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McLaren Health Care’s Karmanos Cancer Institute in Flint shows how a hospital can add proton-treatment capacity without starting an entirely new center: redesign a shelled conventional vault around smaller upright equipment, reuse the existing synchrotron and beamline, and engineer every structural, shielding, utility and access detail around the treatment system. Gresham Smith’s 2022 design converted a planned third rotating-gantry vault into two rooms for LEO Cancer Care’s upright Marie systems while aiming to keep adjacent proton vaults operating.
The project is often described as “first in the world,” but that phrase needs a precise scope and date. The design was presented as a first-of-its-kind McLaren installation; later vendor announcements describe a separate Marie integration at Stanford. McLaren reported the Flint expansion complete in May 2025 and expected the proton units to come online in 2026 after FDA clearance. A January 2026 state-hearing statement still described clearance and operationalization as future steps, and no authoritative source reviewed for this article confirms that McLaren had treated its first patient by October 13, 2026.
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The project in one sentence
McLaren’s original proton center, designed in 2012, reserved three conventional rotating-gantry vaults. Two were built out and the third was left as a shell for future growth. When McLaren selected LEO Cancer Care’s upright Marie configuration, the design team determined that the smaller equipment footprint could divide that one large planned vault into two treatment rooms. The result is a specialized retrofit rather than a simple equipment swap: the building, beam delivery, shielding, controls, utilities and construction sequence all had to be coordinated as one system.
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Why upright proton therapy changes the building brief
Space is organized around a different treatment geometry
A conventional proton room is commonly organized around a large rotating gantry. The gantry, its support structure and the patient positioner drive the room’s diameter, clearances and structural loading. In the McLaren account, the upright Marie layout used about half the space of previous proton therapy systems. That is an architect’s project comparison, not an independently measured industry benchmark, but it explains the central retrofit opportunity: one previously oversized vault could be subdivided into two smaller rooms.
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Upright treatment also changes the relationship between the patient, nozzle, imaging equipment and the beamline. Instead of assuming that a conventional room envelope will work, the design team must set the patient chair, beam height, imaging field, staff sightlines and equipment clearances together. The room is effectively laid out from the treatment position outward.
The equipment can reduce, but does not eliminate, structural demands
Daniel Medrano, identified by McLaren as co-director of research and development for the McLaren Proton Therapy System, said McLaren expected a “sizable capital cost reduction” by choosing upright positioning and imaging instead of its existing three-story, more-than-100-ton rotating-gantry solution. That is a project representative’s projected comparison, not an audited cost result. A smaller treatment system can reduce the volume and complexity of the room, but it still requires substantial radiation shielding, precision alignment, power, cooling, controls and access planning.
How the shelled vault became two treatment rooms
Start with the shell, not a blank site
The third vault already existed as a future expansion zone. Reusing it avoided constructing a new proton building and allowed the team to retain as much existing concrete as practical. The design objective was to increase capacity while limiting work beside the two operating vaults. That constraint affected demolition, deliveries, temporary barriers, utility routing and the order in which systems could be installed.
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Dividing one planned room into two required more than a partition. Gresham Smith described the need for:
- A second treatment nozzle so each room could receive the beam.
- A divider and room-specific treatment infrastructure.
- Supplemental mechanical, electrical and plumbing systems.
- Additional electrical power capacity and distribution.
- Expanded information-technology infrastructure for controls, imaging and communications.
- Control-room and technical-space arrangements that support two treatment workflows.
The 2024 project update explains that the rooms were to share McLaren’s existing synchrotron and beamline. A new switch magnet would direct the beam to either room. This is why the work is best understood as systems integration: the accelerator and much of the beam transport remained part of the original center, while the downstream delivery and room infrastructure were redesigned for two destinations.
Coordinate the vault with the treatment machine
Resolve beam height and patient position early
One of the design team’s discoveries was that the beamline height and the patient chair did not align. The apparent alternative was substantial excavation of the floor, which would have added cost, schedule risk and work in a highly constrained existing structure. Gresham Smith said it worked with LEO to modify the chair instead. That solution belongs to this equipment-and-room combination; another proton system may require a different interface or a different civil intervention.
The lesson for an owner is procedural: freeze the equipment geometry and run a three-dimensional coordination review before committing to concrete, embeds or floor elevations. Confirm the nozzle centerline, chair travel, imaging positions, service clearances, maintenance zones and emergency egress. A late discovery in any of those dimensions can force structural work that is far more disruptive than a controlled equipment modification.
Treat shielding penetrations as engineered interfaces
Gresham Smith described concrete shielding walls four to eight feet thick in the project’s proton rooms. Those dimensions describe this project, not a universal rule for every proton facility. The final thickness and reinforcement pattern depend on beam energy, workload, occupancy, geometry, materials and the radiation-protection design accepted by the relevant authorities.
Conduits, ducts, pipes and cable trays cannot be routed as ordinary building services. Their penetrations must be coordinated with the shielding engineer and structural team so that openings, bends and local shielding do not compromise the design basis. Penetration details should be settled before concrete placement, documented in coordinated drawings and checked during construction.
Design for remote operation
Staff cannot remain in the treatment vault during beam delivery. The project account therefore includes cameras and robotics to support observation and operation from outside the room. A workable layout must give operators dependable visual coverage of the patient, chair, nozzle and room entry points while preserving the interlocks and communications needed for safe treatment. Control rooms were arranged side by side with direct access toward the treatment areas, while a technical room and IT closet supported the equipment and data systems.
Plan delivery, replacement and maintenance before construction
Make a vertical route for heavy equipment
Because the technology had to be placed vertically, the design incorporated concrete-wall bump-outs that would let an A-frame lift carry equipment into the treatment room. This is more than a one-time move-in detail. The same route can support future replacement as proton technology changes, reducing the chance that a hospital will have to dismantle walls or remove major portions of the building to exchange equipment.
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Before construction, the project team should document the complete path from truck unloading to final position: door and corridor dimensions, turning radii, floor loading, overhead obstructions, lifting points, temporary weather protection and the sequence for removing or reinstalling building components. A route that works for delivery but not for replacement creates a long-term ownership problem.
Separate construction from live treatment operations
McLaren’s design objective was to keep adjacent proton vaults operating during construction. That requires a phasing plan that isolates dust, vibration, noise, fire-protection impairments and utility shutdowns from active clinical areas. It also requires daily coordination with treatment operations, infection-prevention staff, facilities personnel and the equipment vendor.
Retaining existing concrete, minimizing work near operating vaults and concentrating new services in the shelled area can reduce disruption, but none of those measures guarantees uninterrupted care. The construction manager must define shutdown windows, temporary routes, monitoring requirements and a response plan for unexpected vibration, power events or accidental penetrations.
What the two configurations mean for facility planning
| Planning question | Conventional rotating-gantry room | Upright Marie retrofit approach |
|---|---|---|
| Room footprint | Large room envelope driven by a rotating gantry and its support structure. | Gresham Smith reported about half the space of previous proton systems for the Marie layout; the source did not publish an independent measurement method. |
| Use of the original vault | The third planned vault would have remained one conventional treatment room. | The shelled vault was redesigned as two smaller treatment rooms. |
| Beam infrastructure | Designed around the original conventional-room arrangement. | Planned reuse of the existing synchrotron and beamline, with a switch magnet directing the beam to either room. |
| Patient position | Positioning is coordinated with the rotating gantry’s range of motion. | Upright positioning requires precise coordination of chair, nozzle, imaging and beam height. |
| Installation access | Access is driven by the gantry’s size, weight and assembly sequence. | Vertical access included wall bump-outs for an A-frame lift and was planned with future replacement in mind. |
| Construction beside active care | A new or conventional expansion could require substantial work around existing operations. | The retrofit plan aimed to preserve neighboring vault operations by retaining concrete and limiting work near active rooms. |
The available project sources do not establish independent total-cost, throughput or patient-outcome comparisons between the two configurations. The meaningful comparison here is architectural and operational: how much room the equipment occupies, how many treatment spaces fit in the shell, how the beam is distributed and how the hospital can install and maintain the system.
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Repair common Windows errors and clear accumulated junk for a smoother, more stable PC - no reinstall needed.Free scan · no reinstallProject scale and what each number describes
| Figure | What it represents | Attribution and qualification |
|---|---|---|
| 8,500 square feet | Announced institute expansion described in 2022. | Gresham Smith’s project description; an announced project figure, not a verified as-built measurement. |
| 3,000 square feet | Planned proton-vault fit-out and renovation. | Gresham Smith’s 2022 description of the work area. |
| Four to eight feet | Concrete shielding-wall thickness described for the proton rooms. | Architect’s account of this project, not a universal proton-room specification. |
| $61 million | Cost reported for McLaren’s completed campus expansion. | McLaren announcement in May 2025; covers the larger campus project, not only proton rooms. |
| 13,735 square feet | Clinical-space addition reported for the completed campus expansion. | McLaren announcement in May 2025; broader than the 3,000-square-foot proton fit-out figure. |
A practical retrofit workflow for hospital owners
- Verify the existing shell. Survey the vault’s dimensions, concrete, reinforcement, embedded items, floor elevations, roof loading, access openings and the condition of any installed services.
- Obtain a coordinated equipment model. Require the proton-system vendor to provide nozzle, chair, imaging, service, maintenance and replacement envelopes, not just a room outline.
- Map the beamline and switching strategy. Confirm how the existing synchrotron and beamline connect to the new rooms, where a switch magnet is located, and what access is needed for alignment and maintenance.
- Run shielding and penetration coordination. Establish the radiation-protection design basis, then coordinate every conduit, duct, pipe and cable route before concrete or shielding work begins.
- Test the patient-position geometry. Check beam height, chair travel, imaging views, transfer paths, emergency access and staff sightlines with full-scale or digital mock-ups.
- Design the delivery and replacement route. Prove the path for lifting, staging, installation, removal and future equipment exchange, including temporary structural protection.
- Divide clinical and construction zones. Set barriers, negative-air or dust controls where required, vibration limits, fire-watch procedures, shutdown windows and communication protocols with the operating center.
- Commission room and system interfaces together. Acceptance should cover shielding documentation, interlocks, imaging, controls, network connectivity, beam switching, emergency procedures and regulatory submissions—not just the equipment installation.
Timeline and current status
| Date | Project milestone |
|---|---|
| Late 2012 | McLaren’s center was designed for three conventional gantry vaults; two were built and a third was shelled for later expansion. |
| 2022 | McLaren and LEO announced a partnership for two Marie upright systems, and Gresham Smith described the vault conversion and expansion design. |
| September 24, 2024 | Gresham Smith described reuse of the existing synchrotron and beamline, with a modified switch magnet serving two rooms. |
| May 22, 2025 | McLaren announced completion of a $61 million, 13,735-square-foot campus expansion and said the proton units were expected online in 2026 pending FDA clearance. |
| January 22, 2026 | A McLaren representative told a state hearing that the units had been introduced and that clearance was expected before operationalization. |
| 2026 forecast | LEO’s project case study said first treatment at McLaren was expected in 2026. The reviewed sources do not confirm that treatment had begun by October 13, 2026. |
Use “first in the world” precisely
Priority claims in medical technology are configuration-specific. In this case, “first in the world” may refer to a particular combination of upright patient positioning, beam source, room arrangement and delivery system, rather than to every upright proton facility. The Flint project was presented as first-of-its-kind in the original design account. In 2026, vendor material also described a separate Marie installation at Stanford using compact proton equipment from another supplier. Those are distinct sites and configurations.
For construction and healthcare audiences, the defensible wording is to name the facility, equipment configuration and date of the claim. Do not convert a planned installation into a confirmed clinical milestone, and do not state that McLaren has treated patients until a dated McLaren or regulator source confirms it.
Design lessons that transfer to other specialized facilities
- Equipment selection can unlock capacity. A smaller treatment footprint may allow one reserved room to become two, but only after shielding, utilities, controls and access are redesigned.
- Existing infrastructure is an asset and a constraint. Reusing a synchrotron and beamline can avoid major construction while imposing strict limits on alignment, switching and maintenance access.
- Small geometric errors become major civil work. The beam-height and chair mismatch demonstrates why vendor and architect coordination must precede excavation or concrete placement.
- Replacement access belongs in the first design. An A-frame route and wall bump-outs can protect the hospital from future demolition when technology changes.
- Continuity of care is a design criterion. Phasing, barriers, utility planning and work-zone controls are as important as the final room layout when neighboring treatment spaces remain active.
- Separate intent from proof. Architect descriptions explain design decisions; owner announcements establish project milestones; regulatory records establish clearance. None of those sources alone proves patient outcomes.
Bottom line for proton-vault retrofits
The McLaren Flint project demonstrates a repeatable way to think about adding proton capacity: begin with a shelled or underused vault, select equipment whose geometry fits the available structure, divide the room only after beam and shielding coordination, reuse upstream infrastructure where feasible, and design delivery, replacement and construction phasing at the same time as the treatment rooms. Its value as a case study lies in those integration decisions—not in an unverified claim about first treatment or in unsupported cost and clinical comparisons.
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