An ever-increasing number of projects represent the age-old adage, “ten pounds of aspiration in a five-pound bag”. Because many hospitals are land-locked, adaptive re-use in a healthcare environment is increasingly becoming the norm. More often than naught the original hospital was never constructed much less intended to be modified. With the advent of technological advances in modalities as well as patient care models there has been an ever-increasing need to consider repurposing existing hospital “real estate”. The presentation’s project is transforming a 2011 Linear Accelerator suite with a two-story 2016 addition built on-top into a suite introducing a state-of-the-art modality: an MRI-Linac suite. This necessitated developing a complete understanding of the existing built environment and translating this zone into a radically new patient care service without interrupting existing services and departments. Thus, the presentation is helping to reassure that projects can become reality with the proper team, communication, and collaboration. Core Competencies: Strategic Planning; Space Planning and Programming; Design; Equipment Planning; Construction Management; A-E Selection Process; Transition Planning; Equipment Acquisition; Claims Adjudication Principles; Computer Principles and Applications AIA Course Number: 2023.05.011 AIA CEU = 1 LU/HSW