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electronrt:instructions_for_use:instructions_for_use [2022/04/18 20:55] – [Access Control] dpatenaudeelectronrt:instructions_for_use:instructions_for_use [2025/11/28 16:29] (current) – [Coordinates and Units of Measure] kerhart
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 It is the responsibility that the user performs end-to-end testing prior to the clinical implementation of the decimal eRT app. The user should follow accepted industry guideline (such as AAPM TG244) for the end-to-end testing. This testing should be performed by qualified personnel. It is the responsibility that the user performs end-to-end testing prior to the clinical implementation of the decimal eRT app. The user should follow accepted industry guideline (such as AAPM TG244) for the end-to-end testing. This testing should be performed by qualified personnel.
  
-It is the responsibility of the facility to ensure that all users of the decimal eRT treatment planning system have had training on the product and possess the appropriate clinical education, experience, and (where applicable) licensure to develop clinical treatment plans. This includes, but is not limited to, the application training provided by .decimal staff. +It is the responsibility of the facility to ensure that all users of the decimal eRT treatment planning system have had training on the product and possess the appropriate clinical education, experience, and (where applicable) licensure to develop clinical treatment plans. This includes, but is not limited to, the application training provided by .decimal staff. 
 + 
 +Before commissioning it is required that an initial Acceptance Testing process is completed. This testing will ensure that the decimal eRT application functions properly within the installed clinical environment of the end users. This testing will utilize manufacturer supplied inputs, including beam models, as the goal is only to ensure proper system operation, not assess the accuracy or quality of user commissioning activities. As such, the Acceptance Testing, is a prerequisite to, not a replacement for commissioning and end-to-end testing. Details regarding Acceptance Testing can be found [[electronrt:instructions_for_use:acceptance_testing|here]].
  
 It is recommended that users follow acceptable global standards during the commissioning of the decimal eRT product. During the clinical set up, the following should be tested to ensure clinical safety prior to treatment: It is recommended that users follow acceptable global standards during the commissioning of the decimal eRT product. During the clinical set up, the following should be tested to ensure clinical safety prior to treatment:
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 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>).  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: By default when decimal eRT is installed the cache locations are set to the following:
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 **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. **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 === === 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.+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. Exported information includes the operator name (the user logged into the eRT software) and the date of export.
 === Data Backup Recommendations === === Data Backup Recommendations ===
  
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 === Internet Data Transfer === === Internet Data Transfer ===
  
-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.+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. Order files will contain the name, business email address, and business phone number of the user placing the order, as well as the date the order is placed.
  
 <imgcaption internet_data_transfer|Internet Data Transfer>{{ :electronrt:instructions_for_use:decimal_ert_internet_transmission.png?direct&400 |}}</imgcaption> <imgcaption internet_data_transfer|Internet Data Transfer>{{ :electronrt:instructions_for_use:decimal_ert_internet_transmission.png?direct&400 |}}</imgcaption>
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   * 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)   * 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)
  
 +FIXME Add figure with the Patient Coordinate system here
  
 ==== Data Validation and Limits ==== ==== Data Validation and Limits ====
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 Users authenticate and launch the decimal eRT application using the [[decimalauncher:decimallauncher#authentication | decimal Launcher]].  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 its 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. 
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 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. 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.
  
-== Inactivity Timeout ==+=== 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. 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.
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 === Account Permissions === === Account Permissions ===
  
-Account permissions are able to be set by the Site Administrator within [[https://direct.dotdecimal.com|decimal Direct]]. eRT has two levels of account permissions:+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   - **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   - **Feature Permissions**: A feature by feature granular permission for the user
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 | **Default     ** | A default user with normal treatment planning permissions \\ - Recommended permission level for all dosimetry personnel | | **Default     ** | A default user with normal treatment planning permissions \\ - Recommended permission level for all dosimetry personnel |
 | **Research    ** | Not applicable for decimal eRT | | **Research    ** | Not applicable for decimal eRT |
-| **Physics     ** | Elevated user with physics access \\ - Sandbox configuration/user|+| **Elevated    ** | Elevated user with physics access \\ - Sandbox configuration/user|
  
 == Feature Permissions == == Feature Permissions ==
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 In addition, eRT also provides user based permissions for specific features within the application. In addition, eRT also provides user based permissions for specific features within the application.
  
-^ Permission    ^ Description ^ +^ Permission    ^ Permission Level ^ Description ^ 
-| **IM Device** |  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//  | +| **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** |  Allows the user to approve and lock treatment plans required to order hardware devices for fabrication | +| **Plan Approval** | User Account | Allows the user to approve and lock treatment plans required to order hardware devices for fabrication | 
-| **Facility Configuration** | Allows the user to edit the Organization and Treatment machines, including commissioning data | +| **Facility Configuration** | User Account | Allows the user to edit the Organization and Treatment machines, including commissioning data |
-| **Read Only** | Flags the user for read only use of all features in eRT disallowing the editing of the Organization, Course, and Plans |+
  
  
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 ---- ----
-<WRAP centeralign>.decimal LLC \\ 121 Central Park Place, Sanford, FL 32771 \\ 1-800-255-1613</WRAP>+ 
 +<WRAP centeralign>Copyright © 2020 - 2025 .decimal, LLC. All Rights Reserved. \\  
 +//decimal eRT® is a trademark of .decimal, LLC.// \\ 
 + 
 +121 Central Park Place, Sanford, FL 32771 \\ 1-800-255-1613</WRAP>
electronrt/instructions_for_use/instructions_for_use.1650315338.txt.gz · Last modified: by dpatenaude