This project consists of a 260,000 square foot, seven-story cancer and research facility. There are four floors of diagnostic and clinical spaces, three floors of laboratory spaces, and one full size mechanical penthouse. The facility includes 50,000 square feet of BioSafety Level-2 research labs and support space, as well as a radiation oncology suite including exam rooms and two linear accelerators, which are connected underground to the existing radiation oncology suite. This project presented several structural challenges due to the building placement, which is nestled between existing structures on three sides and an existing road on the fourth side. The design required the careful placement of a four-bay loading dock over the main mechanical room, which itself was inserted over the linear accelerator vaults. These additions were installed directly adjacent to the existing radiation oncology suite while it remained in service. A portion of the loading dock was also designed using bridge technology that spanned over the existing suite to avoid interruption of services. This project was fast tracked, which required extensive structural coordination with limited information as well as great agility during the construction process.