Hello,
On Windows IoT Enterprise LTSC, the supported way to completely replace the standard Windows shell (explorer.exe) with your proprietary medical UI is to configure Shell Launcher v2. This feature allows you to define a custom shell executable that runs in place of Explorer, so operators never see the desktop, taskbar, or background.
The configuration is done through PowerShell or MDM policy. Using PowerShell, you would run commands from the ShellLauncher module. For example, you can set your medical UI binary as the default shell for all users with:
powershell
Set-ShellLauncherDefaultShell -Shell "C:\Program Files\YourApp\MedicalUI.exe"
If you need different shells for different user accounts, you can use Set-ShellLauncherShell with the appropriate SID. The configuration is stored under the registry hive HKLM\SOFTWARE\Microsoft\Windows\CurrentVersion\ShellLauncher, and Shell Launcher v2 ensures that explorer.exe is not invoked at all.
It’s important to note that Shell Launcher v2 is only available on Windows 10/11 Enterprise and IoT Enterprise editions. Once configured, the system boots directly into your medical UI binary. Operators will not have access to the desktop environment unless you explicitly configure an alternate shell for administrators. For servicing and maintenance, you should define a fallback shell (typically explorer.exe) for a designated admin account so that IT staff can still access the Windows desktop when required.
This approach is fully supported by Microsoft and is the recommended best practice for kiosk‑style or dedicated device scenarios such as medical imaging machines. It ensures that clinical operators interact only with your proprietary application and never see the Windows desktop.
I hope you've found something useful here. If it helps you get more insight into the issue, it's appreciated to accept the answer. Should you have more questions, feel free to leave a message. Have a nice day!
Domic Vo.