Image orientation

Interpretation of the orientation

The orientation of the DICOM images is displayed by one or more uppercase letters in the middle on the top and left of the view.

If Anatomical Orientation Type (0010,2210) attribute is absent or has a value of BIPED, anatomical direction is:

  • A: anterior
  • P: posterior
  • R: right
  • L: left
  • H: head
  • F: foot

If Anatomical Orientation Type (0010,2210) attribute has a value of QUADRUPED (since Version4.1.0), anatomical direction is designated by:

  • LE: Left
  • RT: Right
  • D: Dorsal
  • V: Ventral
  • CR: Cranial
  • CD: Caudal
  • R: Rostral
  • M: Medial
  • L: Lateral
  • PR: Proximal
  • DI: Distal
  • PA: Palmar
  • PL: Plantar Quadruped orientation Quadruped orientation

If the orientation is not perfectly aligned according to the 3 axes of the referential then there can be a secondary and tertiary orientation (in subscript) separated by “-”.


For some modalities such as CR or DX, the orientation comes from the Patient Orientation (0020,0020) attribute and is not displayed when using the rotation tools because it cannot be recalculated dynamically.

For other modalities such as CT and MRI, the orientation is always displayed because it is dynamically calculated.


To display or hide the orientation on the image, select it from the Display panel on the right (DICOM Annotations > Orientation).

Orientation in 2D multiplanar reconstruction (MPR)

The image below shows the 3 views of the orthogonal MPR. The uppercase letter at the left or at the top designates the orientation of each multiplanar view whose type (axial, coronal, sagittal) is defined at the bottom.

MPR orientation MPR orientation


The color of the axes used comes from the one defined in DICOM Patient Orientation. Blue corresponds to the left-right axis, the red axis to anterior-posterior, and the green axis to foot-head.

The colored square in the MPR view above corresponds to the plane that is perpendicular to one of the axes.