What planning techniques and constraints do you use when treating H&N cancer with VMAT as it relates to arcs that sweep through shoulders that ride high?

For VMAT planning, we do try to avoid beams from angles where the shoulders can get in the way. In Eclipse, this can be relatively easily accomplished by turning on avoidance sectors during optimization. If this function is not available, one can choose to split the arcs, which will be more work for...

Dr. @Dr. First Last's recommendations are excellent. If these interventions are unsuccessful, an alternative "old school" option (at the risk of dating myself) from the early days of HN IMRT (prior to MLCs, when MLC size/number were limited, & prior to current common 45 deg collimator rotation) was ...