Perhaps not for medical, but you can coax windows to behave mostly "realtime" (aka 1ms polling interval) by invoking some win32 API around the multimedia timer interface. This still works as of Win11, but it has to be foreground and not running on battery and a few other reasonable constraints.
There are really 2 things you need to avoid: Context switching, and tripping over the internals of the kernel. By forcing the multimedia timer to 1khz, you can address the latter. You should still try to run your time-sensitive code on a dedicated thread and never yield to the OS, even if yielding is made less costly. Keeping the cache hot all the way thru is way more important. If the kernel doesn't have an opportunity to make a decision about your priority, you don't have to worry about a thing. Hold onto the thread of execution and never let go. Async/await is your enemy. Poll everything.
For me, the biggest win is in the development experience. Building this stuff on Windows is like cheating compared to being forced to target an obscure RTOS linux distribution up-front. Even then, if I build my RT product in something like .NET6+, it is plausible I could compile the exact same code for a more power efficient platform after completing initial development on windows. The only code that would be platform-specific are any "hacks" like one-time mm_timer calls.
There are really 2 things you need to avoid: Context switching, and tripping over the internals of the kernel. By forcing the multimedia timer to 1khz, you can address the latter. You should still try to run your time-sensitive code on a dedicated thread and never yield to the OS, even if yielding is made less costly. Keeping the cache hot all the way thru is way more important. If the kernel doesn't have an opportunity to make a decision about your priority, you don't have to worry about a thing. Hold onto the thread of execution and never let go. Async/await is your enemy. Poll everything.
For me, the biggest win is in the development experience. Building this stuff on Windows is like cheating compared to being forced to target an obscure RTOS linux distribution up-front. Even then, if I build my RT product in something like .NET6+, it is plausible I could compile the exact same code for a more power efficient platform after completing initial development on windows. The only code that would be platform-specific are any "hacks" like one-time mm_timer calls.