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Non-coplanar techniques, combined with prone positioning and deep inspiration breath hold (DIBH) techniques, could accomplish this. A planning study was performed in patients requiring left-side adjuvant breast and axillary\/periclavicular lymph node irradiation (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u20098). Simulation was performed in prone crawl position using DIBH. Coplanar and non-coplanar short-arc VMAT plans were compared. Non-coplanar plans featured\u2009\u2264\u200920\u00b0 angular separation between planes. Feasibility was tested using a CAD model, including a prone crawl breast couch positioned in an up to 20\u00b0 angle (transverse plane) with the couchtop. Non-coplanar techniques can further reduce radiation exposure. Adding beams in planes with \u00b1\u200915\u00b0 to \u00b1\u200920\u00b0 angular separation with the transverse plane yielded\u2009&gt;\u200920% mean-dose reductions simultaneously to heart, lungs and esophagus, compared to coplanar plans. Plans with \u2264\u2009\u00b1\u200920\u00b0 angular separation with the transverse plane proved feasible on linacs lacking couch isocenter rotations. Angular separation of \u00b1\u200915\u00b0 seems the best compromise between OAR-sparing and technical challenges. Non-coplanar radiotherapy options yielded superior OAR sparing compared to coplanar techniques in patients requiring adjuvant breast and lymph node irradiation and should be considered for improved radiation toxicity prevention.\n                  <\/jats:p>","DOI":"10.1038\/s41598-026-54571-4","type":"journal-article","created":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T13:25:10Z","timestamp":1780925110000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Organ at risk sparing by non-coplanar prone breast radiotherapy on Halcyon\/Ethos linacs utilizing breast couch slewing"],"prefix":"10.1038","volume":"16","author":[{"given":"Bruno","family":"Speleers","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael E. 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