Adding a Linac


PyMedPhys has a range of tools that interface with an Elekta Linac. All of these interface points utilise “APIs” that the Elekta Linac exposes in its default configuration. This document was written during the process of adding a new Linac, at a remote site, to our already existing infrastructure within Cancer Care Associates. We host the PyMedPhys application at one of our sites, and that application is then able to access each Linac at all of our sites by utilising SSH tunnels.

This document is written assuming that the servers within your centre being utilised are Windows machines, however, it should be possible to adapt the instructions here to work for other operating systems.


Before getting started you will need the following:

  • The Hospital DNS IP Address that the NSS of the Linac was assigned.

    • Throughout this documentation it will be assumed that this is

  • A name that can uniquely identify the Linac and will not change, eg. its serial number.

    • Throughout this document it will be assumed that this is 4299.

  • A login username and password to the NSS to be able to access its file shares that it is sharing with the centre’s network via SAMBA.

  • A server where you can run the iCom listener

    • This server should be able to have a guarantee that the connection between the server and the Linac will have near-zero network interruptions. This is due to the following bug at still being unresolved.

    • You will need permission to create a service on this iCom server and to set that service to be able to boot on server start.

  • A shared network drive at your centre where you will be storing the iCom and TRF records.

    • Throughout this document the iCom network path will be assumed to be \\NBCCC-pdc\physics\NBCC-DataExchange\iCom.

  • A shared network drive at your centre which can be mounted by the iView to be utilised as a QA iView imaging database.

The iCom listener

Elekta Linacs have an iCom protocol that can be utilised to determine various parameters about the Linac state, eg. Gantry angle. This section details how we have set up the PyMedPhys iCom listener CLI tool.

Installing PyMedPhys on the iCom listener server

In our case, the server where the iCom listener is to be installed has the requirement that the installation has minimal impact on the other software that is also running on that same server. If you don’t have that restriction you can follow the Get Started to install PyMedPhys in the usual fashion.

So that the Python installation itself has minimal impact on the system we utilise Python’s embedded distribution, an example download of one such distribution is available at

Also, given this installation of PyMedPhys is only going to be running as an iCom listener it only needs a very minimal set of dependencies.

To install PyMedPhys within the embedded distribution these notes were followed, we followed these steps by doing the following:

  • Extracted the Python embedded zip to C:\Users\Public\Documents\python

  • Edited the python39._pth, uncommenting the last line to change from #import site to import site.

  • Downloaded and then ran C:\Users\Public\Documents\python\python.exe

  • Installed PyMedPhys by running C:\Users\Public\Documents\python\python.exe -m pip install pymedphys[icom]==0.36.1.

Make sure to adjust the above versions appropriately to match what is current.

The physics-server git repository

To facilitate SSH tunnelling between the sites there is a server with the hostname physics-server at each site. The relevant software and configuration on these servers is stored within a public GitHub repository at All of the code snippets presented within this iCom section are adapted from the code found within that repository’s NBCC/icom directory.

Setting up the iCom listener as a Windows service

To convert the PyMedPhys CLI tool into a Windows service the NSSM tool was utilised. It takes .bat files and converts them into a Windows service. A file called 4299_listening.bat was created with the following contents:

SET PYTHON_DIR="C:\Users\Public\Documents\python"

pymedphys icom listen \\NBCCC-pdc\physics\NBCC-DataExchange\iCom

The key being that, given the way that Python and PyMedPhys was installed on that server, the pymedphys CLI command was not found within the server’s %PATH% variable. As such, before utilising the pymedphys CLI the embedded python distribution is temporarily added to the path. Here is the Hospital DNS IP Address of the Linac, and \\NBCCC-pdc\physics\NBCC-DataExchange\iCom is the directory where the iCom records are to be stored.

Once this .bat file was defined NSSM was downloaded with its .exe placed at C:\Users\Public\Documents\physics-server\bin. Then, to create the service the following .bat file was created and run as administrator:

SET GIT_ROOT=C:\Users\Public\Documents\physics-server


nssm install icom_listening_%SERIAL% %SERIAL%_listening.bat

nssm set icom_listening_%SERIAL% Application %HERE%\%SERIAL%_listening.bat
nssm set icom_listening_%SERIAL% AppDirectory %HERE%

nssm set icom_listening_%SERIAL% AppStdout %HERE%\%SERIAL%_listening_log.txt
nssm set icom_listening_%SERIAL% AppStderr %HERE%\%SERIAL%_listening_log.txt

nssm set icom_listening_%SERIAL% AppRestartDelay 300000

Then, within the Windows services manager this service was set up so that its Startup Type is set to Automatic and the Log On As setting was then set to a user that had the appropriately scoped permissions.

iView database

Not yet documented.

TRF indexing

Not yet documented.

Updating the config.toml file

Not yet documented.