MEPIS was commissioned to provide MEP services for replacing the existing LINAC machine with a new combo LINAC/MRI machine. The project constraints included active adjacent spaces with patients and staff members, tight ceiling space, insufficient existing building utilities, such as processed chilled water flowrate, to serve new equipment, maintaining shielding from radiation and working with material acceptable for use in MRI rooms. MEPIS documented the existing conditions and provided floor plans and specifications for the design of HVAC modifications, which included providing new non-ferrous ductwork and diffusers to accommodate new heat load. Cryogen vent and Emergency exhaust ducts were sized per manufacturer’s recommendations. New processed chilled water lines were brought into the equipment room for cooling. Fire Protection scope included relocating sprinkler heads and tying to the existing mains to accommodate new ceiling configurations. New non-ferrous piping and sprinkler heads were provided for the MRI treatment room. Electrical support was provided by designing power requirements for the new equipment, treatment, and control rooms. New lighting design and controls, phone and data designs, and new fire alarm devices were also provided. Plumbing scope included a new sink in the MRI Treatment Room and floor drains with floor cleanouts.