As an increasing number of surgeries are being moved to ambulator surgery centers, hospitals must meet the demands of higher acuity patients and more complex cases. Hybrid operating rooms (OR) combine the traditional OR with an image guided interventional suite allowing for a broader range of cases. While traditionally used for cardiac and vascular cases, the hybrid OR has evolved to accommodate other types of surgeries such as neuro, trauma, brachytherapy, and high-risk obstetrics. Incorporating intraoperative CT and MRI means that patients can be treated quicker and more accurately which may lead to a shorter length of stay and a reduced risk of reoperation. This learning activity will discuss the design considerations when building a new hybrid OR, the equipment that may be included, types of emerging procedures that may be performed in the OR, and the benefits and challenges associated.