Sometimes the ideal site for a facility is a complex one—for example, if the benefit of bringing healthcare services to the surrounding community outweighs the cost of designing and building in a constricted location. This was the case for the new Cancer Institute at Allegheny General Hospital in Pittsburgh.

In an effort to compete with major health systems in the area, owner Allegheny Health Network (AHN), which operates 14 hospitals across Western Pennsylvania, wanted to build a flagship location for cancer care. The new facility would unite AHN’s local treatment centers spread throughout the region and house state-of-the-art equipment and a research institute.

Its Allegheny General Hospital is geographically and figuratively the heart of AHN, nestled in Pittsburgh’s urban North Side neighborhood and serving patients since its opening in 1936.Adding a cancer institute to this urban campus would bring cancer care services to the forefront of not just the hospital but the health system as a whole.

But first, AHN, engaging with the neighborhood and working with Pittsburgh-based IKM Architecture, needed to address several challenges related to the site, space layout, equipment planning and installation, and patient and staff experience.


Urban building site restrictions

Completed in 2020, the institute not only delivers general care to nearby patients but is also a hub where the most advanced cancer cases in the network are treated. Situated prominently on busy North Avenue, the new facility infills an existing courtyard directly adjacent to the original hospital building and at the public-facing border of the campus.

The sleek, curving glass façade of the new building is designed to signify to the community the high level of cancer care taking place inside and creates an updated front entrance to Allegheny General Hospital.

The new addition is strategically positioned to connect with the existing hospital’s main building. However, site conditions also meant that the 84,000-square-foot facility touches six separate structures bordering the site. This includes several substantial additions since the 1970s, such as a 10-story patient tower completed in 1981.

As a result of generations of construction, the cancer center site is restricted on three sides by existing buildings, on the fourth side by busy North Avenue, and from above by flight paths to the nearby helipad located atop a garage construction in 1993. With two basement levels aligning with the subgrade floors of the existing hospital, the new facility also sits below the foundations of some of the surrounding buildings.

Upon excavation of new foundations for the new cancer facility, shoring and bracing solutions were implemented to support the neighboring structures, which included the original hospital, a 1986 clinical building, and the garage with helipad.

However, construction phasing plans required flexibility to accommodate circumstances that arose during construction. These includes unforeseeable subgrade conditions and temporary brief construction pauses to accommodate the nearby emergency department helipad. Redesigns occasionally affected program in addition to structure. In these cases, it was necessary to evaluate the balance of engineering feasibility, construction cost, and program impact.

For example, one solution to the space planning challenges associated with the tight site was to create an entrance experience through the adjacent existing garage. Additionally, each floor plan iteration was analyzed as part of a larger whole to achieve seamless integration with the overall campus.

Because it’s not always possible to understand the full picture of site conditions before breaking ground, consistent collaboration between the architect, engineers, and hospital was vital to maintaining momentum on the project.

The project team was also in contact with the city to manage access to the site from congested North Avenue, a primary conduit across multiple adjacent neighborhoods, gaining permission to block off a lane throughout the construction period.


Connecting a new building to existing hospital services

Placing the Cancer Institute beside the original hospital building allowed the existing radiation oncology department to connect and expand into the new facilities. This also created space for new equipment including a gamma pod and an MRI-guided linear accelerator.

However, with the existing department housed on the second basement level below grade, seamless expansion required the cancer institute to match a depth of 14 feet below the lowest grade, or 27 feet below the first floor of the hospital.

The benefit and convenience of merging new space with old was determined to be worth the added expense and complexity of digging down further. It enabled the radiation oncology department to seamlessly expand without disruption to the existing services.

The approach also created a natural link between the 1936 structure and the new facility. This connectivity continues at the street level, where the addition’s new lobby atrium acts as a junction for those entering the institute from the hospital and those entering from the street.


Planning for cancer care equipment installation

Along with construction of a new cancer care facility comes installation of the latest technology to best treat patients. For this project, the challenge of accommodating equipment came in two forms: designing the vaults and physically moving the equipment into place.

Here, not only is the radiation oncology department below grade, but connectivity to the existing hospital dictated a set floor-to-floor height that’s less than the typical height of equipment vaults. Under normal circumstances, a linear accelerator room might take up a one-and-a-half-story height in order to fit enough concrete to contain the radiation from the equipment.

For AHN’s project, the reality of squeezing the vaults into a tighter space prompted the project team to consider alternatives to concrete, instead using thin lead bricks. The solution was an added cost but reduced the thickness of the radiation shielding between floors, enabling it to fit the tight parameters of the urban site.

Taking advantage of the proximity to North Avenue, an areaway was built into the facility that’s accessible from the street to allow equipment to be lowered into the subgrade level by crane. From there, equipment is shifted along to the proper vault, whether in the new facility or through the connection to the existing department.

The project team worked together to prepare the construction and MEP infrastructure for the installation of new equipment, ensuring that the space was ready for the highly specialized delivery. Additionally, a removable roof on the areaway facilitates the replacement of magnets in the future.


Addressing patient flow between two buildings

Recognizing the variation in treatment at the facility, from the sickest patients who may be pushed on a stretcher to comparatively healthy patients who are able to direct themselves through the department, Allegheny General Hospital wanted to separate inpatients and outpatients to the greatest degree possible.

Despite the complexity of merging new and existing spaces at the basement level, the location of the cancer institute allows the two patient populations to have separate circulation paths. Specifically, inpatients enter from the existing hospital on one side of the department. Outpatients come in from the street on the opposite side. These two groups with differing needs can access the same facility through separate corridors located on opposite sides of the basement level.

Meanwhile, the ground-level atrium forms an iconic main lobby space in the new building where patients and visitors can orient themselves relative to the rest of the hospital. As people flow in from the street or hospital, they converge in the atrium. This space acts as the front door to the institute and the campus beyond while also providing space for visitors to wait for appointments, access informational resources, and gather socially.


Design to maximize natural light

Another project goal was to provide as much access to natural light as possible to facilitate healing. Due to limitations of the urban setting and proximity to existing buildings, daylighting solutions had to be strategically implemented to maximize effectiveness.

Every effort was made to include natural light in patient areas, such as a large infusion center where exterior windows are distributed throughout the space to make views to the park across North Avenue a focal point.

The infusion area itself is set up as shared lounge space instead of being divided among private infusion bays. Some patients may be required to sit in their chair for many hours, while others may have the ability to move around during the course of infusion treatments. The lounge provides options for seating with access to daylight. And the views of nature and city life offer a richer alternative to the TV, phone, or surrounding patients.

These views are also present in patient and family waiting areas on all floors, serving to orient visitors within the structure. Additionally, primary patient corridors end in natural light. A light well was also created in the below-grade family waiting area to carry daylight down to the radiation oncology department.


Integrating a new cancer center on an existing campus

As much as the Cancer Institute is intended to represent forward-thinking care, its design also honors the historic nature of Allegheny General Hospital. The new structure neighbors the hospital’s iconic South Tower, whose 22 stories of white brick rise above the North Side landscape and are visible from across the Allegheny River in downtown Pittsburgh.

This landmark has been a fixture of the community for a century and is beloved by residents of the surrounding neighborhood. The design team recognized the significance of the building and catered the new lobby atrium to highlight the existing building’s masonry articulation and sculptural terracotta.

The design places tree-like columns in the center of the atrium to avoid interfering with the structure of the historic wall and to minimize construction directly against it. Positioning the columns away from the façade also allows it to have an unobstructed presence in the new facility.

This preservation brings new life to the intricate façade and provides the opportunity for visitors to appreciate the filigree up close.

The complexities of building on urban sites may be daunting, but they can be managed effectively through strategic solutions and consistent collaboration between the hospital and project team. It’s important to understand the existing conditions and the obstacles that come with them. Also, recognize when an obstacle has the potential to become an opportunity.

For example, the historic façade of the South Tower could have been easily covered up to simplify the design of the new project. But by constructing an atrium at this juncture of the old hospital and the new facility, it instead highlights the institution’s legacy and provides a meaningful gathering space for the community.

The best urban facilities fit seamlessly into the context of the community and the landscape of nearby architecture. While construction of these facilities may pose additional challenges, they ultimately create higher visibility as significant care institutions integrated within the surrounding neighborhood.

John Keelan, AIA, ACHA, is a principal at IKM Architecture (Pittsburgh). He can be reached at Roger Hartung, AIA, NCARB, is a principal at IKM Architecture. He can be reached at