1-800-255-1613</WRAP>