After two decades of operation, the world’s first proton therapy centers are beginning to upgrade. The equipment that pioneered advanced cancer treatment is being replaced—as you can imagine, the technology has evolved dramatically.
These upgrade projects are entirely new territory in healthcare construction. As the architects behind the world’s first major proton therapy upgrade at Massachusetts General Hospital, we’re learning that replacing proton therapy equipment is nothing like any other medical facility renovation. Every assumption from traditional construction gets challenged when you’re reverse-engineering a building designed around equipment that’s 1,000 times more complex than a LINAC.
Why Upgrade Instead of Rebuild?
The first hospital-based proton therapy center opened at Loma Linda University Medical Center in California decades ago. Massachusetts General Hospital’s facility has been treating patients for approximately 25 years. These centers were built when proton therapy technology was still in its infancy, yet they’ve continued delivering life-saving treatment year after year.
Here’s what’s driving upgrades: the technology. Proton therapy equipment has dramatically improved over the past two decades—it’s now utilizing more precise targeting, faster treatment times, and new delivery methods that weren’t possible with first-generation systems.
The best way to take advantage of these clinical advances is to proactively upgrade to give patients access to the latest treatment technology. That decision transforms a 25-year-old facility into a state-of-the-art center without the multi-million dollar investment required to build new.
The Massachusetts General Hospital Project
Our team is currently project managing the world’s first major proton therapy center upgrade at Massachusetts General Hospital in Boston. The Francis H. Burr Proton Therapy Center opened in 2001, built on decades of pioneering work by Mass General physicians and the Harvard Cyclotron Laboratory. Those physicians became the first in the world to discover how to harness high-energy protons for medical care.
Now, 24 years later, the Burr Center is undergoing a complete proton equipment upgrade. This project has proven to be the most challenging we’ve ever undertaken—and we’ve designed more proton therapy centers than any other firm globally.
The fundamental challenge is that these facilities weren’t designed to be upgraded. Proton therapy centers aren’t just buildings that hold machines—they are the machines. The equipment, the structure, and the 14-foot concrete shielding walls function as an integrated instrument requiring precision construction.
When the Burr Center opened, no one imagined needing to remove and replace the equipment decades later. A tower was built above the proton therapy center after the original facility was completed, adding another layer of complexity. Now we’re tasked with decommissioning the original system, removing equipment through spaces never intended for equipment removal (proton therapy equipment is too big to go through doors and is often put in through the roof), and installing new technology—all while maintaining FDA standards and keeping the facility operational.
This is true reverse engineering. We’re working backward from an existing building to understand how we can make it ready for a completely new system. The size, shape, and footprint of the new equipment from the same vendor are similar to the old equipment, which helps, but getting equipment in and out has been the biggest challenge.
Even with smaller equipment dimensions, we’ve had to blow out concrete walls. The process is taking longer than initially expected because only a limited number of workers can safely operate in the vault space simultaneously. Every day brings discoveries about how the original facility was constructed and new challenges that no one in proton therapy has addressed before.
The Texas Project
We’re now assembling a team for the second upgrade project, this time in Texas. This project presents an entirely different scenario from Massachusetts General Hospital.
In Texas, the facility is replacing old equipment with new equipment from a different vendor. The size, shape, and configuration of the new system are significantly different from the original equipment. This means we can’t simply swap old for new—we have to fundamentally reconfigure the space.
The scope includes dynamiting walls to accommodate the new equipment footprint. Unlike Massachusetts General, where equipment dimensions were similar, this project requires major structural modifications to the existing vault. The extent of demolition and reconstruction depends entirely on the equipment selection—a lesson that reinforces what we’ve learned across dozens of new builds: equipment choice shapes everything.
Decommissioning
Perhaps the most complex aspect of both upgrade projects is decommissioning. No one has decommissioned a proton therapy system before at this scale. The process of safely removing equipment that’s been integrated into the building structure, handling radioactive components, and preparing the space for new installation requires protocols that didn’t exist until these projects demanded them.
There’s no guarantee the new equipment footprint will match the old one perfectly. When you’re working under an existing tower or within existing structural constraints, every inch matters. The decommissioning process must be carefully sequenced with the installation timeline to minimize downtime and ensure the facility can eventually return to treating patients.
Lessons Learned
These early upgrade projects are teaching us lessons that will benefit the entire industry. We’re developing new methodologies, documentation, and planning processes specifically for proton therapy upgrades.
One critical development: working with equipment manufacturer IBA and Legion Healthcare Partners, our team led a year-long “Gap Analysis” to rewrite IBA’s Interface Building Document specifically for the Mass General upgrade. This analysis identified the differences between IBA’s standard requirements and what the existing building can provide. The existing building interface documents were written for new construction, not renovations. Upgrade projects require completely different considerations—structural assessments, equipment removal logistics, phased construction sequencing, and operational continuity planning.
Every challenge we solve in Massachusetts General and Texas becomes knowledge we can apply to future upgrade projects and new greenfield facilities. We’ve gotten good at anticipating challenges in new construction. Now we’re learning to anticipate them in upgrades—and those insights make our new project designs more thoughtful about future flexibility.
The Economics of Upgrading
While upgrade projects are complex, they’re significantly less expensive than new construction. Equipment has actually gotten more expensive over the past 25 years, but buildings have gotten smaller and more efficient. Today’s average upgrade project costs $150-175 million—a substantial investment, but far less than the $250+ million required for a new center.
This cost advantage makes upgrades attractive for institutions that already have proton therapy infrastructure and want to maintain their position as regional cancer care leaders without the full capital commitment of building new.
Looking Ahead
Upgrade projects are an exciting new phase in proton therapy’s evolution. As more centers reach 20-25 years of operation, the industry needs proven methodologies for equipment replacement. The work happening now in Boston and Texas is creating the blueprint for future upgrades nationwide.
These projects prove that proton therapy facilities can have extended lifespans through equipment modernization. The massive concrete structures built to contain radiation can serve multiple generations of technology—if the upgrade process is managed correctly.
At Jessen Proton, we’re committed to solving the complex challenges these projects present. Every obstacle we overcome makes the next upgrade project smoother and more predictable. As the architects who designed the industry’s first major upgrade, we’re building the expertise that will guide proton therapy centers through their next quarter-century of service.
Questions about upgrading your proton therapy center? Contact us to discuss how lessons from the world’s first upgrade projects can inform your center’s future.
