Our firm was tasked with adding two new linear accelerator vaults, HDR vault, and a new clinical program to support this hospital based radiation oncology expansion on an existing compact site. A complete reorganization of the floor plan was required to provide new order to an otherwise cluttered arrangement of existing services around the new treatment modalities. Large scale site work was required to relocate an existing private road to accommodate the new vaults. The scope expanded into the rearrangement and relocation of other hospital departments in order to allow for the Cancer Center to meet its spatial needs. Further project needs included the department remaining in operation throughout the construction duration such that in depth architectural phasing plans were developed in coordination with the client. A new and dynamic facade was created on the exterior to provide the client with a new and powerful image of quality treatment.