It can be done with the cab on and its pretty easily accomplished. All repairs on the 6.0L can be done without pulling the cab. Just take out all the A/C components and the passenger fender well and you have access to the back bolt on the head. I did studs and a delete in cab on our 07 550 shop truck with a buddy in 9 hrs. Once you get good at EGR deletes, they only take 3 hrs.My buddies gathering parts to do that and studs on his 04, he's got himself believing we(yes we i've been drug in on this cause he's saved my behind helping with countless projects of mine) Can do all of it with the cab on. How longs this thing gonna be sitting in my driveway?